Scenario Analysis: This scenario is professionally challenging because it requires a nurse to balance the immediate need for patient care with the ethical and regulatory obligations surrounding the use of investigational treatments. The pressure to provide the best possible care, coupled with the inherent uncertainties of experimental therapies, necessitates careful judgment. The nurse must navigate potential conflicts between patient autonomy, the physician’s orders, and the established protocols for research participation, all while ensuring patient safety and data integrity. Correct Approach Analysis: The best professional practice involves a thorough review of the patient’s informed consent documentation and the investigational treatment protocol. This approach is correct because it directly addresses the regulatory and ethical requirements for administering experimental therapies. Informed consent ensures the patient understands the risks, benefits, and alternatives, and has voluntarily agreed to participate. The protocol provides the specific guidelines and procedures that must be followed, ensuring patient safety and the validity of research data. Adhering to these documents is paramount for patient protection and compliance with ethical research standards. Incorrect Approaches Analysis: Proceeding solely based on the physician’s verbal order without verifying the patient’s informed consent and the protocol details is ethically and regulatorily unsound. This failure bypasses crucial patient rights and safety checks, potentially leading to the administration of a treatment the patient has not fully agreed to or that deviates from established safety parameters. Administering the treatment based on the assumption that all necessary approvals are in place, without direct verification, is also problematic. While often protocols are followed diligently, the responsibility for ensuring compliance rests with the individual administering the treatment. This assumption can lead to unintentional breaches of protocol or consent requirements, compromising patient safety and research integrity. Relying on the patient’s previous participation in other clinical trials as a substitute for current, specific informed consent for this investigational treatment is a significant ethical and regulatory lapse. Each investigational treatment requires its own distinct informed consent process, tailored to the specific risks and procedures involved. Prior consent for different trials does not automatically extend to new, unrelated research. Professional Reasoning: Professionals should employ a systematic decision-making process when faced with situations involving investigational treatments. This process begins with identifying the core ethical and regulatory principles at play, such as patient autonomy, beneficence, non-maleficence, and justice, alongside compliance with research regulations. Next, they should gather all relevant information, including patient records, physician orders, informed consent forms, and the investigational protocol. A critical step is to verify that all necessary documentation is complete and accurate, and that the patient’s consent is informed and voluntary for the specific treatment being considered. If any discrepancies or ambiguities arise, the professional must seek clarification from the appropriate parties, such as the principal investigator, research coordinator, or ethics committee, before proceeding. This proactive approach ensures patient safety, upholds ethical standards, and maintains regulatory compliance.

Scenario Analysis: This scenario presents a professional challenge because it requires a nurse to navigate the specific, often nuanced, requirements for advanced certification within a particular regional context. Misunderstanding or misapplying these requirements can lead to a denial of certification, wasted professional development efforts, and a delay in achieving recognition for specialized skills. Careful judgment is required to ensure all eligibility criteria are met, aligning with the purpose of the certification itself. Correct Approach Analysis: The best professional approach involves meticulously reviewing the official documentation for the Advanced Latin American Ambulatory Care Nursing Specialist Certification. This documentation will clearly outline the purpose of the certification, which is to recognize nurses with specialized knowledge and skills in ambulatory care within the Latin American context, and detail the precise eligibility criteria. These criteria typically include specific educational prerequisites, a defined period of relevant clinical experience in ambulatory care settings within Latin America, and potentially a demonstration of competency through examination or portfolio submission. Adhering strictly to these published guidelines ensures that the applicant meets the established standards for advanced practice and professional recognition in this specialized field. Incorrect Approaches Analysis: Pursuing certification based solely on general nursing experience without verifying its relevance to Latin American ambulatory care settings is an incorrect approach. This fails to acknowledge the specific regional focus and specialized nature of the certification, potentially leading to an application that does not meet the defined experience requirements. Relying on anecdotal advice from colleagues about eligibility without consulting the official certification body’s guidelines is also an incorrect approach. While well-intentioned, informal advice may be outdated, incomplete, or inaccurate, leading to a misunderstanding of the true requirements and a flawed application. Assuming that a general advanced practice nursing certification from another region automatically qualifies an applicant for this specific Latin American certification is another incorrect approach. Each certification has its own distinct purpose and eligibility framework, and cross-jurisdictional equivalency cannot be assumed without explicit recognition by the certifying body. This overlooks the unique context and standards of the Latin American ambulatory care nursing specialty. Professional Reasoning: Professionals should approach advanced certification with a systematic and evidence-based methodology. This involves: 1) Identifying the specific certification of interest. 2) Locating and thoroughly reviewing the official documentation from the certifying body, paying close attention to the stated purpose and all eligibility requirements. 3) Self-assessing current qualifications against these requirements, seeking clarification from the certifying body if any aspect is unclear. 4) Developing a plan to meet any outstanding requirements. This structured approach ensures that professional development efforts are aligned with recognized standards and increases the likelihood of successful certification.

