NR 510 Week 4 Discussion: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study

NR 510 Week 4 Discussion: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study

NR 510 Week 4 Discussion: 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.

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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:
1. What are the potential ethical and legal implications for each of the following practice members?
2. Medical assistant
3. Nurse Practitioner
4. Medical Director
5. Practice
6. What strategies would you implement to prevent further episodes of potentially illegal behavior?
7. What leadership qualities would you apply to effect a positive change in the practice? A€¯ Be thinking about the culture of the practice.
A scholarly resource must be used for EACH discussion # question.

NR 510 Week 4 Discussion : Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Sample

Healthcare policies and leadership are profound aspects that provide operational standards and ethical expectations for healthcare professionals. Often, care providers like physicians, nurse practitioners, and medical assistants operate under strict ethical standards and professional guidelines that underscore the rationale for promoting patient safety, improving care quality, and averting unethical practices that compromise the principles of patient-centered, dignified care. According to Varkey (2020), the major bioethical principles are beneficence, non-maleficence, autonomy, and justice. In essence, care providers bear an ethical obligation to benefit the patient, prevent or intercept harmful practices, respect values, and patient preferences, and ensure fairness and impartiality when delivering care to patients of diverse backgrounds. Although ethical standards are an inherent and inseparable part of clinical medicine, many incidents expose healthcare professionals to ethical dilemmas and the subsequent ramifications of making trade-offs between ethical decisions. While ethical dilemmas and decisions have implications for the nursing practice, this assessment elaborates on a case study where ethical standards are at stake due to inconsistencies in health professionals’ roles and responsibilities.

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An Overview of the Case Scenario

As a family nurse practitioner employed in a busy primary care office, I should collaborate with other care providers in our group, including one physician and three nurse practitioners. Also, our office has back staff members consisting of eight medical assistants. They are responsible for filing, answering calls from patients, processing laboratory results, and taking prescription requests from patients and pharmacies. Among all medical assistants, Stephanie is the most experienced and very efficient having worked in the practice for 10 years. Additionally, she has an excellent rapport with other care providers and knows every patient in the practice.

Although Stephanie is a reputable and experienced medical assistant, her interactions with Mrs. Smith trigger ethical and legal dilemmas. In essence, Mrs. Smith visited the office and brought an empty bottle of amoxicillin for a refill. The patient’s medical history shows that her last appointment was a year ago following similar claims of persistent cough. Surprisingly, the empty bottle has the patient’s name on the label and indicates that she visited the office a week ago. Further, the label indicates that I was the prescriber of medication during her last visit to the office. Finally, the patient admits that she spoke to Stephanie last week to inform her about the persistent cough. It turns out that Stephanie prescribed and administered medication without involving me or other providers in the practice, an aspect that triggers ethical, professional, and legal interpretation of healthcare professionals’ scopes of practice.

A Brief Interpretation of the Case Scenario

Undoubtedly, Stephanie’s decision to prescribe and administer medication for Mrs. Smith is contrary to her operational scope and beyond her approved duties. As a medical assistant, Stephanie is responsible for filing, answering calls from patients, processing laboratory results, and taking prescription renewal requests from patients and pharmacies. These responsibilities necessitate the need for collaborating with nurse practitioners and the physician to ensure effective care processes. Stephanie’s inability to execute roles within her authority can threaten the patient’s health and safety, as well as jeopardize her license.

For instance, the Virginia Board of Medicine can revoke a physician’s assistant license following the failure to practice by the requirements of their practice agreement, negligence, and failure to comply with any regulation of the Board required for licensure of a physician assistant (Virginia Department of Health Professions, 2021). As a result, any decision to report Stephanie to the state’s board of medicine can lead to multiple ramifications, including license revocation, suspension, or fine.

Secondly, Stephanie’s actions contradict the universally accepted procedures for treating patients with chronic cough claims. In essence, she did not evaluate the potential causative and contributing factors for chronic cough. Also, she overlooked the necessary medical examinations necessary for ascertaining whether Mrs. Smith is grappling with acute or chronic cough. According to Perotin et al. (2018), a widely accepted contingency plan for managing patients with chronic cough complaints encompasses various steps, including initial clinical evaluations for checking warning signs and assessing the most frequent causes by testing for asthma, non-asthmatic eosinophilic bronchitis, and gastroesophageal reflux disease.

Further, it is essential to consider assessing other potential causes of chronic cough like cardiac arrhythmia, somatic cough syndrome, and non-asthmatic pulmonary disease (Perotin et al., 2018). Finally, Stephanie should have considered a thorough physical exam to check for any inconsistencies in the lymph nodes or irritation in the patient’s throat. The inability to consider these interventions for managing a patient grappling with acute or chronic cough compromised the tenets of evidence-based care processes.

