A PMHNP practicing in a state that requires a collaborative practice agreement (CPA) with a physician is managing a 33-year-old man with treatment-resistant schizophrenia. After two failed antipsychotic trials, the PMHNP determines that clozapine is the evidence-based next step. However, the collaborating psychiatrist is on medical leave for six weeks and the CPA specifically requires physician co-signature for clozapine initiation. The patient is clinically deteriorating, experiencing command auditory hallucinations to harm himself, and the next available psychiatrist consult is four weeks away. The PMHNP must determine how to proceed within legal and ethical boundaries.