The investigation demonstrates a common challenge faced by advanced practice registered nurses (APRNs) preparing for high-stakes certification exams: balancing comprehensive preparation with the demands of clinical practice and personal life. The ethical imperative is to ensure competence and patient safety, which requires adequate preparation without compromising current patient care responsibilities or engaging in dishonest practices. Careful judgment is required to select a preparation strategy that is both effective and ethically sound, adhering to professional standards and the principles of lifelong learning. The best approach involves a structured, self-directed study plan that integrates learning with clinical experience. This includes allocating dedicated time for review, utilizing a variety of reputable resources such as professional organization guidelines (e.g., AANA), peer-reviewed literature, and established review courses, and actively seeking opportunities to apply learned concepts in clinical practice. This method aligns with the ethical obligation to maintain professional competence and the principle of beneficence towards patients by ensuring the provider is well-prepared. It also respects the timeline by being proactive and realistic about the learning curve. An ethically unacceptable approach would be to rely solely on memorization of practice questions without understanding the underlying principles. This fails to develop true competency and risks superficial knowledge that may not translate to safe patient care in novel or complex situations. It also bypasses the ethical responsibility to engage in deep learning and critical thinking, which are fundamental to professional practice. Another professionally unacceptable approach is to delegate preparation tasks to colleagues or subordinates without direct personal engagement and understanding. This not only violates professional integrity but also fails to meet the individual’s responsibility for their own competency assessment. It can also create an unfair burden on others and potentially compromise the quality of preparation. A further ethically questionable approach is to delay preparation until the last possible moment, leading to rushed, superficial study and increased stress. This reactive strategy can result in inadequate knowledge acquisition and a higher likelihood of exam failure, ultimately impacting the ability to provide safe and effective anesthesia care. It demonstrates a lack of foresight and commitment to professional development. Professionals should employ a decision-making framework that prioritizes self-assessment of knowledge gaps, realistic time management, and the selection of evidence-based preparation resources. This framework should include setting achievable study goals, regularly evaluating progress, and seeking mentorship or support when needed, all while maintaining a commitment to ethical conduct and patient well-being.

This scenario presents a professional challenge because it requires a Certified Registered Nurse Anesthetist (CRNA) to navigate the complex requirements for maintaining professional competency and eligibility for practice, specifically concerning the Applied North American Nurse Anesthesia Professional Practice Competency Assessment. The CRNA must accurately interpret the purpose and eligibility criteria to ensure their continued licensure and ability to practice safely and legally. Careful judgment is required to avoid misinterpreting guidelines, which could lead to professional sanctions or practice limitations. The best professional approach involves proactively and accurately identifying the specific requirements for the Applied North American Nurse Anesthesia Professional Practice Competency Assessment as outlined by the relevant North American regulatory bodies and professional organizations. This includes understanding the assessment’s purpose, which is to evaluate the CRNA’s current knowledge and skills against established professional standards to ensure ongoing patient safety and quality of care. Eligibility is determined by factors such as recertification cycles, specific practice changes, or mandates from accrediting bodies. By diligently reviewing official documentation and seeking clarification from the appropriate professional organizations if needed, the CRNA ensures they meet all prerequisites for participation and successful completion, thereby maintaining their professional standing and licensure. This aligns with the ethical obligation to practice competently and adhere to all regulatory mandates. An incorrect approach would be to assume that prior successful completion of similar assessments automatically exempts an individual from current requirements, without verifying the specific mandates for the current assessment cycle or individual circumstances. This overlooks the dynamic nature of professional standards and the potential for updated assessment criteria. Another unacceptable approach is to rely on informal or anecdotal information from colleagues regarding eligibility or purpose, rather than consulting official sources. This introduces a significant risk of misinformation and non-compliance. Furthermore, attempting to bypass or delay participation in the assessment due to perceived inconvenience or a lack of understanding, without actively seeking to clarify requirements, demonstrates a disregard for professional obligations and patient safety. Professionals should employ a systematic decision-making process that prioritizes accurate information gathering from authoritative sources. This involves identifying the governing bodies and their official publications related to competency assessments. When in doubt, direct communication with the relevant professional organizations or regulatory agencies is crucial. A proactive stance, where the CRNA anticipates and prepares for assessment requirements well in advance, is indicative of responsible professional practice.

