Navigating Ethical and Legal Issues in Nursing Transition to Practice

This report delves into the complexities of nursing transition to practice, examining a clinical scenario involving ethical dilemmas, specifically the conflict between patient autonomy and beneficence. It explores medico-legal issues, clinical decision-making processes, and the scope of practice, highlighting professional nursing standards. The report also analyzes teamwork and interdisciplinary practice issues, emphasizing the importance of interprofessional collaboration and the key roles and responsibilities of a newly graduated registered nurse. Recommendations are provided to guide nurses in navigating ethical challenges and making informed decisions within their scope of practice, promoting patient-centered care and adherence to professional standards. The analysis underscores the significance of ethical diligence, respecting patient autonomy, and fostering collaborative relationships within the healthcare team to ensure optimal patient outcomes and professional conduct. The report stresses the need for new nurses to understand their limitations, seek guidance, and prioritize continuous professional development to navigate the intricate landscape of healthcare effectively.

Running head: NURSING TRANSITION TO PRACTICE 1
Nursing Transition to Practice
Name of Author
Institution
Date of Submission

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Abstract
Nursing transition into practice can be a complex process for most students. Nursing practice is a
closely regulated area regarding ethical obligations, legal ramifications, leadership, and other
professional standards. It is important to understand and get prepared to tackle realities like
ethical and legal issues in practice, leadership challenges, confidentiality, professional standards,
scope of practice and responsibilities. The clinical scenario of Jade’s dilemma provides a good
learning opportunity. Jade faces an ethical dilemma between autonomy and beneficence
principles that are associated to legal ramifications. Other areas covered under the clinical
scenario include scope of practice, clinical decision making, interprofessional team and
collaboration, roles and responsibilities of a newly registered graduate nurse and teamwork
parameters. There are also various recommendations for Jade regarding the future of her
practice. For instance, it is recommended that she should understand her scope of work and
operate within her limitations.

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Table of Contents
Introduction……………………………………………………………………………………….4
Ethical and Medico-Legal Issues …………………………………………………………………4
Clinical Decision Making ………………………………………………………………………...6
Scope of Practice and Professional Nursing Standards …………………………………………..7
Teamwork and Interdisciplinary Practice Issues …………………………………………………8
Interprofessional team and Collaborative Skills…………………………………………………. 9
Key Roles and Responsibilities of a Newly Graduated Registered Nurse………………………. 9
Conclusion ……………………………………………………………………………………... 11
Recommendation……………………………………………………………………………….. 11
References ……………………………………………………………………………………….12

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Nursing Transition to Practice
1. Introduction
Nursing transition into practice can be a complex process for most students. However, it
is a closely regulated area regarding ethical obligations, legal ramifications, leadership, and other
professional standards. The regulations aim at streamlining nursing practice and protecting
different rights within the healthcare sector. Registered nurses are expected to perform and
deliver their services to patients using an evidence-based approach. However, due to the
diversity of patients associated with healthcare, many challenges face registered nurses in
practice. The challenges pose dilemma to nurses regarding their decision making and leadership
skills. The nurses are hence expected to deliver healthcare services in a professional manner
taking all care to improve the quality of lives of the patients.
The assignment provides a clinical scenario that abounds many critical issues for
discussion. Some of the areas covered in the case study include ethical and medico-legal issues,
clinical decision making, and the scope of practice, professional nursing standards, teamwork,
and interdisciplinary practice issues. This report will analyze the “Clinical Scenario: Jade’s
Dilemma?” through the above-mentioned parameters of practice surrounding the case study.
2. Ethical and Medico-Legal Issues
The ethical principles of autonomy and beneficence were conflicting according to the
clinical scenario. Autonomy places the patient, Bethany at the center of the treatment
interventions. Hence, their decisions should be respected with regards to care. If they refuse
treatment then that should be respected and given priority. As an ethical concern, I believe

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engaging Bethany’s mother about the intentions of the health services was in order and expected
from a registered nurse. On the other hand, beneficence dictates that actions should be taken to
benefit another individual. The action of seeking to administer a paracetamol to Bethany was
aimed at benefiting her. These principles caused a serious ethical dilemma to Jade as a registered
nurse. However, it should be noted that in situations of ethical dilemma, there is no single
decision that can be deemed to be absolutely justified yet a choice must be made (Johnstone &
Crock, 2007).
Informed consent is a key fundamental requirement in the healthcare setting for
registered nurses and other health professionals. Patients entrusts nurses to respect their feelings
and decisions. Consent falls under delivery of patient-centered care framework where the needs
of the patient must be respected. The patients must be in a position of understanding all the
medical interventions that would be used during their care (Sinclair, Papps & Marshall, 2016). In
the clinical scenario, it is clear that Bethany, a patient lacks the capacity as a minor to give their
consent. Given the presence of her mother, it is expected that the parent makes decision for her.
It is clear from the scenario that other nurses had decided to administer treatment to Bethany
despite refusal of her mother. According to the mother, their religion cannot allow the use of
medications for the treatment of medical conditions. The mother develops suspicion on the
motives of the medical team and denied Bethany ice cream. Attempting to offer treatment to
Bethany before securing a court order was illegality and unethical. For the case of Bethany, it
can be argued that it would have been to their best interest to receive treatment given the pain
they are going through. However, the final decision about treatment was at the prerogative of the
mother as her legal representative according to the scenario ("Nursing and Midwifery Board of
Australia - Professional Codes & Guidelines," 2019).

