NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study with complete solutions

1. What are the potential ethical and legal implications for each of the following practice members? In the case study presented, there are both ethical and legal implications for all members of the interdisciplinary team involved. The medical assistant has an ethical duty to practice nonmaleficence to each patient. This includes only participating in behaviors that “do no harm” in patient care. Medical assistants are responsible for patient record keeping and collection of patient data and lab specimens, in most primary care settings. Legally, all medical assistants must be overseen in a hierarchy-fashion by either a nurse practitioner or attending physician, respective to individual state laws. In the case study, the medical assistant, Stephanie, acted outside of her scope of practice both ethically and legally. Stephanie was unethical because she made a medical decision to prescribe Mrs. Smith amoxicillin without the appropriate medical or nursing training, of which could have caused unwanted patient harm resulting in maleficence to the patient (ex. allergic reaction, inappropriate dose, adverse event, etc.). Stephanie was entirely beyond legal practice boundaries because she falsified a nurse practitioner’s identity, likely forged the APRN’s signature for the script, and she used the nurse practitioner’s license to misuse the power of diagnostic and prescriptive authority to treat Mrs. Smith. For these behaviors, Stephanie could potentially experience the following consequences: suspension or revocation of her license to practice as a medical assistant, monetary fines, jail time, and the inability practice as a medical assistant in additional states (Office of Professional Licensure and Certification, 2017). The nurse practitioner would also be at fault and has ethical and legal implications for malpractice. The nurse practitioner has ethical implications in the situation because justice was not practiced. Justice pertains to the notion that all patient are treated equally and fairly. The nurse practitioner failed to oversee the actions of the medical assistant to ensure that patient care was being performed fairly and within reason. Legally, it is the nurse practitioner’s wrong-doing that she did not supervise the actions of the medical assistant. If the nurse practitioner had evaluated and verified the prescription renewal requests per the practice’s protocols as should have been completed for all of the patients, perhaps the medical assistant’s actions could have been prevented. Legal implications for the nurse practitioner include liability for negligent supervision (Office of Professional Licensure and Certification, 2017). This study source was downloaded by from CourseH on :02:45 GMT -05:00 . The medical director is often the overseer or even the proprietor of the practice. The medical director and the practice office is at fault for the medical assistant’s actions. Ethically, the physician and the practice as a whole is in criticism because of lack of appropriate employment screening, employee credibility and employee training. The medical director has legal implications because of a lack of inadequate supervision within the practice. The medical director and practice are liable because of the respondeat superior doctrine (“Let the Master Answer”). This implies that superiors are responsible for the actions of their employees. Legal implications for the medical director and practice include lawsuits and practice fines (Cornell Law School: Legal Information Institute, 2020). 2. What strategies would you implement to prevent further episodes of potentially illegal behavior? There are a plethora of strategies that I would implement to prevent such further episodes of potentially illegal behavior regarding nurse practitioner and interdisciplinary group practice. First, education and training regarding state scope of practice law would be reinforced within the practice. Examples of criteria that would be supported include: licensing requirements, practice agreements, employee responsibilities, potential for liability, and prohibited behaviors. Next, all members of the practice would be expected to be licensed and credentialed, and would be expected to undergo background screening routinely. Contracts for role performance and expectations would be established. Updated policies and protocols would be established for interdisciplinary team members to follow and refer to. Although I believe these strategies would aid in alleviating potentially illegal patient practice behavior, I would also acknowledge that human error is possible without ill intent. With this in mind, I would encourage employees of the practice to obtain and secure malpractice liability insurance (Emergency Care Research Institute, 2015). 3. What leadership qualities would you apply to effect a positive change in the practice? Be thinking about the culture of the practice. To bring a positive change into effect within the practice setting, I would apply many leadership qualities as an advanced practice registered nurse. To bring about a positive change, the APRN must practice good collaboration and coaching skills to other key members of the team. A strong foundation in collaboration leads to members believing in the innovative qualities the nurse practitioner possesses. Additional leadership qualities include strong research skills, foundation of policy and scope of practice knowledge, consultation, and ethical decision making (Heinen, van Oostveen, Peters, Vermeulen, & Huis, 2019). References Office of Professional Licensure and Certification: New Hampshire Board of Nursing. (2017). Statements Related to Lying, Fraud, Theft. Retrieved from Cornell Law School: Legal Information Institute. (2020). Respondeat Superior. Retrieved from This study source was downloaded by from CourseH on :02:45 GMT -05:00 Emergency Care Research Institute. (2015). Scope of Practice Laws for Nurse Practitioners and Physician Assistants. Retrieved from tab=2 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.