Potential Ethical and Legal Implications of Stephanie’s Actions for Practice Members

Medical Assistant

Medical assistants in Virginia are responsible for assisting medical managers (physicians) in every aspect of medical management processes. According to the Virginia Department of Health Professions (2021), a practice agreement for physician assistants includes acts under § 54.1-2952, including provisions for the periodic review of patient charts and electronic records, collaborating and consulting other parties to the agreement, and patients, and frequent joint evaluations of the delivered services. Also, the state’s law authorizes every physician assistant to consider appropriate physician input in complex clinical situations, including emergencies and referrals.

Although medical assistants play a forefront role in providing quality care, they cannot prescribe or administer medication in absence of a physician. This aspect means that a physician is the only authorized healthcare professional to prescribe medication and provide insights into providing quality care during emergencies. If reported, Stephanie can face multiple legal ramifications, including losing her job and certification, or license revocation. Also, if the patient exhibited any issues associated with the situation, the nursing practitioner (NP), Stephanie, and the physician can be susceptible to lawsuits on accounts of violating professional standards and negligence.

Nurse Practitioner (NP)

Nurse practitioners provide various health care services, including health promotion, disease prevention, health education, and interpreting diagnostics. According to the American Association of Nurse Practitioners (AANP, n.d.), nurse practitioners can operate as care providers, educators, mentors, researchers, administrators, and leaders. However, their operational scopes vary across states. For example, Virginia is a restrictive state, meaning that state laws limit the scope of practice by requiring collective agreement, supervision, and delegation by external healthcare providers such as physicians and physician assistants (Peterson, 2017). In the context of Stephanie’s actions, nurse practitioners (NPs) can face legal implications such as lawsuits due to their failure to collaborate with her in delivering evidence-based care for Mrs. Smith. In essence, they should have collaborated with the physician and Stephanie in ensuring that the prescribed medications are consistent with the patient’s health needs and goals.

Medical Director

Medical directors (physicians) in Virginia can delegate, supervise, and mentor other healthcare professionals, including medical assistants and nurse practitioners (Peterson, 2017). This factor means that they are liable for unprofessional conduct such as intentional or negligent conduct in practice that can cause or is likely to cause harm to a patient. Stephanie’s case presents a typical scenario of ineffective delegation and supervision practice by the physician. As a result, the physician would bear the ethical and legal implications of allowing the medical assistant to call in new prescriptions with appropriate oversight from the prescriber.

Practice

Undeniably, Stephanie’s actions can result in multiple ethical and legal implications for the overall office practices. In essence, Mrs. Smith’s awareness of organizational and team inconsistencies can lead to legal activities that can tarnish the organization’s reputation and lead to fines, license revocation, and suspension. As a result, her actions necessitate the need for reliable institutional protocols and guidelines to enshrine ethical and professional standards for care delivery. According to Bah & Sey-Sawo (2018), extensive experiences, supervision, mentorship, and preceptorship programs are essential in improving health professionals’ ethical competencies and value orientation. Developing ethical codes and standards can be a gold standard for enabling healthcare professionals to enhance their moral, legal, and professional competencies.

Strategies for Preventing Further Episodes of Potentially Illegal Behavior

Undoubtedly, the failure to adhere to ethical and professional standards can result in multiple ramifications, including lawsuits, license revocation, suspension, and loss of jobs for negligent or unethical healthcare professionals. Although Stephanie is an experienced and the most efficient medical assistant in our practice office, her actions are potentially illegal and can attract punishment if reportable to the state’s board of medicine.

Another takeaway from the case scenario is that a lack of a collaborative organizational culture forms the basis for unethical behaviors and acts, including negligence. According to Kadivar et al. (2017), patient safety is an aspect of ethical and legal imperatives, meaning any slight violations can trigger moral and legal implications. As a result, it would be essential to enact various measures to prevent potentially illegal behavior and actions. These interventions include:

Educating Healthcare Professionals to Create a Culture of Team Performance and Professional Integrity

Although healthcare professionals have background knowledge and awareness of ethical and professional standards obtained during their education programs, it is essential to emphasize extensive experiences and lifelong learning to enable them to thrive amidst incidences of ethical dilemmas. DuBois et al. (2018) contend that healthcare professionals often ignore cases of egregious ethical violations and cover-up unethical practices to avoid legal implications and consequences. As a result, educating healthcare professionals about the rationale for creating a culture of professional integrity can protect patients and whistleblowers, as well as dismantle the status quo of the fear to report unethical behaviors. Also, training care providers on the importance of team performance can promote effective delegation of responsibilities and enables health professionals to pursue collective objectives.

