ASBN Position Statement 98–6
ASBN Position Statement 98–6
Decision
Making Model
Making Model
The following position statement, the Decision Making Model,
The following
position
statement,
the section
DecisionforMaking
Model,
is provided
as a special
pull-out
reference
iswhen
provided
as
a
special
pull-out
section
for
reference
making decisions about your scope of practice.
when making decisions about your scope of practice.
The profession of nursing is a dynamic discipline. Practice
potentials
andof
develop
health care
thechange
profession
nursinginisresponse
a dynamictodiscipline.
Practice
the
profession
of
nursing
is aindynamic
discipline.
Practice
needspotentials
of
society,
technical
advancements,
and
expansion
change
and
develop
response
tothe
health
care of
potentials
change technical
and
develop
in
response
toahealth
care
scientific
All licensed
nurses
share
needsknowledge.
of society,
advancements,
and
the expansion
needs
of
society,
technical
advancements,
and
the
expansion
common
base ofknowledge.
responsibility
and accountability
of scientific
all licensed
nurses share a common
of
scientific
knowledge.
allaccountability
licensed
nursesdefined
share aascommon
defined
asofthe
practice
of and
nursing.
However,
base
responsibility
the pracbase
of
responsibility
and
accountability
defined
as the
practice
of
nursing.
However,
competency
based
scopes
competency based practice scopes of individualpractice
tice
of
nursing.
However,
competency
based
practice
scopes
of
individual
nurses
may
vary
according
to
the
type
of
basic
nurses may vary according to the type of basic
of
individual
nursespractice
may
vary
according
toand
the
of basic
licensure
preparation,
practice
experiences,
andtype
professional
licensure
preparation,
experiences,
licensure
preparation,
practice
experiences,
and
professional
development
activities.
professional development activities.
development
activities.
the parameters
of the
practice
scopes
The
parameters
of the
practice
scopes
areare defined by
the
parameters
of the practice
scopes are
defined by
basic
licensure
preparation
and
advanced
defined by basic licensure preparation and education. Within
basic licensure preparation and advanced education. Within
advanced education. Within this scope of practice,
The mission of the
The mission of the
Arkansas State Board
Arkansas State Board
of Nursing is to protect
of Nursing is to protect
the public and act as
the public and act as
their advocate by
their advocate by
effectively regulating
effectively regulating
the practice of nursing.
the practice of nursing.
all nurses should remain current and increase their expertise
and
variety of
practice
experience,
in-service
this skill
scopeinofapractice,
allways,
nursese.g.,
should
remain
current and
this
scopetheir
ofand
practice,
alland
nurses
should
remain
current
andpraceducation,
continuing
education.
Practice
responsibility,
increase
expertise
skill
in a variety
of ways,
e.g.,
increase
their expertise
andeducation,
skilland
in arelative
variety
of
ways,
pracaccountability,
levels
ofe.g.,
independence
tice experience,
in-service
and continuing
educatice
experience,
in-service
education,
and
continuing
educaare also expanded
in this way.
tion. Practice responsibility,
accountability,
and relative levels
tion.
Practice responsibility,
accountability,
and relative
levels
The
licensed
nurseinisthis
responsible
and
of independence
are also
expanded
way.
of independence
are also
expanded
in
this
way.
the licensedaccountable,
nurse
is responsible
and
accountable,
both
pro- for
both professionally and legally,
the licensed
nurse
responsible
and
accountable,
both
professionally
anddetermining
legally,isfor
determining
his/her
personal
scope
his/her personal scope of nursing
fessionally
legally,
forSince
determining
his/her
personal
of nursing and
practice.
since
the
role
ofscope
nurses,of
practice.
theand
roleresponsibilities
and responsibilities
of
nursing
practice.
since
the
role
and
responsibilities
of
nurses,
and
consequently
the
scope
of
nursing
practice,
is
ever
changnurses, and consequently the scope of nursing
and
consequently
the
of nursing
practice, isthat
everthe
changing and
increasing
in scope
complexity,
it is important
nurse
practice,
is ever
changing
and increasing
in
ing
and
increasing
in
complexity,
it
is
important
that
the
nurse
makes decisions
regarding
his/her
own
scope
of
practice.
complexity, it is important that the nurse makes
makes decisions regarding his/her own scope of practice.
decisions regarding his/her own scope of practice.
