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Study guide · Safe and Effective Care Environment

Coordinated Care

18 to 24% of the exam · 31 activity statements

Coordinated Care is the largest category on the NCLEX-PN: how the practical nurse works within the team to keep care organized, safe, legal and ethical. Items ask which client to see first, what to assign to assistive personnel, when to report to the RN or primary health care provider, and how to handle orders, consent, confidentiality, advance directives and mandatory reports within the LPN/VN scope. Most items are judgment and priority decisions, not recall.

A study feature written by ExamDragon, not part of the real exam. Each heading is one of the Related Activity Statements NCSBN lists for this category (31 of them), in our words; NCSBN's wording is in its Test Plan.

At a glance

Safe and Effective Care Environment
18 to 24%

of the exam (NCSBN's range)

Activity statements
31
Key terms
12

What this guide covers, statement by statement

  1. Base clinical decisions on information from a range of trustworthy sources
  2. Help write and revise the client's care plan
  3. Give client care or tasks to suitable staff, such as aides or other practical nurses
  4. Plan and rank care by what each client needs
  5. Notice conflict among staff and report it
  6. Speak up for what clients need and are entitled to
  7. Help clients speak up for themselves
  8. Take part in quality improvement, for example by gathering data or joining a committee
  9. Include the client in decisions about their care
  10. Check in with clients once they have gone home
  11. Take part in staff learning, such as in-service sessions and keeping skills current
  12. Know the limits of your own skills and ask for help with tasks or assignments
  13. Step in or report when another worker's practice is unsafe
  14. Help with discharging or transferring clients
  15. Help with the process of referring a client
  16. Report issues as rules and policy require, such as abuse, neglect, gunshot wounds or infectious disease
  17. Take part in getting the client's consent
  18. Keep client information confidential
  19. Protect the client's privacy
  20. Give clients information on advance directives
  21. Help gather data about the client
  22. Use health information technology in giving care
  23. Base the care you give on evidence
  24. Work as part of a team drawn from different disciplines
  25. Keep watch on the work of aides and other assistive staff
  26. Help deliver care that is high quality and cost effective
  27. Give and take report
  28. Act in line with the nursing code of ethics
  29. Stay within the legal limits of practical nursing
  30. Check orders from prescribers and handle them correctly
  31. Give fair care with equal access for every client, whatever their ethnicity, culture, sexual orientation, or gender identity and expression

1Base clinical decisions on information from a range of trustworthy sources

  • The client is the primary source of data; the record, the family, other team members, laboratory results and the medication reference are secondary sources that confirm or add to it.
  • Use current, approved references: the facility's policies and procedures, an up-to-date drug reference and the prescriber's orders, not memory or a coworker's habit.
  • Compare new data with the client's baseline and trend; one value means little until it is set against what is normal for this client.
  • When sources disagree (the client says one allergy, the record lists another), clarify before acting and report the discrepancy to the RN or provider.
  • LPN/VN scope: the practical nurse gathers and verifies data and reports it; the RN analyzes it and makes the nursing judgment for complex or unstable clients.
  1. In practiceA resident's record shows no allergies, but the resident's daughter says her mother broke out in hives after taking an antibiotic last year. The nurse holds the newly prescribed antibiotic, confirms the reaction with the resident, records the allergy and reports it to the RN and provider, because a second credible source has raised a safety issue.
  2. Where questions turnActing on a single unverified source, such as a coworker's report or an old entry, when the client or a current record says otherwise.
Practise this activity

2Help write and revise the client's care plan

  • The RN develops the plan of care; the LPN/VN contributes data, suggests interventions and helps update it as the client changes.
  • Report when an outcome is not being met (pain still 7 of 10 after the planned measures, a wound getting larger) so the plan can be revised.
  • Goals in the plan are client-centered, measurable and time-limited, for example walking 50 feet with a walker twice a day by Friday.
  • Share what the client tells you about preferences, routines and goals; those details make the plan workable.
  • Follow the current plan consistently and document care given and the client's response, which is the evidence for any change.
  1. In practiceA client with a stage 2 pressure injury on the sacrum is turned every 2 hours per the plan, yet the nurse measures the wound as larger than last week. The nurse documents the measurement and reports to the RN that the goal is not being met, so the RN can revise the plan and consult the wound care team.
  2. Where questions turnChanging the plan independently or continuing an ineffective plan without reporting that the expected outcome was not reached.
Practise this activity