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Ethics is at the core of nursing practice. Ethics demands that one acts in a professional
manner by making the right clinical decisions in service delivery. According to the clinical
scenario, Jade refuses to give the medication to Bethany despite the counsel of the doctor and
that of Lisa. Jade is not convinced about the ethical aspect of treating the patient against their
will. Respecting patients entails recognition of their capacity to participate in healthcare services.
Refusal to administer the drug secretly to Bethany demonstrated Jade’s determination to respect
the religious values of the mother. On the other hand, Jade was acting against the wishes and
expectations of her colleagues. It is important to undertake collaborative approach towards the
care of patients. Jade refused to engage in an illegality and chose to remain ethical (Chang &
Daly, 2015). Her ethical diligence is also demonstrated by the fact that she was neither told about
the religious perspective of the case nor about making Bethany ‘a ward of the state.’
3. Clinical Decision Making
Nurses are expected to manifest sound clinical reasoning while dispending their work to
ensure they make appropriate decisions. All decisions in health care are critical and cumulatively
affect the patient health outcomes. Accurate decision making requires adequate information and
evidence to inform clinical reasoning (Chang & Daly, 2015). According to the clinical scenario,
there was a breakdown in information. Jade was not duly informed about the information that
had been omitted from tape that had been left by the nurse on night shift. As such, Jade was not
aware of the discrete information about Bethany’s religious affiliations and the decision of the
medical team.
Subsequently, due to lack of enough experience in practice, Jade decides to consult the
doctor about Bethany’s problem. As a registered nurse, she made the right decision after

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understanding the plight of Bethany’s mother in light of her religious beliefs. After consultation,
Jade refuses to make a favorable decision at least to the medical team to give Bethany
medication. I believe through the principle of beneficence; an individual should act to the benefit
of the patient. Given that Bethany could not make personal decisions in the case, it is clear that
her best interest was to receive treatment and get better (Sasso et al., 2016). It would have been
appropriate to administer to Bethany the paracetamol as they waited for the court order to be
granted.
Moreover, Jades decision to tell Bethany’s mother about the intentions of the medical
team was a hurried decision. When the dilemma is viewed from the perspective that she was in
charge and wanted to get into a good therapeutic relationship with the patient, the action can be
considered appropriate (Sasso et al., 2016). It is clear that Bethany’s mother had become highly
suspicious of the medical team and something had to be done. On the other hand, a look at the
greater picture and the best interest of the patient, Jade would have withheld some information
from Bethany’s mother to help improve her health quality. It was wrong to reveal information
that would have helped save the life of the little Bethany illustrated by the fact that Bethany’s
mother left the hospital with a sick child.
4. Scope of Practice and Professional Nursing Standards
Nurses are expected to maintain professional standards while practicing. Nurses should
be working within their scope of practice to promote evidence-based care. For instance, nurses
are supposed to understand and implement their professional obligations well. Jade has a
responsibility to arrive to work early for the handover process to be effected well. Lisa is also
concerned about the lateness of Lisa to work. By arriving late to work, Jade violates the

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professional practice standards (Chang & Daly, 2015). Consequently, she finds out about the
religious beliefs of Bethany’s mother and strives to respect her choices by all means. She
manifests the nursing professional standard that places patients at the center of care.
As a professional one should be objective and focused. Within her scope of practice, Jade
would have sought to remain adherent to her nursing roles of seeking alternative measures to
enable treatment of Bethany ("Nursing and Midwifery Board of Australia - Professional Codes &
Guidelines," 2019).
5. Teamwork and Interdisciplinary Practice Issues
The healthcare environment is very complex and entails the interaction of different
medical professionals. Despite the differences in roles, the main aim of healthcare service
provision is to improve the lives of patients and hence their wellbeing. Hence, the bar for
teamwork and interdisciplinary collaboration is set so high (Stanley, 2016). As put in the clinical
scenario, the facility has a medical team that helps make critical decisions at difficult times like
the case of Bethany. Jade should understand the scope of her practice as a registered nurse. In the
case when a patient has refused to accept treatment and yet they get to a medical facility, it
means their options are running out. Given her limited experience in practice, she would have
closely worked with the medical team to get a court order to save the child. Teamwork entails
trust and having confidence about the common interest. It was clear that the medical team had a
motive to ensue effective treatment of Bethany. However, the mother was the only impedance
whose solution was through the court order being sought. This indicated that the medical team
was not willing to violate the practice standards but were acting to the best interest of the ailing
Bethany.