Th
he
e P
Pr
ra
ac
ct
t ii c
ce
e o
o ff N
Nu
ur
r ss ii n
ng
g
T
The Practice of Professional (Registered) Nursing:
TheThe
Practice
(Registered)
deliveryof
of Professional
health care services
which requireNursing:
assessment,
The delivery
of health
care services
require
diagnosis,
planning,
intervention,
andwhich
evaluation
fallassessment,
within the profesdiagnosis,
planning,
intervention,
and
evaluation
fall
within the professional nurse scope of practice.
sional
nurse
scope of practice.
the
performance
for compensation of any acts involving:
the
performance
for compensation of any acts involving:
• theobservation,careandcounseloftheill,injuredorinfirm;
••theobservation,careandcounseloftheill,injuredorinfirm;
themaintenanceofhealthorpreventionofillnessofothers;
••themaintenanceofhealthorpreventionofillnessofothers;
thesupervisionandteachingofotherpersonnel;
•
•thesupervisionandteachingofotherpersonnel;
thedelegationofcertainnursingpracticestootherpersonnel;
••thedelegationofcertainnursingpracticestootherpersonnel;
administrationofmedicationsandtreatments
•where
administrationofmedicationsandtreatments
such acts require substantial specialized judgment and skill
wheresuchactsrequiresubstantialspecializedjudgmentand
wheresuchactsrequiresubstantialspecializedjudgmentand
based
on
knowledge
and application
of the principles
of biologiskill based
on knowledge
and application
of the principles
of
skill
based
on
knowledge
and
application
of
the
principles
cal,
physical
and
social
sciences.
ACA
§
17-87-102
(6)
biological, physical and social sciences. ACA § 17-87-102 (2)(A-E)
(A-E) of
biological, physical and social sciences. ACA § 17-87-102 (2) (A-E)
The Practice of Advanced Practice Nursing:
TheThe
Practice
of Advanced
Practice
Nursing:
advanced
practice nurse
shall practice
in accordance with
advanced
practice
nurse
shall
practiceinin
accordance
with
The
advanced
practice
nurse
practice
accordance
with
the
theThe
scope
of practice
defined
byshall
the appropriate
national
certifythe
of
practice
defined
byappropriate
the
national
scope
of practice
defined
by theset
national
certifying
body and
ingscope
body
and
the
standards
forthappropriate
in the
ASBN
Rules certifyand
ing
body and set
theforth
standards
forthRules.
in theThe
ASBN
Ruleshealth
and care
the
standards
in the set
ASBN
advanced
practice
nurse
Regulations.
The
advanced
practice
nurse
may
provide
Regulations.
The
advanced
practice
provide
health
care
may
providethe
health
care
for which
thenurse
APN may
is educationally
prepared
for which
APN
is educationally
prepared
and
for which
compefor
which
the
is educationally
prepared
and
for which compeand
forhas
which
competence
has maintained.
been attained
and
maintained.
tence
beenAPN
attained
and
tencethe
hasdelivery
been attained
and
maintained.
of health
care
services for compensation by profesthe nurses
deliverywho
of health
care services
for compensation
byskills
professional
have gained
additional
knowledge and
sional
nurses
who have
gained additional
knowledge
andofskills
through
successful
completion
of an organized
program
nursthrough
successful
of an
of nursing education
that completion
certifies nurses
fororganized
advancedprogram
practice roles
as
ing
education
that
certifies nurses
for advanced
practice roles
as
advanced
nurse
practitioners,
certified
nurse anesthetists,
certified
advanced
nurse practitioners,
certified
nurse anesthetists,
certified
ACA
17-87-102
nurse midwives,
and clinical nurse
specialists.