This scenario is professionally challenging because it requires the nurse to balance immediate patient needs with the complex ethical and regulatory requirements surrounding patient consent and data privacy, particularly in a resource-constrained ambulatory care setting. The nurse must act swiftly to provide care while ensuring all actions are legally and ethically sound, avoiding potential breaches of patient confidentiality or unauthorized treatment. The best approach involves obtaining informed consent from the patient for the specific procedure and for the use of their medical information, while also ensuring that any information shared with the family is done with the patient’s explicit permission. This aligns with fundamental patient rights and ethical principles of autonomy and confidentiality, as well as regulatory frameworks that mandate patient consent for treatment and disclosure of protected health information. Specifically, in Latin American contexts, patient autonomy and the right to privacy are increasingly emphasized in healthcare legislation and ethical codes, often mirroring international standards. This approach respects the patient’s right to make decisions about their own body and their personal data, ensuring that care is provided with their full understanding and agreement. An incorrect approach would be to proceed with treatment based solely on the family’s request without direct patient consent, even if the patient appears incapacitated. This violates the principle of patient autonomy and could lead to legal repercussions for providing unauthorized treatment. Furthermore, sharing detailed medical information with the family without the patient’s consent, even if well-intentioned, constitutes a breach of patient confidentiality, which is a serious ethical and regulatory violation. Another incorrect approach would be to delay necessary treatment significantly while attempting to obtain extensive written documentation for every minor interaction, which could compromise patient well-being and is often not a proportionate response to the situation, especially in an ambulatory care setting where timely intervention is crucial. Professionals should employ a decision-making framework that prioritizes patient rights and safety. This involves a rapid assessment of the patient’s capacity to consent, followed by clear communication with the patient about their condition, treatment options, and the implications of their decisions. If the patient lacks capacity, the framework dictates seeking consent from a legally authorized representative, while still striving to involve the patient in decisions to the extent possible. Simultaneously, maintaining strict confidentiality and only disclosing information with explicit patient permission is paramount. This systematic approach ensures that care is both effective and ethically compliant.

Scenario Analysis: This scenario is professionally challenging because it requires the nurse to navigate the complexities of a patient’s evolving health status across different life stages, integrating diagnostic findings with ongoing monitoring to ensure appropriate and timely interventions. The challenge lies in synthesizing information from various sources, anticipating potential complications, and adapting care plans dynamically, all while adhering to ethical principles of patient autonomy and beneficence within the Latin American ambulatory care context. Correct Approach Analysis: The best approach involves a systematic, comprehensive, and continuous assessment process that integrates diagnostic data with ongoing monitoring across the lifespan. This includes utilizing validated assessment tools, interpreting diagnostic results in the context of the patient’s age and developmental stage, and proactively identifying potential health risks or changes. This approach is correct because it aligns with the core principles of patient-centered care, evidence-based practice, and the ethical imperative to provide high-quality, individualized care. In Latin American ambulatory care, this translates to a commitment to early detection, prevention, and management of chronic and acute conditions, respecting the patient’s social determinants of health and cultural context. Incorrect Approaches Analysis: One incorrect approach involves relying solely on episodic assessments without a continuous monitoring framework. This fails to capture subtle but significant changes in a patient’s condition, potentially leading to delayed diagnosis or management of emergent issues, and violates the ethical duty to provide ongoing, vigilant care. Another incorrect approach is to interpret diagnostic results in isolation, without considering the patient’s comprehensive history, developmental stage, or potential for age-related physiological changes. This can lead to misinterpretations, inappropriate treatment decisions, and a failure to address the holistic needs of the patient, contravening ethical principles of thoroughness and patient well-being. A further incorrect approach is to prioritize the patient’s immediate complaints over potential long-term health implications identified through diagnostic monitoring. This reactive rather than proactive stance can result in missed opportunities for preventative care and management of chronic conditions, which is ethically problematic as it may not optimize the patient’s long-term health outcomes. Professional Reasoning: Professionals should employ a decision-making framework that emphasizes continuous learning, critical thinking, and interdisciplinary collaboration. This involves regularly reviewing patient data, staying abreast of current diagnostic and monitoring technologies, and engaging in reflective practice to refine assessment and intervention strategies. When faced with complex cases, professionals should consult with colleagues, seek expert opinions, and prioritize patient safety and well-being above all else, ensuring that care is both clinically sound and ethically defensible within the specific regulatory and cultural landscape of Latin American ambulatory care.

