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Place the following in a proper hierarchy of guidance and explain how an RN uses the following
to determine their own personal safe scope of practice.
Agency Policy
Statutory law - State Nurse Practice Act
Personal Ability
State Board of Nursing Rules - correct answer ✔✔ 1. Statutory Law - State Nurse Practice Act
2. State Board of Nursing Rules
3. Agency Policy
4. Personal Ability
Define the difference between an independent and a dependent nursing action. Give one
example of each. - correct answer ✔✔ Independent - These are actions that the nurse is able to
initiate independently. The following would be an example of a health promotion nursing
intervention, which is an independent nursing action:
Mrs. James has started a new medication for her high blood pressure. She is concerned about
the side-effects and is refusing to take the medication. The nurse intervenes by educating the
patient on the purpose of the medication, the side-effects of the medication and the possible
consequences of high blood pressure.
Dependent - These interventions will require an order from another health care provider such
as a physician:
Mrs. James blood pressure is consistently 180/100. The nurse reports this to the physician. The
physician orders and antihypertensive medication for the patient. The nurse administers the
oral medication to the patient as ordered.
,Please describe the difference between assigning a task and delegating a task as described by
Dr. Berman. - correct answer ✔✔ Assigning: Within the person's scope of practice. (ex. asking
another nurse to assess patient for s&s of sepsis)
Delegating: Not within the person's scope of practice. (ex. asking UAP to administer medication
in CA.)
Understand the Statutory Authority of State Nurse Practice Acts (page 107) - correct answer
✔✔ The nursing practice act in each state accomplishes at least 4 objectives:
1. Defines the practice of professional nursing
2. Sets the minimum educational qualifications and other requirements for licensure
3. Determines the legal titles and abbreviations nurses may use
4. Provides for disciplinary action of licensees for certain causes
Know the most common reason nurses are disciplined - correct answer ✔✔ "the most common
reason nurses are disciplined by SBNs is for practicing while under the influence of alcohol or
other substance, often a narcotic taken from the workplace"
Understand what Coker found regarding nurses and malpractice cases in his study of
malpractice trials between 1995-2001. - correct answer ✔✔ 60% of cases occurred in acute care
hospitals; six major categories of negligence resulted in malpractice lawsuits against nurses
1. Failure to follow standards of care
2. Failure to use equipment in a responsible manner
3. Failure to communicate
4. Failure to document
5. Failure to assess and monitor
6. Failure to act as a patient advocate
, Understand social media and confidentiality guidelines - correct answer ✔✔ Confidentiality =
protection of private information gathered about a patient during the provision of health care
services
The Code of Ethics states "nurse has a duty to maintain confidentiality of all patient information,
both personal and clinical in the work setting and off duty in all venues, including social media
and any other means of communication... Nurses are responsible for providing accurate,
relevant data to members of the health care team and others who have a need to know"
Important facts to know about social media:
Posts & photos are never private (can always be reposted/retweeted), there is no erasing digital
content, as soon a you write or say something, you have lost control of the message & what
happens to the info you have passed along
Understand what actions are acceptable exceptions to a nurses' obligation regarding
confidentiality. - correct answer ✔✔ Nurses may be ordered by a court to share information
without the patient's consent
Based on common, state, or municipal law, nurses have the duty to report or disclose certain
information such as suspected abuse or neglect of a child or elder, gunshot wounds, certain
communicable diseases, & threats towards third parties (Laws vary by state)
Understand what the Patient Self-Determination Act of 1991 provides. - correct answer ✔✔
Applies to acute care & long term care facilities that receive Medicare & Medicaid funds
PSDA act requires that acute care & long term care facilities:
1. Provide written information to all adult patients about their rights under state law
2. Ensure institutional compliance with state laws on advance directives
3. Provide for education of staff & the community on advance directives