ACA §§17-87-102
(3) (4)
nurse midwives, and clinical nurse specialists. ACA § 17-87-102 (3)
The Practice of Registered Nurse Practitioner Nursing:
Thethe
Practice
ofofRegistered
Nursing:
delivery
health careNurse
servicesPractitioner
for compensation
in colthe delivery of health care services for compensation in col-
ASBN Update • www.arsbn.org
Fall 2002
ASBN Update • Fall 2002
laboration with and under the direction of a licensed physician
laboration
with
and under
the direction
of a licensed
or under the
direction
of protocols
developed
with a physician
licensed
or
under
the
direction
of
protocols
developed
with
a licensed
ACA
§
17-87-102
(8)
(A)
physician. ACA § 17-87-102 (4) (A)
physician. ACA § 17-87-102 (4) (A)
The Practice of Practical Nursing:
TheThe
Practice
Nursing:
delivery
ofofPractical
health
services
areare
performed
under
the
deliveryof
healthcare
care
serviceswhich
which
performed
under
delivery
of
care services
which
are
performed
under
the
direction
ofofthe
professional
nurse,
licensed
physician,
or licensed
thethe
direction
thehealth
professional
nurse,
licensed
physician,
or
the
direction
of
the
professional
nurse,
licensed
physician,
or
dentist,
observation,
intervention,
and evaluation,
fall
licensedincluding
dentist, including
observation,
intervention,
and evalualicensed
dentist,
including
and evaluation, fall
within
the LPn/LPtn
scope ofintervention,
practice.
within
the
LPN/LPTN
scopeobservation,
of practice.
tion,the
fallperformance
within the LPn/LPtn
scope ofof
practice.
for compensation
acts involving:
the
performance
for
compensation
of
• thecareoftheill,injured,orinfirm; acts involving:
••thecareoftheill,injured,orinfirm;
thedelegationofcertainnursingpracticestootherpersonnel
•
thedelegationofcertainnursingpracticestootherpersonnel
under
thethe
direction
of aofregistered
professional
nurse,
an an
under
direction
a registered
professional
nurse,
under
the
direction
of aa licensed
registered
professional
nurse,
an
advanced
practice
nurse,
physician
or a or
licensed
advanced
practice
nurse,
a licensed
physician
a licensed
advanced
practice
a licensed
physician
or
a speciallicensed
dentist,
which
actsacts
donurse,
notnot
require
the the
substantial
specialized
dentist,
which
do
require
substantial
dentist,
which acts
not require
the substantial
specialskill,
judgement,
and do
knowledge
required
in professional
izedskill,judgement,andknowledgerequiredinprofesizedskill,judgement,andknowledgerequiredinprofesnursing.
ACA
§
17-87-102
(5)
sional nursing. ACA § 17-87-102 (5)
sional nursing. ACA § 17-87-102 (5)
The Practice of Psychiatric Technician Nursing:
Thethe
Practice
of Psychiatric
Technician
performance
for compensation
of Nursing:
acts involving:
performance for compensation of acts involving:
•the
thecareofthephysicallyandmentallyill,retarded,
• thecareofthephysicallyandmentallyill,retarded,
injured,orinfirm;
•injured,orinfirm;
thedelegationofcertainnursingpracticestootherpersonpersonnel
• thedelegationofcertainnursingpracticestootherpersonnel
the carrying out of medical orders under the direction
the
out ofprofessional
medical
orders
under
the
direction
of a regisnel
carrying
out
of medical
orders
under
thepractice
direction
ofcarrying
athe
registered
nurse,
an advanced
tered
professional
nurse,
an
advanced
practice
nurse,
a
licensed
of
a
registered
professional
nurse,
an
advanced
practice
nurse, a licensed physician or a licensed dentist, where
physician
or
a
licensed
dentist,
where
such
activities
do
not renurse,
a licensed
or athe
licensed
dentist,
where
such activities
dophysician
not require
substantial
specialized
quire
the
substantial
specialized
skill,
judgement,
and
knowledge
such
activities do not require the substantial specialized
skill,judgement,andknowledgerequiredinprofessional
required
in ACA
professional
nursing. ACA § 17-87-102 (7)
skill,judgement,andknowledgerequiredinprofessional
nursing.
