NCLEX-RN ® Examination Detailed Test Plan for the National Council Licensure Examination for Registered Nurses NCLEX-RN ® DETAILED TEST PLAN Effective | April 2013 Candidate Version Mission Statement The National Council of State Boards of Nursing (NCSBN ®) provides education, service and research through collaborative lead- ership to promote evidence-based regulatory excellence for patient safety and public protection. Copyright ©2012 National Council of State Boards of Nursing, Inc. (NCSBN ®) All rights reserved. NCSBN ®, NCLEX ®, NCLEX-RN ®, NCLEX-PN ®, NNAAP ®, MACE ®, Nursys ® and TERCAP ® are registered trademarks of NCSBN and this document may not be used, reproduced or disseminated to any third party without written permission from NCSBN. Permission is granted to boards of nursing to use or reproduce all or parts of this document for licensure related purposes only. 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Suggested Citation: National Council of State Boards of Nursing. i 2013 NCLEX-RN ® Detailed Test Plan - Candidate Version National Council of State Boards of Nursing 2013 NCLEX-RN ® Detailed Test Plan Candidate Version Effective Date April 2013 ii 2013 NCLEX-RN® Detailed Test Plan - Candidate Version iii 2013 NCLEX-RN ® Detailed Test Plan - Candidate Version Table of Contents I. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 II. 2013 NCLEX-RN ® Test Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Classification of Cognitive Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Test Plan Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 ƒ Client Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 ƒ Integrated Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Distribution of Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Overview of Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 ƒ Safe and Effective Care Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 ƒ Health Promotion and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 ƒ Psychosocial Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 ƒ Physiological Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 III. 2013 NCLEX-RN ® Detailed Test Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Safe and Effective Care Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 ƒ Management of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 ƒ Safety and Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Health Promotion and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Psychosocial Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Physiological Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 ƒ Basic Care and Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 ƒ Pharmacological and Parenteral Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 ƒ Reduction of Risk Potential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 ƒ Physiological Adaptation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 IV. Administration of the NCLEX-RN ® Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Examination Length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 The Passing Standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Similar Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Reviewing Answers and Guessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 Scoring the NCLEX ® Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 ƒ Computerized Adaptive Testing (CAT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 ƒ Pretest Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 ƒ Passing and Failing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 ƒ Scoring Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 ƒ Types of Items on the NCLEX-RN ® Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 ƒ NCLEX ® Examination Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 ƒ Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 ƒ Tutorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 V. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55 1 2013 NCLEX-RN ® Detailed Test Plan - Candidate Version I. Background The Candidate Detailed Test Plan for the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) was developed by the National Council of State Boards of Nursing, Inc (NCSBN®). The purpose of this document is to provide more detailed information about the content areas tested in the NCLEX-RN® Examination than is provided in the basic NCLEX-RN Test Plan. This booklet contains the: „ 2013 NCLEX-RN® Test Plan; „ Information on testing requirements and sample examination questions (items); and „ References. About the NCLEX-RN ® Test Plan (Section II) The test plan is reviewed and approved by the NCLEX® Examination Committee (NEC) every three years. Multiple resources are used, including the recent practice analysis of registered nurses (RNs), and expert opin- ions of the NEC, NCSBN content staff, and boards of nursing (NCSBN’s