NR510-10372 week4 Ethical Issues And Organization Change You are a family nurse practitioner employed in a busy primary care office. The providers in the g
NR510-10372 week4 Ethical Issues And Organization Change You are a family nurse practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice, and has an excellent rapport with all of the providers.
Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and asked if she could have a refill. You noted the patient’s name on the label, and the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie nor do the other providers in the practice.
Discussion Question:
What are the potential ethical and legal implications for each of the following practice members?:
Medical assistant
Nurse Practitioner
Medical Director
Practice
What strategies would you implement to prevent further episodes of potentially illegal behavior?
What leadership qualities would you apply to effect a positive change in the practice? Be thinking about the culture of the practice. Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study
Part One
You are a family nurse practitioner employed in a busy primary care office. The providers in the group
include one physician and three nurse practitioners. The back office staff includes eight medical
assistants who assist with patient care as well as filing, answering calls from patients, processing
laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie,
a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She
knows almost every patient in the practice, and has an excellent rapport with all of the providers.
Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago
for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and
asked if she could have a refill. You noted the patient’s name on the label, and the date on the bottle
was 1 week ago. You also noted your name printed on the label as the prescriber. The patient
admitted that she called last week concerned about her cough and spoke to Stephanie. You do not
recall having discussed this patient with Stephanie nor do the other providers in the practice.
Discussion Question:
What is your next logically sound course of action? Provide evidence to support your response.
RESPONSE:
Being employed in the health care industry for the past 10 years, I have yet to work along side of a
medical assistant (MA). In order to gain a stronger understanding of the role of the MA, I did a little
research. According to the American Association of Medical Assistants (AAMA) (2018), medical
assistants work beside physicians, nurse practitioners and physician assistants, most commonly in
outpatient or ambulatory care settings, such as doctor offices and clinics. MA’s are trained to perform
administrative and clinical duties within their scope of practice as defined by their governing state and
policies of their place of employment (AAMA, 2018). Some of the clinical duties of a MA may include,
but not limited to: taking medical histories, explaining treatment procedures to patients, assisting the
healthcare provider during exams, administering medications as directed by the provider, and
transmitting prescription refills as directed (AAMA, 2018). As for this week’s case study, Stephanie
performed the duty of independently prescribing a medication under the nurse practitioner’s name,
which is clearly not within the MA’s scope of practice.
What is my next logically sound course of action? First, the clinical duty of Stephanie calling in a
prescription not approved by me, the nurse practitioner, not only put me at risk for legal and/or
disciplinary actions against my license, but she also failed to recognize the potential dangers to the
patient’s overall safety and health. The scenario and conversation between the MA and the patient can
be played out in a variety of ways as to how and why the MA thought her course of action would be
acceptable. Was the patient prescribed the same medication at her last appointment? Did the patient
tell Stephanie what antibiotic works best for her based on her symptoms? Did Stephanie perform this
duty because she felt comfortable and proficient at her job due to her years of employment? I am sure
Stephanie did not do this act maliciously. As stated by DeNisco and Barker (2015), sometimes good
people make bad decisions when faced with certain circumstances.
The next appropriate course of action would be to have a private conversation with Stephanie
examining and questioning the current dilemma in a calm and professional manner. I would want to get
Stephanie’s version of the story with hopes of her telling me the truth prior to taking any further action.
During our conversation, I would want to remind her of her duties and responsibilities as defined by the
governing state law and the policies enforced by the practice. It would also be pertinent to reiterate on
the legality and appropriateness of prescribing medications, which Stephanie should be aware of. I
would also want to review the practice’s policy and procedure on the MA’s duty and responsibility of
prescription refills. The next course of action would be to notify my supervisor, whether it be the
physician or office manager, of the current workplace dilemma. I feel an occurrence of this magnitude
cannot be ignored because of the potential legal and safety ramifications it could impose on the party’s
involved if this situation ever reoccurred. Buppert (2015) explains an approach for nurse practitioners to
consider when faced with an ethical dilemma: gather information (legal or ethical in nature, consider
scope of practice, patient privacy and confidentiality, who is benefiting or who is hurt), structure a plan
(identify course of action, alternate approaches, and pros and cons of preferred course of action),
present the issue to the appropriate person or persons, and lastly, make a decision.
References
American Association of Medical Assistants (AAMA). (2018). What is a medical assistant? Retrieved from
http://www.aama-ntl.org/medical-assisting/what-is-a-medical-assistant#.Wmj4rUxFyM8 (Links to an
external site.)
