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NR 506 Week 2 Discussion: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study/Health Care Policy (Spring 2021) GRADED A

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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: 1.What are the potential ethical and legal implications for each of the following practice members? Medical assistant Nurse Practitioner Medical Director Practice 2.What strategies would you implement to prevent further episodes of potentially illegal behavior? 3.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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1. What are the potential ethical and legal implications for each of the following practice
members?
o Medical assistant: The medical assistant can get into legal trouble by having her
name on the bottle as the physician. Even though she more than likely did not call in that
prescription, legally she does not have the credentials to prescribe any medication. Ethically it
does seem the medical assistant is providing beneficence to the patients she has known the last
ten years she has been with the practice.
o Nurse Practitioner: The nurse practitioner can get into legal trouble because she is
responsible for this patient. Allergies, dosing, and purpose of the medication is what needs to
be questioned before prescribing any medication. The nurse practitioner can be held
responsible because she is the primary care provider for this patient. Ethically, non-
maleficence can be contraindicated in this case.
o Medical Director: The medical director can be held responsible for this patient
because the nurse practitioner works under the medical director. The medical director provides
trust and autonomy to the nurse practitioner. Legally the medical director can have his license
taken away along with the nurse practitioner, and medical assistant involved in this case.
o Practice: The practice itself is at risk of being sued or even closing due to
malpractice. This patient could have potentially died, had an allergic reaction, anything could
have happened, and this practice would have been held responsible. Justice in this practice
would be beneficial.
2. What strategies would you implement to prevent further episodes of potentially illegal
behavior?

There are ways to prevent mistakes like this happening in the future. Some examples are
knowing and putting practice rules and guidelines into play for each and every employee at the
practice. Communicate with employees involved in the patient care and patients as well.
According to Buppert (2017), good communication with patients and staff provides satisfaction
and satisfaction provides less lawsuits. Spending an adequate amount of time with the patients
can prevent mistakes because you are taking the time to answer all questions and get what you
have to get done to provide that patient with the most adequate care you can provide. Know the
employees job title and descriptions before asking one to participate in the patients care.

3. What leadership qualities would you apply to effect a positive change in the practice? Be
thinking about the culture of the practice.

Leadership changes are needed to provide a successful practice. Values have to change along
with what is going on in the practice. “Values are the motivating power of a person’s actions
and necessary to survival, both psychologically and physically” (DeNisco, 2015). Values can
motivate each employee differently. Every person has a different culture so recognizing what
each employee appreciates is important. It is important to recognize qualities that are brought to
the practice that will make it stand out. Be firm but do it in a fashion that is professional and
appropriate. Most importantly, communicate and make sure patients and employees are happy
with their surroundings.

References:



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