Develops a comprehensive assessment of the participant's needs (assimilating participant's history from various sources), follows plan of care implemented by IDT team, provides services and/or treatments requiring specialized nursing skill, councils the client and family in meeting nursing need, coordinates services, informs the physician and other staff of changes in the client's needs, and assists with transfers of care (respite, discharge from facility). VANs use their discretion to assess symptoms (through a physical or verbal assessment, or a telephonic conversation), analyze potential diagnoses, and based on such diagnoses, determine the appropriate level of intervention (i.e. education, clinic visit, urgent care, emergency room), recommend a course of treatment, and begin treatment.