Professional Practice, Ethics, and Legal Issues
This domain tests consent, confidentiality, delegation, and advocacy - the situations where the right clinical answer still requires a legal and ethical frame.
Core rules
- Legal consent for a minor comes from a parent or guardian; the child provides developmentally appropriate assent from about age 7.
- Emancipated minors - married, in the military, or court-declared - consent for themselves. Many states also allow minors to consent for STI testing, contraception, and mental health care; know your state's rules.
- Emergency exception: treat life-threatening conditions without consent when no guardian is available.
- Confidentiality has limits: danger to self or others, suspected abuse, and some reportable conditions require disclosure. Say this at the start of an adolescent visit.
- Delegation: the registered nurse retains assessment, teaching, and evaluation; unlicensed assistive personnel may perform tasks within their training.
- Ethical principles: beneficence, nonmaleficence, autonomy, justice. The child's best interest guides surrogate decisions.
- Incident reports document facts and go to risk management; they are not filed in the medical record.
Worked example
A 16-year-old requests confidential STI testing. Establishing confidentiality means explaining its limits first: results and treatment can remain private where state law permits minor consent, but a disclosure of abuse or a plan of self-harm must be reported. The nurse provides the test, gives private teaching time, and documents only what policy allows. Promising absolute secrecy before knowing the limits is the error.
Traps
- Promising an adolescent that nothing will be shared.
- Delegating assessment or patient teaching to unlicensed staff.
- Obtaining consent from a 15-year-old for surgery.
- Charting opinions or blame in an incident report.