3Give client care or tasks to suitable staff, such as aides or other practical nurses

  • Assign by the five rights: right task, right circumstance, right person, right direction and communication, right supervision and evaluation.
  • Assistive personnel can do routine, predictable tasks for stable clients: bathing, feeding a client without swallowing problems, ambulating, toileting, routine vital signs, intake and output.
  • Do not assign to AP data collection that needs nursing judgment, teaching, evaluation of a response, care of an unstable client, or medication administration (except a certified medication aide where state law and policy allow).
  • Give clear direction: what to do, for whom, by when, what to report right away (for example a pulse over 100 or a client who is dizzy) and any special precautions.
  • Unstable or newly admitted clients and tasks outside PN scope go to the RN; know your state's rules on whether and when an LPN/VN may assign to other LPN/VNs.
  1. In practiceThe nurse on a rehabilitation unit asks an AP to take vital signs for four stable clients and to report at once any blood pressure above 160/100 or below 90/60. The nurse keeps for self the client who returned from a procedure an hour ago, because a recently changed client needs licensed observation.
  2. Where questions turnAssigning to AP a task that needs judgment, such as checking a new admission or reinforcing teaching, or giving vague direction with no report-back parameters.
Practise this activity

4Plan and rank care by what each client needs

  • First the airway, breathing and circulation; then safety; then other physiological needs; then psychosocial needs (Maslow).
  • An acute or sudden change comes before a chronic, expected or stable finding; an actual problem before a potential one.
  • Time-critical care comes early: insulin with meals, scheduled antibiotics, pain medication before therapy, a client due for a procedure.
  • Cluster care to save the client's energy and your time, and plan rounds so every client is seen early in the shift.
  • Report any client whose condition is unstable or worsening to the RN at once; triage of unstable clients is the RN's role.
  1. In practiceAt the start of a shift in long-term care, the nurse learns one resident has new shortness of breath, one is due for a scheduled oral medication, one wants help writing a letter and one has a chronic leg ulcer due for a dressing change. The nurse goes first to the resident with new shortness of breath, collects data and reports to the RN, because a breathing change can threaten life.
  2. Where questions turnChoosing the client with the most tasks or the loudest request over the one with a new change in airway, breathing or circulation.
Practise this activity

5Notice conflict among staff and report it

  • Signs of staff conflict include tension, avoidance, gossip, refusing to help each other, and arguments in front of clients.
  • Address it early, privately and respectfully with the person involved, using "I" statements and facts, not blame.
  • Keep the focus on client safety and care; conflict that affects care or that you cannot resolve goes to the charge nurse or manager through the chain of command.
  • Never argue or discuss a conflict where clients or visitors can hear.
  • Collaboration and compromise are usually the most effective styles; avoidance only delays the problem.
  1. In practiceTwo AP refuse to help each other turn clients and the nurse notices turns being missed. The nurse speaks with them privately about the missed turns and the risk to clients, and when the tension continues reports it to the charge nurse, because unresolved conflict is now affecting care.
  2. Where questions turnIgnoring conflict that is affecting care, or confronting staff in front of clients.
Practise this activity

