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

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

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. 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. 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 t

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

he visit, my findings and actions, and Stephanie’s actions then report what has occurred to the primary physician and office manager.


Mitchell, A., & Oliphant, C. M. (2016). Responsibility for ethical prescribing. The Journal for Nurse Practitioners12(3), A20. Retrieved from DOI: 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. Antibiotics2(4), 465-476. doi:10.3390/antibiotics2040465

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Since this is a detrimental mistake and issue, this would require a meeting with all the MAs and providers. However, I believe initially, there should be a private meeting with Stephanie to go over what exactly happened and a followup meeting to discuss the consequences of her action. Usually, when one makes a mistake on the unit I work for, it is brought up during monthly meetings or huddles because the management does not want staff to repeat the same mistake and cause more harm to the patient or even put their job and/or license at risk. For example, a nurse accidentally mixed two patient’s lab draw tubes and put it in one bag and sent it to laboratory. We never saw the actually meeting with the nurse, what the consequence was and management tried to not expose which nurse it was. However, thru gossip, the staff found out who. It was brought up in huddle several times to remind nurses to please remember to label lab draws correctly because this can cause patient harm if mislabeled or sent improperly to lab. I think having two staff meetings is appropriate because there should be one private meeting with Stephanie and another meeting with the staff as a whole to prevent this from happening again.

A good time to address Stephanie would be after the office has closed for the day (Young, 2014). I would not confront Stephanie directly. I would speak with the physician first to inform him/her of the situation (if he/she is not already aware of it) then request a meeting between the physician, myself, the hiring manager, and Stephanie. While it’s better to address workplace conflicts as soon as possible, sometimes help from a mediator will help eliminate further conflict (Young, 2014). I am an advocate of non-confrontational dialogues. Once the situation about Stephanie’s actions have been discussed in private with the persons involved and the appropriate disciplinary measures taken, a meeting with all the MA’s should be set up. This meeting is not to discredit Stephanie or inform the MA’s of Stephanie’s mistake but to retrain them in their scope of practice, remind them of the proper office procedures on how to handle difficult patient requests, and cover the laws regarding prescriptive authority (who is allowed to call in prescriptions and in what capacity).


Young, M. O. (2014). Constructive feedback and disciplinary action. American Nurse Today9(4). Retrieved from

I am glad that you brought up looking at Stephanie’s reasoning or mindset about the situation. I think you are right that Stephanie was trying to help or avoid a confrontation with the patient, but Stephanie’s decision definitely made the situation worse instead of better. I cracked up about your comments regarding the patient who wrote a letter to the president of the hospital for not receiving an antibiotic for dehydration. That patient should be writing the president a thank you note for your great nursing. What this patient did not realize is that a possible side effect to taking antibiotics is diarrhea. If not monitored properly, diarrhea can cause severe dehydration. Today, patients are so quick to file lawsuits against doctors and nurses if they do not get their way or if the outcome of the medical procedure is not what they expected it to be. Is there a solution to minimizing the number of medical lawsuits filed per year? After researching my own question, I came across an article that discusses the profile of patients most likely to file litigious claims. The article states, respecting patients’ need for information during clinical consultations and disclosing medical errors when they occur is the more patient-centered approach and the best way to lessen the likelihood of a claim (Tsimtsiou, 2014). The point of this statement is that medical staff need to be more forthcoming to patients instead of trying to please them. If Stephanie had politely informed the patient that she would have to wait until her appointment to discuss her refill request for the antibiotic, noted the patient’s file, and forwarded the patient’s request to the NP assigned to the patient, Stephanie would have followed protocol and taken a patient-centered approach.


Tsimtsiou, Z., Kirana, P., Hatzimouratidis, K., & Hatzichristou, D. (2014). What is the profile of patients thinking of litigation? Results from the hospitalized and outpatients’ profile and expectations study. Hippokratia, 18(2), 139–143.