This scenario presents a professional challenge due to the inherent conflict between patient autonomy, the nurse anesthetist’s duty of care, and the legal framework surrounding informed consent and patient capacity. The nurse anesthetist must navigate the complexities of assessing a patient’s ability to make informed decisions when faced with potential cognitive impairment, ensuring patient safety without unduly infringing on their rights. Careful judgment is required to balance these competing ethical and legal considerations. The best professional approach involves a systematic and collaborative assessment of the patient’s capacity to consent. This includes clearly explaining the proposed anesthesia plan, assessing the patient’s understanding of the risks, benefits, and alternatives, and evaluating their ability to deliberate and make a choice. If capacity is questionable, the nurse anesthetist should involve the patient’s designated healthcare proxy or legal guardian, adhering to established protocols for surrogate decision-making. This approach is correct because it prioritizes patient safety and well-being while respecting patient rights and adhering to legal requirements for informed consent and capacity assessment, as mandated by professional nursing standards and state practice acts. It aligns with the ethical principles of beneficence, non-maleficence, and respect for autonomy. An incorrect approach would be to proceed with the anesthesia without a thorough assessment of capacity, especially if there are observable signs of potential impairment. This fails to uphold the nurse anesthetist’s duty to ensure informed consent and could lead to a breach of professional standards and potential legal ramifications. Another incorrect approach would be to unilaterally decide the patient lacks capacity and proceed with surrogate consent without a formal assessment or consultation, thereby undermining patient autonomy and potentially misinterpreting the patient’s wishes. Proceeding with anesthesia based solely on the family’s insistence without independent professional assessment of the patient’s capacity also represents a failure to adhere to professional obligations and legal requirements. Professionals should employ a decision-making framework that begins with recognizing potential issues with patient capacity. This involves active listening, clear communication, and observation. If capacity is doubted, the next step is to conduct a formal capacity assessment, which may involve consulting with colleagues, the patient’s physician, or ethics committees. Documentation of the assessment process and the rationale for any decision regarding capacity or the involvement of a surrogate decision-maker is crucial. This systematic approach ensures that patient rights are protected, safety is paramount, and legal and ethical obligations are met.

This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the perceived best interests of a vulnerable individual, compounded by the need to navigate complex ethical and legal considerations across the lifespan. The CRNA must balance patient autonomy with the duty of care, particularly when a patient’s capacity to make informed decisions is in question. Careful judgment is required to ensure patient safety while respecting individual rights and adhering to professional standards. The best professional practice involves a comprehensive, multi-faceted approach that prioritizes patient safety and well-being through a systematic diagnostic and monitoring process, while also respecting the patient’s autonomy to the greatest extent possible. This includes a thorough assessment of the patient’s current condition, a review of their medical history, and an evaluation of their cognitive and decision-making capacity. If capacity is deemed compromised, the CRNA must then engage in a process of identifying appropriate surrogate decision-makers or legal guardians, ensuring that all actions are taken in accordance with established legal and ethical frameworks for incapacitated individuals. This approach aligns with the principles of beneficence, non-maleficence, and respect for autonomy, as well as professional practice standards that mandate thorough assessment and appropriate intervention based on patient capacity. An approach that immediately overrides the patient’s stated preference without a formal assessment of their decision-making capacity is ethically and legally problematic. This failure to assess capacity violates the principle of respect for autonomy and could lead to unnecessary interventions or the denial of appropriate care based on assumptions rather than evidence. Furthermore, bypassing established legal and ethical protocols for managing incapacitated patients can result in legal repercussions and a breach of professional duty. Another unacceptable approach involves solely relying on the family’s immediate concerns without independently verifying the patient’s current condition or capacity. While family input is valuable, the CRNA has a direct professional responsibility to assess the patient. Delegating this critical assessment solely to family members, or acting solely on their assertions without independent CRNA evaluation, fails to uphold the CRNA’s duty of care and can lead to misjudgments about the patient’s actual needs and wishes. Finally, proceeding with a procedure that the patient has explicitly refused, even if the CRNA believes it is in their best interest, without a thorough capacity assessment and appropriate legal/ethical authorization, constitutes a significant ethical and legal violation. This disregards the fundamental right of a competent individual to refuse medical treatment and can lead to accusations of battery or assault. Professionals should employ a decision-making framework that begins with a thorough assessment of the patient’s current clinical status and cognitive capacity. If capacity is questionable, the next step involves engaging in a structured process to determine appropriate surrogate decision-making, adhering to legal and ethical guidelines. Throughout this process, open communication with the patient (to the extent possible), their family, and the healthcare team is paramount. This systematic approach ensures that decisions are evidence-based, ethically sound, and legally compliant, prioritizing the patient’s safety and rights.

