Professional practice
The Professional practice domain tests whether you can behave as an accountable, autonomous practitioner inside a regulated scope of practice: what you may do, what you must delegate, what you must record, and how you hand over. Items rarely ask for a definition; they present a situation and ask what the nurse does next.
Scope, competence and accountability
- You are accountable for your own practice and for the decision to delegate. Accountability itself can never be delegated; only tasks can.
- Before delegating to a nursing assistant or student, apply the five rights: right task, right circumstance, right person, right direction and communication, right supervision and evaluation.
- Tasks involving assessment, care planning, evaluation or invasive procedures stay with the registered nurse. If a situation exceeds your competence, say so and escalate; refusal on competence grounds is professional, not insubordinate.
Documentation and handover
- Record contemporaneously, objectively and factually: what you observed, what you did, what you told the patient, and how you evaluated the result. Avoid opinions such as stable or fine.
- Structured handover (SBAR: situation, background, assessment, recommendation) reduces omission errors. Use closed-loop communication with read-back for verbal orders.
- Incident reports are quality tools kept separate from the clinical record. Never amend or destroy an original entry; a late entry must be labelled and dated as such.
Worked example
An assistant reports a drowsy patient with BP 88/50 mmHg. The reasoning chain is: assessment is not delegable, so the nurse reassesses using ABCDE, checks trends, medications and fluid balance, positions the patient flat with legs raised if appropriate, and calls the physician using SBAR, stating a recommendation rather than only a number. The assistant is then given a defined monitoring task with a clear escalation threshold.
Traps that cost marks
Documenting conclusions instead of findings; assuming delegation removes responsibility; altering notes after an incident; giving a verbal order without read-back.