Quality of Care. The RN systematically shall evaluate the quality and effectiveness of nursing practice in the aggregate. Measurement Criteria. The RN shall: Participate in activities to evaluate quality of care including, but not limited to, monitoring the structure, process, and outcome of nursing practice, with consideration for access and cost; Use quality monitoring data to identify opportunities for improving care; and Participate in activities related to implementing changes designed to improve care. Performance Appraisal. The RN shall be accountable for evaluating the RN's own nursing practice on a regular basis in relation to professional practice standards and relevant statutes and regulations. Measurement Criteria. The RN shall: Participate in peer review as appropriate; and Seek guidance, support, education, and supervision as necessary. The RN shall demonstrate knowledge of and shall comply with: Relevant professional practice standards; Statutes and regulations governing nursing; and The policies and procedures of the practice setting. Education. The RN shall acquire and maintain current knowledge and competency in nursing practice. Measurement Criteria. The RN shall: Participate in educational opportunities and experiences to maintain professional competence; and Obtain knowledge and skills appropriate to the practice setting. Collegiality. The RN shall contribute to the professional development of peers, colleagues, and others. Measurement Criteria. The RN shall share knowledge and skills with peers, colleagues, and others. The RN shall contribute to a supportive and healthy work environment. Ethics. The RN's decisions and actions shall reflect ethical principles. Measurement Criteria. The RN shall: Comply with the Code of Ethics in COMAR 10.27.19; Maintain client confidentiality within legal and regulatory standards; Act as a client advocate and assist clients to advocate for themselves; Deliver care in a nonjudgmental and nondiscriminatory manner that is sensitive to client diversity; Deliver care in a manner that preserves client autonomy, dignity, and rights; and Seek available resources to help formulate ethical decisions. Collaboration. The RN shall collaborate with the client, family, significant others, and other health care providers in providing care. Measurement Criteria. The RN shall: Collaborate with the client, family, significant others, and other health care providers in the formulation of overall goals, the plan of care, and decisions related to care and the delivery of services; and Consult with health care providers for client care. Research. The RN shall participate in research activities appropriate to the licensee's position, education, and practice environment. Measurement Criteria. The RN shall: Support the client's rights related to research; Participate in data collection; Participate in identification of clinical problems suitable for nursing research; and Utilize established facility-approved research protocols. Resource Utilization. The RN shall consider factors related to safety, effectiveness, and cost in planning and delivering client care. Measurement Criteria. The RN: Shall assist the client, family, and significant others in identifying services and options available to address health-related needs; Shall evaluate factors related to safety, effectiveness, and cost when performing, assigning, delegating, and supervising nursing care, and teaching the client, family, and significant others; and As a case manager, may identify and facilitate options and services for meeting individual health needs by enhancing quality, cost-effective clinical outcomes while decreasing fragmentation and duplication of care. Assignment, Delegation, and Supervision. The RN may assign nursing acts or delegate nursing tasks to individuals who are competent to perform those acts or tasks, when the assignment or delegation does not jeopardize the client's welfare. Measurement Criteria. When delegating a nursing task to an unlicensed person, the RN shall assess the client and determine that the delegation is consistent with COMAR 10.27.11. When delegating a nursing task to an unlicensed person, the registered nurse shall: Instruct; Direct; Regularly evaluate the performance of nursing tasks by the unlicensed person; Rectify a situation in which the unlicensed person under the licensee's supervision is performing nursing tasks incorrectly; and Prohibit the continued performance of an unlicensed person who is performing the delegated nursing task or tasks incompetently. When the RN is assigning a nursing act to another licensed nurse, the RN shall: Verify that the nursing act is within the licensed nurse's legal scope of practice; Verify that the licensed nurse has the knowledge, skills and clinical competency to perform the assigned act; Verify that the assigned act is consistent with the facility's policies and procedures; Regularly evaluate the licensed nurse who is performing the assigned nursing act; Rectify a situation in which the licensed nurse assigned to perform the nursing act has performed the nursing act incorrectly; and Prohibit the continued performance of the assigned nursing act by a licensed nurse who is performing the assigned nursing act or acts incompetently. Refusal. The RN has the right and the responsibility to refuse to perform, assign, or delegate nursing acts. Measurement Criteria. The RN has the right and responsibility to refuse to perform a nursing act which is beyond the parameters of the nurse's education, capabilities, and clinical competency. The RN shall obtain appropriate education, training, and supervision as required to perform nursing functions which are beyond the parameters of the nurse's education and clinical competence. The RN has the right to refuse to accept responsibility and accountability for supervising, monitoring, instructing, or evaluating an unlicensed person performing a nursing task that has not been delegated by that nurse.