This scenario presents a professional challenge due to the inherent conflict between resource limitations and the ethical imperative to provide optimal patient care. The nurse anesthetist must navigate the complexities of pathophysiology to make a decision that balances patient safety, potential outcomes, and the practical constraints of the healthcare setting. Careful judgment is required to avoid compromising care while adhering to professional standards and institutional policies. The best professional approach involves a thorough, pathophysiology-informed assessment of the patient’s current condition and projected needs, coupled with a transparent discussion with the patient and/or their surrogate about the available options and their associated risks and benefits. This approach prioritizes patient autonomy and informed consent, ensuring that decisions are made collaboratively and align with the patient’s values and understanding of their disease process. It directly addresses the core competency of pathophysiology-informed clinical decision-making by applying knowledge of the disease to tailor care, and it aligns with ethical principles of beneficence, non-maleficence, and respect for autonomy. Regulatory frameworks, such as those governing professional nursing practice and patient rights, mandate this level of informed participation and individualized care planning. An approach that solely prioritizes cost containment without a comprehensive clinical assessment risks violating the principle of beneficence and potentially leading to suboptimal patient outcomes. This could be seen as a failure to uphold the professional duty of care, as it places financial considerations above the patient’s physiological needs. Furthermore, it may contravene institutional policies regarding patient care standards and ethical guidelines that emphasize patient well-being as the primary concern. Another unacceptable approach would be to proceed with a less optimal treatment option based on assumptions about patient compliance or perceived likelihood of success without a detailed pathophysiological understanding of why that option might be less effective or carry higher risks for this specific patient. This bypasses the critical step of applying pathophysiological knowledge to individualize care and could lead to adverse events or prolonged recovery, failing to meet the standard of care expected in nurse anesthesia practice. It also neglects the ethical obligation to provide the most appropriate care based on the patient’s unique clinical picture. Finally, an approach that involves unilaterally making a decision without adequate patient or surrogate involvement, even if based on a sound clinical judgment, can be ethically problematic. While the nurse anesthetist possesses the clinical expertise, patient autonomy and the right to make decisions about their own healthcare are paramount. Failing to engage in shared decision-making, even when the clinical rationale is strong, can undermine trust and patient satisfaction, and may not fully align with regulatory expectations for patient-centered care. Professionals should employ a decision-making framework that begins with a comprehensive understanding of the patient’s pathophysiology and its implications for treatment. This should be followed by an evaluation of all available treatment options, considering their efficacy, risks, benefits, and resource implications. Crucially, this clinical assessment must be integrated with open communication and shared decision-making with the patient and/or their surrogate, ensuring that the chosen course of action is both clinically sound and ethically aligned with the patient’s wishes and values.