6Speak up for what clients need and are entitled to

  • Clients have the right to information, privacy, respectful care, to take part in decisions and to refuse treatment, even when the team disagrees.
  • Advocate by voicing a client's unmet need or concern to the RN or provider: uncontrolled pain, a wish to refuse a treatment, a need for an interpreter.
  • Advocacy means supporting the client's own wishes and values, not substituting yours.
  • If a concern is not resolved, use the chain of command: charge nurse, then supervisor, then other facility resources such as an ethics committee or patient advocate.
  • Protect vulnerable clients (those who are confused, very young, or who do not speak the language) who cannot easily speak for themselves.
  1. In practiceA client tells the nurse she does not understand why she is having a procedure tomorrow and does not want it. The nurse reports this to the RN and the provider before any preoperative medication, because the client has the right to understand and to refuse.
  2. Where questions turnPersuading the client to accept what the team wants, or keeping a client's stated concern to yourself.
Practise this activity

7Help clients speak up for themselves

  • Encourage clients to ask questions, write down concerns before appointments and repeat back what they were told.
  • Help clients keep an up-to-date list of their medications, allergies and providers to carry with them.
  • Reinforce their right to a second opinion, to refuse, to see their record and to bring a support person.
  • Respect the choices clients make once they are informed, even when you would choose differently.
  • Point clients to resources such as the facility's patient advocate, support groups and reliable health information.
  1. In practiceA client newly managing heart failure says he feels rushed at his provider visits. The nurse helps him write three questions to take to his next appointment and reinforces that he may ask the provider to explain anything again, because self-advocacy keeps him an active partner in his care.
  2. Where questions turnSpeaking for a capable client instead of helping the client speak for himself.
Practise this activity

8Take part in quality improvement, for example by gathering data or joining a committee

  • Quality improvement looks at systems and processes, not individual blame; incident data are used to find patterns.
  • The PN takes part by collecting data (hand hygiene audits, fall rates, pressure injury counts), joining committees and trying new processes.
  • A common model is Plan, Do, Study (or Check), Act: test a small change, measure the result, then adopt, adapt or drop it.
  • Root cause analysis asks why an event happened until the system cause is found.
  • Report near misses as well as errors; they show weak points before anyone is harmed.
  1. In practiceA unit's falls increased at night. The nurse joins the falls committee, collects data on the times and circumstances of each fall for a month and finds most happened when clients walked to the bathroom alone, which leads the committee to trial scheduled toileting rounds.
  2. Where questions turnTreating quality improvement as discipline for one person rather than a look at the process.
Practise this activity

9Include the client in decisions about their care

  • Ask about the client's goals, values, routines and preferences and pass them to the RN for the plan of care.
  • Offer real choices when they exist (time of bath, order of tasks, food preferences) to support control and dignity.
  • Give information in plain words so the client can decide; a competent adult may decline any treatment.
  • Include family in decisions only as the client wishes, or as the legal health care agent when the client cannot decide.
  • Report to the RN or provider when a client wants to change or refuse part of the plan.
  1. In practiceA resident in a skilled care facility dislikes morning showers. The nurse asks when she would prefer to bathe, reports the preference so the plan is updated, and her refusals of care stop, because she now has a say in her routine.
  2. Where questions turnMaking decisions for a capable client to save time, or letting the family overrule the client's own wishes.
Practise this activity

10Check in with clients once they have gone home

  • Follow-up calls or visits after discharge check symptoms, understanding of medications, access to supplies and whether appointments are made.
  • Ask open questions and use teach-back ("Tell me how you are taking your water pill") rather than "Do you have any questions?"
  • Report new or worsening symptoms, medication confusion or unmet needs to the RN or provider; the PN reinforces existing teaching and does not give new medical advice.
  • Watch for warning signs specific to the condition, such as weight gain in heart failure or fever and redness at a surgical site.
  • Document the call, what the client reported and to whom concerns were passed.
  1. In practiceDuring a follow-up call two days after discharge, a client with heart failure says he has gained 3 lb (1.4 kg) since yesterday and his ankles are swollen. The nurse tells him this needs to be reported, notifies the RN and provider according to the clinic's protocol, and documents the call.
  2. Where questions turnReassuring the client that a warning sign is expected instead of reporting it.
Practise this activity

11Take part in staff learning, such as in-service sessions and keeping skills current