Partnering with Law Enforcement Agencies to Provide Clinical Guidelines and Protocols

Providing clinical protocols and guidelines for ethical standards can address uncivil behaviors by increasing caregivers’ awareness of the potential ethical and legal implications of violating professional and moral standards. According to DuBois et al. (2018), collaborating with law enforcement agencies can facilitate the process of investigating unethical practices that compromise care quality and jeopardize patient safety. In essence, it promotes swift but informed decisions to correct unprofessional conduct.

Continuous Review of Ethical Codes and Guidelines

As a nurse leader, I would ensure that the code of ethics is up-to-date and available in all care units. Further, I would engage other care providers in reviewing ethical and professional standards to ensure that they understand its provisions and are committed to upholding ethical provisions. More essentially, it would be essential to conduct orientation programs for newly employed care providers to enhance their knowledge and awareness of moral behaviors and actions. These strategies will enable care providers to circumvent the potential consequences and implications of violating professional and ethical codes.

Leadership Qualities to Promote Positive Change in the Practice

Undeniably, implementing measures for preventing unethical behaviors can necessitate the need for transforming the organization’s culture to accommodate team performance, timely reporting, and interdisciplinary collaboration. As a result, transforming the institutional culture requires the incorporation of appropriate leadership qualities to change staff members’ mindsets and address restraining factors for change. Hargett et al. (2017) argue that embracing critical thinking, emotional intelligence, selfless services, and being a role model in encouraging professional integrity are profound leadership strategies that resonate with positive change. As a leader, I would motivate team members to sustain ethical behaviors, communicate effectively to share information regarding ethical codes, act with personal integrity to operate as a role model and think critically to assess situations and provide informed solutions.

Conclusion

Health policies and leadership are inseparable concepts in promoting ethical and professional standards in healthcare contexts. Stephanie’s case presents a typical scenario of the ethical and legal implications of violating moral standards. By reviewing the case study, it is valid to contend that nurse assistants, nurse practitioners, and physicians must collaborate to ensure safer medication administration and prescription approaches. Therefore, these professionals bear the consequences of violating ethical codes, including suspension, license revocation, and fines. Therefore, it is essential to implement evidence-based measures for preventing potentially illegal behaviors, as well as embrace effective leadership qualities to promote positive change in the practice.

References

American Association of Nurse Practitioners. (n.d.). Scope of practice for nurse practitioners. Retrieved May 9, 2022, from https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners#

Bah, H. T., & Sey-Sawo, J. (2018). Teaching and practicing nursing code of ethics and values in the Gambia. International Journal of Africa Nursing Sciences, 9, 68–72. https://doi.org/10.1016/j.ijans.2018.08.005

DuBois, J. M., Anderson, E. E., Chibnall, J. T., Diakov, L., Doukas, D. J., Holmboe, E. S., Koenig, H. M., Krause, J. H., McMillan, G., Mendelsohn, M., Mozersky, J., Norcross, W. A., & Whelan, A. J. (2018). Preventing egregious ethical violations in medical practice: Evidence-Informed recommendations from a multidisciplinary working group. Journal of Medical Regulation, 104(4), 23–31. https://doi.org/10.30770/2572-1852-104.4.23

Hargett, C., Doty, J., Hauck, J., Webb, A., Cook, S., Tsipis, N., Neumann, J., Andolsek, K., & Taylor, D. (2017). Developing a model for effective leadership in healthcare: A concept mapping approach. Journal of Healthcare Leadership, Volume 9(9), 69–78. https://doi.org/10.2147/jhl.s141664

Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., & Zarvani, A. (2017). Ethical and legal aspects of patient’s safety: A clinical case report. Journal of Medical Ethics and History of Medicine, 10(15), 15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150915/

Perotin, J.-M., Launois, C., Dewolf, M., Dumazet, A., Dury, S., Lebargy, F., Dormoy, V., & Deslée, G. (2018). Managing patients with chronic cough: Challenges and solutions. Therapeutics and Clinical Risk Management, Volume 14, 1041–1051. https://doi.org/10.2147/tcrm.s136036

Peterson, M. E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 74–81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/

Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

Virginia Department of Health Professions. (2021). Chapter 29 of Title 54.1 of the Code of Virginia Medicine (pp. 1–138). http://www.dhp.virginia.gov/media/dhpweb/docs/med/leg/Ch29_Medicine.pdf