Feb 23, 2024 NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two
NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two
NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two
The case study has potential and legal implications for the medical assistant, nurse practitioner, medical director, and the practice. First, medical assistants do not have the legal mandate to engage in activities such as prescribing and refilling prescriptions. Stephanie should understand the consequences of her actions such as her license for practice being revoked because of the safety issues associated with her actions. The nurse practitioner, medical director, and practice administrator have the responsibility of ensuring that each of the personnel in the institution perform as per their scope of practice (Griffith & Tengnah, 2020). They must assess the skill levels and competencies of the medical assistants and other providers to provide the required care and communicate their limitations to them.
I will embrace some strategies to prevent potentially illegal behaviors in the future in the practice site. One of them is clarifying the roles and responsibilities of the different members involved in the patient care in the setting. The roles and responsibilities should be communicated to ensure accountability, transparency and responsibility. I will also administer staff assessment tests to determine their understanding of their expected responsibilities and consider strategies such as training them to prevent similar occurrences in the future (Varkey, 2021). Lastly, I will display the policies, standards, and regulations that guide employee behaviors in the organization to eliminate potential issues in the future.
One of the leadership qualities that I would apply to effect a positive change in the practice is leading as an example. Nurse practitioners should demonstrate best practices that others can emulate for safety, quality, and efficiency. The other leadership quality I would apply is strengthening open communication, seeking and providing feedback to the other members of the team to ensure continuous quality improvement (Heinen et al., 2019). Lastly, I will advocate the adoption of effective leadership styles such as transformational leadership to encourage the development of the desired competencies among the care team.
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References
Griffith, R., & Tengnah, C. (2020). Law and Professional Issues in Nursing. SAGE.
Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing, 75(11), 2378–2392. https://doi.org/10.1111/jan.14092
Varkey, B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119
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Like I stated in Part 1, this can be a serious matter even if the patient is not physically harmed. Since Stephanie is the medical assistant, placing and verifying orders are not in her job description. Even as I am now as a bedside nurse, placing orders without proper verification from a MD/NP/DO would land me in some trouble if this happened.Only nursing orders, like IV pump, heating pad or basic equipment/care can be placed by the nurse at the hospital I work at.
As an NP in this situation, I do not think that the NP is held liable. If a nurse places an order and document that it was verified by the MD, but thru investigation it was found that it was not, the MD is not held liable. The same should go for the NP. The nurse would be reprimanded for doing that and the MD will not held liable or be found at fault. In school for each profession, one is taught what they can and cannot do within legal limits. Stephanie got comfortable and thought it was go to go outside of her job description that I am sure she already knows. The practice as a whole may be liable, especially if harm was done to the patient. The principle of non-maleficence (to do no harm) states that a health care professional should act in such a way that he or she does no harm, even if her or his patient or client requests this. Stephanie may have not had bad intent and was thinking she was probably helping in this situation to alleviate some of the work for the providers and NPs. Also, she probably thought she was making it more simple for the patient. However, this could cause harm to the patient as a NP or MD must assess if and why a new antibiotic must be ordered in the first place. Also, the practice is responsible and must be held liable of alerting Mrs. Smith of the situation so the he knows what he going on. This maybe the hardest part as Mrs. Smith might lose trust in the practice, place a bad review and can have the right to sue the facility even if no physical harm was done. Negligence can be seen as failure to take reasonable care or steps to prevent loss or injury to another person. Nursing negligence is when a nurse who is fully capable of caring does not care in the way a reasonably prudent nurse would, and as a result the patient suffers unnecessarily. Even though this was not directly a nursing issue, she can still sue for negligence. Mrs. Smith may do nothing at all once told if she feels strongly tied to the practice. However, it is completely up to Mrs. Smith how she wants to go about the issue. If she decides to take it that far into suing the practice, Stephanie might be at risk to lose her job as she now becomes a liability to the practice. There is many ways this situation goes depending on the outcome. (Tinnon, 2017)
To prevent that issue, maybe the medical assistant can only have access to certain parts of the program. For example, maybe when it comes to prescriptions, the medical assistant can not print out or issue it out to the patient till the NP/MD signs off and verifies it. The program should stop her from issuing it to the patient without proper verification. For example, in the hospital setting, even if the program is the same name, each profession has their own set customized for their job description. A nurse’s screen will look different from a PCA, unit secretary or a respiratory therapist. With this setup, one can only access what is felt is allowed for the specific job description. (Schub & Kornusky, 2016)
Reference:
Schub, T. B., & Kornusky, J. M. (2016). Standing Orders, Order Sets, and Protocols: Government Regulations. CINAHL Nursing Guide,
Tinnon, E (2017). Situational awareness and Nursing Code of Ethics. Nurse Educator, 43(1), 32-36.
