Professional Practice
Scope, standards, and safety
NNP practice is governed by state licensure, institutional privileging, and a collaborative agreement. Know your scope: assessment, diagnosis, ordering, procedures, and referral. Use two patient identifiers, read back verbal orders, and reconcile high-alert medications such as gentamicin, insulin, and opiates. Report errors through the safety event system and disclose adverse events to families.
Evidence-based practice and quality
Participate in unit bundles: central line-associated bloodstream infection prevention, hand hygiene, ventilator-associated pneumonia, and medication safety. Use SBAR for handoffs and simulation for rare emergencies. Quality improvement uses plan-do-study-act cycles and run charts.
Ethics and legal issues
Informed consent requires capacity, disclosure, understanding, and voluntariness. In emergencies, treat under the emergency exception and document. Conflicts about futility or goals of care go to the ethics committee. Mandated reporting applies to suspected abuse or neglect.
Worked example
A nurse questions a gentamicin order that is tenfold the usual dose. Reasoning: stop and verify the order, check the infant's weight and renal function, report through the safety system, monitor levels, and disclose to the family if harm occurred. A just-culture response examines system factors rather than blaming the individual.
Traps
- Accepting verbal orders without read-back.
- Documenting retrospectively to fix a record.
- Practicing outside state scope or hospital privileging.