Professional Practice
Professional practice tests how nurses work safely within scope, communicate, delegate, escalate, and improve care. OMSB-style items focus on accountability, teamwork, documentation, incident reporting, and evidence-based practice rather than technical procedures alone.
Core rules
- Scope of practice is set by law, regulation, employer policy, and competence. A registered nurse may not perform a task outside scope even if a colleague does it routinely.
- Delegation has five rights: right task, circumstance, person, direction/communication, and supervision/evaluation. Delegate only stable, predictable tasks to trained assistive personnel; assessment, teaching, care planning, and evaluation remain the nurse’s responsibility.
- Use SBAR: Situation, Background, Assessment, Recommendation. State the concern and what you need, not a long narrative.
- Escalate through the chain of command when a patient is deteriorating and the response is inadequate; document the escalation.
- Incident reporting is non-punitive and focused on system learning. Report near misses and errors; do not alter the record to hide them.
- Evidence-based practice uses the best evidence, clinical expertise, and patient values. Quality improvement uses measurement, small tests of change, and reassessment.
Worked example
A newly admitted patient with chest pain has new ST elevation on ECG. Reasoning: this is a time-critical finding. The nurse should stay with the patient, call the rapid response/medical team, give aspirin if not contraindicated and ordered, prepare for reperfusion, and document times. The nurse should not wait for the next scheduled round or delegate the ECG interpretation to a nursing assistant. SBAR: Situation: new ST elevation; Background: chest pain started 20 minutes ago; Assessment: diaphoretic, BP 100/65; Recommendation: immediate review and reperfusion plan.
Traps
Do not delegate initial assessment or patient teaching. Do not accept an assignment you are not competent to perform without support; speak up. Do not falsify or backdate documentation. Do not use incident reports as punishment or substitute for clinical escalation.