Scenario Analysis: This scenario presents a professional challenge rooted in the ethical imperative to ensure patient safety while navigating potential conflicts arising from differing clinical opinions and the need for timely medication management. The CRNA must balance their responsibility to the patient’s immediate well-being with the established protocols for medication reconciliation and the collaborative nature of healthcare. The urgency of the situation, coupled with the potential for a critical medication error, necessitates a prompt and ethically sound decision-making process. Correct Approach Analysis: The best professional practice involves immediately verifying the discrepancy and addressing the potential safety risk directly with the prescribing physician. This approach prioritizes patient safety by proactively identifying and rectifying a potentially dangerous medication error before it can be administered. It aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm). Furthermore, it adheres to professional standards of practice that mandate vigilance in medication administration and encourage open communication among healthcare providers to prevent adverse events. This collaborative approach respects the roles of both the CRNA and the physician while ensuring the patient receives the correct and safest treatment. Incorrect Approaches Analysis: One incorrect approach involves administering the medication as prescribed without further inquiry, assuming the physician’s order is correct. This fails to uphold the CRNA’s professional responsibility to question and verify potentially unsafe orders, directly violating the principle of non-maleficence and potentially leading to significant patient harm. It also disregards the importance of medication reconciliation and the CRNA’s role as a patient advocate. Another incorrect approach is to delay administration and wait for the physician to be available at a later, unspecified time, without attempting immediate clarification. This creates an unacceptable risk to the patient who may require the medication for immediate therapeutic benefit or whose condition could be exacerbated by the delay. It prioritizes administrative convenience over patient safety and fails to act with the necessary urgency in a critical care setting. A further incorrect approach is to unilaterally change the medication order without consulting the prescribing physician. While the CRNA may have identified a potential issue, altering a physician’s order without their explicit agreement or a clear, established protocol for such an action constitutes a breach of professional boundaries and could lead to legal and ethical ramifications. It bypasses the collaborative decision-making process essential for safe patient care. Professional Reasoning: Professionals should employ a structured decision-making process that begins with identifying the potential risk. This involves a critical assessment of the medication order against the patient’s current status and known allergies. If a discrepancy or potential safety concern arises, the immediate next step is to seek clarification from the prescribing provider. This communication should be clear, concise, and focused on the specific concern. If the provider cannot be reached promptly, established institutional protocols for medication discrepancies and emergency situations should be followed, which may involve consulting a supervisor or a designated pharmacist. Throughout this process, the paramount consideration must always be the patient’s safety and well-being.

Scenario Analysis: This scenario is professionally challenging because it requires the Certified Registered Nurse Anesthetist (CRNA) to navigate a complex situation involving a candidate’s performance on a competency assessment, the established blueprint weighting and scoring, and the potential need for a retake. The CRNA must balance the imperative to uphold professional standards and patient safety with fairness to the candidate, all while adhering to the specific policies of the assessment program. Misinterpreting or misapplying the blueprint weighting and scoring policies could lead to an inaccurate assessment of competency, potentially jeopardizing patient care if an inadequately prepared CRNA is deemed proficient. Conversely, an overly lenient or arbitrary approach could undermine the integrity of the assessment process and the profession. Correct Approach Analysis: The best professional practice involves a meticulous review of the candidate’s performance against the established blueprint weighting and scoring criteria. This approach requires the CRNA to objectively evaluate each section of the assessment, considering the designated weight of each component as outlined in the blueprint. If the candidate’s score, when calculated according to the blueprint’s weighting, falls below the established passing threshold, the CRNA must then consult the retake policy. This policy will dictate the specific procedures for remediation and re-assessment. This systematic and objective application of established criteria ensures fairness, consistency, and adherence to the program’s standards, directly supporting the goal of assessing and maintaining professional competency. This aligns with the ethical obligation to ensure that all practitioners meet the required standards for safe patient care. Incorrect Approaches Analysis: One incorrect approach involves making a subjective judgment about the candidate’s overall perceived competence, disregarding the precise blueprint weighting and scoring. This fails to uphold the established assessment framework, introducing bias and inconsistency. The program’s integrity is compromised when individual scores are not calculated according to the defined weights, potentially leading to an inaccurate determination of proficiency and a failure to identify areas requiring further development. This also violates the principle of fairness by not applying the same objective standards to all candidates. Another incorrect approach is to immediately recommend a retake based on a single perceived weakness, without first completing the full scoring process according to the blueprint. This bypasses the established scoring mechanism and the defined passing threshold. It can be perceived as punitive and does not allow for a comprehensive evaluation of the candidate’s performance across all weighted domains. The retake policy is typically triggered by a failure to meet the established passing score, not by an ad-hoc decision based on isolated observations. A further incorrect approach involves modifying the blueprint weighting or scoring criteria to accommodate the candidate’s performance. This is a direct violation of the established assessment policies and undermines the validity and reliability of the entire competency assessment program. Such an action would create an unfair advantage for the candidate and compromise the standardization necessary for a credible assessment. It also fails to address the underlying reasons for the candidate’s performance issues, which may require targeted remediation. Professional Reasoning: Professionals should approach competency assessments with a commitment to objectivity and adherence to established policies. The decision-making process should begin with a thorough understanding of the assessment blueprint, including weighting and scoring mechanisms. Performance data should be analyzed against these objective criteria. If a candidate falls below the passing threshold, the next step is to consult the program’s retake policy. This systematic process ensures that assessments are fair, consistent, and accurately reflect the candidate’s readiness to practice. Professionals must prioritize the integrity of the assessment process and the safety of the patients who will be cared for by the assessed individuals.

