NUR 213 – Exam 1 Study Guide
1. Information from article readings:
Practice drift: another way of describing a “shortcut,” or “rule-bending” done in order to
accomplish an immediate goal, to meet a perceived expectation of another, and/or to promote
efficiency. “Drift” from the standard of care and has the potential to jeopardize patient safety.
Three types of errors within “Just Culture:”
• Human error: entirely unintentional
• At-risk behavior: aware of risk, though believed to be justified or insignificant
• Reckless behavior: conscious disregard of substantial and unjustifiable risk
Violating boundaries of a professional relationship including but not limited to physical, sexual,
emotional, or financial exploitation of the patient of the patient’s family member or caregiver.
Financial exploitation includes accepting or solicitating money, gifts, or the equivalent during the
professional relationship.
Professional boundaries are defined as “the spaces between the nurse’s power and the patient’s
vulnerability. Boundary violations can occur when there is uncertainty about the needs of the
patient versus the needs of the nurse.
• No matter how the patient behaves, it is the legal and ethical responsibility of the nurse to
maintain a therapeutic relationship
• Under-involvement: involves neglecting the patient, showing disinterest, and distancing
yourself from the patient
• Over-involvement: examples include boundary crossing/violations, and sexual
misconduct
• If you are unsure about your boundaries as a nurse seek guidance from nursing leaders or
HR because it is your responsibility as the nurse to identify if the relationship is moving
outside of the therapeutic nurse-patient range and take steps to correct it
• Boundary crossing: when a nurse briefly but unintentionally crosses professional lines in
an effort to meet a particular need of the patient for therapeutic purpose
• Boundary violation: occurs when there is confusion about the needs of the patient versus
the needs of the nurse
• Financial exploitation: can range from borrowing money from the patient to the nurse
convincing the patient to make her the power of attorney of adding her to the patient’s
will. Nurse should never share financial needs with patients. Giving or accepting gifts is
not appropriate.
• Social media/texting violations: do not send messages/photos to patients, family
members, or caregiver via social media or text. Do not accept “friend requests” from
patients. If a nurse engages with patients via social media, it is important to have a
separate professional account from their personal one.
• Sexual misconduct: “engaging in conduct with a patient that is sexual or may reasonably
be interpreted by the patient as sexual; any verbal behavior that is seductive or sexually
demeaning to a patient; or engaging in sexual exploitation of a patient or former patient.
,Four problematic behaviors in regard to boundaries:
• Undue self-disclosure: when used within the therapeutic relationship, should be limited
and used with the intention of assisting the patient is a positive way.
• Secretive behavior: should never be secrets between the nurse and the patient. Example:
nurse texting patient about being late for their assignment in the patient’s home, while not
informing the healthcare agency.
• “Super nurse”: believes that no one can take care of the patient better than him/her
• Special patient treatment: for example, bring specialty coffee for favorite patient
whenever you work
Four elements that are often seen in boundary violations:
• Role-reversal: scenario in which the nurse uses the patient for gratification or satisfaction
leaving the patient to take care of the nurse
• Double bind: occurs when the patient wants to terminate the relationship but knows this
will end receiving help from the nurse. Patient experiences fear of abandonment and
feelings of guilt, so they allow the relationship to continue.
• Professional privilege: nurse takes information received while providing care to a patient
and uses it for personal benefit
• Secrecy: keeping information inappropriately private between the patient and nurse
It is imperative to avoid developing a ‘friends’ relationship with the patient and their family.
Legal consequences: many behaviors related to boundary violations and sexual misconduct can
also be reportable for possible criminal charges. May not only impact RN license but legal
implications as well.
While establishing a professional nurse-patient relationship, understanding the necessity of
terminating the relationship when patient care is no longer required is critical. During the
termination phase, it is important to prepare the patient when the end of the professional
relationship is approaching.
Your responsibility: as a part of professional reflective practice, it is essential to self-evaluate
your interactions and behaviors with your clients.
Six standards necessary to establish and sustain healthy work environments:
• Skilled Communication: successful teams must have members who are able and willing
to communicate honestly, with the intent of achieving team goals and not just those of the
individual.
o NC LPN and RN rules require the licensed nurses communicate and receive
communication accurately and timely as fits the need of the patient.
o NC RN Rules addressing management require an RN manager to be continuously
available, assess capabilities of personnel, delegate responsibilities and evaluate
performances
o Nursing Rules require that both RN and LPN document accurately and timely all
information relevant and involving an assigned patient
, o Nursing communication also requires that we interact with patients and those
around them in a compassionate and empathetic manner
• True Collaboration: Just Culture concepts supported by the NCBON recognize the
importance for all team members to honestly communicate without fear of judgment
concerning unplanned events. In true collaboration each party is always attempting to
reach perfection, knowing that is not possible, and recognizing that when errors or near
misses are identified it further strengthens that road to perfection. Collaboration is
successful by using effective communication (active listening, flexibility, and developing
trust).