In this weeks reading, we learned about the legal scope of nursing practice and how to solve ethical dilemmas. Thankfully Stephanie was honest and admitted what she did. In a healthcare dilemma that is probably seen far too often, Stephanie was in the wrong for assuming the prescription was ok without consulting me. Patients can be pushy, but Stephanie could have either set Mrs. Smith up with a same-day appointment, have her come in a day or two to be seen early, or at least checked with the on-call physician or Nurse Practitioner in the practice to see if the prescription was ok. The first legal concern is a medical assistant prescribing. The role of a Medical Assistant is to escort patient, take vital signs, and write down the chief complaint in the medical record (Chapman & Blash, 2017). Prescribing is outside of her scope of practice. The ethical dilemma is reporting a hard-worker or not for trying to help you out. This may be her first offense, but she should know better, especially with ten years experience, that she was acting outside her job description. Telephone prescribing is risky due to lack of physical assessment, testing for infections, and the possibility of over-prescribing antibiotics (Ewen, Willey, Kolm, McGhan, & Drees, 2015). An antibiotic for a cough is probably useless and could potentially lead to yeast infections or lead to antibiotic-resistant infections, doing Mrs. Smith more harm than good. I am liable for this situation because my name is on the prescription, and any harm to the patient could be a negligence or malpractice suit. I should also follow up with all of my patients and their symptoms. I also need the correct coding and documentation for billing purposes. Things need to be appropriately documented. Depending on the state of practice and the ability of the physician to delegate NPs to prescribe, the practice could also be seen liable. The practice should also oversee the hiring and firing of employees as well as making sure people are in their scopes of practice. A good way to safeguard my role would be to not prescribe via telephone. Although more time consuming, physically assessing my patients and testing for illness before I prescribe medications is safer for my license and my patients.
Chapman, S. A., & Blash, L. K. (2017). New roles for medical assistants in innovative primary care practices. Health Services Research, 5(2), 383-406. doi:10.1111/1475-6773.12602
Ewen, E., Willey, V. J., Kolm, P., McGhan, W. F., & Drees, M. (2015). Antibiotic prescribing by telephone in primary care. Pharmacoepidemiology And Drug Safety, 24(2), 113-120. doi:10.1002/pds.3686
Although writing an unauthorized prescription is illegal, regardless of the type, I do believe she should be punished more for writing a prescription for a controlled substance. Controlled substances usually have harsher side effects and a higher potential for abuse, meaning the patient should be monitored closely. Antibiotic resistance and yeast infection are far better than overdose and addiction. She knows nothing about the patient or drug. If every person that walked in the door got what they asked for, the world would be filled with addicted people. Assessing for the true need of medications is crucial- the opioid epidemic is already so high. Patients need to know the medication, how to properly take, the side effects, and come back to be checked. I would be cautious in prescribing refills too. Nurse Practitioners can only prescribe so much depending on state laws and drug class. A medical assistant with no pharmacology and assessment training has no business doing either, and I would not want her to ruin me practicing as an NP under my educational scope.
There are a few ethical-legal concerns with this situation. Stephanie has practiced outside of her scope of practice by calling in a prescription without speaking with a physician. She has forged documentation by doing this as well. According to the Centers for Medicare & Medicaid Services, fraud is “the intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person (Curtin, 2014). Stephanie has given a prescription intentionally. Not only that, the patient was never examined by a provider. There could have been more wrong with Mrs. Smith other than just a “cough”. The patient needs to be fully examined before any medications are prescribed.
The liability of this situation lies on both Stephanie and the practice. First off, what has happened needs to be reported to the patient. Mrs. Smith needs to be aware that what was done was wrong, and that no provider ever permitted that prescription to be written. The pharmacy also needs to be notified. Lastly, the nursing board needs to be notified of Stephanie’s practicing outside of her scope of practice. She can potentially lose her license over this situation.
A meeting should be held with the other nurse practitioners and physician. As a group, we need to be sure that each of the med aides is aware of their role and their scope of practice. Education needs to be done frequently.
The liability that falls on both myself and the practice is the potentially of being sued. Unfortunately, having nothing to do with this situation occurring, we are both still liable. Stephanie is hired and working underneath me in the practice as one of my staff members.
Curtin, L. (2014). Documentation: You’ve got a lot to lose. American Nurse Today, 9(9). Retrieved from https://www.americannursetoday.comLinks to an external site.
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