Scenario Analysis: This scenario presents a professional challenge due to the inherent complexity of managing a patient with a chronic, progressive condition like COPD in an ambulatory care setting. The challenge lies in distinguishing between expected disease exacerbations and potential complications that require immediate, more intensive intervention. The nurse must integrate a deep understanding of COPD pathophysiology with real-time clinical data to make timely and appropriate decisions, balancing the need for prompt treatment with the avoidance of unnecessary hospitalizations or interventions. This requires a nuanced approach that goes beyond simple symptom recognition. Correct Approach Analysis: The best professional approach involves a comprehensive assessment that integrates the patient’s current subjective report of symptoms with objective clinical findings and a thorough understanding of their chronic disease trajectory. This includes evaluating the severity and nature of the dyspnea, assessing for new or worsening adventitious lung sounds, observing for changes in oxygen saturation, and considering the patient’s baseline functional status and previous exacerbation patterns. This approach is correct because it aligns with the principles of evidence-based practice and patient-centered care, emphasizing a holistic view of the patient’s condition. It allows for the identification of subtle but significant changes indicative of a worsening exacerbation or a new complication, guiding the decision to escalate care appropriately within the ambulatory setting or refer for higher levels of care, thereby optimizing patient outcomes and resource utilization. This aligns with ethical obligations to provide competent and compassionate care. Incorrect Approaches Analysis: One incorrect approach involves solely relying on the patient’s subjective report of increased shortness of breath without a thorough objective assessment. This fails to account for the potential for subjective dyspnea to be influenced by factors other than a significant physiological deterioration, and it risks missing critical objective signs of worsening hypoxia or infection that require immediate intervention. This approach is ethically problematic as it may lead to delayed or inadequate treatment. Another incorrect approach is to attribute all worsening symptoms solely to the natural progression of COPD and manage them with the patient’s usual rescue medications without considering potential secondary complications such as pneumonia or pneumothorax. This overlooks the pathophysiological principle that exacerbations can be triggered by various factors, some of which necessitate different or more aggressive management strategies than routine symptom relief. This can lead to prolonged illness and increased morbidity. A further incorrect approach is to immediately escalate care to the emergency department based on a single symptom of increased dyspnea, without performing a detailed clinical assessment to determine the severity and underlying cause. While caution is important, this approach can lead to unnecessary emergency room visits, increased healthcare costs, and potential patient anxiety, without necessarily providing a better outcome than appropriate management within the ambulatory setting. This demonstrates a failure to apply critical thinking and pathophysiology-informed decision-making. Professional Reasoning: Professionals should employ a systematic decision-making process that begins with a comprehensive patient assessment, incorporating both subjective and objective data. This assessment should be guided by an understanding of the underlying pathophysiology of the patient’s condition. Next, the professional should compare the current findings to the patient’s baseline and previous patterns of illness. This comparison, informed by pathophysiological knowledge, helps differentiate between expected variations and significant deviations. The professional then considers potential differential diagnoses and complications, evaluating the likelihood and severity of each. Finally, based on this integrated analysis, the professional determines the most appropriate course of action, which may include further ambulatory interventions, medication adjustments, patient education, or referral to a higher level of care.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the need for continuous professional development and maintaining certification with the practical realities of a busy ambulatory care setting. The nursing specialist must navigate the institution’s policies regarding certification renewal, which are directly tied to the blueprint weighting, scoring, and retake policies, without compromising patient care or personal well-being. Understanding the implications of these policies on professional standing and the institution’s commitment to specialized care is crucial. Correct Approach Analysis: The best professional approach involves proactively understanding the certification body’s blueprint weighting, scoring, and retake policies and aligning personal study and renewal efforts accordingly. This means reviewing the official certification materials