Educational preparation must meet State Board of Nursing requirements.
Requires vocational or community college education prior to licensure exam.
Roles and responsibilities:
Works under supervision of an RN
Collaborates within the nursing process, assists with care plan, consults with team, recognizes need for referrals
Possesses technical knowledge and skill
Participates in delivering nursing care
PN Scope Cont.
Provides direct patient care under the direction of an RN, physician, or other licensed practitioner.
Basic patient care; Medication administration (except IV push in some states); wound care; client health assessments (not initial); documentation; collaboration; education reinforcement.
Out of Scope of Practice
Initial client admission to a facility.
Initial client health assessment.
Some facilities may allow RN cosign.
Intravenously pushed (IVP) medications and blood administration.
Initial client teaching; can reinforce teaching.
Clinical decisions; changes in client condition require RN notification.
Delegation
Delegation is transference of responsibility and authority for an activity to a competent individual.
Key issue: the person who delegates remains accountable.
The five rights of delegation: right task, right circumstances, right person, right direction/communication, right supervision/evaluation.
Delegation cont.
The person delegated to must have:
Knowledge and skill to perform the task
Demonstration of competence
Appropriate licensure for the task
Examples of tasks that may be delegated to PNs (Licensed Practical Nurses)
Monitor findings as input to the RN’s ongoing assessment.
Reinforce client teaching from a standard care plan.
Perform tracheostomy care, suctioning, NG tube patency checks.
Administer enteral feedings.
Insert urinary catheter.
Administer medications (excluding IV medications in some states).
Legal Issues
Legal issues in nursing encompass rights, responsibilities, and scope of practice defined by state nurse practice acts and by criminal and civil laws.
Legal Issues - Nursing
All patients have a legal right to expect competent nursing services.
Nursing students must be prepared to provide safe care consistent with legal requirements.
Malpractice: conduct deviating from the standard of practice dictated by a profession.
Nurses must know regulations of healthcare providers, institutions, payment systems, and federal/state laws apply to healthcare.
Laws
Tort Law defines and addresses unintentional and intentional actions or omissions that cause harm.
Types of torts:
Unintentional: negligence, malpractice
Intentional: assault, battery, false imprisonment, invasion of privacy
Negligence
Conduct that deviates from what a reasonable person would do in a given circumstance.
A negligent act occurs when an individual damages person or property without intent to injure.
May be due to carelessness (e.g., failure to implement safety measures for a client at risk for falls).
Malpractice
Malpractice includes acts and omissions by a professional while performing duties.
A major area of law for nurses; may jeopardize a nurse’s license and patient safety.
Nursing students are held to the same standard of conduct as licensed nurses.
Example: administering a large dose due to miscalculation, causing harm.
Elements to Prove Negligence
Duty to provide care as defined by a standard.
Breach of duty by failure to meet standard (e.g., fall risk assessment not performed).
Foreseeability of harm (failure to address risk could endanger client).
Breach of duty causing harm.
Harm occurred to the client (e.g., fall).
HIPAA and Privacy
Health Insurance Portability and Accountability Act (HIPAA) of 1996:
Minimize exclusion of preexisting conditions as barrier to insurance, designates rights for individuals who lose coverage, and eliminates medical underwriting in group plans.
Establishes the Privacy Rule: a national standard for disclosure of private health information.
Private Health Information
Privacy Rule protects information that identifies an individual.
Access to medical records is regulated under the Privacy Rule.
Confidentiality
Confidentiality: assurance that private information will not be disclosed without patient consent.
Applies to both the nature of information and how it is treated after disclosure.
Confidentiality (cont.)
How to handle confidentiality:
Obtain information appropriately.
Disclose information only as permitted.
Advocate for confidentiality.
Be familiar with agency policies and procedures for protecting privacy.
Mandatory Reporting
Mandatory reporting is a legal requirement to report designated acts/events per state/local law.
Nurses are typically required to report: abuse or suspected abuse; certain injuries/illnesses (e.g., communicable diseases); crimes involving minors.
Mandatory Reporting (cont.)
Nurses must report incompetent, unethical, or illegal conduct.
Reports may involve violence, abuse, neglect toward patients or other nurses, or conduct by family members or other providers.
Report through the chain of command and may be required to report to the institution and the state BON.
Impaired Healthcare Providers
If a nurse suspects a coworker’s behavior that jeopardizes client care or indicates possible substance use, there is a duty to report to the appropriate manager.
Good Faith Immunity
Healthcare workers are protected from civil/criminal liability when reporting suspected abuse in good faith.
May be required to disclose protected health information; this is not considered a HIPAA violation in these circumstances.
Responsibility
Personal responsibility: all nurses, including students and practitioners.
Never perform an act you are unsure how to perform.
Show accountability for your actions.
Admit errors when they occur.
Know and follow facility policies and procedures.
Understand how to report errors.
Reporting Errors and Near Misses
Nurses have an ethical and legal responsibility to report errors and near misses.
Use incident reports to improve patient safety and care quality.
Failure to report may breach duty and could lead to malpractice.
What is Ethics?
Ethics refers to standards of right and wrong that influence human behavior, including rights, obligations, benefits to society, fairness, and virtues.
In professional nursing, ethics is a system of moral principles governing behaviors and relationships based on professional beliefs and values.
Values
Values are personal beliefs about truths and worth of behaviors, thoughts, objects.
Values provide the foundation for ethical standards within individuals or groups.
Values Essential for Professional Nurse
Altruism
Autonomy
Human Dignity
Integrity
Social Justice
Altruism
Concern for the welfare and well-being of others.
Autonomy
Right to self-determination.
Human Dignity
Inherent worth and uniqueness of individuals and populations.
Integrity
Honesty and adherence to a strong ethical framework in professional practice.
Social Justice
Upholding justice and fairness on a social scale.
American Nurses Association Code of Ethics
A general guide for the profession’s membership and social contract with the public.
Initially created in the 1950s and last updated in 2015.
Serves as a statement of nurses’ ethical obligations and duties, the profession’s nonnegotiable ethical standard, and commitment to society.
It is vital for nurses to be familiar with the ANA Code of Ethics (see Module 44 Box 44.2 for the 9 provisions).
Ethical Principles
Autonomy
Beneficence
Justice
Veracity
Autonomy
Right to self-determination.
Patients have the right to determine their own care; nurses honor decisions even if they conflict with what nurses believe is best for the patient.
Violating autonomy occurs when a nurse disregards patient choices.
Beneficence
Actions that promote good for the patient.
Nonmaleficence
A commitment to do no harm.
Justice
Treating all patients fairly, in accordance with standards or laws.
Veracity
Truth-telling; honesty and transparency.
Applying Principles
The goal of ethical reasoning is to reach a decision that is in the patient’s best interest and preserves integrity for all involved.
Responsible ethical decision-making should be rational, systematic, and based on ethical principles and codes of ethics, not on emotions, impulsive decisions, fixed policies, or precedent.
References
Pearson (2024). MyLab Nursing with Pearson etext access card for nursing: A concept-based approach with clinical nursing skills (4th ed.)