NR510 Week 4 Organizational Change and Ethical-Legal Influences In Advanced Practice Nursing Case Study
You are a family nurse practitioner employed in a
... [Show More] 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.
Discussion Question: 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.
ANSWER
Dr. Distler and Peers,
In this situation, I would thoroughly investigate the situation about the prescription. I would look in the patient’s chart for any documentation regarding the phone call and prescription. I would speak with the other nurse practitioners and the medical doctor. Once it was clear that the prescription given was not done so by another licensed healthcare provider within the office, then I would address the issue with Stephanie the medical assistant (MA). MAs work with the medical doctor, physician assistant, nurse practitioner, and nurses mostly in clinics, ambulatory care centers, and outpatient facilities.
MAs administrative duties consist of computer data entry and retrieval, operating telephones, making sure correspondence and billing are handled appropriately. The clinical duties of a MAs include updating or receiving medical history of patients, preparing and assisting the licensed provider with examinations, performing venipuncture procedures and transmitting prescription refills as directed. The MA is an unlicensed professional or allied health provider who offer both administrative or clinical support under supervision to the medical doctors, physician assistants, and nurse practitioner in an ambulatory care or clinical setting (Gray, Harrison, & Hung, 2016).
Stephanie had clearly operated out of her scope of practice. Medical assistants may only call in routine refill prescriptions that are exactly as before with no changes under the direct supervision of a medical doctor, PA, or NP. The medical assistant may not call in new prescriptions or prescriptions that have changes. In speaking with Stephanie, I would need to clarify if this was an isolated event. If this was intentional or if Stephanie was unclear of her specific job functions. I would let Stephanie know that this is an ethical issue because she called in a new prescription and it is not authorized in her scope of practice. This situation could cause for legal ramifications in the event an issue that arises from a pharmaceutical mistake. American Association of Medical Assistance (AAMA) Prohibited Conduct states, “ As assistant acting beyond the scope of this chapter may be: (1) considered to be engaged in the unlicensed practice of medicine; and (2) subject to all applicable penalties and fines in accordance with Health Occupations Article, §§14-602 and 14-607, Annotated Code of Maryland, and COMAR 10.32.02. (AAMA)”. With this being said, if Stephanie knowingly called in a prescription without the authorization of another licensed healthcare provider, disciplinary actions up to and including termination would take place. If this situation was an unintentional incident, then Stephanie face a written warning with education provided and any future incidents or issues would lead to termination.
Title 10 MARYLAND DEPARTMENT OF HEALTH. Chapter 12 Delegation of Acts by a Licensed Physician to an Assistant Not Otherwise Authorized under the Health Occupations Article or the Education Article http://www.aama-ntl.org/docs/default-source/legal/md-regulations.pdf?sfvrsn=4
Gray, CP., Harrison, MI., & Hung, D. (2016). Medical Assistants as Flow Managers in Primary Care: Challenges and Recommendations. https://www.ncbi.nlm.nih.gov/pubmed/27356444
Hycenta,
I totally agree with your response in the clarification of job description of the medical assistant (MAs). Stephanie was clearly wrong in calling in the prescription for the patient and she was aware that this was not a part of her job description as stated in the second part of the case study. Communicating with the physician or even the office manager (if one) was not considered in this situation. Continued education and training should be a priority and implemented at this time. Because of the severity of the issue, I stated in my initial post that “disciplinary actions up to and including termination would take place. If this situation was an unintentional incident, then Stephanie face a written warning with education provided and any future incidents or issues would lead to termination.”
Haimanot,
In your response you pointed out that “Stephanie may have acted in some ways under pressure” which I can agree with you. Also another interesting point you made was Stephanie “might even be to shield busy providers from receiving another call”. I also agree that that could have been another concern of Stephanie’s. Stephanie and all other staff would need to be reintroduced to their job descriptions and their scope of practice. Stephanie or any of the other staff should not feel pressured into making poor decisions and cause or create unethical situations and unnecessary legal issues for the clinic and other healthcare providers. Because Stephanie knew better but decided to practice unlawfully, there should be some measure of disciplinary action taken. Thank you for those great points you added to the discussion. [Show Less]