§ 17-87-102 (6)
nursing. ACA § 17-87-102 (6)
Position statement 98–6 Decision Making MoDel
Position statement 98–6 Decision Making MoDel
15
15
15
Scope
of Practice
Decision
Making
Model
Scope
of Practice
Decision
Making
Model
Define the activity/task
Identify,
Scope
of Practice
Decision Making Model
Define
the activity/task
Identify,
Describe, Clarify problem/need
Describe, Clarify problem/need
Define the activity/task Identify,
Describe, Clarify problem/need
YES
YES
YES
Is the activity permitted by the
Arkansas Nurse Practice Act?
NO
NO
Is the activity permitted by UNSURE
the
NO
Is the activity permitted by the YES
Arkansas Nurse Scope
Practiceof
Act?
Practice Decision Making Model
Arkansas Nurse Practice Act?
Is the activity/task precluded under
any other law, rule or policy?
UNSURE UNSURE
YES
NO
Define the activity/task Identify,
Is the activity consistent with:
Describe, Clarify problem/need
Pre-licensure/post-basic education program National
Nursing Standards Nursing Literature/Research
Institutional policies and procedures Agency
Accreditation Standards Board Position Statements
Is Community
the activity permitted
Standards?by the
Arkansas Nurse Practice Act?
NO
NO
Is the activity/task precluded under
Is the activity/task precluded
under YES
YES
UNSURE
any other law, rule or policy?
any other law, rule or policy? YESNO
Has the nurse completed special
Is the activity/task
education ifprecluded
needed? under
any other law, rule or policy?
YES
Defer to a professional qualified to do activity/task.
Scope of Practice Decision Making Model
NO
NO
YES
NO
Does the nurse possess the
Is the appropriate
activity consistent
with:
knowledge?
Define the activity/task
Identify,
Pre-licensure/post-basic education program National
Describe, Clarify problem/need
Nursing Standards Nursing Literature/Research
YESand procedures Agency
Institutional policies
Accreditation Standards Board Position Statements
Is there documented evidence
Community Standards?
of
competency
& skill?by the
Is the activity permitted
Arkansas Nurse Practice Act?
NO
NO
IsIsthe
with:
Defer to the Arkansas State
NO
the activity
activityIsconsistent
consistent
with
the activity
consistent with:
Board of Nursing for deciYES
NO
Pre-licensure/post-basic education
program
National
sion.
program;
National
NO
YES
Pre-licensure/post-basic
education
program National
YES
NO
NO
Nursing
Standards
Nursing
Literature/Research
NO
Nursing Standards;
Literature/Research;
Defer to a professional qualNursingNursing
Standards
NursingUNSURE
Literature/Research
ified to do activity/task.
YES
Institutional
policies
and
procedures
Agency
Institutional policiesInstitutional
and procedures;
Agency
Accreditation
policies
and procedures
Agency
YES
YES
Nurse may Model
perform the
Accreditation
Standards
BoardScope
Position
NO
ofStatements
Practice
Decision
Making
NO
Standards;
Board
Position
Statements;
activity/task according
Accreditation Standards Board NO
Position Statements
to acceptable and
Community
Standards?
Community Standards?
prevailing standards of safe
Community Standards?
NO
YES
YES
Has the nurse completed special
Would a reasonable & prudent
education if needed?
nurse do theprecluded
act?
