Editing RN Scope of Practice (section)

== The nursing process and independent clinical judgment ==

The nursing process is the structured problem-solving framework that operationalizes RN judgment. It is commonly taught in five steps, remembered as ADPIE:

# '''Assessment.''' Systematic collection of subjective and objective data.
# '''Diagnosis.''' Analysis of the data to identify the human response the nurse will treat, such as impaired gas exchange or risk for falls. This is a nursing diagnosis, not a medical diagnosis.
# '''Planning.''' Setting priorities and writing measurable, time-limited, client-centered outcomes, then selecting interventions.
# '''Implementation.''' Carrying out or delegating the interventions and documenting the care.
# '''Evaluation.''' Comparing the client's actual response to the expected outcome and revising the plan as needed.

Two features of this framework are heavily tested. First, assessment comes before intervention unless the situation is an immediate life threat with an established protocol, such as absent pulse or an active fire. Second, evaluation loops back to assessment; an intervention that did not produce the expected outcome requires reassessment rather than repetition.

=== Independent versus dependent versus interdependent functions ===

* '''Independent (nurse-initiated) actions''' require no provider order. Repositioning, oral hygiene, incentive spirometry coaching, emotional support, most patient teaching, skin assessment, and fall precautions are examples.
* '''Dependent actions''' require a provider order, such as administering a medication or inserting an indwelling urinary catheter.
* '''Interdependent or collaborative actions''' are carried out with other disciplines, such as implementing a mobility plan with physical therapy.

The RN is obligated to question and to refuse to carry out an order that is illegible, incomplete, contraindicated, or unsafe, and to escalate through the chain of command if the concern is not resolved. Carrying out a clearly erroneous order does not transfer liability to the prescriber.