✅ The 10 NCLEX Traps Covered in the Episode

Assuming the spouse is the automatic decision maker
→ Trap: Ignoring the legal requirement for a designated healthcare proxy.

Mixing up advance directives vs. medical orders
→ Trap: Treating a living will or POLST as interchangeable with a DNR.

Misunderstanding informed consent roles
→ Trap: Thinking the nurse provides the explanation instead of the provider.

Violating HIPAA through casual conversation or curiosity
→ Trap: Discussing PHI in hallways, checking charts you’re not assigned to, or posting online.

Failing to use chain of command in conflict
→ Trap: Not escalating when family demands contradict legal documents or patient safety is at risk.

Delegating unsafely or outside scope
→ Trap: Forgetting the Five Rights of Delegation or assigning unstable patients to UAPs.

Incorrect prioritization under pressure
→ Trap: Addressing psychosocial needs before airway, breathing, or circulation.

Neglecting supervision and follow-up after delegation
→ Trap: Delegating and not verifying completion or evaluating results.

Skipping medication reconciliation during transitions of care
→ Trap: Failing to catch duplications, omissions, or interactions during handoffs.

Confusing system errors with personal blame in quality improvement
→ Trap: Not recognizing that root cause analysis focuses on process—not punishment.

Show Notes Summary (Key Learning Outline)

Legal & Ethical Foundations

Advance Directives: Living will, durable power of attorney, DNR/AND, and POLST.

Nurse’s Role: Verify documents, educate families, advocate for patient wishes, use chain of command when in conflict.

Informed Consent: Provider explains; nurse verifies understanding, witnesses signature, documents, and notifies provider if refused.

HIPAA: Share minimum necessary information only; report breaches immediately.

Case Management & Coordination

RN as Coordinator: Plan across the continuum—discharge planning starts at admission.

Resource Utilization: Refer appropriately—social work, dietician, therapy services.

Structured Communication: SBAR and teach-back methods for accuracy and safety.

Medication Reconciliation: Compare meds at each transition to prevent errors.

Leadership & Conflict Resolution

Assertive Communication: “I” statements, focus on safety.

Chain of Command: Escalate unresolved patient-safety concerns promptly.

Conflict vs. Collaboration: Maintain professionalism; document and debrief.

Prioritization & Delegation

Prioritization Frameworks:

Level 1 = ABCs, hemorrhage, seizures.

Level 2 = Acute pain, mental-status changes, safety risks.

Level 3 = Routine teaching, psychosocial support.

Five Rights of Delegation: Task, circumstance, person, direction, supervision.

Scope Reminders:

UAP: ADLs, vitals (stable only).

LPN: Focused assessments, some meds, reinforce teaching—not initiate.

Quality & Safety

Leadership Styles: Autocratic (emergency), democratic (team input), transformational (inspiring).

Management Functions: Planning, organizing, directing, controlling (PODC).

Performance Improvement: Use PDSA cycles; focus on systems, not blame.

Sentinel Events & RCA: Analyze root causes; fix processes, not people.

Legal Accountability

Negligence Elements: Duty, breach, causation, damages.

Mandatory Reporting: Abuse, communicable diseases, impaired coworkers.

Technology Safety: Secure EHR access, barcode verification, never override alerts.

💡 Key Takeaways

RNs are accountable coordinators, not just task-doers.

Legal protection = follow chain of command + document everything.

Prioritize using ABCs and Maslow’s hierarchy.

Delegate safely using the Five Rights.

Quality improvement and leadership are part of daily practice, not optional extras.

Need to reach out? Send an email to Brooke at [email protected]