Is the activity/task
under
any other law, rule or policy?
YES
Does the nurse possess the
Is the nurse prepared to accept
appropriate knowledge?
of action?
Isthe
theconsequences
activity consistent
with:
Pre-licensure/post-basic education program National
Define
the activity/task
Identify,
Nursing Standards
Nursing Literature/Research
Describe,
Clarify
problem/need
Institutional
policies
and procedures
Is there
documented
evidenceAgency
Accreditation Standards
Board& Position
of competency
skill? Statements
Community Standards?
16
YES
YES
YES
YES
care. State
Defer tonursing
the Arkansas
Board of Nursing for decision.
NO
NO
NONO
NO
Position
statement
98–6
Decision Making MoDel
Is the activity
permitted
by the
Arkansas Nurse Practice Act?
Would a reasonable & prudent
Has the nurse completed special
nurse do the act?
education if needed?
UNSURE
ASBN Update • Fall 2002
Defer to a professional
qualNO
Has the nurse completed
special
Scope of
Practice Decision Making
ified to doModel
activity/task.
Defer to a professional qualHas the
nurse completed
special YES
YES
Nurse
may
perform
the
YES
Defer to a professional qualeducation if needed?
NONO
activity/task according
education if needed?
ified to do activity/task.
to acceptable and
NO
Is the activity/task precluded under
any other law, rule or policy?
Is the nurse prepared to accept
Does the nurse possess the
the consequences
of action?
Define
the activity/task
Identify,
appropriate knowledge?
Describe, Clarify problem/need
YES
YES
Is the activity
consistent with:
YES
Pre-licensure/post-basic education program National
NONO
Nursing Standards
Nursing
Literature/Research
Is there
documented
evidence
NO
Is
the
activity
by the
Institutional policies
andpermitted
procedures
Agency
of competency
& skill?
Arkansas
Nurse
Act?
Accreditation
Standards
BoardPractice
Position
Position
statement
98–6 Statements
Decision Making MoDel
Community Standards?
YES
YES
NO
ified to do activity/task.
prevailing standards of safe
nursing care.
Defer to the Arkansas State
Board of Nursing for decision. Update • Fall 2002
ASBN
Does the nurse
possess
theYES
Scope
ofUNSURE
Practice
Decision Making NO
Model
NO
YES possess the
Does the nurse
YES
appropriate knowledge?
NO
Defer to a professional qualappropriate knowledge?
YES
16
Would a reasonable & prudent
Is the activity/task precluded under
nurse do the act?
anythe
other
law,
rule or policy?
Has
nurse
completed
special
if needed?
Defineeducation
the activity/task
Identify,
Describe,NO
Clarify problem/need
YES
Is theYES
nurse prepared to accept
Is the activity consistent with:
the consequences of action?
Pre-licensure/post-basic
program
Does theeducation
nurse possess
the National
Nursing Standards
Nursing
Literature/Research
appropriate
knowledge?
Is the
activity
permitted
by the
YES
Institutional
policiesNurse
and procedures
Agency
Arkansas
Practice Act?
Accreditation Standards Board Position Statements
YES
Community Standards?
YES
YES
NO
NO
NO
NO
NO
ified
to domay
activity/task.
Nurse
perform the
activity/task according
to acceptable and
prevailing standards of safe
nursing care.
OR
Defer to the Arkansas State
Defer to the Arkansas State
NO
UNSURE
Defer to the Arkansas
State
NO
Is there documented
evidence
Scope
of
Practice Decision
Making
Model
Board of Nursing for deciIs there
documented
evidence YES
Board
of
Nursing
for deciYES
sion.
of competency & skill?
Board of Nursing for deciNO
Defer to a professional qualof competency
YES & skill?
sion.
Is there documented evidence
statement
98–6
Decision Making MoDel
of competency
& skill?
IsPosition
the activity/task
precluded
under
any other law, rule or policy?
