Legal & Ethical Nursing Practice
Not publishedof exam
Registration & Practising CertConsent & ConfidentialityScope, Competence & SafetyDocumentation & Culture
Professional Nursing Practice
Not publishedof exam
Patient ID, SBAR & InfectionMedication & Drug CalculationsDiabetes, NG, IV & WoundsBCLS 2026 & Emergencies
Collaborative Practice & Teamwork
Not publishedof exam
Delegation & AccountabilityEnrolled Nurse SupervisionHandover & Read-BackTransdisciplinary Care Planning
Continuing Professional Education & Development
Not publishedof exam
Reflective Practice & GapsContext-Relevant CPEEvidence-Based QualityPeer & Student Teaching
Quick Facts
- Exam
- SNB RN Licensure Examination
- Regulator
- Singapore Nursing Board
- Delivery
- Pearson VUE computer-based MCQ
- Time Limit
- 60 minutes; no extension
- Calculator
- On-screen calculator provided
- Max Attempts
- 2 attempts total allowed
- Second ATT
- 6 calendar months after exam
- Pass Validity
- Valid for 5 years
- Published examination fee
- S$85 before prevailing GST
Ethical & Legal Dilemma Picker
- Asked to perform unfamiliar procedure→Raise concern and request support
- Relative requests confidential clinical information→Check consent or lawful disclosure basis
- Capacitated adult refuses recommended treatment→Respect informed refusal and document
- Unsafe clinical practice threatens patient→Protect patient and report escalation
SNB Licensure & Registration Rules
- Practising Cert
- Valid PC required alongside registration
- Employer HR
- Submits application for SNB authorisation
- CBT Provider
- Pearson VUE since Nov 2024
- Attempt Limit
- Maximum two attempts per licensure
- Second ATT period
- Starts six months after last LEFresh employer-HR application; authorization required
- Passing-result validity
- Five years from examination dateSeparate from a valid practising certificate
- SNB fee schedule item 16
- S$85 before prevailing GST
- Individual ATT dates
- Control booking; usual period may differ
Ethics, Consent & Documentation
- Beyond Competence
- Raise concern and seek assistance
- Relative Inquiries
- Needs consent or justified basisLawful disclosure exceptions still apply
- Informed Refusal
- Respect capacitated patient self-determination
- Record Entry
- Date, time, signature or initials
- Cultural Care
- Ask individual values and wishes
- Unfit to Practise
- Protect patients; arrange help or reassignment
SBAR Clinical Handover Sequence
Situation first, Background second, Assessment third, Recommendation fourth
S: SituationB: BackgroundA: AssessmentR: Recommendation
Acute Delirium vs Baseline Status
Acute Delirium
- Develops over hours to days
- Fluctuating inattention and confusion
- Requires urgent cause investigation
Documented prior baseline
- Patient’s usual cognitive pattern
- Can include chronic cognitive impairment
- New changes require prompt assessment
Compare with documented individual baseline
Acute Deterioration & Emergency Picker
- Unresponsive adult gasps; no pulse→Activate emergency and start CPR(Trained pulse check: ≤10 seconds)
- Suspected acute blood transfusion reaction→Stop transfusion immediately, then assess
- Post-opioid slow breathing and drowsiness→Summon urgent help, support airway
- Hypoglycemic adult can swallow safely→Oral fast glucose under local protocol(15 g; recheck after 15 minutes)
- Patient has active convulsive seizure→Protect from hazards; monitor airway
Patient ID, Communication & Handover
- Two Identifiers
- Name and date of birthUse approved patient identifiers
- Invalid Identifier
- Never use bed or room
- Teach-Back
- Patient explains in own words
- SBAR Framework
- Situation, Background, Assessment, Recommendation
- Surgical Pause
- Confirm patient, procedure, and site
- Reassessment
- Evaluate response and adjust plan
Rule of 15 for Conscious Hypoglycemia
Adult, safe swallow: fast glucose, reassess after fifteen minutes
Use local adult hypoglycemia threshold15 g fast-acting oral glucoseRecheck after 15 minutesUnsafe swallow: no oral glucose
Safe NG Confirmation vs Whoosh Test
Accepted Confirmation
- Aspirate pH within approved protocol
- Correct radiographic interpretation when indicated
- Confirm before administering feed or medicines
Whoosh Auscultation
- Air insufflation over epigastrium
- Can mimic gastric placement
- Never rely on to feed
Approved confirmation pathway; hold if uncertain
Infection Control & Bedside Safety Picker
- Hands are visibly soiled→Wash with soap and water
- Suspected infectious pulmonary tuberculosis→Use airborne room and respirator
- Confirming NG placement before use→Follow approved pH/radiographic confirmation pathway(Hold feeding if placement remains uncertain)
- Patient coughs with wet voice eating→Refer for swallowing dysphagia evaluation
- Non-blanching erythema over bony prominence→Offload pressure and reassess skin
Infection Control & Catheter Care
- Standard Precautions
- Apply to all patients
- Visibly Soiled Hands
- Wash with soap and water
- Suspected infectious pulmonary TB
- Airborne room and fit-tested respirator
- Urinary Bag
- Below bladder and off floor
- Insulin Pen Rule
- Single patient only; never share
- Unsafe Practice
- Protect patient and report promptly
Pre-Incision Time-Out Trio
Confirm right patient, right procedure, and right surgical site
Correct PatientCorrect ProcedureCorrect Site
Soap & Water vs Alcohol Handrub
Soap and Water
- Required when visibly soiled
- Physically removes organic debris
