Decision Tree

The following decision tree was developed by the National Council of State Boards of Nursing and was adopted by the New Hampshire Board of Nursing in January, 2007 to assist licensed nurses to interpret the applicability of law and rules in a given practice situation.

• Describe the act to be performed.
• Review the scope of practice for your licensure level.

APRN

• Assessing clients, synthesizing and analyzing data, understanding and applying nursing principles at an advanced level;  providing expert teaching and guidance;  working effectively with clients, families and of the members of the health care team;  managing clients' physical and psycho-social health-illness status; utilizing research skills;  analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem, and selecting appropriate treatment; making independent decisions in solving complex client care problems;  performing acts of diagnosing, prescribing, administering and dispensing therapeutic measures;  and recognizing limits of knowledge and experience, planning for situations beyond expertise, consulting with or referring to other health care providers as appropriate.

LNA

Nursing assistant shall be able to:

• Assist individuals to attain and maintain functional independence in a home or health care facility.
• Demonstrate comprehension related to individuals' emotional, mental, physical, and social health needs through skillful, direct nursing-related activities.
• Demonstrate observational and documenting skills required for reporting of people's health, safety, welfare, physical and mental condition, and general well-being.
• Exhibit behaviors supporting and promoting care recipients' rights.
• Form a relationship, communicate, and interact effectively with individuals and groups.
• Provide safe nursing-related activities under the supervision of an RN or an LPN.

LPN

• Contributing to data collection, participating in development of plan of care, implementing aspects of care as directed, maintaining client safety, participating in evaluating care, and delegating to qualified others.

RN

• Assessment, nursing diagnosis, setting goals, planning care strategies, implementing care, delegating care to qualified others, supervising, evaluating, teaching, managing care, maintaining client safety, collaborating with other health care members.

 

1. Is this act expressly permitted or prohibited by the Nurse Practice Act for the license you hold?

UNSURE GO TO #2

WITHIN SCOPE FOR YOUR LICENSE GO TO #3

PROHIBITED STOP

 

2. Is the act consistent with at least one of the following standards?

• Board of Nursing standards of practice (if promulgated in jurisdiction)
• National nursing organization standards of practice
• Nursing literature and research
• Reasonable, prudent nursing in similar circumstances

YES GO TO #3

NO

NOT WITHIN SCOPE FOR YOUR LICENSE

 

3. Do you personally possess the depth and breadth of knowledge to perform the act safely and effectively, as acquired in a pre-licensure program, post-basic program, continuing education program or structured self-study?

YES GO TO #4

NO

STOP Until additional knowledge gained

 

4. Do you personally possess current clinical skills to perform the act safely?

YES

NO

STOP Until clinical skills are attained

 

5. Is the performance of the act within the accepted "standard of care" which would be provided in similar circumstances by reasonable and prudent nurses who have similar training and experience and consistent with appropriately established facility/agency policies and procedures?

YES

NO

STOP Performance of act may place both patient/client and nurse at risk!

 

6. Are you prepared to accept the consequences of your actions?

YES Perform the act *

NO

The accountability is not assumed! Notify appropriate person(s).

* With valid order when necessary, and in accordance with agency policies and procedures