Has the nurse completed special
education
if needed?
Define
the activity/task
Identify,
NOClarify problem/need
NO
Describe,
Would
a reasonable
& prudent
16
YESconsistent
nurse
do the act?
Is the activity
with:
Pre-licensure/post-basic education program National
DoesNursing
the nurse
possess the
Standards
Literature/Research
YES
YES Nursing
appropriate
knowledge?
the activity
permitted
byAgency
the
InstitutionalIspolicies
and procedures
Arkansas
Nurse
Practice
Act?
AccreditationIsStandards
Position
Statements
the nurseBoard
prepared
to accept
Community
YESStandards?
the consequences
of action?
YES
YES
NO
NO
NO
NO
NO
ASBN Update • Fall 2002
sion.
ified to do activity/task.
Nurse may perform the
activity/task according
to acceptable and
Defer to the
ArkansasofState
prevailing
standards
safe
Board nursing
of Nursing
for decicare.
sion.
Defer to a professional qualified to do activity/task.
NO
Would a reasonable
& prudent
NO
Scope
of UNSURE
Practice
Decision
Making Model
YES
YES & prudent
Would
a reasonable
YES
NO
nurse do the act?
nurse do the
YES act?
YES
Is there documented evidence
competencyprecluded
& skill? under
Is theofactivity/task
rule or special
policy?
Has any
the other
nurselaw,
completed
education if needed?
Define the activity/task Identify,
NO
NO
Describe,
Clarify problem/need
Position
98–6
Decision Making MoDel
Would statement
a reasonable
& prudent
YES
16
nurse do
the act?with:
Is the activity
consistent
Pre-licensure/post-basic
education
program
Does the nurse
possess
the National
Nursing Standards
Nursing
Literature/Research
appropriate
knowledge?
YES
Is thepolicies
activityand
permitted
by theAgency
Institutional
procedures
Nurse
Practice
Act?Statements
Accreditation
Standards
Board
Position
IsArkansas
the
nurse
to accept
YES prepared
Community
Standards?
the
consequences
of action?
IsUNSURE
there documented evidence
YES & skill?
of competency
YES
Is the activity/task precluded under
any
law, rule or policy?
Has other
the nurse
YES completed special
education if needed?
YES
YES
Is the nurse prepared to accept
Is the nurse prepared to accept
the consequences of action?
the consequences of action?
YES
16
Would aNO
reasonable & prudent
YESdo the act?
nurse
Is the activity consistent with:
Pre-licensure/post-basic
education
programthe
National
Does the
nurse possess
YES
Nursing Standards
Nursing Literature/Research
appropriate
knowledge?
Institutional policies and procedures Agency
Is the nurse prepared to accept
Accreditation Standards Board Position Statements
YES of action?
the consequences
Community Standards?
Is there documented evidence
YES
ofYES
competency & skill?
Has the nurse completed special
YES
education if needed?
16
16
16
NO
NO
YES
NO
NO
Position statement 98–6 Decision Making MoDel
YES
16
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Position
statement
98–6
Decision Making MoDel
Would
a reasonable
& prudent
ASBN Update • Fall 2002
Nurse may perform the
activity/task according
andState
Defer to
to acceptable
the Arkansas
prevailing
standards
safe
Board of Nursing
for of
decinursing
sion.care.
NO
Defer to a professional qualified to do activity/task.
Nurse may perform the
Nurse may perform the
activity/task according
activity/task according
to acceptable and
to acceptable and
prevailing standards of safe
prevailing standards of safe
nursing care.
nursing care.
ASBN Update • Fall 2002
Nurse may perform the
activity/task according
to acceptable and
Defer to standards
the Arkansas
State
prevailing
of safe
Boardnursing
of Nursing
care.for decision.
Defer to a professional qualified to do activity/task.
ASBN Update • Fall 2002
YES
Position statement 98–6 Decision
Making MoDel
nurse do the act?