to identify key knowledge areas and their relative importance (blueprint weighting), understanding how the examination is scored, and knowing the procedures and limitations for retaking the exam if necessary. This proactive stance ensures that the nursing specialist can dedicate study time efficiently, prepare adequately for the examination, and meet renewal deadlines without undue stress or risk of lapse in certification. This aligns with ethical obligations to maintain competence and professional standards, as well as institutional expectations for specialized nursing practice. Incorrect Approaches Analysis: One incorrect approach is to rely solely on informal discussions with colleagues about the certification exam and its policies. This is professionally unacceptable because it risks misinformation and a superficial understanding of critical requirements. Official documentation from the certifying body is the definitive source for blueprint weighting, scoring, and retake policies. Relying on hearsay can lead to inadequate preparation, missed deadlines, or failure to meet specific renewal criteria, potentially jeopardizing the nursing specialist’s certification. Another incorrect approach is to assume that the institution’s internal continuing education requirements are a direct substitute for the specific requirements of the ambulatory care nursing certification. While institutional requirements are important, they may not directly map to the specialized knowledge and skills assessed by the certification exam. This approach fails to recognize that certification is a distinct professional credential with its own rigorous standards, and neglecting these specific requirements can lead to a lapse in certification, impacting the specialist’s role and the institution’s ability to claim specialized nursing expertise. A further incorrect approach is to postpone engagement with the certification renewal process until the last possible moment, hoping to cram study and complete requirements. This is professionally unsound as it creates unnecessary pressure, increases the likelihood of errors in understanding or completing the renewal application, and leaves no room for unforeseen circumstances. It also demonstrates a lack of commitment to maintaining professional credentials and can lead to a stressful and potentially unsuccessful renewal experience, undermining the specialist’s confidence and professional standing. Professional Reasoning: Professionals should adopt a proactive and informed approach to maintaining certifications. This involves consulting official documentation from certifying bodies, understanding the specific requirements of their specialty, and integrating these requirements into their professional development plan. Regular review of certification guidelines, especially changes in blueprint weighting, scoring, or retake policies, is essential. When in doubt, direct communication with the certifying body is always the most reliable course of action. This systematic approach ensures competence, upholds professional standards, and contributes to the quality of patient care.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for patient care with the ethical and regulatory obligations to obtain informed consent. The patient’s distress and potential for rapid deterioration complicate the process, demanding a nuanced approach that prioritizes patient autonomy while ensuring safety. Navigating these competing demands requires careful judgment and adherence to established ethical principles and legal frameworks governing healthcare in Latin America. Correct Approach Analysis: The best professional practice involves a multi-faceted approach that prioritizes obtaining informed consent while acknowledging the patient’s emergent condition. This includes clearly and concisely explaining the proposed treatment, its benefits, risks, and alternatives in a language and manner the patient can understand. Crucially, it requires assessing the patient’s capacity to consent. If capacity is compromised due to their condition, the next step is to seek consent from a legally authorized surrogate decision-maker, if available, while continuing to involve the patient in decisions to the extent possible. This approach upholds the fundamental ethical principle of patient autonomy and aligns with the legal requirements for informed consent in most Latin American healthcare systems, which generally mandate that patients have the right to make decisions about their own medical care after being adequately informed. Incorrect Approaches Analysis: One incorrect approach involves proceeding with treatment without attempting to obtain informed consent, even if the patient appears distressed. This violates the patient’s right to self-determination and can lead to legal repercussions and ethical breaches, as it disregards the foundational principle of autonomy. Another incorrect approach is to delay necessary treatment significantly while waiting for a surrogate decision-maker, especially if the patient’s condition is life-threatening and they are exhibiting signs of distress. While consent is vital, the principle of beneficence (acting in the