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?
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.
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Ethical and Legal Implications
There are several ethical and legal implications affecting the different levels of care and leadership in the healthcare center in the scenario. The medical assistants are only responsible for taking calls, processing laboratory results, and refilling. According to Ahmadi & Aslani (2018), a prescription can only be done by physicians and sometimes by advanced nurse practitioners, depending on the state. In the scenario, Stephanie made an illegal move by prescribing medication that would attract legal actions if any complications would happen to the patient. The medical assistant also did not share the patient’s information with the APRNs concerning her health as required, which is unethical. Stephanie never discussed the patient’s call with the nurse practitioner, which is both illegal and unethical since she assumed the responsibility of a nurse practitioner or a physician. Lastly, she used the nurse practitioner’s identity to prescribe and refill medications to the patient, unethical.
The nurse practitioner may face litigation if the patient is affected by the medication either after being given the wrong medication or misdiagnosis. According to Samad et al. (2021), the person who is typed on the drug container as the prescriber bears full responsibility in case of any problem or errors, and thus the nurse practitioner may be sued, and their license is withdrawn. The medical director of the healthcare center may be sued for allowing the medical assistants to perform duties unlicensed. Despite Stephanie being a long-serving medical assistant, it is illegal and unethical to give the medical assistant powers equal to that of the nurse practitioners. The medical director’s actions may also result in organizational chaos with mistrust and disorderliness. The facility’s general practice may be shut down in case the regulatory agencies find out the professional misconduct and unethical practices that do not reflect safety, honesty, and care for patients.
In controlling these faults in the facility’s system of care, there are some strategies that I would implement. The first strategy is ensuring that all calls are recorded in the system for review to easily track the communication of the medical assistants and the patients. On the calls, the patient concerns and assistants’ replies should be recorded in a sheet and delivered to the nursing practitioners to avoid any delays or miscommunication. The second strategy would be ensuring that any prescription is done through the nurse practitioner before fills or refills. This would ensure that there are minimal errors in prescriptions.
The leadership qualities that I can apply in changing the situation would be team-building and coaching. In the scenario, the staff is not linked since the medical assistants are not sharing the call information or key issues with the APRNs, which is a social breakdown. Al-Dossary (2017) notes that team-building skills highly enhance the staffers’ integration and reduce conflict within the system. The team requires regular training and coaching on key responsibilities and ethics of work. According to Al-Dossary (2017), continuous coaching is required to deliver healthcare services by creating a competent team able to meet the desired standards.
From the review case, you have indicated that the medical assistant committed an illegal action prescribing the medication, a role that she is not licensed to. This is an unlawful practice, according to Moulis et al. (2018), which leads to 14 percent of prescription errors in the United States. You could have also included her misconduct of using the NPs name in the prescription as an identity fraud which is an illegal action that may lead to litigation. On the interventions, apart from controlling the calls and prescriptions, retraining the staff on every level of practice’s responsibilities, the legal and ethical practices that are significant to the healthcare center are important. Organizing workshops may improve the coordination and observation of key legal and ethical issues.
From your analysis, the main problem is the medical director’s trust in Stephanie to deliver services as a nurse practitioner. Even though it is advantageous for a health facility to have a long-serving practitioner, the licensure does not change, and thus it is wrong for the director to trust the medical assistant with NP roles. You have also indicated that the key interventions are close monitoring of the calls and ensuring prescription controls. You may also include installing an EHR system that, according to Ahmadi & Aslani (2018), provides direct communication with the concerned physician or nurse practitioner. The leadership skills employed are important in ensuring that the team is intact and well equipped with continuous coaching. You may also include problem-solving skills required to solve the issues surrounding the scenario, including stolen identity.