- Visibly soiled with blood/body fluids
Alcohol Handrub
- Used on visibly clean hands
- Fast routine point-of-care decontamination
- Not for visibly dirty hands
Visibly soiled always needs washing
Medication Safety & Calculations
- Allergy Check
- Verify and clarify before giving
- Liquid Volume
- Desired over stock × volume
- Liquid example: 450 mg ordered
- Stock: 150 mg per 5 mLCalculated administration volume: 15 mL
- Pump Rate mL/h
- Total mL divided by hours
- 480 mL over 4 hours
- 120 mL per hour
- Opioid + Benzo
- High respiratory depression overdose risk
Singapore BCLS 2026 Arrest Check
Unresponsive, abnormal breathing, no pulse: activate response and compress
Trained pulse check: ≤10 secondsCompression rate: 100–120 per minuteUse AED promptly when available
Approved Identifiers vs Room Number
Approved Identifiers
- Full patient name
- Date of birth or ID
- Matched against wrist band
Invalid Location Cue
- Bed number or room number
- Patients frequently change beds
- Causes wrong-patient administration errors
Verify person, never bed number
Enteral Tubes, Fluids & Diabetes
- NG placement before use
- Approved aspirate-pH or radiographic pathwayDo not feed when placement uncertain
- Whoosh Test
- Unsafe; never use for NG
- Meal Wet Voice
- Refer for trained dysphagia assessment
- Fluid Intake Total
- Include IV meds and blood
- Adult hypoglycemia, safe swallow
- 15 g fast glucose; reassess promptlyRecheck after 15 minutes; protocol governs
- Ischemic Foot Ulcer
- Prompt vascular assessment; escalate deterioration
Teach-Back vs Closed Yes/No Question
Teach-Back Method
- Patient explains in own words
- Reveals hidden misunderstandings early
- Confirms practical self-care readiness
Closed Questioning
- Asks 'Do you understand?'
- Patients often nod politely
- Misses critical dosing errors
Ask patient to restate instructions
Wounds, Mobility, Delirium & Mental Health
- Pressure Ulcer Log
- Document area, depth, and undermining
- Non-Blanching Redness
- Relieve pressure and reassess skin
- Acute Confusion
- Suspect delirium; assess underlying causes
- Falls Prevention
- Match measures to assessed risks
- Suicide Screening
- Ask directly about thoughts, intent
- End-of-Life Care
- Follow wishes; prioritize comfort, symptoms
Singapore BCLS 2026 & Emergencies
- Unresponsive, abnormal breathing, no pulse
- Activate response; begin trained CPRTrained pulse check: ≤10 seconds
- Compression Rate
- 100 to 120 per minuteBCLS 2026
- AED Analysis/Shock
- No patient contact; resume CPR
- Transfusion Reaction
- Stop transfusion first; assess, notify
- Convulsive seizure
- Protect head; do not restrain patientNever insert objects into the mouth
- Asthma First Aid
- Assist prescribed inhaler with spacer
Safe RN Delegation vs Unsupervised Hand-off
Safe Delegation
- Matches staff role and competence
- Gives clear instructions and supervision
- RN retains delegation/supervision responsibilities
Unsafe Hand-off
- Assigns beyond staff competence
- Assumes RN accountability disappears
- Lacks follow-up or supervision
Both parties retain relevant accountability
Delegation, Handover & CPE Picker
- Assigning task to Enrolled Nurse→Match competence and provide supervision
- Handing over unstable clinical case→Structure with SBAR and read-back
- Checking patient understanding of discharge→Use teach-back in own words
- Reflection reveals clinical skill gap→Complete targeted learning and competency
Delegation, Handover & Teamwork
- RN delegation accountability
- Retains delegation and supervision responsibilities
- Delegation Check
- Verify role, competence, and supervision
- Receiver Handover
- Clarify and confirm via read-back
- Care Coordination
- Involve patient, family, multidisciplinary team
- EN Supervision
- Guide and monitor Enrolled Nurses
- Delegatee accountability
- Retains responsibility for own accepted actions
CPE, Reflection & Quality Improvement
- Identified Skill Gap
- Plan learning and demonstrate competence
- Selecting CPE
- Match clinical context and scope
- Process Change Check
- Track outcome measures over time
- Pulse Oximetry
- Interpret alongside physical clinical findings
- Walking Aid Rule
- Keep within reach; match assistance
Common Traps
Sharing Multi-Dose Insulin Pens
One pen for one patient ≠ New needle never allows sharing
Gasping vs Normal Breathing
Unresponsive, abnormal breathing: activate emergency response ≠ Absent or uncertain pulse: begin CPR
Pulse Oximeter Over-Reliance
SpO2 supplements physical assessment ≠ Never ignore respiratory distress signs
IV Meds in Fluid Balance
Count IV meds and blood ≠ Not only oral water intake
Restraining a Seizing Patient
Clear area and protect head ≠ Never put objects in mouth
Second Attempt Immediate Retake Myth
Second ATT waits 6 months ≠ Requires fresh employer HR application
Last Minute
- 1.Pearson VUE examination: 60 minutes
- 2.Second ATT: six months after examination
- 3.Passing result: five years from examination
- 4.Practice requires registration and valid PC
- 5.Patient identifiers exclude bed numbers
- 6.Uncertain NG placement: withhold tube use
- 7.Insulin pens belong to one patient
- 8.Unsafe swallowing: no oral hypoglycemia treatment
- 9.Suspected transfusion reaction: stop transfusion
- 10.Adult compression rate: 100–120 per minute
- 11.Infectious pulmonary TB: airborne precautions
- 12.Delegation retains relevant professional accountability
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