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

Chamberlain University NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two

Whether one passes or fails an academic assignment such as the Chamberlain University NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two

The introduction for the Chamberlain University NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two

After the introduction, move into the main part of the NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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

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 though

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

t 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)

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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.

Sample Answer 2 for NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two

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

Sample Answer 3 for NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two

The medical assistant’s actions raise several ethical-legal concerns because she broke several laws. She is not authorized to write prescriptions under her scope of practice. Medical assistants are to work directly under the primary care provider (Chapman & Blash, 2017). If the patient had developed an allergic reaction to amoxicillin, the practice could have been sued. Patients can be difficult to handle, especially when they feel hey know what’s best for their health. I understand and value that Stephanie just wanted to help, but her actions put the practice, the patient’s health, and my license at risk. As nursing students, we receive extensive training about our scope of practice and laws governing what we can and cannot do. It is safe for me to assume that Stephanie has done this before since she has been at the practice for 10 years. The medical assistants in the office need to undergo staff training about scope of practice and policies regarding patient interaction. Stephanie should face disciplinary action, which may affect her ability to work as a medical assistant. The ethical dilemma is that the physician or myself will have to report a co-worker when she was only trying to assist. On the other hand, Stephanie is a veteran medical assistant. She should have known that she was acting outside of her scope of practice. All she is authorized to do with patients is to take vital signs and write down the health complaint of the patient (Chapman & Blash, 2017). The medical ramifications of her actions put the patient at risk. Prescribing medications over the phone pose a great risk to a patient’s health because the patient has not been tested for infections or been given a physical assessment (Ewen et al., 2015). Stephanie obviously did not know that prescribing an antibiotic for a cough was useless, and she put the patient at risk for developing a yeast infection or resistance to the antibiotic. I do not believe I am liable because Stephanie used my name without my consent. This could also be considered identity theft. The practice is liable because it employs Stephanie and must report her actions to clear up any legal action that will affect me or the livelihood of the practice in the future. Stephanie may be a good employee, but I believe she knew the legal ramifications of using my name. Her actions pose ethical concerns. She should never misrepresent her role, scope of practice, or assume the role of another provider (Chapman & Blash, 2017). In the future, the office may establish a policy that requires NPs to call in their own prescriptions for patients. The office can also establish a sign-off rule in which the NP and physician must sign a prescription order.

References:

Chapman, S. A., & Blash, L. K. (2017). New roles for medical assistants in innovative primary care practices. Health Services Research, 52(S1), 383-406. Retrieved from https://doi.org/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. Retrieved from doi:10.1002/pds.3686

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

There are ethical-legal considerations in this situation, as Stephanie’s actions were outside her scope of practice. Additionally, if any harm came to the patient in any way, any blame and legal actions would be placed against the licensed prescriber (in this case the liability would lie in myself as the NP). I would have to speak with Stephanie about her actions. I would tell her I understand that patient’s can be persistent at times, however she should have taken a message with the patient and told her she would call her back, and then discuss the situation with me first. I may have still allowed for a prescription to be phoned in, but it would be up to my digression to do so, and would not only at least be aware of the situation, but be able to treat it accordingly.

According to Goldberg )2014), every act performed by a physician, is not necessarily counted as practicing medicine. Courts concede that certain duties such as administering injections, drawing blood, or changing bandages may be performed by non-physicians, however, courts find that diagnosing and treatments such as prescribing medications, is considered crossing the line into the practice of medicine. I would have to explain to Stephanie that her actions not only put the patient at potential risk of harm, but she also placed me at legal risk as well. I would ask her to never again put me in that position, and to please come to me with patient issues, even if it is something that she doesn’t think I would mind doing for the patient. I would make it politely clear that this can never happen again, under any circumstances. She needs to always speak with the licensed prescriber before phoning in any medications of any kind, for any patient.

Goldberg, D. (2014). My ‘medical technicians’ are unlicensed. What is my crime?. Dermatology Times, 35(9), 12.

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