  • Attend in-services and skills days and complete required competency checks before doing a new procedure or using new equipment.
  • Keep the continuing education your state requires for license renewal, and current certifications such as basic life support.
  • Share what you learn with coworkers and help orient new staff within your scope.
  • Ask for education when you notice a gap, for example a new pump or a policy you have not used.
  • Follow the facility's current policy, which reflects updated evidence, over how you learned it in the past.
  1. In practiceThe unit switches to a new enteral feeding pump. Before her next shift the nurse completes the in-service and the return demonstration, because using equipment without training is unsafe.
  2. Where questions turnUsing a new device or skill after only watching a coworker, without the required training or competency check.
Practise this activity

12Know the limits of your own skills and ask for help with tasks or assignments

  • Do only what is within your scope, your training and your facility's policy; when unsure, ask before acting.
  • If you have not done a task, or not done it recently, tell the charge nurse and ask for supervision or help.
  • If an assignment is unsafe for your skills (for example a client needing care outside PN scope), tell the charge nurse before accepting it and propose a solution.
  • Once you have accepted an assignment, leaving without handing off care is abandonment.
  • Asking for help is a safety behavior, not a weakness.
  1. In practiceA float nurse from long-term care is assigned a client with a new tracheostomy needing suctioning, which she has not performed in years. She tells the charge nurse and asks for an RN to supervise the first suctioning, because unfamiliar procedures put the client at risk.
  2. Where questions turnPerforming an unfamiliar or out-of-scope task to avoid looking incompetent, or walking off an accepted assignment.
Practise this activity

13Step in or report when another worker's practice is unsafe

  • Unsafe practice includes impairment, skipping safety checks, falsifying records, rough handling and acting beyond scope.
  • If a client is in immediate danger, intervene first to protect the client (stop the act, remove the person from the bedside).
  • Then report to the charge nurse or supervisor promptly, through the chain of command; state facts, not opinions.
  • Suspected impairment (alcohol on the breath, slurred speech, missing controlled substances) is reported to the supervisor at once; do not confront the person alone or let them keep caring for clients.
  • Reporting may also go to the board of nursing as state law requires; document objectively per policy.
  1. In practiceThe nurse sees an AP about to transfer a frail resident without the mechanical lift the care plan requires. The nurse stops the transfer, helps do it safely with the lift and then reports the event to the charge nurse, because the client's safety comes first and the practice must be corrected.
  2. Where questions turnWaiting until after the shift to report, or confronting an impaired coworker privately while they continue client care.
Practise this activity

14Help with discharging or transferring clients

  • Discharge planning starts at admission; the PN contributes data on the client's home, supports, self-care ability and equipment needs.
  • Medication reconciliation compares home and current medications at every transition; report omissions, duplicates or conflicts.
  • The RN or provider does the initial discharge teaching for a new diagnosis; the PN reinforces it and checks understanding with teach-back.
  • On transfer, give a complete handoff report to the receiving nurse and send the required records.
  • A competent adult may leave against medical advice: notify the RN and provider, explain the risks, offer the form; do not restrain the client.
  1. In practiceA client going home after hip replacement repeats back the hip precautions the RN taught, but cannot say which medication is for blood clots. The nurse reinforces the teaching with the medication list and reports the gap to the RN, because the client must understand anticoagulant therapy before leaving.
  2. Where questions turnDoing initial teaching for a new diagnosis as the PN, or detaining a competent client who chooses to leave.
Practise this activity

15Help with the process of referring a client

  • Notice and report needs the current team cannot meet: trouble swallowing (speech therapy), poor mobility (physical therapy), daily living skills (occupational therapy), diet (dietitian), finances or placement (social work or case management).
  • Referrals generally need an order or the RN's or case manager's action; the PN identifies the need and reports it.
  • Explain to the client why a referral is suggested and respect a refusal.
  • Share relevant information with the receiving service as policy allows and with the client's consent.
  • Follow up that the referral happened and that the client's need was met.
  1. In practiceWhile feeding a resident, the nurse notices coughing with every sip of thin liquid. She stops the thin liquids, reports to the RN and asks about a speech therapy swallow evaluation, because coughing with liquids suggests aspiration risk.
  2. Where questions turnIgnoring a need because it is outside nursing, or arranging a service without the needed order or the client's agreement.
Practise this activity