Member Boards) to ensure that the test plan is consistent with state nurse practice acts. Following the endorsement of proposed revisions by the NEC, the test plan document is presented for approval to the Delegate Assembly, which is the decision-making body of NCSBN. About the NCLEX-RN ® Detailed Test Plan (Section III) The detailed test plan serves a variety of purposes. It is used to guide candidates preparing for the examination, to direct item writers in the development of items and to facilitate the classification of examination items. Two versions of the detailed test plan have been created: Item Writer/Item Reviewer/Nurse Educator version and Candidate version. The Candidate version that is provided in this document offers a more thorough and com- prehensive listing of content for each Client Needs category and subcategory outlined in the test plan. Sample items are provided at the end of each category, which are specific to the Client Needs category being reviewed in that section. The Item Writer/Item Reviewer/Nurse Educator version of the detailed test plan provides the same comprehensive listing of content and sample items for each Client Needs category and subcategory outlined in the test plan. In addition, the Item Writer/Item Reviewer/Nurse Educator version also provides an item writing tutorial with sample case scenarios to provide nurse educators with hands-on experience in writing NCLEX® style test questions. For up-to-date information about the NCLEX-RN Examination, visit the NCSBN website at www.ncsbn.org. 2 2013 NCLEX-RN® Detailed Test Plan - Candidate Version 3 2013 NCLEX-RN ® Detailed Test Plan - Candidate Version II. 2013 NCLEX-RN ® Test Plan Introduction Entry into the practice of nursing is regulated by the licensing authorities within each of the National Council of State Boards of Nursing (NCSBN ®) member board jurisdictions (state, commonwealth and territorial boards of nursing). To ensure public protection, each jurisdiction requires candidates for licensure to meet set require- ments that include passing an examination that measures the competencies needed to perform safely and effectively as a newly licensed, entry-level registered nurse (RN). NCSBN develops a licensure examination, the National Council Licensure Examination for Registered Nurses (NCLEX-RN ®), which is used by member board jurisdictions to assist in making licensure decisions. Several steps occur in the development of the NCLEX-RN Test Plan. The first step is conducting a practice analy- sis that is used to collect data on the current practice of the entry-level nurse (see Report of Findings from the 2011 RN Practice Analysis: Linking the NCLEX-RN® Examination to Practice, NCSBN, 2012a). Twelve thousand newly licensed RNs are asked about the frequency and importance of performing 141 nursing care activities. Nursing care activities are then analyzed in relation to the frequency of performance, impact on maintaining client safety and client care settings where the activities are performed. This analysis guides the development of a framework for entry-level nursing practice that incorporates specific client needs, as well as processes fun- damental to the practice of nursing. The second step is the development of the NCLEX-RN Test Plan, which guides the selection of content and behaviors to be tested. The NCLEX-RN Test Plan provides a concise summary of the content and scope of the licensing examination. It serves as a guide for examination development, as well as candidate preparation. The NCLEX® examination assesses the knowledge, skills and abilities that are essential for the entry-level nurse to use in order to meet the needs of clients requiring the promotion, maintenance or restoration of health. The follow- ing sections describe beliefs about people and nursing that are integral to the examination, cognitive abilities that will be tested in the examination and specific components of the NCLEX-RN Test Plan. Beliefs Beliefs about people and nursing underlie the NCLEX-RN Test Plan. People are finite beings with varying capaci- ties to function in society. They are unique individuals who have defined systems of daily living reflecting their values, motives and lifestyles. People have the right to make decisions regarding their health care needs and to participate in meeting those needs. The profession of nursing makes a unique contribution in helping clients (individual, family or group) achieve an optimal level of health in a variety of settings. For the purposes of the NCLEX examination, a client is defined as the individual, family or group which includes significant others and population. Nursing is both an art and a science, founded on a professional body of knowledge that integrates concepts from the liberal arts and the biological, physical, psychological and social sciences. It is a learned profession based on knowledge of the human condition across the life span and the relationships of an individual with oth- ers and within the environment. Nursing is a dynamic, continually evolving discipline that employs critical think- ing to integrate increasingly complex knowledge, skills, technologies and client care activities into evidence- based nursing practice. The goal of nursing for client care is preventing illness and potential complications; protecting, promoting, restoring, and facilitating comfort; health; and dignity in dying. 