• Effective Decision Making: rooted in evidence-based practice. Critical thinking is an
essential element in decision making, which involves recognizing choices, and requires
analysis and problem-solving.
• Appropriate Staffing: It is the RN and LPN’s responsibility to consider staffing
assignment factors each time they accept an assignment. RN Rules state that the nurse
responsible for administering nursing services is responsible to allocate resources and
maintain standards of practice.
• Meaningful Recognition: communicating acknowledgment that what a person did made a
difference. This is sometimes known as a “soft skill” but has proven to have increasing
importance. “Soft skills” are no considered requirements needed in order to provide
efficient and effective care (compassion for example).
• Authentic Leadership: knowing the right thing to do and stating it although individuals I
an organization may not agree. Five key characteristics identify leaders:
o Ability to understand their own purpose
o Practice solid values
o Lead with heart
o Establish enduring relationships
o Practice self-discipline
Accountability: involves being answerable for the outcomes of a test or assignment. Nurses are
accountable for their own actions of others, such as subordinates and trainees.
Responsibility: specific obligation associated with the performance of duties of a particular role,
and it belongs to the individual performing the duties.
Collaboration: defined as two or more individuals working toward a common goal by combining
their skills, knowledge, and resources while avoiding duplication of effort. In healthcare, the
common goal of each collaborative team is to improve patient outcomes, whether the patient is
an individual, a group, or a community.
Altruism: concern for the welfare and well-being of others
Autonomy: right to self-determination
Beneficence: actions that one takes should promote good, it is the basic obligation to assist others
Nonmaleficence: nurses do no harm and instead safeguard their patients. It doesn’t mean that the
nurse performs only actions that carry no risk to the patient. After all, many actions, such as
administering medications, carry some degree of risk. In most cases, the risk of hard is weight
against the potential benefit
Justice: treating all patients fairly and in accordance with honor, standards, or law
Veracity: individuals who tell the truth
, Standards of care (standards of practice): professional standards or guidelines used to determine
what a nurse should or should not do. They describe responsibilities for which nurses are
accountable, thereby setting a desirable and achievable benchmark against which the
performance and care standards of individual nurses may be measured.
Negligence: conduct that deviates from what a reasonable person would do in a particular
circumstance. Negligent act occurs when an individual damages the person or property of
another person without ant intent to injure.
Malpractice: should an individual fail to meet the standard of conduct for their profession, this
failure may be considered an instance of professional negligence aka malpractice
Delegation: essential competency of nursing practice and fosters work efficiency gained by the
team approach. Nursing decisions related to the delegation of tasks/activities to the UAP must
always be grounded in the protection of the public and the provision of safe competent nursing
care.
• Delegation: is a decision-making process that requires the nurse to use nursing
knowledge and judgment, possess an understanding of the nursing law and rules, and
retain accountability for the delegation and the outcome of nursing care. The transfer or
hand-off to a competent individual the authority to perform a task/activity in a specific
setting/situation. The nurse remains accountable for appropriate delegation.
• Authority: the power to act
• Assignment: to designate responsibility for implementation of a specific activity or set of
activities to a person licensed and competent to perform such activities
• Supervision: to oversee and provide guidance, direction, evaluation, and follow-up by the
nurse for the performance of assigned and delegated nursing activity or set of activities
• Unlicensed assistive personnel (UAP): unlicensed person who through the delegation
process provides client care activities. Titles include: NA I, NA II, Medication Aide,
Nurse Tech, Medical Assistant, Medical Office Assistant, Personal Care Assistant,
Habilitation Tech.
The Nursing Practice Act (NPA): is a general statute through which the BON has authority to
regulate nursing practice in NC. Delegation is a component of the scope of practice for both the
RN and LPN:
• RN: permitted to teach, assign, delegate, and supervise licensed and unlicensed personnel
for the implementation of the nursing plan of care.
• LPN: permitted to assign or delegate nursing interventions to other LPNs and UAP under
the supervision of the RN
Decisions to delegate nursing tasks/activities to UAP are based on the RNs assignment of the
client’s nursing care needs and the following criteria:
• UAPs knowledge and skills
• Verification of UAPs clinical competence by an RN and variables in the practice setting:
o Complexity and frequency of nursing care needed:
▪ Proximity of clients to staff
▪ Accessible resources
▪ Qualifications and number of staff
1. Information from article readings:
Practice drift: another way of describing a “shortcut,” or “rule-bending” done in order to
accomplish an immediate goal, to meet a perceived expectation of another, and/or to promote
efficiency. “Drift” from the standard of care and has the potential to jeopardize patient safety.
