Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Studies

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

NR 510 Week 4 Discussion Part One – 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. Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Studies.

ORDER A PLAGIARISM-FREE PAPER HERE

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.

NR 510 Week 4 Discussion Part One – Discussion Question:

What is your next logically sound course of action? Provide evidence to support your response.

NR 510 Week 4 Discussion Part One Sample

My immediate action is to address the patient’s reason for the visit. According to Mitchell and Oliphant (2016), I have a responsibility to conduct a comprehensive patient interview or consultation before prescribing any medications. While there are ethical issues with what Stephanie did, even though her intentions were good, this must be addressed in private later. Mrs. Smith has already taken a prescribed dose of amoxicillin for her cough. If the amoxicillin has not cleared up the cough, I should not provide her with a refill order just yet. Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Studies. This may have been the wrong medicine to prescribe for a cough in the first place. For one, if Mrs. Smith felt comfortable with Stephanie calling in a prescription order without the doctor’s consent, this may not be the first time she has been prescribed an antibiotic without being checked-out first. Mrs. Smith may have developed a resistance to the antibiotic. Norris et al. (2013) state antibiotic resistance is a serious, growing threat that causes the bacteria in patients’ bodies to become immune to the antibiotics medicinal properties. Many respiratory conditions are viral infections not bacteria-based illnesses, and Mrs. Smith may not have known that antibiotics only work against bacteria. There are many possible factors as to why Mrs. Smith has developed a chronic cough. I should conduct her physical exam and ask her questions about her cough (when it developed, the type of cough like wet or dry, does the patient smoke, any shortness of breath, has she taken any medication other than amoxicillin to treat the cough). I should then draw Mrs. Smith’s blood to send to lab for testing to determine if she has become resistant to amoxicillin. Also, during her physical, I can see if movement or exertion prompt her to cough. Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Studies. Once the physical has been performed and cough symptoms evaluated, I will take medications, past health history, and any present conditions I have recognized during the physical into consideration then decide on the best cough treatment plan. Once the patient has been taken care of, I will create thorough notes to document the visit, my findings and actions, and Stephanie’s actions then report what has occurred to the primary physician and office manager.

NR 510 Week 4 Discussion Part One References

Mitchell, A., & Oliphant, C. M. (2016). Responsibility for ethical prescribing. The Journal for Nurse Practitioners, 12(3), A20. Retrieved from DOI: https://doi.org/10.1016/j.nurpra.2016.01.008Links to an external site.

Norris, P., Chamberlain, K., Dew, K., Gabe, J., Hodgetts, D., & Madden, H. (2013). Public beliefs about antibiotics, infection and resistance: A qualitative study. Antibiotics, 2(4), 465-476. doi:10.3390/antibiotics2040465. Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Studies.

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

NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Discussion Part Two – Upon further investigation, you learn that Stephanie spoke with the patient and called the medication into the patient’s pharmacy without consulting with a provider. Stephanie claimed that the patient was insistent about needing a prescription. Because Mrs. Smith was coming into the office the following week for an appointment, she didn’t think you would mind if the patient received the prescription early. Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Studies.

Discussion Question:

What are the ethical-legal concerns associated with this situation? What is your liability in this situation, if any? What is the practice’s liability in this situation? What quality improvement strategies might you implement as an APN in this practice to safeguard your role and assure patient safety? Provide evidence to support your response.

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

On a basic/standard level of ethical legal concerns, no medical professional should be doing anything in representation of another provider;this should be well known to all medical professionals. It’s as basic as not giving someone your badge to take a blood sugar, common practice learned day 1. Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Studies As a medical assistant Stephanie should have known this was wrong, she knows she shouldn’t document under another provider and is fully aware she can not decide which medication a patient needs, only a refill of a prescription which is authorized by the provider whose name will be on the prescription.

As the provider who “prescribed” the medication it is my responsibility and liability if this was the wrong medication, the patient has an allergic or any adverse reaction because Stephanie was unaware of the patients allergies or other condition/medication that may interfere with the new medication. Talking more severely, had this been the wrong medication and adverse/serious reactions had resulted for the patient there may not have been a way to determine who had called in the prescription, leaving the NP open for a legal repercussions or medical malpractice(Buppert, 2015). This is one of many reasons functioning within ones scope of practice is pertinent daily life as an NP. Liability for the practice is high because if something had happened it would not only come back to the NP but the practice as you are a practice employee. Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Studies.

As far as quality improvement for now you could call in your own prescriptions and refills but long term this is not time efficient. The practice should hold a class or informational session required for anyone ordering prescriptions as well as a policy put into place for medical assistants to follow strictly in this role if they are going to have the responsibility of sending in medication refills. Another solution is that they could enter it but it has to be signed off by the NP, which is also time consuming for an NP daily schedule. In conclusion there are many alternatives other that what Stephanie chose and there needs to be serious education put into place.
Buppert, C. (2015). Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Studies Nurse practitioner’s business practice & legal guide (5th ed.). Retrieved from https://bookshelf.vitalsource.com. Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Studies