Feb 23, 2024 NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part One
NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part One
NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part One
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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My immediate action is to address the patient’s reason for the visit. According to Mitchell and Oliphant (2016), I have a responsibility to conduct a comprehensive patient interview or consultation before prescribing any medications. While there are ethical issues with what Stephanie did, even though her intentions were good, this must be addressed in private later. Mrs. Smith has already taken a prescribed dose of amoxicillin for her cough. If the amoxicillin has not cleared up the cough, I should not provide her with a refill order just yet. This may have been the wrong medicine to prescribe for a cough in the first place. For one, if Mrs. Smith felt comfortable with Stephanie calling in a prescription order without the doctor’s consent, this may not be the first time she has been prescribed an antibiotic without being checked-out first. Mrs. Smith may have developed a resistance to the antibiotic. Norris et al. (2013) state antibiotic resistance is a serious, growing threat that causes the bacteria in patients’ bodies to become immune to the antibiotics medicinal properties. Many respiratory conditions are viral infections not bacteria-based illnesses, and Mrs. Smith may not have known that antibiotics only work against bacteria. There are many possible factors as to why Mrs. Smith has developed a chronic cough. I should conduct her physical exam and ask her questions about her cough (when it developed, the type of cough like wet or dry, does the patient smoke, any shortness of breath, has she taken any medication other than amoxicillin to treat the cough). I should then draw Mrs. Smith’s blood to send to lab for testing to determine if she has become resistant to amoxicillin. Also, during her physical, I can see if movement or exertion prompt her to cough. Once the physical has been performed and cough symptoms evaluated, I will take medications, past health history, and any present conditions I have recognized during the physical into consideration then decide on the best cough treatment plan. Once the patient has been taken care of, I will create thorough notes to document the visit, my findings and actions, and Stephanie’s actions then report what has occurred to the primary physician and office manager.
Reference
Mitchell, A., & Oliphant, C. M. (2016). Responsibility for ethical prescribing. The Journal for Nurse Practitioners, 12(3), A20. Retrieved from DOI: https://doi.org/10.1016/j.nurpra.2016.01.008Links to an external site.
Norris, P., Chamberlain, K., Dew, K., Gabe, J., Hodgetts, D., & Madden, H. (2013). Public beliefs about antibiotics, infection and resistance: A qualitative study. Antibiotics, 2(4), 465-476. doi:10.3390/antibiotics2040465
I agree that this may not have been the first time Stephanie did this. It would seem unlikely to me that she would tell the patient she was doing it without the knowledge of the NP. I feel like it would of been something she may have mentioned that she was going to have the NP call something in. I also agree that if she is requesting more antibiotic then it was possibly the wrong medication for her cough. Perhaps it was just a virus. I know patients are always requesting an antibiotic for any and everything that is wrong with them. I once had a patient insist on an antibiotic for being dehydrated. Even filed a formal complaint to the president of the hospital because she did not receive the antibiotic. With patients being so quick to threaten legal action or complain, it is likely Stephanie did what she did to attempt to keep the patient from complaining.
Instructor Storm,
You asked if having a staff meeting and addressing it with all the MAs would be a better approach than a one on one meeting. For some things I think this may be acceptable, however in this situation I believe that both would be appropriate. If it was me I would have a meeting with all the MAs and a separate meeting with Stephanie. This is not something I feel should be left to a simple warning. This is too serious of a matter. Having one group meeting would be like giving Stephanie the thinking that it was not that serious and she may continue to do this. Next time it could be a stronger medication or something that would cause a bad reaction. So I definitely think disciplinary action is in order. Even if it is just a first offence.
I am glad that you brought up looking at Stephanie’s reasoning or mindset about the situation. I think you are right that Stephanie was trying to help or avoid a confrontation with the patient, but Stephanie’s decision definitely made the situation worse instead of better. I cracked up about your comments regarding the patient who wrote a letter to the president of the hospital for not receiving an antibiotic for dehydration. That patient should be writing the president a thank you note for your great nursing. What this patient did not realize is that a possible side effect to taking antibiotics is diarrhea. If not monitored properly, diarrhea can cause severe dehydration. Today, patients are so quick to file lawsuits against doctors and nurses if they do not get their way or if the outcome of the medical procedure is not what they expected it to be. Is there a solution to minimizing the number of medical lawsuits filed per year? After researching my own question, I came across an article that discusses the profile of patients most likely to file litigious claims. The article states, respecting patients’ need for information during clinical consultations and disclosing medical errors when they occur is the more patient-centered approach and the best way to lessen the likelihood of a claim (Tsimtsiou, 2014). The point of this statement is that medical staff need to be more forthcoming to patients instead of trying to please them. If Stephanie had politely informed the patient that she would have to wait until her appointment to discuss her refill request for the antibiotic, noted the patient’s file, and forwarded the patient’s request to the NP assigned to the patient, Stephanie would have followed protocol and taken a patient-centered approach.
References Tsimtsiou, Z., Kirana, P., Hatzimouratidis, K., & Hatzichristou, D. (2014). What is the profile of patients thinking of litigation? Results from the hospitalized and outpatients’ profile and expectations study. Hippokratia, 18(2), 139–143.
