Professional Practice and Ethical/Legal Responsibilities
Professional Practice and Ethical/Legal Responsibilities tests the PN's scope of practice, client advocacy, confidentiality, consent, and accountability.
Legal framework
- The Nurse Practice Act defines PN scope; practice under supervision and follow state rules. The PN can witness an informed consent signature but cannot obtain consent or explain risks and benefits; that is the provider's responsibility.
- Maintain confidentiality under HIPAA; share only the minimum necessary information with the care team. Report suspected abuse, neglect, or communicable disease as required by law.
- Ethical principles include autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity.
Worked example
A surgeon asks the PN to 'get the consent signed' for an appendectomy. The PN confirms the provider has explained the procedure, risks, and alternatives; answers only questions within scope; witnesses the signature; and documents. If the client says, 'I don't understand,' the PN stops and notifies the provider rather than obtaining the signature. Reasoning: consent must be informed and voluntary. Witnessing is not the same as obtaining consent; the PN cannot supply missing information.
Accountability
Document objective, timely, factual entries; correct errors per policy without obliterating; never falsify. Incident reports are for quality improvement, not the client record. Advocate for the client's wishes, including refusal of treatment, and follow advance directives.
Traps
Witnessing consent before the provider's explanation; discussing a client in public areas; documenting a nursing assessment that was not performed; ignoring a client's refusal; promising not to report abuse.