Scope and Ethics — NCLEX-PN

Prioritization is deciding which client need or task to address first when several compete for attention. Use the ABCs — Airway, Breathing, Circulation — and Maslow’s hierarchy, addressing physiologic and safety needs before psychosocial ones. As a rule, acute, unstable, and unexpected problems take priority over chronic, stable, and expected ones.

Collaboration is working with the interdisciplinary team — providers, therapists, dietary, social work, and pharmacy — to coordinate complete client care. Clear, structured communication such as SBAR keeps everyone aligned and reduces error. Initiate referrals through the RN rather than acting outside your scope, and share the information each team member needs to do their part.

A referral directs a client to another professional or service — physical therapy, dietary, social work, home health — for specialized care. Discharge planning and referrals should begin on admission, not at discharge, so needs are met before the client leaves. Anticipating post-discharge needs early is one of the most effective ways to prevent readmission.

Accountability means owning the consequences of your own actions and decisions, and it cannot be transferred — only the task can. When a nurse delegates, the person doing the work is responsible for performing it correctly, but the delegating nurse remains accountable for the decision to delegate and for following up on the outcome. This is why you must know each task, each person’s competence, and your own scope before assigning anything.

Informed consent is the client’s voluntary agreement to a treatment after the provider explains the risks, benefits, and alternatives. The provider is responsible for obtaining consent; the nurse witnesses the signature and confirms the client understands. If the client cannot describe the procedure in their own words, stop and notify the provider rather than proceeding.

HIPAA is the federal law that protects the privacy and security of client health information. It applies to all forms of protected health information — written, spoken, and electronic — and limits disclosure to those involved in the client’s care or as the law allows. Violations can result in civil and criminal penalties as well as loss of licensure.

An incident is an event outside routine care that harmed, or could have harmed, a client — a fall, a medication error, or a needlestick. File a factual, non-blaming incident report, but do not mention the report itself in the client’s chart; chart only the objective clinical facts and the client’s condition. Incident reports are internal quality-improvement tools, so keep them objective rather than speculative.