Professional and Ethical Practice Flashcards

A practical nurse discovers that a colleague has been falsifying vital sign documentation for multiple patients over several shifts. The colleague confesses privately and begs the nurse not to report it, claiming personal stress caused the lapse and promising it will never happen again. What is the nurse's primary obligation?

Answer: Report the behavior to the nurse manager immediately, regardless of the colleague's personal circumstances

Falsifying patient documentation is a serious breach of professional standards and patient safety — it is not a minor lapse that can be managed through peer agreement. The nurse has a mandatory professional and ethical obligation to report unsafe or unethical practice to a supervisor immediately. Loyalty to a colleague never supersedes the duty to protect patients. Monitoring without reporting, or offering a self-report grace period, delays necessary intervention and makes the nurse complicit in ongoing harm.

A practical nurse working in a long-term care facility is asked by a competent resident to help draft an advance directive that explicitly refuses CPR and artificial nutrition. The nurse's own religious beliefs strongly conflict with withholding life-sustaining treatment. What is the most ethically and professionally appropriate action?

Answer: Inform the resident of the nurse's beliefs and explain that a different staff member will need to assist them

A nurse has the right to conscientious objection when personal moral or religious beliefs conflict with a patient's care request. However, the nurse must never abandon the patient — they are obligated to promptly arrange for another qualified provider to fulfill the resident's wishes. Assisting despite sincere moral objection is not required, but ensuring the patient receives the care they are entitled to is mandatory. Involving the physician to 'counsel' the resident on spiritual implications would inappropriately impose values on the competent resident's autonomous decision.

During a home visit, a practical nurse notices fresh bruising on an elderly client who is cognitively intact. When asked, the client tearfully reveals that their adult son causes the injuries but firmly refuses any intervention, saying, 'He's all I have — if you report this, I'll lose him.' The client has full decision-making capacity. What should the nurse do?

Answer: Report the suspected abuse to the appropriate authority because elder abuse reporting obligations exist regardless of client consent

In most Canadian jurisdictions, suspected elder abuse triggers a mandatory reporting obligation that supersedes client confidentiality and even a competent client's refusal. Unlike adult abuse in general, elder abuse legislation in many provinces requires healthcare workers to report regardless of whether the victim consents. The nurse should inform the client compassionately that reporting is a legal duty, but must proceed with the report. Contacting the perpetrator would be dangerous and inappropriate, and ethics consultation does not override a statutory duty to report.

A practical nurse is floated to an unfamiliar unit and assigned to care for a patient requiring a skill the nurse has performed only twice during training, with no recent supervised practice. The charge nurse is overwhelmed and says, 'You'll be fine — just look it up.' What is the most appropriate response?

Answer: Decline to perform the skill and ask the charge nurse to reassign it to a competent nurse or provide direct supervision

Practicing within one's competence is a core professional standard. A nurse who lacks current competence in a skill must not perform it independently — reviewing a manual does not confer clinical competence. The nurse must communicate the limitation clearly and advocate for safe assignment: either reassignment of the task to a competent provider or direct supervision by one. Patient consent does not authorize a nurse to exceed competence boundaries; competence is a professional standard, not a contractual arrangement with the patient.

A practical nurse receives a verbal order from a physician over the phone during a night shift. The nurse has significant doubt about the appropriateness of the dose ordered — it is twice the typical range — but the physician insists it is correct and becomes dismissive. What is the correct sequence of actions?

Answer: Refuse to administer the medication, document the refused order, and escalate to the charge nurse or on-call supervisor

A nurse who has a reasonable doubt about a medication order must not administer it. Following an order blindly does not protect the nurse legally — nurses are independently accountable for medications they administer. The correct course is to refuse to give a medication the nurse believes to be unsafe, document the situation, and immediately escalate through the chain of command (charge nurse, supervisor, or on-call physician). Administering a self-adjusted dose is outside the nurse's scope of practice and creates additional risk. Consulting pharmacy is a reasonable supplementary step but does not replace escalation through the professional chain of command.

A practical nurse who is active on social media posts a general reflection on a 'heartbreaking shift' without naming patients, the facility, or any identifying details. A colleague comments on the post mentioning the ward name and the type of cases seen that day. What is the nurse's most appropriate professional obligation at this point?

Answer: Remove the original post entirely, as the combination of the post and the comment now creates identifiability risk

Confidentiality breaches can result from the aggregation of individually innocuous details. Even if the nurse's original post was compliant in isolation, the colleague's comment — adding ward name and case type — may create a mosaic that renders patients identifiable. The nurse now has a professional obligation to mitigate the risk by removing the original post, since it is the anchor to which identifying context has been publicly attached. Reporting to the regulatory body is premature for what may be addressable through immediate corrective action. Doing nothing is ethically indefensible once the nurse is aware of the compounded risk.