16Report issues as rules and policy require, such as abuse, neglect, gunshot wounds or infectious disease

  • Nurses are mandated reporters of suspected child abuse and, in most jurisdictions, abuse or neglect of older or dependent adults; suspicion is enough, proof is not needed.
  • Follow your facility's policy and state law: report to the RN or supervisor and to the agency named by law, within the required time.
  • Many jurisdictions require reporting of gunshot or stab wounds to law enforcement and certain communicable diseases to public health.
  • Document objectively: exact quotes, measured injuries, behaviors seen; no opinions or accusations.
  • Good-faith reporters are protected by law; never promise a client you will keep abuse a secret.
  1. In practiceA 4-year-old has bruises in several stages of healing on the back and upper arms, and the parent's account changes with each question. The nurse documents the findings and the exact statements and reports to the RN and the designated authority per policy, because a reasonable suspicion must be reported.
  2. Where questions turnWaiting for proof before reporting, or promising to keep a disclosure confidential.
Practise this activity

17Take part in getting the client's consent

  • The provider performing the procedure explains it, its risks, benefits and alternatives and obtains informed consent; this cannot be passed to the nurse.
  • The nurse may witness the client's signature (as policy allows), which confirms the signer's identity and that the signature was voluntary.
  • The client must be an adult with capacity, not under the effect of sedating medication, and informed in a language they understand, with a qualified interpreter when needed.
  • If the client has questions, seems unsure or says they were not told, do not proceed: notify the provider.
  • Exceptions include emergencies (implied consent) and minors, whose parent or guardian consents unless the minor is emancipated or the law allows minors to consent for specific care.
  1. In practiceBefore a colonoscopy, a client signs the consent form, then asks the nurse what a perforation is. The nurse notifies the provider and does not give the preprocedure sedative, because the client's question shows the consent is not yet informed.
  2. Where questions turnExplaining the procedure's risks yourself, or witnessing a signature after the client has received a sedative.
Practise this activity

18Keep client information confidential

  • Share health information only with those directly involved in the client's care, and only what they need (minimum necessary).
  • Release information to family or others only with the client's permission or the legal authority of a representative.
  • Never discuss clients in public areas, on social media (even without names) or with your own friends and family.
  • Log off when you leave a computer, never share passwords and look only at the records of clients in your care.
  • Confidentiality limits are set by law: mandatory reports and threats of serious harm to others may require disclosure.
  1. In practiceA caller says she is a client's sister and asks how surgery went. The nurse checks whether the client has authorized information to this person and, finding no authorization, explains she cannot share details and offers to give the client a message, because only authorized people may receive health information.
  2. Where questions turnSharing information because the caller sounds like family, or opening a chart out of curiosity.
Practise this activity

19Protect the client's privacy

  • Knock and wait before entering; close the door or curtain for care, examination and personal conversations.
  • Expose only the body part being treated and keep the client draped.
  • Hold sensitive conversations (diagnosis, finances, sexual history) in a private place, not a hallway or shared room within earshot.
  • Ask visitors to step out during care if the client prefers, and respect a client's wish for a same-gender caregiver where possible.
  • Keep whiteboards, charts and screens free of information others should not see.
  1. In practiceThe nurse needs to collect data on a resident's incontinence in a shared room. She closes the curtain, lowers her voice and asks the roommate's visitor to step out, because privacy protects the resident's dignity.
  2. Where questions turnDoing care or a sensitive interview with the curtain open or in front of visitors to save time.
Practise this activity

