APRN Ethical Duties and Patient Autonomy in ESRD Care
This paper examines the professional and ethical responsibilities of an Advanced Practice Registered Nurse (APRN) caring for a non-compliant patient with end-stage renal disease (ESRD). Drawing on Nevada nursing statutes, the paper addresses three core questions: what professional duties the APRN owes the patient, with whom she may appropriately discuss ethical concerns, and how she must balance her clinical obligations against the patient's legal right to self-determination. The analysis highlights documentation practices, chain-of-command communication, and the limits of nurse authority when a competent adult refuses to follow prescribed care.
- Overview of the Clinical Scenario: Non-compliant ESRD patient background and APRN concern
- Professional Responsibilities of the APRN: Statutory nursing duties and scope of practice
- Discussing Ethical Concerns Through Proper Channels: Documentation, referral, and chain-of-command steps
- Respecting Patient Autonomy and the Right to Self-Determination: Balancing nurse obligations with patient rights
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What makes this paper effective
- It grounds ethical arguments in specific statutory authority (NRS 632.005 and 632.017–18), giving the analysis legal credibility rather than relying solely on abstract moral principles.
- The paper uses a clear question-and-answer structure that mirrors real clinical decision-making, making each argument directly actionable for a practicing nurse.
- It maintains a measured, non-judgmental tone toward the patient's non-compliance, consistently distinguishing what the nurse can do from what she is authorized to do.
Key academic technique demonstrated
The paper demonstrates applied ethical reasoning within a professional scope-of-practice framework. Rather than resolving the ethical tension abstractly, it maps each ethical concern onto a concrete professional action — documentation, physician notification, psychological referral — showing how nursing ethics translates into clinical procedure.
Structure breakdown
The paper opens with a brief patient overview that establishes the clinical context. It then works through three sequentially organized questions: professional duties, channels for ethical communication, and patient autonomy. Each section builds on the last, moving from the nurse's internal obligations outward to the patient's rights, producing a coherent argument about the boundaries and responsibilities of APRN practice.
Overview of the Clinical Scenario
The patient is a 59-year-old man who is overweight and hypertensive, with a history of alcoholism. He has been diagnosed with end-stage renal disease (ESRD) but refuses to adhere to his prescribed diet, medication regimen, and instructions to abstain from alcohol. The APRN assigned to his care is concerned about her roles and responsibilities in this situation.
Professional Responsibilities of the APRN
As a licensed professional, the APRN's responsibility is to apply her skills and, to the best of her ability, do whatever is necessary to assist in the patient's continued treatment. Under NRS 632.005, the State of Nevada specifically indicates that nurses should assist in maintaining the health, safety, and welfare of their patients. Further, the practice of professional nursing under NRS 632.017–18 encompasses care of the ill, injured, and infirm. As a nurse, the APRN is responsible for carrying out the physician's orders to the best of her ability. She is not responsible for the patient's adherence to protocol or instructions; however, she is responsible for informing the patient — even on a continual basis — of best-practice instructions. She is also responsible for notifying her superiors when the patient is not participating appropriately in his own care.
The APRN's role is not that of a diagnostician. Her role within the care system is to assist and provide professional care for the patient. It is likewise not her role or responsibility to introduce her own sense of morality or judgment in determining what the best use of advanced care, medications, or procedures might be. Because the patient is of sound mind and is mobile, it is her responsibility to take her concerns about his health to the proper authority.
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