Three types of errors within “Just Culture:”
• Human error: entirely unintentional
• At-risk behavior: aware of risk, though believed to be justified or insignificant
• Reckless behavior: conscious disregard of substantial and unjustifiable risk
Violating boundaries of a professional relationship including but not limited to physical, sexual,
emotional, or financial exploitation of the patient of the patient’s family member or caregiver.
Financial exploitation includes accepting or solicitating money, gifts, or the equivalent during the
professional relationship.
Professional boundaries are defined as “the spaces between the nurse’s power and the patient’s
vulnerability. Boundary violations can occur when there is uncertainty about the needs of the
patient versus the needs of the nurse.
• No matter how the patient behaves, it is the legal and ethical responsibility of the nurse to
maintain a therapeutic relationship
• Under-involvement: involves neglecting the patient, showing disinterest, and distancing
yourself from the patient
• Over-involvement: examples include boundary crossing/violations, and sexual
misconduct
• If you are unsure about your boundaries as a nurse seek guidance from nursing leaders or
HR because it is your responsibility as the nurse to identify if the relationship is moving
outside of the therapeutic nurse-patient range and take steps to correct it
• Boundary crossing: when a nurse briefly but unintentionally crosses professional lines in
an effort to meet a particular need of the patient for therapeutic purpose
• Boundary violation: occurs when there is confusion about the needs of the patient versus
the needs of the nurse
• Financial exploitation: can range from borrowing money from the patient to the nurse
convincing the patient to make her the power of attorney of adding her to the patient’s
will. Nurse should never share financial needs with patients. Giving or accepting gifts is
not appropriate.
• Social media/texting violations: do not send messages/photos to patients, family
members, or caregiver via social media or text. Do not accept “friend requests” from
patients. If a nurse engages with patients via social media, it is important to have a
separate professional account from their personal one.
• Sexual misconduct: “engaging in conduct with a patient that is sexual or may reasonably
be interpreted by the patient as sexual; any verbal behavior that is seductive or sexually
demeaning to a patient; or engaging in sexual exploitation of a patient or former patient.
,Four problematic behaviors in regard to boundaries:
• Undue self-disclosure: when used within the therapeutic relationship, should be limited
and used with the intention of assisting the patient is a positive way.
• Secretive behavior: should never be secrets between the nurse and the patient. Example:
nurse texting patient about being late for their assignment in the patient’s home, while not
informing the healthcare agency.
• “Super nurse”: believes that no one can take care of the patient better than him/her
• Special patient treatment: for example, bring specialty coffee for favorite patient
whenever you work
Four elements that are often seen in boundary violations:
• Role-reversal: scenario in which the nurse uses the patient for gratification or satisfaction
leaving the patient to take care of the nurse
• Double bind: occurs when the patient wants to terminate the relationship but knows this
will end receiving help from the nurse. Patient experiences fear of abandonment and
feelings of guilt, so they allow the relationship to continue.
• Professional privilege: nurse takes information received while providing care to a patient
and uses it for personal benefit
• Secrecy: keeping information inappropriately private between the patient and nurse
It is imperative to avoid developing a ‘friends’ relationship with the patient and their family.
Legal consequences: many behaviors related to boundary violations and sexual misconduct can
also be reportable for possible criminal charges. May not only impact RN license but legal
implications as well.
While establishing a professional nurse-patient relationship, understanding the necessity of
terminating the relationship when patient care is no longer required is critical. During the
termination phase, it is important to prepare the patient when the end of the professional
relationship is approaching.
Your responsibility: as a part of professional reflective practice, it is essential to self-evaluate
your interactions and behaviors with your clients.
Six standards necessary to establish and sustain healthy work environments:
• Skilled Communication: successful teams must have members who are able and willing
to communicate honestly, with the intent of achieving team goals and not just those of the
individual.
o NC LPN and RN rules require the licensed nurses communicate and receive
communication accurately and timely as fits the need of the patient.
o NC RN Rules addressing management require an RN manager to be continuously
available, assess capabilities of personnel, delegate responsibilities and evaluate
performances
o Nursing Rules require that both RN and LPN document accurately and timely all
information relevant and involving an assigned patient
, o Nursing communication also requires that we interact with patients and those
around them in a compassionate and empathetic manner
• True Collaboration: Just Culture concepts supported by the NCBON recognize the
importance for all team members to honestly communicate without fear of judgment
concerning unplanned events. In true collaboration each party is always attempting to
reach perfection, knowing that is not possible, and recognizing that when errors or near
misses are identified it further strengthens that road to perfection. Collaboration is
successful by using effective communication (active listening, flexibility, and developing
trust).