Buppert, C. (2015). Nurse practitioner’s business practice & legal guide (5th ed.). Retrieved from
https://bookshelf.vitalsource.com
DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the
profession (3rd ed.). Retrieved from https: bookshelf.vitalsource.com
Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study
Part Two
Upon further investigation, you learn that Stephanie spoke with the patient and called the medication
into the patient’s pharmacy without consulting with a provider. Stephanie claimed that the patient
was insistent about needing a prescription. Because Mrs. Smith was coming into the office the
following week for an appointment, she didn’t think you would mind if the patient received the
prescription early.
Discussion Question:
What are the ethical-legal concerns associated with this situation? What is your liability in this
situation, if any? What is the practice’s liability in this situation? What quality improvement strategies
might you implement as an APN in this practice to safeguard your role and assure patient safety?
Provide evidence to support your response.
RESPONSE:
The ethical-legal concerns associated with this situation could potentially impose serious penalties, not
only on the medical assistant, but on the nurse practitioner, physician and the overall practice. Could
you imagine the legal consequences if Mrs. Smith would have had an allergic reaction to the antibiotic
and suffered severe effects, or even worse, died as a result of an unlicensed personnel practicing
medicine? The potential legal issues associated with this type of an occurrence could include
malpractice and negligence because of tasks being performed outside the healthcare worker’s scope of
practice. According to the American Association of Medical Assistants (AAMA) (2018), medical
assistants may not legally prescribe medication autonomously or refill prescriptions independently.
Stephanie’s act could have legal implications on the nurse practitioner because of using him or her as
the prescriber, and the physician because he or she is responsible for the oversight of medical assistants.
On the ethical side of this situation, I feel Stephanie performed this task because her professional
judgment was dominated by her personal judgement and feelings towards Mrs. Smith. As healthcare
professionals, we all want what is best for the patient, but we have to know when to put aside our
personal judgments and follow the rules and policies that direct our practice. Ethical principles and
theories provide the foundation for all ethical behavior and provide direction in the decision-making
process (DeNisco & Barker, 2015). Stephanie’s negligent act of calling in a prescription not approved by
the nurse practitioner or physician is a task she performed outside her scope of practice, which
definitely should be grounds for disciplinary action. To what extent? That would be up to the practice
and justice system to decide.
What quality improvement strategies could be implemented in this practice to safeguard the role of the
nurse practitioner and assure patient safety? As with any member of the healthcare team, medical
assistants are equally essential to the process of delivering safe and efficient patient care. According to
the AAMA (2018), medical assistants can perform a variety of tasks, which is why it is imperative for
employers to define their permissible tasks. The tasks allowed to be executed by the medical assistant
rest with state regulations, the employing organization, and the licensed providers supervising their
work (Gregory, 2014). Rules and regulations are governed by the individual states and they provide a
framework as to what can be delegated, but a healthcare organization or practice can further limit these
tasks if necessary (Gregory, 2014). Healthcare providers can also decide to limit what tasks they are
comfortable with delegating, because competency of the medical assistant is the responsibility of the
provider and the employing organization (Gregory, 2014). With that being said, the healthcare practice,
if not done so already, needs to have a policy and procedure that clearly delineates the scope of practice
and permissible tasks of each member of the healthcare team. Clarifying professional roles can serve
several purposes: defining each person’s responsibilities, ensuring appropriate implementation of each
professional’s role, enhancing professional scopes of practice, and thereby ensuring efficient patient
care (Brault et al., 2014).
References
American Association of Medical Assistants (AAMA). (2018). What is a medical assistant? Retrieved from
http://www.aama-ntl.org/medical-assisting/what-is-a-medical-assistant#.Wmj4rUxFyM8 (Links to an
external site.)Links to an external site.
Brault, I., Kilpatrick, K., D’Amour, D., Contandriopoulos, D., Chouinard, V., Dubois, C., & Beaulieu, M.
(2014). Role clarification processes for better integration of nurse practitioners into primary healthcare
teams: A multiple-case study. Nursing Research and Practice, 2014(170514), 1-9.
doi:10.1155/2014/170514
DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the
profession (3rd ed.). Retrieved from https: bookshelf.vitalsource.com
Gregory, M. (2014). Researching the scope of practice for medical assistants. AAACN Viewpoint, 36(2),
13-14. Retrieved from
http://eds.b.ebscohost.com.chamberlainuniversity.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=4&sid=9
3d14472-8def-422d-9b39-9f7e7a227607%40sessionmgr101 (Links to an external site.)Links to an
external site.
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