Scenario Analysis: This scenario is professionally challenging because it involves a critical intersection of patient safety, legal obligations, and professional ethics concerning the accuracy and completeness of clinical documentation. The CRNA must navigate the potential for retrospective review, audits, and legal scrutiny, where incomplete or inaccurate records can have significant consequences for patient care, reimbursement, and professional standing. The pressure to document efficiently while ensuring absolute accuracy requires careful judgment. Correct Approach Analysis: The best professional practice involves meticulously reviewing and verifying all patient data, including the electronic health record (EHR) and any device-generated information, against the actual intraoperative events and the patient’s physiological responses before signing off on the anesthesia record. This approach ensures that the documentation accurately reflects the care provided, is compliant with regulatory requirements for record-keeping, and upholds the ethical obligation to maintain truthful and complete patient records. Adherence to standards set by professional organizations and regulatory bodies like the Centers for Medicare & Medicaid Services (CMS) and state boards of nursing mandates accurate and timely documentation. Incorrect Approaches Analysis: Failing to thoroughly review and reconcile all data before final sign-off, assuming the EHR has automatically captured all relevant information, is a significant failure. This approach risks overlooking critical events, device malfunctions, or manual entries that may not have been correctly recorded, leading to inaccurate documentation that does not reflect the actual patient care provided. This violates the principle of accurate record-keeping and can have legal and ethical ramifications. Relying solely on the initial entry of data without a final verification step, even if the data appears plausible, is also professionally unacceptable. This overlooks the possibility of data entry errors, system glitches, or the need to add contextual information that might not be automatically captured. It bypasses the essential step of ensuring the record’s integrity and completeness, potentially misrepresenting the care delivered and failing to meet regulatory expectations for comprehensive documentation. Accepting the default settings of the EHR as sufficient without a critical review of the generated data against actual patient status and interventions is another failure. EHR systems are tools, and their output requires professional validation. This approach abdicates the CRNA’s responsibility to ensure the accuracy and completeness of the record, potentially leading to a false representation of care and non-compliance with documentation standards. Professional Reasoning: Professionals should employ a systematic approach to documentation review. This involves a pre-sign-off checklist that includes verifying patient identification, confirming all administered medications and fluids, reviewing all vital signs and waveform data, ensuring all interventions and their rationale are documented, and reconciling any discrepancies between manual entries and system-generated data. This process should be integrated into the workflow, recognizing that accurate documentation is an integral part of patient care and a legal and ethical imperative.

Scenario Analysis: This scenario is professionally challenging because it requires the Certified Registered Nurse Anesthetist (CRNA) to balance patient safety with the practicalities of resource allocation and institutional policy. The CRNA must assess the immediate risk to the patient while also considering the broader implications of their decision on the surgical team’s workflow and the availability of necessary equipment. This necessitates a nuanced judgment that prioritizes patient well-being without compromising the integrity of the procedure or the safety protocols. Correct Approach Analysis: The best professional practice involves a systematic risk assessment that prioritizes patient safety above all else. This approach entails a thorough evaluation of the patient’s physiological status, the nature of the planned procedure, and the potential immediate and long-term consequences of proceeding without the specific equipment. It requires the CRNA to communicate any identified risks clearly and collaboratively with the surgeon and the rest of the surgical team. If the risk assessment reveals a significant threat to patient safety, the CRNA must advocate for delaying the procedure until the necessary equipment is available or an acceptable alternative is identified and validated. This aligns with the ethical principles of beneficence and non-maleficence, as well as professional standards that mandate the CRNA to ensure a safe anesthetic environment. The American Association of Nurse Anesthesiology (AANA) Code of Ethics, for instance, emphasizes the CRNA’s responsibility to advocate for the patient and to practice within their scope and competence, which includes ensuring appropriate resources are available for safe patient care. Incorrect Approaches Analysis: One incorrect approach involves proceeding with the surgery despite the identified equipment deficit, assuming the risk is minimal or that the surgeon can compensate. This fails to uphold the CRNA’s primary responsibility for patient safety and violates the principle of non-maleficence. It disregards the potential for unforeseen complications that the missing equipment is designed to manage, thereby exposing the patient to unnecessary harm. This also contravenes AANA guidelines that stress the