Nursing Leadership, Management and Ethics
Domain 7 tests the nurse as manager and professional: delegation, prioritisation, staffing, conflict, quality improvement, and the legal and ethical framework, including the Nurses and Midwives Act and the Patients' Rights Charter.
Delegation and accountability
- Five rights: right task, right person, right circumstance, right direction, right supervision.
- The delegator keeps accountability. Never delegate assessment, teaching, evaluation or clinical judgment - those stay with the registered nurse. Support staff may take vital signs, ambulate, feed and record intake and output under supervision.
Consent and confidentiality
- Valid consent is informed, voluntary and given by someone with capacity - generally 18 years and above in Kenya, with statutory exceptions for specified services.
- Confidentiality may be breached only where law or policy requires: notifiable disease reporting, court order, serious risk to self or others, and audit.
Quality and safety
- Incident reports document facts, not blame, and are not part of the patient record.
- Just culture separates human error (console), at-risk behaviour (coach) and reckless behaviour (sanction).
Worked example
You are in charge with one registered nurse and two support staff. One patient needs a blood transfusion started, another needs analgesia, and a third is waiting for discharge teaching. Reasoning: transfusion checks and monitoring cannot be delegated, so the registered nurse takes the transfusion. You assess and give the analgesia, because pain needs assessment and evaluation. Support staff take observations, ambulate and feed patients. Discharge teaching waits until the transfusion is running safely - it is the only task with genuine flexibility.
Traps
Delegating to the most available rather than the most competent person; accepting a verbal order without read-back; recording an incident only in the nursing notes; assuming a doctor's order removes the nurse's duty to question an unsafe prescription.