patient’s best interest) may necessitate urgent intervention in emergent situations, and an absolute delay without any attempt to assess capacity or seek emergent consent from the patient or available surrogate would be professionally unsound. A third incorrect approach is to assume the patient’s consent based on their distress or the urgency of the situation without any attempt to communicate the treatment plan or assess their understanding. This paternalistic approach undermines patient autonomy and fails to meet the legal and ethical standards for informed consent, which require active communication and comprehension. Professional Reasoning: Professionals should employ a decision-making framework that begins with assessing the patient’s capacity to consent. If capacity is present, clear communication about the treatment, risks, benefits, and alternatives is paramount. If capacity is compromised, the next step is to identify and consult with a legally authorized surrogate decision-maker, while continuing to involve the patient in decision-making to the greatest extent possible. In emergent situations where immediate intervention is life-saving and obtaining consent is impossible, healthcare professionals must document the rationale for proceeding under the doctrine of implied consent or necessity, always aiming to obtain consent as soon as the patient’s condition permits. This framework prioritizes patient rights, safety, and ethical practice.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for patient care with the long-term implications of incomplete and potentially inaccurate clinical documentation. The pressure to provide timely care can sometimes lead to shortcuts in documentation, which can have serious consequences for patient safety, legal liability, and regulatory compliance within the Latin American ambulatory care setting. Careful judgment is required to ensure that documentation is both efficient and comprehensive, adhering to established standards. Correct Approach Analysis: The best professional practice involves meticulously completing all required fields in the electronic health record (EHR) at the point of care, including the patient’s chief complaint, assessment, plan, and any relevant diagnostic or treatment orders. This approach ensures that the documentation is contemporaneous, accurate, and reflects the full scope of the patient encounter. Adherence to this practice is crucial for regulatory compliance, as it provides a clear and auditable record of care delivered, supporting billing, quality reporting, and legal defense. Ethically, it upholds the principle of patient autonomy by ensuring that their care is well-documented and transparent. Incorrect Approaches Analysis: One incorrect approach involves delaying the completion of detailed documentation until after the next patient has been seen, relying on brief notes or memory aids. This practice significantly increases the risk of omissions, inaccuracies, and the potential for misinterpretation of the patient’s condition and treatment plan. It creates a gap in the legal record and can lead to non-compliance with regulatory requirements for timely and accurate record-keeping, potentially impacting reimbursement and exposing the facility to legal challenges. Another incorrect approach is to only document the minimum information required for billing purposes, omitting clinical details about the patient’s assessment, differential diagnoses, or rationale for treatment decisions. This approach fails to provide a complete picture of the patient’s care, hindering continuity of care if the patient sees other providers or is referred. It also falls short of regulatory expectations for comprehensive clinical documentation that supports quality patient care and outcomes, and can be viewed as a failure to uphold professional ethical standards regarding thoroughness. A third incorrect approach is to use generic, pre-populated templates without tailoring them to the specific patient’s situation, leading to documentation that does not accurately reflect the individual encounter. While templates can improve efficiency, their misuse can result in inaccurate or misleading records. This can lead to regulatory non-compliance if the documentation does not truly represent the services rendered and the patient’s condition, and ethically compromises the integrity of the patient’s medical record. Professional Reasoning: Professionals should employ a systematic approach to clinical documentation. This involves understanding the specific regulatory requirements for ambulatory care in their Latin American jurisdiction. Before beginning patient encounters, they should familiarize themselves with the EHR system and any available documentation templates. During the encounter, they should aim to document key findings and decisions in real-time or immediately following the patient’s departure. Post-encounter, a thorough review and completion of all documentation should be prioritized before moving on to the next patient or concluding the workday. This structured approach ensures accuracy, completeness, and compliance, safeguarding both the patient and the healthcare provider.

