Editing RN Scope of Practice (section)

== Patient education, advocacy, and documentation ==

Patient and family education is an RN responsibility. The RN assesses readiness and barriers to learning, develops the teaching plan, delivers the initial teaching, and evaluates comprehension, often using teach-back. Others may reinforce teaching that the RN has already provided.

Advocacy obligations include obtaining and honoring the client's expressed preferences, supporting informed consent, and protecting confidentiality. On the question of informed consent, the standard exam distinction is that the provider performing the procedure is responsible for disclosing the nature, risks, benefits, and alternatives, while the nurse witnesses the signature, confirms that the client is competent and not impaired, and confirms that the client's questions have been answered. If the client cannot describe the procedure, the nurse stops and notifies the provider rather than explaining it.

Documentation must be accurate, timely, objective, and complete. Charting care that was not performed, charting in advance, or altering a record is grounds for discipline. The general rule taught for correcting a paper record is a single line through the error, the correction, and the nurse's initials and date, with no obliteration.