Professional Role, Ethics, and Healthcare Delivery Systems
Know where your authority comes from
Scope of practice is defined by state law - the nurse practice act, prescriptive authority rules, and, in many states, a collaborative or supervisory agreement - not by hospital policy and not by certification. Certification demonstrates knowledge; credentialing and privileging allow you to practice in a specific facility; payer enrollment allows you to bill. Items asking what the AGACNP should do are really asking which authority applies. When state law and facility policy conflict, state law sets the floor.
Ethics essentials
Informed consent requires capacity, disclosure of risks, benefits, and alternatives, and voluntariness; a true emergency permits treatment without consent when delay risks serious harm. Capacity is a clinical determination made at the bedside: can the patient communicate a choice, understand the information, appreciate the consequences, and reason with it? Competence is a legal status decided by a court - do not conflate the two. When capacity is absent, follow the surrogate hierarchy and the patient's known wishes, not the family's preference alone. Know HIPAA's minimum-necessary rule, mandatory reporting duties, EMTALA screening and stabilization obligations, and conflict-of-interest disclosure.
Systems and quality
Expect items on documentation and billing basics, value-based payment, never events, root cause analysis versus a just-culture review, and the PDSA improvement cycle. The professional answer usually protects the patient, documents the reasoning, and escalates through the correct channel.
Worked rule of thumb
A patient with intact decisional capacity refuses a recommended admission after a full explanation. Document the discussion, offer alternatives and close follow-up, and honor the refusal. Do not override it or route consent to a family member.