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6. Interprofessional team and Collaborative Skills
Different healthcare professionals operate under certain codes of ethics and conduct that
guide their practice. It is expected that a registered nurse should understand and appreciate the
need for interprofessional collaboration. The interprofessional team has the ability to offer
unique perspectives to care that significantly improve the health outcomes of patients (Leigh,
Rutherford & Williamson, 2017). For instance, the medical team entails individuals from
different specialties. As a new registered nurse, Jade has not appreciated the significance of
teamwork and collaboration. In the clinical scenario, the doctor informs Jade that due to her new
experience she may not understand the responsibilities of other professionals in the facility.
The efforts of the leadership to convince Jade on how to handle the situation failed. She
ignored all the directions and instead acted to her convictions. The lack of consideration exposed
Bethany to more health risks as her mother eventually left the facility. Jade must learn to accept
that teamwork and healthcare practice is not about individuals; it requires collaboration and
interprofessional input.
7. Key Roles and Responsibilities of a Newly Graduated Registered Nurse
It is important to clarify the roles and responsibilities of newly graduated registered
nurses due to the practical nature of nursing profession. The first responsibility of a nurse is
professional development. Jade is expected to gain professional development by learning from
the senior practitioners in their areas of practice. The aim of a registered nurse new in the
profession is to learn as much as they can and not to counter decisions made by more
experienced superiors. It should be noted that in scenarios involving ethical dilemmas, no

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approach can be deemed to be inappropriate (Ailey et al., 2015). However, in the presence of a
medical team one is expected to sacrifice their opinions to allow the team perspective to apply.
Further, Jade is expected to assist and support the nursing personnel in the facility to
deliver care to patients. It is important to delineate between a patient and their relatives. Jade
must know that she is obligated to act to the best interest of Bethany as a patient and not the
mother. Also, she is only required to provide support and not to take charge. She is expected to
work and learn under the guidance of the medical team and the coordinator, Lisa. Disclosure of
sensitive information to Bethany’s mother was a violation of confidentially and trust to other
members of the team (Chang & Daly, 2015).
8. Conclusion
According to the clinical scenario, Jade faces dilemma on her ability to make clinical
decisions. Jade feels it is not ethical and legal to administer medication to Bethany. She is
compelled to inform her mother about the impending court order. The wrong disclosure that did
not factor in the health interests of Bethany and the medical team influences Bethany’s mother to
leave the hospital exposing her to more risks. Bethany acts contrary to the professional standards
and scope of practicing by making self-centered decisions, oblivious of the opinions of others.
9. Recommendations
1. Jade should understand to appreciate her scope of practice and work within her
professional standards of practice.
2. Jade should understand the concept of greater good for the patient. The best interest of a
patient should be considered primary to their relatives and guardians reservations.

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3. Jade should understand her supportive roles and the need to improve her clinical
competence as a newly registered graduate nurse.
4. Jade should appreciate the significance of interprofessional team and collaboration. She
needs to embrace the fact that teamwork is about compromise and trust. Going against
team deliberations is not the best approach. Instead she should engage in the
interprofessional meetings to air her views.
5. Jade needs to realize that ethical practice also entails the relationship between fellow
employees. In the code of ethics, one must maintain ethical practice while delivering care
to the patient as well as while working with other professionals in practice.

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10. References
Ailey, S., Lamb, K., Friese, T., & Christopher, B. A. (2015). Educating nursing students in
clinical leadership. Nursing Management, 21(9).
Chang, E. & Daly, J., (2015). Transitions in Nursing: Preparing for Professional Practice.
Churchill Livingston.
Johnstone, M., & Crock, E. (2007). Dealing with ethical issues in nursing practice. Transitions in
nursing: Preparing for professional practice.
Leigh, J. A., Rutherford, J., & Williamson, T. (2017). Stakeholder perspectives of an approach to
healthcare leadership development through use of a multidimensional leadership
development conceptual model. International Journal of Practice-Based Learning in
Health and Social Care, 5(1), 77-96.
Nursing and Midwifery Board of Australia - Professional Codes & Guidelines. (2019). Retrieved
16 September 2019, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements.aspx
Sasso, L., Bagnasco, A., Bianchi, M., Bressan, V., & Carnevale, F. (2016). Moral distress in
undergraduate nursing students: A systematic review. Nursing ethics, 23(5), 523-534.
Sinclair, J., Papps, E., & Marshall, B. (2016). Nursing students' experiences of ethical issues in
clinical practice: A New Zealand study. Nurse education in practice, 17, 1-7.

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Stanley, D. (Ed.). (2016). Clinical leadership in nursing and healthcare: Values into action. John
Wiley & Sons.