Professional and Ethical Nursing Practice
The professional frame
Irish nursing practice rests on the NMBI Code of Professional Conduct and Ethics, whose principles - respect for the dignity of the person, professional behaviour, privacy and confidentiality, accountability and responsibility, and working with others - act as the lens for every scenario question. Candidates must also understand scope of practice: you practise within your own competence, you are personally accountable for your actions and omissions, and delegation is a decision you remain answerable for. Consent and capacity (including supported decision-making), confidentiality and its lawful limits, advocacy, professional boundaries, documentation, and the duty to raise concerns about unsafe practice all recur across papers.
Ethical reasoning
The four principles - autonomy, beneficence, non-maleficence and justice - need to be applied, not merely named. Know the difference between duty-based (deontological) and outcome-based (consequentialist) reasoning, and be able to spot conflicts, for example a capacitous refusal that clinicians believe is unwise.
Traps
- "The doctor ordered it" is never a defence; the nurse is accountable for administering safely.
- Respecting autonomy does not mean persuading the patient to agree.
- Confidentiality is not absolute secrecy - disclosure can be justified to protect a person from serious harm.
- Delegation is not abdication, but you are not accountable for every act of another professional.
- Policies support judgement; they do not replace it.
Rule of thumb
Apply a three-part test to every option: Is it safe? Is it within my role and competence? Have I escalated and documented? The answer that satisfies all three is almost always the correct one.
Worked example
A patient with capacity declines a prescribed antibiotic. Option A: nurse explains risks and accepts the refusal, documents it, informs the prescriber. Option B: nurse asks a colleague to persuade the patient. Option A is correct - autonomy plus escalation plus documentation.