importance of a comprehensive pre-anesthetic assessment and the identification and mitigation of all potential risks. Another incorrect approach is to immediately halt the procedure without a thorough risk assessment and collaborative discussion with the surgical team. While patient safety is paramount, an overly rigid stance without exploring all viable options can disrupt patient care and workflow unnecessarily. This approach may fail to consider potential acceptable workarounds or the surgeon’s expertise in managing similar situations with alternative strategies, provided those strategies are deemed safe after careful consideration. It bypasses the collaborative decision-making process essential in a surgical setting. A third incorrect approach is to delegate the decision-making solely to the surgeon without independently conducting a CRNA-specific risk assessment. While collaboration is crucial, the CRNA has a distinct professional responsibility to evaluate the anesthetic implications and safety of the situation. Relying entirely on the surgeon’s judgment, without the CRNA’s own critical analysis of the anesthetic risks and management, abdicates professional accountability and may overlook anesthetic-specific concerns. Professional Reasoning: Professionals should employ a structured approach to risk assessment, beginning with a comprehensive evaluation of the patient and the planned procedure. This should be followed by a collaborative discussion with the entire surgical team to identify potential risks and explore mitigation strategies. If significant risks to patient safety are identified and cannot be adequately managed, the professional must advocate for delaying or modifying the plan of care. This decision-making process should be guided by ethical principles, professional standards, and regulatory requirements, always prioritizing the well-being of the patient.

The analysis reveals a complex scenario involving leadership, delegation, and interprofessional communication within a North American nurse anesthesia setting, specifically highlighting the challenges of managing a high-acuity patient with a critical, time-sensitive complication. The professional challenge lies in balancing the immediate need for intervention with the established protocols for delegation and communication, ensuring patient safety while respecting professional roles and responsibilities. Careful judgment is required to navigate potential conflicts, maintain team cohesion, and achieve the best possible patient outcome. The best approach involves the Certified Registered Nurse Anesthetist (CRNA) taking immediate leadership to assess the situation and then delegating specific, appropriate tasks to qualified personnel, such as the anesthesia technician, while simultaneously initiating direct communication with the surgeon to convey critical information and coordinate care. This approach is correct because it aligns with the principles of effective leadership in emergency situations, where the CRNA, as the anesthesia expert, is responsible for patient safety and has the authority to direct care. Delegation of tasks to the anesthesia technician is appropriate if within their scope of practice and competency, freeing the CRNA to focus on critical decision-making and direct patient management. Prompt and clear communication with the surgeon is essential for collaborative problem-solving and timely intervention, reflecting best practices in interprofessional communication and patient advocacy. This adheres to professional standards that emphasize the CRNA’s role in patient advocacy, team collaboration, and ensuring the safe and effective administration of anesthesia, particularly during emergent events. An incorrect approach would be for the CRNA to attempt to perform all necessary tasks independently without delegating or effectively communicating with the surgical team. This is professionally unacceptable as it can lead to delays in critical interventions, burnout, and potential errors due to overwhelming workload. It fails to leverage the skills of other team members and undermines the collaborative nature of patient care. Another incorrect approach would be for the CRNA to delegate tasks to personnel without confirming their competency or understanding of the situation, or to communicate in a vague or delayed manner with the surgeon. This is professionally unacceptable because it compromises patient safety by introducing the risk of incorrect execution of delegated tasks or a lack of timely, critical information exchange with the surgeon, potentially leading to suboptimal or harmful patient outcomes. It violates ethical obligations to ensure competent care and effective communication. A further incorrect approach would be for the CRNA to solely rely on the surgeon to manage the complication without actively participating in the assessment and directing anesthesia-related interventions. This is professionally unacceptable as it abdicates the CRNA’s responsibility for patient safety within the perioperative environment and fails to utilize their specialized knowledge and skills to contribute to the resolution of the complication. It represents a failure in leadership and interprofessional collaboration. Professionals should employ a decision-making framework that prioritizes patient safety, involves rapid situational assessment, clear identification of critical needs, and the strategic utilization of team resources. This includes understanding the scope of practice for all team members, practicing clear and concise communication, and assuming leadership when necessary to ensure optimal patient care, especially in emergent circumstances.