• Effective Decision Making: rooted in evidence-based practice. Critical thinking is an
essential element in decision making, which involves recognizing choices, and requires
analysis and problem-solving.
• Appropriate Staffing: It is the RN and LPN’s responsibility to consider staffing
assignment factors each time they accept an assignment. RN Rules state that the nurse
responsible for administering nursing services is responsible to allocate resources and
maintain standards of practice.
• Meaningful Recognition: communicating acknowledgment that what a person did made a
difference. This is sometimes known as a “soft skill” but has proven to have increasing
importance. “Soft skills” are no considered requirements needed in order to provide
efficient and effective care (compassion for example).
• Authentic Leadership: knowing the right thing to do and stating it although individuals I
an organization may not agree. Five key characteristics identify leaders:
o Ability to understand their own purpose
o Practice solid values
o Lead with heart
o Establish enduring relationships
o Practice self-discipline
Accountability: involves being answerable for the outcomes of a test or assignment. Nurses are
accountable for their own actions of others, such as subordinates and trainees.
Responsibility: specific obligation associated with the performance of duties of a particular role,
and it belongs to the individual performing the duties.
Collaboration: defined as two or more individuals working toward a common goal by combining
their skills, knowledge, and resources while avoiding duplication of effort. In healthcare, the
common goal of each collaborative team is to improve patient outcomes, whether the patient is
an individual, a group, or a community.
Altruism: concern for the welfare and well-being of others
Autonomy: right to self-determination
Beneficence: actions that one takes should promote good, it is the basic obligation to assist others
Nonmaleficence: nurses do no harm and instead safeguard their patients. It doesn’t mean that the
nurse performs only actions that carry no risk to the patient. After all, many actions, such as
administering medications, carry some degree of risk. In most cases, the risk of hard is weight
against the potential benefit
Justice: treating all patients fairly and in accordance with honor, standards, or law
Veracity: individuals who tell the truth
, Standards of care (standards of practice): professional standards or guidelines used to determine
what a nurse should or should not do. They describe responsibilities for which nurses are
accountable, thereby setting a desirable and achievable benchmark against which the
performance and care standards of individual nurses may be measured.
Negligence: conduct that deviates from what a reasonable person would do in a particular
circumstance. Negligent act occurs when an individual damages the person or property of
another person without ant intent to injure.
Malpractice: should an individual fail to meet the standard of conduct for their profession, this
failure may be considered an instance of professional negligence aka malpractice
Delegation: essential competency of nursing practice and fosters work efficiency gained by the
team approach. Nursing decisions related to the delegation of tasks/activities to the UAP must
always be grounded in the protection of the public and the provision of safe competent nursing
care.
• Delegation: is a decision-making process that requires the nurse to use nursing
knowledge and judgment, possess an understanding of the nursing law and rules, and
retain accountability for the delegation and the outcome of nursing care. The transfer or
hand-off to a competent individual the authority to perform a task/activity in a specific
setting/situation. The nurse remains accountable for appropriate delegation.
• Authority: the power to act
• Assignment: to designate responsibility for implementation of a specific activity or set of
activities to a person licensed and competent to perform such activities
• Supervision: to oversee and provide guidance, direction, evaluation, and follow-up by the
nurse for the performance of assigned and delegated nursing activity or set of activities
• Unlicensed assistive personnel (UAP): unlicensed person who through the delegation
process provides client care activities. Titles include: NA I, NA II, Medication Aide,
Nurse Tech, Medical Assistant, Medical Office Assistant, Personal Care Assistant,
Habilitation Tech.
The Nursing Practice Act (NPA): is a general statute through which the BON has authority to
regulate nursing practice in NC. Delegation is a component of the scope of practice for both the
RN and LPN:
• RN: permitted to teach, assign, delegate, and supervise licensed and unlicensed personnel
for the implementation of the nursing plan of care.
• LPN: permitted to assign or delegate nursing interventions to other LPNs and UAP under
the supervision of the RN
Decisions to delegate nursing tasks/activities to UAP are based on the RNs assignment of the
client’s nursing care needs and the following criteria:
• UAPs knowledge and skills
• Verification of UAPs clinical competence by an RN and variables in the practice setting:
o Complexity and frequency of nursing care needed:
▪ Proximity of clients to staff
▪ Accessible resources
▪ Qualifications and number of staff
