NR 510- dq 2 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two
NR 510- dq 2 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study 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.
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.
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Like I stated in Part 1, this can be a serious matter even if the patient is not physically harmed. Since Stephanie is the medical assistant, placing and verifying orders are not in her job description. Even as I am now as a bedside nurse, placing orders without proper verification from a MD/NP/DO would land me in some trouble if this happened.Only nursing orders, like IV pump, heating pad or basic equipment/care can be placed by the nurse at the hospital I work at.
As an NP in this situation, I do not think that the NP is held liable. If a nurse places an order and document that it was verified by the MD, but thru investigation it was found that it was not, the MD is not held liable. The same should go for the NP. The nurse would be reprimanded for doing that and the MD will not held liable or be found at fault. In school for each profession, one is taught what they can and cannot do within legal limits. Stephanie got comfortable and thought it was go to go outside of her job description that I am sure she already knows. The practice as a whole may be liable, especially if harm was done to the patient. The principle of non-maleficence (to do no harm) states that a health care professional should act in such a way that he or she does no harm, even if her or his patient or client requests this. Stephanie may have not had bad intent and was thinking she was probably helping in this situation to alleviate some of the work for the providers and NPs. Also, she probably thought she was making it more simple for the patient. However, this could cause harm to the patient as a NP or MD must assess if and why a new antibiotic must be ordered in the first place. Also, the practice is responsible and must be held liable of alerting Mrs. Smith of the situation so the he knows what he going on. This maybe the hardest part as Mrs. Smith might lose trust in the practice, place a bad review and can have the right to sue the facility even if no physical harm was done. Negligence can be seen as failure to take reasonable care or steps to prevent loss or injury to another person. Nursing negligence is when a nurse who is fully capable of caring does not care in the way a reasonably prudent nurse would, and as a result the patient suffers unnecessarily. Even though this was not directly a nursing issue, she can still sue for negligence. Mrs. Smith may do nothing at all once told if she feels strongly tied to the practice. However, it is completely up to Mrs. Smith how she wants to go about the issue. If she decides to take it that far into suing the practice, Stephanie might be at risk to lose her job as she now becomes a liability to the practice. There is many ways this situation goes depending on the outcome. (Tinnon, 2017)
To prevent that issue, maybe the medical assistant can only have access to certain parts of the program. For example, maybe when it comes to prescriptions, the medical assistant can not print out or issue it out to the patient till the NP/MD signs off and verifies it. The program should stop her from issuing it to the patient without proper verification. For example, in the hospital setting, even if the program is the same name, each profession has their own set customized for their job description. A nurse’s screen will look different from a PCA, unit secretary or a respiratory therapist. With this setup, one can only access what is felt is allowed for the specific job description. (Schub & Kornusky, 2016)
Reference:
Schub, T. B., & Kornusky, J. M. (2016). Standing Orders, Order Sets, and Protocols: Government Regulations. CINAHL Nursing Guide,
Tinnon, E (2017). Situational awareness and Nursing Code of Ethics. Nurse Educator, 43(1), 32-36.
In this weeks reading, we learned about the legal scope of nursing practice and how to solve ethical dilemmas. Thankfully Stephanie was honest and admitted what she did. In a healthcare dilemma that is probably seen far too often, Stephanie was in the wrong for assuming the prescription was ok without consulting me. Patients can be pushy, but Stephanie could have either set Mrs. Smith up with a same-day appointment, have her come in a day or two to be seen early, or at least checked with the on-call physician or Nurse Practitioner in the practice to see if the prescription was ok. The first legal concern is a medical assistant prescribing. The role of a Medical Assistant is to escort patient, take vital signs, and write down the chief complaint in the medical record (Chapman & Blash, 2017). Prescribing is outside of her scope of practice. The ethical dilemma is reporting a hard-worker or not for trying to help you out. This may be her first offense, but she should know better, especially with ten years experience, that she was acting outside her job description. Telephone prescribing is risky due to lack of physical assessment, testing for infections, and the possibility of over-prescribing antibiotics (Ewen, Willey, Kolm, McGhan, & Drees, 2015). An antibiotic for a cough is probably useless and could potentially lead to yeast infections or lead to antibiotic-resistant infections, doing Mrs. Smith more harm than good. I am liable for this situation because my name is on the prescription, and any harm to the patient could be a negligence or malpractice suit. I should also follow up with all of my patients and their symptoms. I also need the correct coding and documentation for billing purposes. Things need to be appropriately documented. Depending on the state of practice and the ability of the physician to delegate NPs to prescribe, the practice could also be seen liable. The practice should also oversee the hiring and firing of employees as well as making sure people are in their scopes of practice. A good way to safeguard my role would be to not prescribe via telephone. Although more time consuming, physically assessing my patients and testing for illness before I prescribe medications is safer for my license and my patients.
Chapman, S. A., & Blash, L. K. (2017). New roles for medical assistants in innovative primary care practices. Health Services Research, 5(2), 383-406. doi:10.1111/1475-6773.12602
Ewen, E., Willey, V. J., Kolm, P., McGhan, W. F., & Drees, M. (2015). Antibiotic prescribing by telephone in primary care. Pharmacoepidemiology And Drug Safety, 24(2), 113-120. doi:10.1002/pds.3686
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