REx-PN professional practice: ethics, scope, and Canadian PN accountability

The RPN/PN scope of practice is legislated provincially under health professions acts and regulated by provincial nursing regulatory bodies. While scope varies by province, the REx-PN assesses national competency standards.

Core PN competencies: Assessment and data collection, care plan contribution and implementation, medication administration within scope, therapeutic communication, patient education and counselling, documentation, and escalation to RN/provider when clinical needs exceed PN scope.

Scope boundaries: The PN collaborates with and reports to the RN within an established care plan. Independent clinical judgment about complex care needs, comprehensive nursing assessment, and care plan development belong to the RN scope. The PN recognises when situations exceed their scope and escalates appropriately — this is a professional competency, not a failure.

Accountability and responsibility: The PN is accountable for the care they provide. Delegated tasks remain within the accountability of the delegating RN. The PN accepts only tasks within their competence and declines tasks beyond their scope or ability.

The Canadian Nurses Association Code of Ethics and provincial nursing regulatory body standards guide ethical practice. Key principles tested on REx-PN:

Autonomy: Respect for the patient's right to make informed decisions about their own care, including the right to refuse treatment. The PN provides information and supports decision-making but does not override competent patient choices.

Beneficence and non-maleficence: Acting in the patient's best interest and avoiding harm. When there is tension between patient autonomy and harm prevention (e.g., patient refusing a life-sustaining treatment), the ethical framework involves consultation with the healthcare team, ethics committee if available, and respecting the patient's expressed wishes if they have decision-making capacity.

Confidentiality and privacy: Patient health information is protected under provincial privacy legislation (e.g., PHIPA in Ontario, HIA in Alberta) and PIPEDA federally. Disclosure without consent is appropriate only in specific circumstances: duty to report (child abuse, communicable diseases), duty to warn (specific credible threat to an identifiable person), and legal requirements.

Truth-telling and transparency: Honest communication with patients about their condition, care, and options. If an error occurs, the PN has a professional and ethical obligation to report it and ensure the patient is informed through the appropriate disclosure process.

Accurate, complete, and timely documentation is both a professional standard and a legal requirement in Canadian nursing practice.

Documentation principles: Objective data only (what was observed, measured, or stated by the patient — not interpretation unless framed as clinical observation). Date, time, and signature for each entry. No blank spaces. Late entries documented as late entries with current time. Errors crossed out with a single line, dated and initialled (no white-out or overwriting). Electronic documentation: consistent with institutional system standards.

What to document: Assessment findings, care provided, patient responses, patient statements (in quotes), communications with other team members (including content of notifications and escalations), changes from baseline, and patient and family education provided and patient response.

Incident reporting: Adverse events and near-misses are reported through the institutional incident reporting system. The medical record documents the care given and clinical facts. Do not document the incident report in the patient record. Both are required and serve different purposes.