20Give clients information on advance directives

  • Facilities that receive federal funds must ask on admission whether the client has an advance directive and give written information about the client's rights.
  • A living will states wishes about life-sustaining treatment; a durable power of attorney for health care names an agent to decide if the client cannot.
  • A provider order such as a do-not-resuscitate order or a portable medical order form (often called POLST or MOLST) turns wishes into orders the team follows.
  • The PN provides information, places a copy in the record per policy, and reports to the RN or provider any question, change of mind or conflict with current orders.
  • A competent client may change or revoke a directive at any time; the client's current wishes come first.
  1. In practiceA newly admitted resident says she has a living will at home but no copy here. The nurse explains what an advance directive is, asks the family to bring the copy, documents the conversation and reports it to the RN, because the team must know her wishes before an emergency.
  2. Where questions turnAssuming a directive exists without seeing it, or following the family's wishes over the competent client's stated wishes.
Practise this activity

21Help gather data about the client

  • The LPN/VN collects data (vital signs, intake and output, pain level, skin, breath sounds, mental status) and reports it; the RN does the comprehensive and initial assessment.
  • Use a consistent method and correct equipment, and compare findings with the client's baseline.
  • Collect focused data when a client reports a new symptom: onset, location, duration, characteristics, what makes it better or worse.
  • Report abnormal or changed findings promptly and document exactly what was found, with times.
  • Use both subjective data (what the client says) and objective data (what you observe or measure).
  1. In practiceA client on a medical unit says he feels "funny" after lunch. The nurse checks vital signs and capillary blood glucose, finds the glucose is 58 mg/dL (reference 70 to 99 mg/dL fasting), follows the hypoglycemia protocol and reports to the RN, because focused data guide the right response.
  2. Where questions turnDoing a comprehensive admission assessment as the PN, or reporting a change without the data that describe it.
Practise this activity

22Use health information technology in giving care

  • The electronic health record, barcode medication scanning and smart pumps reduce errors only when used as designed.
  • Never use workarounds such as scanning a copy of a wristband or overriding an alert without checking why it fired.
  • Protect access: your own login only, log off or lock the screen, no screenshots or photos of client data.
  • Document in real time or as soon as possible, and correct errors by the system's approved method.
  • Know the downtime procedure (paper forms) for when the system is unavailable.
  1. In practiceThe scanner gives a "wrong client" alert when the nurse scans a medication at the bedside. She stops, rechecks both identifiers and the order, and finds the medication was for the client in the next bed, because the alert caught a real error.
  2. Where questions turnOverriding an alert or scanning a barcode away from the client to save time.
Practise this activity

23Base the care you give on evidence

  • Evidence-based practice combines the best current research, clinical expertise and the client's preferences.
  • Facility policies and care bundles (for falls, catheter-associated infection, pressure injury prevention) put evidence into practice; follow them.
  • Some old habits are not supported: massaging reddened skin over bony prominences, routinely changing a catheter on a fixed schedule without reason, using doughnut-shaped cushions.
  • If a practice seems outdated, raise it with the RN or through quality improvement; do not change policy on your own.
  • Reliable sources include current professional guidelines and peer-reviewed literature, not opinion or advertising.
  1. In practiceA new AP rubs a resident's reddened heel to "get the blood moving." The nurse explains that massaging reddened skin can damage tissue and shows how to float the heels off the bed instead, because current evidence supports offloading.
  2. Where questions turnContinuing a familiar practice that current evidence shows is harmful.
Practise this activity

24Work as part of a team drawn from different disciplines

  • Know each discipline's role: physical therapy (mobility, strength), occupational therapy (daily living skills), speech therapy (swallowing, communication), dietitian, pharmacist, social worker, chaplain, respiratory therapist.
  • Share your observations in team meetings and huddles; the nurse sees the client around the clock.
  • Use structured communication such as SBAR (situation, background, assessment, recommendation) for concise reports.
  • Coordinate schedules so therapies, meals, medications and rest fit together.
  • Respect each member's expertise and refer questions to the right discipline.
  1. In practiceIn a care conference, the physical therapist reports a resident walks well in therapy, but the nurse has seen her refuse to walk to meals because of knee pain in the late afternoon. Sharing this leads the team to time her pain medication before meals, because each discipline sees a different part of the picture.
  2. Where questions turnKeeping relevant observations to yourself or taking on another discipline's role without consulting them.
Practise this activity

