Yes — the PMHNP must contact the FAA immediately to protect public safety.

No — this is covered by standard confidentiality protections and the PMHNP cannot disclose without patient consent.

The PMHNP should address the safety concern directly with the patient, strongly urge him to voluntarily ground himself, document the clinical recommendation, and assess whether the situation rises to a level where a duty-to-protect exception to confidentiality may apply. If the patient refuses to self-ground and the PMHNP determines there is an imminent threat to public safety, jurisdiction-specific guidance should be consulted.

Refer the patient to an occupational medicine specialist and consider the issue resolved.