NO
Position statement
98–6 Decision
Making MoDel
Does the nurse possess the
YES
appropriate knowledge?
NO
Nurse may perform the
ASBN Update • Fall 2002
501.686.2700
ASBN Update •
Fall 20
Decision Making Process
1. Define the Activity/Task:
Clarify what is the problem or need?
Who are the people involved in the decision?
What is the decision to be made and where (what setting or organization)
will it take place?
Why is the question being raised now?
Has it been discussed previously?
2. Is the activity permitted by Arkansas Nurse Practice Act?
no—stop. Defer the activity/task to a professional qualified to do the
activity/task or to the arkansas state Board of nursing for a decision.
Yes—Go to Question # 5—special education needed?
Unsure— Go to Question # 3—Precluded by other law, rule, or policy?
Guidelines
for Decision
Making
the nurse is constantly involved in
the decision-making and problem solving process, whether as a staff nurse or a
manager, regardless of the practice
setting. although their perspectives are
different the process is the same. the
following steps are basic to the process.
Clarify:
Who are the people
involved in the decision?
What is the decision to be
made and where (what
setting or organization) will
it take place?
3. Is activity/task precluded under any other law, rule or policy?
no—Go to Question #4—Consistent with....
Yes—stop. Defer the activity/task to
a professional qualified to do the
activity/task or to the arkansas state
Board of nursing for a decision.
4. Is the activity consistent with:
Pre-licensure/post-basic education
program
national nursing standards
nursing Literature/Research
institutional policies and procedures
agency accreditation standards
Board Position statements
Community standards?
no—stop. Defer the activity/task to a professional qualified to do the
activity/task or to the arkansas state Board of nursing for a decision.
Yes—Go to Question # 5—special education needs?
5. Has the nurse completed special education if needed?
no—stop. Defer the activity/task to a professional qualified to do the
activity/task or to the arkansas state Board of nursing for a decision.
Yes—Go to Question # 6—Possess appropriate knowledge?
6. Does nurse possess appropriate knowledge?
no—stop. Defer the activity/task to a professional qualified to do the
activity/task or to the arkansas state Board of nursing for a decision.
Yes—Go to Question #7—Documented competency?
7. Is there documented evidence of competency & skill?
no—stop. Defer the activity/task to a professional qualified to do the
activity/task or to the arkansas state Board of nursing for a decision.
Yes—Go to Question #8—Reasonable & prudent nurse?
8. Would a reasonable & prudent nurse perform the act?
no—stop. Defer the activity/task to a professional qualified to do the
activity/task or to the arkansas state Board of nursing for a decision.
Yes—Go to Question #9—Prepared to accept consequences?
9. Is nurse prepared to accept the consequences of action?
What is the problem or need?
Why is the question being
raised now?
Has it been discussed
previously?
Assess:
What are your resources?
What are your strengths?
What skills and knowledge
are required?
What or who is available to
assist you?
Identify What are possible solutions?
Options: What are the characteristics
of an ideal solution?
is it feasible?
What are the risks?
What are the costs?
are they feasible?
What are the implications
of your decision?
How serious are the consequences?
Point of What is the best decision?
Decision: When should it be done?
By whom?
What are the implications
or consequences of your
decision?
Howwillyoujudge
the effectiveness of
your decision?
no—stop. Defer the activity/task to a professional qualified to do the
activity/task or to the arkansas state Board of nursing for a decision.
Yes—nurse may perform the activity/task according to acceptable and
prevailing standards of nursing care.
www.arsbn.org
ASBN Update • Fall 2002
Position statement 98–6 Decision Making MoDel
17
17
A pplication
of
G uidelines
Clarify what it is you are being asked to do:
• Gather facts that may influence the decision.
• Are there written policies and procedures available to describe
how and under what conditions you will perform this task?
• Does the new responsibility require professional judgement or
simply the acquisition of a new skill?
