Professional Role, Ethics, Systems, and Collaborative Practice
Know your scope and your team
Professional-practice questions test scope of practice, credentialing, collaborative agreements, and accountability. APRN authority is state-specific: full, reduced, or restricted practice, prescriptive authority, and supervision or collaboration requirements. Know institutional privileging, billing and coding basics, and when to consult rather than transfer care. Collaborative practice means clear role negotiation, closed-loop communication, and shared documentation-not automatic deference.
Ethics framework
Apply autonomy, beneficence, nonmaleficence, justice, and fidelity. Informed consent requires capacity, disclosure, understanding, voluntariness, and authorization. Capacity is decision-specific and clinical; competence is legal. Assess understanding, appreciation, reasoning, and expression of choice. If capacity is absent, follow advance directives and surrogate hierarchy per state law. Ethics consultation clarifies values; it does not make the decision.
Systems and quality
Recognize just culture, error reporting, root-cause analysis, and Plan-Do-Study-Act cycles. Use SBAR and structured handoffs. Address implicit bias and ageism, which can lead to under-treatment of older adults. Mandated reporting applies to suspected abuse or neglect; confidentiality requires HIPAA-compliant minimum necessary disclosure.
Traps
Confusing DNR with comfort-only care; assuming a family member is the legal surrogate; practicing beyond state scope; and documenting opinions rather than facts. A question asking for the most appropriate action often favors the choice that preserves patient autonomy and follows policy.
Worked rule: the capacity script
Ask the patient to teach back the diagnosis, the proposed treatment, the alternatives, and the consequences of refusal. If all four are explained, capacity is likely intact even if the choice seems unwise. Document the assessment.