NCLEX Review Guide: Leadership Management, Ethical & Legal Nursing Practice, and Reporting Requirements

Delegation and Supervision

• Five Rights of Delegation: Right task, right person, right circumstances, right direction/communication, and right supervision must all be met before delegating any nursing task.
• Scope of Practice determines what tasks can be delegated - RNs can delegate to LPNs and UAPs, but cannot delegate assessment, planning, evaluation, or teaching of unstable patients.
• The delegating nurse remains accountable and responsible for the outcome of delegated tasks and must provide adequate supervision.

Conflict Resolution and Team Communication

• SBAR Communication (Situation, Background, Assessment, Recommendation) provides structured format for critical communications between healthcare providers.
• Conflict resolution should focus on collaborative problem-solving rather than win-lose scenarios, addressing issues directly with involved parties first.

Informed Consent and Patient Rights

• Informed Consent requires disclosure of procedure risks, benefits, alternatives, and consequences of refusing treatment - this is the physician's responsibility, not the nurse's.
• Nurses serve as patient advocates and witness signatures, but cannot obtain informed consent for medical procedures.
• Important Alert: If patient has questions about the procedure, stop and contact the physician before proceeding.

Confidentiality and HIPAA

• Minimum Necessary Rule requires sharing only the minimum amount of protected health information necessary to accomplish the intended purpose.
• Patient information can only be shared with healthcare team members directly involved in care, unless patient provides written authorization.
• Breach Alert: Discussing patients in public areas, leaving records visible, or accessing records without legitimate need violates HIPAA.

Abuse Reporting

• Suspected abuse of minors, elderly, or vulnerable adults must be reported immediately to appropriate authorities, regardless of family wishes or lack of definitive proof.
• Documentation should be objective and factual, describing observations without interpretation or judgment about causation.
• Nurses are mandated reporters and have legal protection when reporting suspected abuse in good faith.

1. Ensure immediate safety and provide necessary medical care
2. Document objective findings using body diagrams and photographs if permitted
3. Report to supervisor and appropriate agency (CPS, APS, law enforcement)
4. Complete required documentation and incident reports

Communicable Disease Reporting

• Notifiable diseases must be reported to local health departments within specified timeframes - some require immediate reporting (24 hours), others within 7 days.
• Common reportable diseases include tuberculosis, hepatitis, HIV, STDs, foodborne illnesses, and vaccine-preventable diseases.
• Healthcare facilities typically have infection control personnel who handle reporting, but nurses must recognize reportable conditions.

Impaired Healthcare Worker Reporting

• Patient Safety Priority: Suspected substance abuse or impairment in colleagues must be reported to supervisor immediately to protect patient safety.
• Signs of impairment include frequent absences, mood swings, medication discrepancies, volunteering for night shifts, and physical signs of substance use.
• Most states have peer assistance programs that provide treatment alternatives to disciplinary action for healthcare workers with substance abuse issues.

Common Pitfalls