When it comes to having this meeting, it would be hard not to intimidate the medical assistant. No one likes to be called in for a meeting where they feel as if they are in trouble for something. The only way to make the meeting go as easily as possible would be to be as professional as possible so that it can go by smoothly. Working in healthcare, I have come to learn what probably works best for having a professional meeting. When it comes to conflict and issues at work, the most important thing to do would be to first tell her in private that one wants to discuss about this incident that occurred. One should not tell Stephanie in front of other employees or at the nurse’s station as this would make her feel uncomfortable, embarrassed and can lead to gossip about her or the incident. Carefully and fairly explain the issue at hand and then let her say her side of the story. Only have who needs to be in the meeting there and not have extra people in the meeting. Keep the meeting short and not extended for a long period of time. Scolding, berating or degrading Stephanie will not help and one should remain professional during the meeting. However, one must realize that even if these actions are taken, because of the magnitude of the incident, she may be intimidated or closed off once it is explained the consequences and repercussions. She may automatically try to explain the situation in a way of protecting herself as much as possible to not lose her job. (Gunnarsson, 2017)
Reference:
Gunnarsson, A. (2017) Experiences from ten years of incident reporting in health care: a qualitative study among department managers and coordinators. Bmc Health Services Research, 18
Participation for MSN
Threaded Discussion Guiding Principles
The ideas and beliefs underpinning the threaded discussions (TDs) guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of TDs provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The TD’s ebb and flow is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the TDs generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. TDs foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.
Participation Guidelines
Each weekly threaded discussion is worth up to 25 points. Students must post a minimum of two times in each graded thread. The two posts in each individual thread must be on separate days. The student must provide an answer to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week. If the student does not provide an answer to each graded thread topic (not a response to a student peer) before the Wednesday deadline, 5 points are deducted for each discussion thread in which late entry occurs (up to a 10-point deduction for that week). Subsequent posts, including essential responses to peers, must occur by the Sunday deadline, 11:59 p.m. MT of each week.
Direct Quotes
Good writing calls for the limited use of direct quotes. Direct quotes in Threaded Discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the Grammar, Syntax, APA category.
Grading Rubric Guidelines
Performance Category109840ScholarlinessDemonstrates achievement of scholarly inquiry for professional and academic decisions.Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisionsEvaluates literature resources to develop a comprehensive analysis or synthesis.Uses valid, relevant, and reliable outside sources to contribute to the threaded discussionProvides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions.Evaluates information from source(s) to develop a coherent analysis or synthesis.Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis.Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion.Demonstrates little or no understanding of the topic.Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.Information is taken from source(s) without any interpretation/evaluation.The posting uses information that is not valid, relevant, or reliableNo evidence of the use of scholarly inquiry to inform or change professional or academic decisions.Information is not valid, relevant, or reliablePerformance Category 109840Application of Course Knowledge -Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situationsPosts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources;Applies concepts to personal experience in the professional setting and or relevant application to real life.Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources.Applies concepts to personal experience in their professional setting and or relevant application to real lifeInteractions with classmates are relevant to the discussion topic but do not make direct reference to lesson contentPosts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson.Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real lifeDoes not demonstrate a solid understanding of the principles and concepts presented in the lessonPosts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post.Posts are superficial and do not reflect an understanding of the lesson contentDoes not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real lifePosts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignoredNo discussion of lesson concepts to personal experience in the professional setting and or relevant application to real lifePerformance Category 54320Interactive DialogueReplies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days.(5 points possible per graded thread)Exceeds minimum post requirementsReplies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days.Replies to a post posed by faculty and to a peerSummarizes what was learned from the lesson, readings, and other student posts for the week.Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate daysReplies to a question posed by a peerSummarizes what was learned from the lesson, readings, and other student posts for the week.Meets expectations of 2 posts on 2 different days.The main post is not made by the Wednesday deadlineDoes not reply to a question posed by a peer or facultyHas only one post for the weekDiscussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ commentsDoes not post to the threadNo connections are made to the topic Minus 1 PointMinus 2 PointMinus 3 PointMinus 4 PointMinus 5 PointGrammar, Syntax, APANote: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted.Points deducted for improper grammar, syntax and APA style of writing.The source of information is the APA Manual 6th Edition2-3 errors in APA format.Written responses have 2-3 grammatical, spelling, and punctuation errors.Writing style is generally clear, focused, and facilitates communication.4-5 errors in APA format.Writing responses have 4-5 grammatical, spelling and punctuation errors.Writing style is somewhat focused.6-7 errors in APA format.Writing responses have 6-7 grammatical, spelling and punctuation errors.Writing style is slightly focused making discussion difficult to understand.8-10 errors in APA format.Writing responses have 8-10 grammatical, spelling and punctuation errors.Writing style is not focused, making discussion difficult to understand.Post contains greater than 10 errors in APA format.Written responses have more than 10 grammatical, spelling and punctuation errors.Writing style does not facilitate communication.The student continues to make repeated mistakes in any of the above areas after written correction by the instructor0 points lost -5 points lostTotal Participation Requirementsper discussion threadThe student answers the threaded discussion question or topic on one day and posts a second response on another day. The student does not meet the minimum requirement of two postings on two different daysEarly Participation Requirementper discussion threadThe student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week. The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.
NOTE: To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week’s assignments are due by the next Sunday by 11:59 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Wednesday. Any assignments and all discussion requirements must be completed by 11:59 p.m. MT Wednesday of the eighth week.
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