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According to the Texas Board of Nursing, nurses are advised to use the six-step decision making model developed by the board to assist nurses make a sound professional judgment before undertaking a nursing task or procedure.(Texas Board of Nursing,2010) Step-1: Is the act consistent with the Texas Nursing Practice Act (NPA)? (Texas Board of Nursing: NPA, Ch 301.002(2) Step-2: Is there an appropriate order that authorizes the performance of the activity? Step-3: Is the act supported by conclusive scientific data from nursing research or evidence based practice standards? Has the action approved by a national nursing organization for nurses to practice it in accordance with the guidelines and standards issued by the organization? Step-4: Does the nurse personally posses the knowledge and clinical competency to perform the task safely? Step 5: Is the act within the accepted nursing standards of care which would be provided under similar circumstances by another nurse who have similar training and experience? Does an adverse reaction or consequence of action be resolved by nursing intervention only? Step 6: Is the nurse prepared to accept consequences of the actions? (Accountability).If there is a “no” answer for any of the steps above, then task is not in the nurse’s scope of practice. On top of following this six-step model, the nurse should always take in to consideration any physical, emotional, or institutional ( Eg. Availability of necessary resources ) barriers that might affect competent and safe performance. The nurse should always make patient safety the first priority and should demonstrate a competent level of behavior in the professional role including activities related to quality of care, ethics, collaboration, education, resource utilization and accountability for their actions, for their patients and for their peer....

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