NR 506 Week 2 Discussion
Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study
Purpose
The purpose of this discussion is to discuss organizational changes and ethical-legal influences in a clinical scenario at an out-patient family practice. Students will explore potential effects on patient outcomes and ethical and legal implications for members of the heath care team as a result of illegal behaviors. Students will develop strategies that result in prevention of untoward outcomes that result in a positive practice culture.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
- Demonstrate effective leadership styles in the management of organizational change (CO3)
- Interpret various forms of ethical theories and application into practice (CO4)
- Discuss practice guidelines and malpractice prevention (CO2)
Due Date: Wednesday by 11:59PM MST of Week 2
Initial responses to the discussion topic must be posted by Wednesday 11:59pm MT. Two additional posts to peers and/or faculty are due by Sunday at 11:59pm MT. Students are expected to submit assignments by the time they are due.
A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday of week 2, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).
Total Points Possible: 100
Requirements:
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.
- A scholarly resource must be used for EACH discussion question each week.
Sample Discussion Response
Potential Ethical and Legal Implications
Medical Assistant
Ethically the medical assistant’s behavior violated medical ethical principles. Non maleficence was violated in that harm may have resulted in prescribing an antibiotic under inappropriate conditions. Legally the medical assistant broke the law by prescribing medication without the proper credentials. The medical assistant was fraudulent in her actions to prescribe medication under another person’s name. One aspect of health care fraud is knowingly misrepresenting information that results in unauthorized payments. (Kumaraswamy, Markey, Ekin, Barner, & Rascati, 2022) Thus, fraud resulted in unauthorized prescription drug benefits.
Nurse Practitioner
According to the American Nursing Association Code of Ethics, the nurse practitioner must report the medical assistant’s actions. Provision 3 of the ANA Code of Ethics, highlights nurses should promote the safety of patients and Provision 6 provides nurses should maintain an ethical environment for safe quality healthcare (American Nurses Association, n.d.). The nurse practitioner is not personally legally responsible for the fraudulent actions of the medical assistant; but has a duty to report the medical assistant’s fraudulent actions.
Medical Director
The medical director should follow the similar ethical principles of the nurse practitioner. Perhaps the medical director should ask him or herself if he or she has maintained an ethical environment that promotes a culture of safety in the practice. There must have been weaknesses in policies that may have allowed a fraudulent prescription to be ordered. Legally the medical director should not be held legally responsible for the medical assistant’s fraudulent behavior. The director should have the duty to report the situation along with the nurse practitioner. If the director knowingly allows the behavior to continue; then the director should be held legally accountable.
Practice
The practice ethically should review the work environment and policies to facilitate a culture of safety and veracity. Legally the practice can be held accountable for negligence and health care fraud especially if the practice of prescribing without a license is allowed to continue.
Prevention Strategies
There are many prevention strategies that can be implemented in order to curb further illegal behavior in the practice. The first strategy would be to terminate the employment of the employee who knowingly committed health care fraud. Although it is unfortunate to lose an employee with a good rapport with patients and staff, the practice simply cannot have an employee who committed an illegal offense. Additionally, the practice should execute a chart audit to search for other possible fraudulent offences committed. Next the practice should conduct a review of the office policies, job descriptions, and work practices to identify areas that need improvement. Finally, the practice could implement computerized physician order entry (CPOE) or e-prescribing to help curb further issues. CPOE systems have shown to improve patient safety (Mogharbel, Dowding, & Ainsworth, 2021). Granted proper password security protocols are followed, a CPOE system could prevent further fraudulent prescriptions.
Leadership Qualities to Affect Change
It is important for nurse practitioners to fully abide by the ANA Code of Ethics. Exemplifying adherence to nursing ethics is an essential leadership quality. The ANA Code of Ethics Provision 6 specifically highlights promotion of a culture of safety in health care (American Nurses Association, n.d.) According to Cochrane et al., a safety culture has the three main attributes of trust, report, and improve (2017). A leader who effectively promotes a culture of safety will create a culture where there is mutual trust among employees with systems that include transparent processes to distinguish blameless errors from those which require accountability and corrective measures. (Cochrane, et al., 2017)
References
American Nurses Association. (n.d.). Code of Ethics for Nurses. Retrieved May 10, 2022, from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
Cochrane, B., Hagins, M., Picciano, G., King, J., Marshall, D., Nelson, B., & Deano, C. (2017). High reliability in healthcare: creating the culture and mindset for patient safety. Healthcare Management Forum, 30(2), 61-68. doi:10.1177/0840470416689314
Kumaraswamy, N., Markey, M., Ekin, T., Barner, J., & Rascati, K. (2022). Healthcare fraud data mining methods: A look back and look ahead. Perspectives in Health Information Management, 19(1), 1-18.
Mogharbel, A., Dowding, D., & Ainsworth, J. (2021). Physicians’ use of the computerized physician order entry system for medication prescribing: Systematic review. JMIR Medical Informatics, 9(3), e22923. doi:10.2196/22923
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