• Is this a new expectation for all RNs? LPNs? LPTNs?
• Has this been done before by others in your unit or health care
facility?
• Is it just new to you?
• What about the other facilities in your community or region?
• What are the nurse manager’s expectations about you or other
RNs, LPNs, LPTNs, becoming responsible for this procedure?
• When will this become effective?
• Will there be an opportunity to help you attain the needed
clinical competency?
• Who will be responsible for the initial supervision and evaluation of this newly performed task?
• Will you be given additional time to learn the skill if you need
it?
Assess:
• Are you clinically competent to perform this procedure?
• Do you currently have the knowledge and skills to perform the
procedure?
• Have you had experience in previous jobs with this procedure?
• Who is available to assist you who has that skill and knowledge?
• Is that person accessible to you?
• Do you believe you will be able to learn the new skill in the
allotted time?
• How can you determine that you are practicing within your
scope of nursing?
• What is the potential outcome for the patient if you do or do
not perform the procedure?
Identify options and implications of your decision. The options
include:
• The responsibility/task is not prohibited by the Nurse Practice
Act.
If you believe that you can provide safe patient care based upon
your current knowledge base, or with additional education and
skill practice, you are ready to accept this new responsibility.
You will then be ethically and legally responsible for performing
this new procedure at an acceptable level of competency.
If you believe you will be unable to perform the new task competently, then further discussion with the nurse manager is necessary.
At this point you may also ask to consult with the next level of
management or nurse executive so that you can talk about the
various perspectives of this issue.
It is important that you continue to assess whether this is an isolated
situation just affecting you, or whether there are broader implications. In other words, is this procedure new to you, but nurses in
18
for
D ecision M aking
other units or health care facilities with similar patient populations
already are performing? To what do you relate your reluctance to accept this new responsibility? Is it a work load issue or is it a competency issue?
At this point, it is important for you to be aware of the legal rights of
your employer. Even though you may have legitimate concerns for
patient safety and your own legal accountability in providing competent care, your employer has the legal right to initiate employee
disciplinary action, including termination, if you refuse to accept
an assigned task. Therefore, it is important to continue to explore
options in a positive manner, recognizing that both you and your
employer share the responsibility for safe patient care. Be open to
alternatives.
In addition, consider resources which you can use for additional
information and support. These include your professional organization, both state and national, and various publications. The
American Nurses Association Code for Nurses, standards on practice,
and your employer’s policies and procedures manuals are valuable
resources. The Nurse Practice Act serves as your guide for the legal
definition of nursing and the parameters that indicate deviation
from or violation of the law.
Point of decision/Implications.
Your decision may be:
Accept the newly assigned task. You have now made an agreement
with your employer to incorporate this new responsibility, under the
conditions outlined in the procedure manual. You are now legally
accountable for its performance.
Agree to learn the new procedure according to the plans established
by the employer for your education, skills practice and evaluation.
You will be responsible for letting your nurse manager know when
you feel competent to perform this skill. Make sure that documentation is in your personnel file validating this additional education. If
you do not believe you are competent enough to proceed after the
initial in-service, then it is your responsibility to let the educator and
nurse manager know you need more time. Together you can develop
an action plan for gaining competency.
Refuse to accept the newly assigned task. You will need to document your concerns for patient safety as well as the process you use
to inform your employer of your decisions. Keep a personal copy of
this documentation and send a copy to the nurse executive. Courtesy requires you also send a copy to your nurse manager. When
you refuse to accept the assigned task, be prepared to offer options
such as transfer to another unit (if this new role is just for your unit)
or perhaps a change in work assigned tasks with your colleagues.
Keep in mind though, when you refuse an assignment you may face
disciplinary action, so it is important that you be familiar with your
employer’s grievance procedure.
For additional information on the Nurse Practice Act, Rules and
Position Statements see the ASBN Web site: www.arsbn.org
Approved: November 1998 • Revised: January 1999
501.686.2700