25Keep watch on the work of aides and other assistive staff

  • The nurse who assigns a task stays accountable for checking that it was done correctly and on time.
  • Check results: review vital signs and intake and output the AP recorded and ask about anything unusual.
  • Watch care being given when possible, and give prompt, specific, respectful feedback.
  • Abnormal data reported by AP must be checked by the nurse and reported to the RN as needed.
  • Correct unsafe performance at once and report repeated problems to the charge nurse.
  1. In practiceAn AP records a resident's pulse as 48 without comment. The nurse rechecks the apical pulse, confirms 48, reports to the RN and reminds the AP to report values outside the given range right away, because the nurse must follow up on what was assigned.
  2. Where questions turnAccepting AP-recorded data without review, or believing that assigning a task transfers responsibility for it.
Practise this activity

26Help deliver care that is high quality and cost effective

  • Preventing complications (falls, pressure injuries, catheter-associated infections) is the most effective way to save cost and harm.
  • Use supplies wisely: open only what you need, return unused clean items as policy allows, and avoid taking extra supplies into isolation rooms.
  • Group tasks and plan care to make good use of staff time.
  • Report equipment that is broken or missing rather than improvising.
  • Cost never outweighs safety: never reuse single-use items or skip a needed intervention to save money.
  1. In practiceBefore entering a contact precautions room, the nurse gathers only the supplies needed for the dressing change, because anything taken in that is not used must be discarded.
  2. Where questions turnChoosing a cheaper option that compromises safety, such as reusing a single-use device.
Practise this activity

27Give and take report

  • Use a structured format such as SBAR or I-PASS so nothing important is missed.
  • Include current status, recent changes, pending tests and results, medications and treatments due, safety risks (falls, allergies, isolation, code status) and what to watch for.
  • Give report in a private place or at the bedside so the client can take part and lines, drains and equipment can be checked together.
  • The receiving nurse asks questions and reads back critical details; report is two-way.
  • After receiving report, decide whom to see first, starting with any unstable or changed client.
  1. In practiceAt shift change, the nurse reports first that a resident had a new temperature of 100.9 F (38.3 C) at 1400, that the RN and provider were notified and a urine culture is pending, then the routine information, because the most important change must reach the next nurse clearly.
  2. Where questions turnLeaving out a recent change, a pending result or code status, or giving report in a hallway where others can hear.
Practise this activity

28Act in line with the nursing code of ethics

  • The core ethical principles are autonomy (self-determination), beneficence (doing good), nonmaleficence (avoiding harm), justice (fairness), fidelity (keeping promises) and veracity (truthfulness).
  • Professional codes for nurses call for respect for every person, commitment to the client, protecting rights and safety, and accountability for one's own practice.
  • Keep professional boundaries: no gifts of value, no personal relationships, no sharing personal problems with clients.
  • When an ethical conflict arises, report to the RN or supervisor and use resources such as the ethics committee.
  • Be honest about errors and limits.
  1. In practiceA resident offers the nurse an expensive watch as thanks. The nurse thanks him warmly and declines, following facility policy, because accepting valuable gifts crosses a professional boundary.
  2. Where questions turnChoosing an option that breaks a boundary because it seems kind, or that overrides a competent client's autonomy.
Practise this activity