4 2013 NCLEX-RN® Detailed Test Plan - Candidate Version The RN provides a unique, comprehensive assessment of the health status of the client, applying principles of ethics, client safety, health promotion and the nursing process. The nurse then develops and implements an explicit plan of care. The nurse assists clients to promote health, cope with health problems, adapt to and/or recover from the effects of disease or injury, and support the right to a dignified death. The RN is accountable for abiding by all applicable member board jurisdiction statutes related to nursing practice. Classification of Cognitive Levels Bloom’s taxonomy for the cognitive domain is used as a basis for writing and coding items for the examination (Bloom, et al., 1956; Anderson & Krathwohl, 2001). Since the practice of nursing requires application of knowl- edge, skills and abilities, the majority of items are written at the application or higher levels of cognitive ability, which requires more complex thought processing. Test Plan Structure The framework of Client Needs was selected for the examination because it provides a universal structure for defining nursing actions and competencies, and focuses on clients in all settings. Client Needs The content of the NCLEX-RN Test Plan is organized into four major Client Needs categories. Two of the four categories are divided into subcategories: Safe and Effective Care Environment „ Management of Care „ Safety and Infection Control Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity „ Basic Care and Comfort „ Pharmacological and Parenteral Therapies „ Reduction of Risk Potential „ Physiological Adaptation 5 2013 NCLEX-RN ® Detailed Test Plan - Candidate Version Integrated Processes The following processes are fundamental to the practice of nursing and are integrated throughout the Client Needs categories and subcategories: „ Nursing Process – a scientific, clinical reasoning approach to client care that includes assessment, analysis, planning, implementation and evaluation. „ Caring – interaction of the nurse and client in an atmosphere of mutual respect and trust. In this col- laborative environment, the nurse provides encouragement, hope, support and compassion to help achieve desired outcomes. „ Communication and Documentation – verbal and nonverbal interactions between the nurse and the client, the client’s significant others and other members of the health care team. Events and activities associated with client care are recorded in written and/or electronic records that demonstrate adher- ence to the standards of practice and accountability in the provision of care. „ Teaching/Learning – facilitation of the acquisition of knowledge, skills and attitudes promoting a change in behavior. Distribution of Content The percentage of test questions assigned to each Client Needs category and subcategory of the NCLEX-RN Test Plan is based on the results of the Report of Findings from the 2011 RN Practice Analysis: Linking the NCLEX-RN® Examination to Practice (NCSBN, 2012a) and expert judgment provided by members of the NCLEX® Examination Committee. Client Needs Percentage of Items from Each Category/Subcategory Safe and Effective Care Environment „ Management of Care 17-23% „ Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity „ Basic Care and Comfort 6-12% „ Pharmacological and Parenteral Therapies 12-18% „ Reduction of Risk Potential 9-15% „ Physiological Adaptation 11-17% 6 2013 NCLEX-RN® Detailed Test Plan - Candidate Version Management of Care 20% Safety and Infection Control 12% Health Promotion and Maintenance 9% Psychosocial Integrity 9% Basic Care and Comfort 9% Pharmacological and Parenteral Therapies 15% Reduction of Risk Potential 12% Physiological Adaptation 14% Distribution of Content for the NCLEX-RN® Test Plan NCLEX-RN examinations are administrated adaptively in variable length format to target candidate-specific ability. To accommodate possible variations in test length, content area distributions of the individual examinations may differ up to ±3% in each category. Overview of Content All content categories and subcategories reflect client needs across the life span in a variety of settings. Safe and Effective Care Environment The nurse promotes achievement of client outcomes by providing and directing nursing care that enhances the care delivery setting in order to protect clients and health care personnel. „ Management of Care – providing and directing nursing care that enhances the care delivery setting to protect clients and health care personnel. Related content includes, but is not limited to: „ Advance Directives „ Continuity of Care „ Advocacy „ Establishing Priorities „ Assignment, Delegation and Supervision „ Ethical Practice „ Case Management „ Informed Consent „ Client Rights „ Information Technology „ Collaboration with Interdisciplinary Team „ Legal Rights and Responsibilities „ Concepts of Management „ Performance Improvement (Quality Improvement) „ Confidentiality/Information Security „ Referrals 7 2013 NCLEX-RN ® Detailed Test Plan - Candidate Version „ Safety and Infection Control – protecting clients and health care personnel from health and environ- mental hazards. Related content includes, but is not limited to: „ Accident/Error/Injury Prevention „ Emergency Response Plan „ Safe Use of Equipment „ Security Plan „ Ergonomic Principles „ Standard Precautions/Transmission- Based Precautions/Surgical Asepsis „ Handling Hazardous and Infectious Materials „ Home Safety „ Reporting of Incident/Event/Irregular Occurrence/Variance „ Use of Restraints/Safety Devices Health Promotion and Maintenance The nurse provides and directs nursing care of the client that incorporates the knowledge of expected growth and development principles, prevention and/or early detection of health problems, and strategies to achieve optimal health. Related content includes, but is not limited to: „ Aging Process „ High Risk Behaviors „ Ante/Intra/Postpartum and Newborn Care „ Lifestyle Choices „ Developmental Stages and Transitions „ Self Care „ Health Promotion/Disease Prevention „ Techniques of Physical Assessment „ Health Screening Psychosocial Integrity The nurse provides and directs nursing care that promotes and supports the emotional, mental and social well- being of the client experiencing stressful events, as well as clients with acute or chronic mental illness. Related content includes, but is not limited to: „ Abuse/Neglect „ Family Dynamics „ Behavioral Interventions „ Grief and Loss „ Chemical and Other Dependencies/ Substance Use Disorder „ Mental Health Concepts „ Religious and Spiritual Influences on Health „ Coping Mechanisms „ Sensory/Perceptual Alterations „ Crisis Intervention „ Stress Management „ Cultural Awareness/Cultural Influences on Health „ Support Systems „ Therapeutic Communication „ End of Life Care „ Therapeutic Environment 8 2013 NCLEX-RN® Detailed Test Plan - Candidate Version Physiological Integrity The nurse promotes physical health and wellness by providing care and comfort, reducing client risk potential and managing health alterations. „ Basic Care and Comfort - providing comfort and assistance in the performance of activities of daily living. Related content includes, but is not limited to: „ Assistive Devices „ Nutrition and Oral Hydration „ Elimination „ Personal Hygiene „ Mobility/Immobility „ Rest and Sleep „ Non-Pharmacological Comfort Interventions „ Pharmacological and Parenteral Therapies - providing care related to the administration of medica- tions and parenteral therapies. Related content includes, but is not limited to: „ Adverse Effects/Contraindications/Side Effects/Interactions „ Expected Actions/Outcomes „ Medication Administration „ Blood and Blood Products „ Parenteral/Intravenous Therapies „ Central Venous Access Devices „ Pharmacological Pain Management „ Dosage Calculation „ Total Parenteral Nutrition „ Reduction of Risk Potential - reducing the likelihood that clients will develop complications or health problems related to existing conditions, treatments or procedures. Related content includes, but is not limited to: „ Changes/Abnormalities in Vital Signs „ Diagnostic Tests „ Potential for Complications from Surgical Procedures and Health Alterations „ Laboratory Values „ System Specific Assessments „ Potential for Alterations in Body Systems „ Therapeutic Procedures „ Potential for Complications of Diagnostic Tests/Treatments/Procedures „ Physiological Adaptation - managing and providing care for clients with acute, chronic or life threat- ening physical health conditions. Related content includes, but is not limited to: „ Alterations in Body Systems „ Medical Emergencies „ Fluid and Electrolyte Imbalances „ Pathophysiology „ Hemodynamics „ Unexpected Response to Therapies „ Illness Management 9 2013 NCLEX-RN ® Detailed Test Plan - Candidate Version III. 2013 NCLEX-RN ® Detailed Test Plan The NCLEX-RN Test Plan in the previous section provides a general outline of the categories and subcategories of the examination. The 2013 NCLEX-RN® Detailed Test Plan - Candidate Version is used to guide the direction of examination content to be followed by NCLEX® candidates preparing to take the examination. The activity statements used in the 2011 RN Practice Analysis: Linking the NCLEX-RN® Examination to Practice (NCSBN, 2012a) preface each of the eight content categories and are identified throughout the detailed test plan by an asterisk (*). NCSBN performs an analysis of those activities used frequently and identified as impor- tant by entry-level nurses to ensure client safety. This is called a practice analysis; it provides data to support the NCLEX examination as a reliable, valid measure of competent, entry-level nursing practice. The practice analysis is conducted at least every three years. In addition to the practice analysis, NCSBN conducts a knowledge, skills and abilities (KSA) survey. The primary purpose of this study is to identify the knowledge needed by newly licensed registered nurses (RNs) in order to practice safe and effective care. Findings from both the 2011 RN Practice Analysis: Linking the NCLEX-RN® Examination to Practice (NCSBN, 2012a) and the Report of Findings from the 2011 RN Nursing Knowledge Survey. (NCSBN, 2012c) can be found at www.ncsbn.org/1235.htm. Both documents are used in the development of the NCLEX-RN Test Plan, as well as to inform item development. All task statements in the 2013 NCLEX-RN® Detailed Test Plan require the nurse to apply the fundamental prin- ciples of clinical decision making and critical thinking to nursing practice. The detailed test plan also makes the assumption that the nurse integrates concepts from the following bodies of knowledge: „ Social sciences (psychology and sociology); „ Biological sciences (anatomy, physiology, biology and microbiology); and „ Physical sciences (chemistry and physics). In addition, the following concepts are utilized throughout the four major Client Needs categories and subcat- egories of the test plan: „ Nursing process; „ Caring; „ Communication and documentation; and „ Teaching and learning. Note: There are certain inconsistencies throughout this document related to word usage and punctuation. Sentences or phrases marked by an asterisk (*) are activity statements taken directly from the 2011 RN Practice Analysis: Linking the NCLEX-RN® Examination to Practice (NCSBN, 2012a). In order to provide proper attribution to the original survey these statements have not been altered to fit the overall grammatical style of this docu- ment. In addition, the term “client” refers to the individual, family or group, which includes significant others and population. “Clients” are the same as “residents” or “patients.” NCLEX examination items are developed based on a variety of practice settings such as: acute/critical care, long-term care/rehabilitation care, outpatient care and community-based/home care settings. 10 *Activity Statements used in the 2011 RN Practice Analysis 2013 NCLEX-RN® Detailed Test Plan - Candidate Version Safe and Effective Care Environment Management of Care „ Management of Care – the nurse provides and directs nursing care that enhances the care delivery setting to protect the client and health care personnel. MANAGEMENT OF CARE Related Activity Statements from the 2011 RN Practice Analysis of Newly Licensed Registered Nurses in the U.S. and Member Board Jurisdictions „ Integrate advance directives into client plan of care „ Assign and supervise care provided by others (e.g., LPN/VN, assistive personnel, other RNs) „ Organize workload to manage time effectively „ Participate in providing cost effective care „ Initiate, evaluate, and update plan of care (e.g., care map, clinical pathway) „ Provide education to clients and staff about client rights and responsibilities „ Advocate for client rights and needs „ Collaborate with health care members in other disciplines when providing client care „ Manage conflict among clients and health care staff „ Maintain client confidentiality and privacy „ Provide and receive report on assigned clients (e.g., standardized hand off communication) „ Use approved abbreviations and standard terminology when documenting care „ Perform procedures necessary to safely admit, transfer or discharge a client „ Prioritize the delivery of client care „ Recognize ethical dilemmas and take appropriate action „ Practice in a manner consistent with a code of ethics for registered nurses „ Verify that the client comprehends and consents to care and procedures „ Receive and/or transcribe health care provider orders „ Utilize information resources to enhance the care provided to a client (e.g., evidenced- based research, information technology, policies and procedures) „ Recognize limitations of self/others and seek assistance „ Report client conditions as required by law (e.g., abuse/neglect, communicable disease, gunshot wound) „ Report unsafe practice of health care personnel and intervene as appropriate (e.g., substance abuse, improper care, staffing practices) „ Provide care within the legal scope of practice „ Participate in performance improvement/quality improvement process „ Recognize the need for referrals and obtain necessary orders