PerfectCustomPapers | Organizational Change And Ethical-Legal Influences In Advanced Practice Nursing Case Study

Organizational Change And Ethical-Legal Influences In Advanced Practice Nursing Case Study

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.

Case Study Questions:

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.

Sample Answer

Ethical and Legal Implications:

Medical Assistant (Stephanie):

Ethical: Stephanie might have acted unethically by potentially practicing medicine without a license. Refilling prescriptions typically requires a healthcare provider’s evaluation.
Legal: Stephanie could face legal repercussions for unauthorized practice of medicine, depending on state regulations.

Full Answer Section

Nurse Practitioner (You):

Ethical: You have an ethical obligation to ensure patient safety and appropriate medication use. Prescribing without a proper evaluation is a breach of ethical responsibility.
Legal: Having your name on a potentially unauthorized prescription could lead to legal issues if the medication caused harm.

Medical Director:

Ethical: The medical director has an ethical obligation to ensure the practice operates according to legal and ethical standards. This includes overseeing staff actions and preventing such incidents.
Legal: The medical director could face legal repercussions for not providing adequate oversight and potentially allowing unauthorized practice within the clinic.

Practice:

Ethical: The practice has an ethical responsibility to provide safe and competent care. This includes having clear policies and procedures to prevent unauthorized prescribing.
Legal: The practice could face legal consequences for allowing unauthorized practice of medicine.

Strategies for Prevention:

Clear Policies: Develop and implement clear policies and procedures regarding prescription refills. This should outline who is authorized to refill prescriptions and the process for evaluating refill requests.
Staff Education: Educate all staff, including medical assistants, on the importance of proper procedures for medication refills and the legal and ethical implications of unauthorized practice.
Standardized Process: Implement a standardized process for handling prescription refill requests. This could involve requiring patients to speak directly with a healthcare provider for refills, or having a designated staff member verify refill requests with a provider before processing.
Prescription Monitoring Programs: Utilize state prescription monitoring programs to track controlled substance prescriptions and identify potential misuse.

Leadership for Positive Change:

Open Communication: Foster a culture of open communication where staff feel comfortable reporting potential issues without fear of punishment.
Mentorship: Provide mentorship opportunities for medical assistants to develop their skills and knowledge within their allowed scope of practice.
Teamwork: Promote teamwork and collaboration among all staff members, including medical assistants and providers.
Positive Reinforcement: Recognize and reward staff members who follow proper procedures and demonstrate ethical behavior.

By implementing these strategies, the practice can create a culture of patient safety, ethical practice, and clear communicati

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