Scenario Analysis: This scenario is professionally challenging because it involves a vulnerable patient population (elderly with multiple comorbidities) and the potential for significant harm due to medication errors. The nurse specialist must balance the immediate need for effective pain management with the long-term risks of polypharmacy and adverse drug events, all within a framework of evolving patient needs and potential changes in their health status. Accurate assessment, clear communication, and adherence to prescribing guidelines are paramount. Correct Approach Analysis: The best professional practice involves a comprehensive medication review, including assessing the patient’s current medication regimen, identifying potential drug-drug interactions, drug-disease interactions, and evaluating the appropriateness of each medication for the patient’s current condition and overall health status. This approach prioritizes patient safety by proactively identifying and mitigating risks before prescribing new medications or adjusting existing ones. It aligns with ethical principles of beneficence and non-maleficence, ensuring that interventions are in the patient’s best interest and minimize harm. Regulatory frameworks in Latin America, while varying by country, generally emphasize the importance of evidence-based practice, patient safety protocols, and the role of healthcare professionals in preventing medication-related harm. This systematic review ensures that any prescribing decisions are informed, safe, and tailored to the individual patient’s complex needs. Incorrect Approaches Analysis: Focusing solely on the patient’s immediate complaint of pain without a thorough review of their existing medications and comorbidities represents a significant ethical and regulatory failure. This approach risks exacerbating existing health issues, causing new adverse drug events, or prescribing a medication that interacts negatively with current treatments, potentially leading to serious harm. It neglects the principle of holistic patient care and fails to adhere to best practices in medication management. Prescribing a new analgesic based on the patient’s report alone, without consulting their primary care physician or reviewing their medical history, is also professionally unacceptable. This bypasses established communication channels and collaborative care models, increasing the likelihood of prescribing an inappropriate medication or one that conflicts with existing treatment plans. It undermines the coordinated care essential for patients with multiple comorbidities and could lead to conflicting medical advice and patient confusion. Relying on the patient’s memory of their medications without independent verification is a dangerous practice. Elderly patients, especially those with multiple comorbidities, may have difficulty accurately recalling their medication list, dosages, and schedules. This can lead to prescribing errors, such as duplicating medications, prescribing incorrect dosages, or failing to account for crucial interactions. It demonstrates a lack of due diligence in ensuring medication safety. Professional Reasoning: Professionals should adopt a systematic and patient-centered approach to medication management. This involves a thorough initial assessment, including a detailed medication history, review of all current prescriptions, over-the-counter medications, and supplements. Collaboration with other healthcare providers, such as the patient’s primary care physician, is crucial, especially for patients with complex medical histories. Regular medication reviews, patient education on their medications, and ongoing monitoring for effectiveness and adverse effects are essential components of safe prescribing and patient care. When faced with a new symptom, the professional should always consider the patient’s entire clinical picture and current medication regimen before making any prescribing decisions.

This scenario is professionally challenging because it requires the ambulatory care nurse leader to balance efficient patient care delivery with the ethical and legal responsibilities of delegation. The leader must ensure that tasks are assigned appropriately, considering the skills and competencies of the healthcare team members, while also maintaining patient safety and quality of care. Misjudgment in delegation can lead to patient harm, professional liability, and breaches of regulatory standards. The best approach involves a comprehensive assessment of the patient’s needs and the available staff’s capabilities before delegating tasks. This includes clearly defining the task, communicating specific instructions and expected outcomes, and establishing a plan for follow-up and evaluation. This approach is correct because it aligns with principles of safe delegation, which mandate that nurses delegate only those tasks that are within the scope of practice of the delegatee and for which they have been adequately trained and deemed competent. Furthermore, it upholds the nurse leader’s ultimate accountability for patient care, ensuring that all delegated tasks contribute positively to the patient’s treatment plan and are performed safely and effectively. This proactive and thorough method minimizes risks and maximizes the benefits of teamwork. An approach that involves delegating tasks based solely on workload without assessing individual staff competency or patient acuity is professionally unacceptable. This failure to assess competency can lead to tasks being performed incorrectly, potentially compromising patient safety and violating nursing practice acts that require nurses to delegate appropriately. Another unacceptable approach is to delegate tasks without providing clear instructions or follow-up mechanisms. This lack of communication and oversight creates ambiguity, increases the risk of errors, and demonstrates a disregard for the principles of accountability and patient advocacy. Finally, delegating tasks that are outside the scope of practice of the delegatee, even if they are perceived as simple, is a direct violation of professional and regulatory standards and places both the patient and the delegatee at significant risk. Professionals should employ a decision-making framework that prioritizes patient safety and quality of care. This involves a systematic process of: 1) assessing the patient’s condition and needs, 2) identifying the specific task to be delegated, 3) evaluating the skills, knowledge, and experience of potential delegatees, 4) clearly communicating the task, expectations, and any necessary precautions, 5) providing appropriate supervision and support, and 6) evaluating the outcome of the delegated task. This framework ensures that delegation is a responsible and effective tool for managing patient care.