29Stay within the legal limits of practical nursing

  • Each state or jurisdiction's nurse practice act defines LPN/VN scope; facility policy can narrow it but never widen it.
  • Generally within PN scope: data collection, contributing to the plan, reinforcing teaching, giving medications by routes the state allows, monitoring and reporting.
  • Generally outside PN scope: the initial comprehensive assessment, developing the plan of care, initial teaching of a new diagnosis, IV push medications (in most states the RN's; only where state law and facility policy allow) and triage of unstable clients; involve the RN.
  • Negligence requires a duty, a breach of the standard of care, harm and a link between the breach and the harm; good documentation is your best defense.
  • Accepting an order or assignment beyond your scope does not protect you, even if a supervisor directs it.
  1. In practiceThe charge nurse asks the LPN to give an IV push medication because the RN is busy. The LPN explains this is outside her scope in her state and offers to take over another task so the RN can give it, because practicing outside scope is unsafe and illegal.
  2. Where questions turnPerforming an out-of-scope task because someone in authority asked, or reflexively reporting a problem the PN should act on first.
Practise this activity

30Check orders from prescribers and handle them correctly

  • A complete order has the client's name, date and time, medication or treatment, dose, route, frequency and the prescriber's signature.
  • Question any order that is incomplete, unclear, unsafe for this client or outside usual dose ranges; contact the prescriber before carrying it out.
  • Take verbal or telephone orders only where your state and facility allow LPN/VNs to do so, writing them down and reading them back for confirmation.
  • Avoid error-prone abbreviations (U for units, QD, QOD, trailing zeros, MS); write them out.
  • Transcribe or process orders per policy and check that the order was carried out.
  1. In practiceA new order reads "metoprolol 50 mg" with no route or frequency. The nurse does not give the drug and calls the prescriber to clarify, because an incomplete order cannot be safely carried out.
  2. Where questions turnCarrying out an unclear or unsafe order as written, or guessing the missing part.
Practise this activity

31Give fair care with equal access for every client, whatever their ethnicity, culture, sexual orientation, or gender identity and expression

  • Give the same quality of care to every client regardless of culture, ethnicity, religion, sexual orientation, gender identity or expression, income or disability.
  • Ask, do not assume: the client's name, pronouns, beliefs, preferences and who they consider family.
  • Use a qualified medical interpreter, not a family member or child, for health information.
  • Notice and challenge bias in yourself and others, including in how pain or symptoms are believed and treated.
  • Record the client's identity and preferences accurately so the whole team uses them.
  1. In practiceA transgender client tells the nurse his name is Daniel, though his insurance card shows a different name. The nurse uses Daniel and his pronouns in care, checks identity with the legal name and date of birth for medications as policy requires, and updates the record's preferred name field, because respectful care and safe identification both matter.
  2. Where questions turnLetting assumptions about a client's identity, background or ability to pay change the care given.
Practise this activity

Key terms

Assignment
Giving a staff member the tasks or clients they are allowed and competent to care for, while the nurse stays accountable.
Five rights of delegation
Right task, right circumstance, right person, right direction and communication, right supervision and evaluation.
Assistive personnel (AP)
Trained, unlicensed staff who help with routine care of stable clients under a nurse's direction.
Scope of practice
The activities a nurse may legally perform, set by the jurisdiction's nurse practice act.
Informed consent
A competent client's voluntary agreement after the provider explains a procedure's risks, benefits and alternatives.
Advance directive
A legal document, such as a living will or durable power of attorney for health care, stating care wishes in case the client cannot decide.
Mandated reporter
A person required by law to report suspected abuse or neglect to the proper authority.
Confidentiality
Keeping health information private and sharing only the minimum necessary with those involved in care.
SBAR
Situation, Background, Assessment, Recommendation: a structured format for reports and handoffs.
Chain of command
The order of authority used to raise an unresolved concern: charge nurse, then supervisor, then administration.
Medication reconciliation
Comparing a client's home and current medications at each transition to find omissions, duplicates and conflicts.
Quality improvement
A systematic, non-punitive process of measuring care and testing changes to make it safer and better.

After this guide: You can decide which client to see first, what to assign to assistive personnel, when to report to the RN or provider, and how to protect a client's rights, privacy and wishes within the LPN/VN scope, the law and the code of ethics.

Practise Coordinated Care