Professional Practice, Ethics, Leadership and Patient Safety
Delegation and accountability
Delegation items follow the five rights: right task, right circumstance, right person, right direction and communication, right supervision. An RN may delegate standard, stable, predictable tasks - vital signs on a stable patient, activities of daily living, intake and output, ambulation - but retains assessment, care planning, teaching, evaluation, and any task involving unstable patients or blood products. The RN remains accountable for the delegated task.
Ethics and consent
Know autonomy, beneficence, nonmaleficence, justice, veracity, fidelity, and confidentiality. Informed consent is the prescriber's responsibility; the nurse witnesses the signature and confirms the patient understands, and never coerces. Emancipated and mature minors vary by jurisdiction; in a true emergency, treat under implied consent. Advance directives and healthcare proxies guide care when the patient cannot speak.
Safety and quality
Use SBAR for handoffs, report incidents through the facility reporting system (not in the progress narrative) without blame, and escalate unsafe assignments or orders through the chain of command. Sentinel events such as wrong-site surgery, retained items, or a fall with serious injury trigger root cause analysis. Just culture separates human error from reckless behaviour.
Traps
Options that have a UAP teaching or assessing are always wrong. 'Document the error in the progress notes' is wrong - use the incident report. Advocacy means voicing the patient's wishes even when the team disagrees.
Worked rule
When unsure who should act, ask: does this require nursing judgement, teaching, or an unstable patient? If yes, the RN does it.