Review The Scenario And Address The Questions Below You Are

Review The Scenario And Address The Questions Belowyou Are A Nurse Pr

Review the scenario and address the questions below. You are a nurse practitioner employed in a busy primary care office with responsibilities for managing the office staff, including the medical assistants who aid in client care as well as filing, answering calls from clients, processing laboratory results, and taking prescription renewal requests from clients and pharmacies. The office is part of a larger hospital system. One of the medical assistants has worked in the practice for 10 years and is very proficient at her job. She knows almost every client in the practice and has an excellent rapport with all the providers.

During an office visit, a client requested a refill for an amoxicillin prescription. When examining the empty bottle, you noted that the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber though you did not see the client last week. The client explained that she called last week concerned about her cough and spoke to the medical assistant, who assured her that a prescription would be sent to the pharmacy for the concern. You do not recall having discussed this client with the medical assistant; the other providers in the practice deny speaking to or consulting about the client.

Application of Course Knowledge

Based on the situation above, there are significant ethical and legal implications at the micro-, meso-, and macro-levels of the healthcare system. At the micro-level, which pertains to individual patient-provider interactions, this scenario raises concerns about patient safety, informed consent, and professional accountability. Prescribing medication without proper consultation or documentation can lead to adverse drug reactions, medication errors, or legal liability for the healthcare provider (American Medical Association [AMA], 2020). The miscommunication about prescribing authority and documentation compromises ethical principles of beneficence and non-maleficence, as well as autonomy, given the patient’s reliance on accurate information and appropriate care (Beauchamp & Childress, 2019).

At the meso-level, involving the healthcare practice or organization, there are issues related to clinical protocols, staff communication, and auditing processes. The discrepancy between the provider’s records and the actions of the medical assistant indicates a breakdown in communication protocols and potential lapses in adherence to organizational policies for prescription management. This situation breaches the standards of professional practice and creates vulnerability to legal sanctions if adverse events arise or if malpractice claims are pursued (Kovner & Knickman, 2019).

At the macro-level, which encompasses the broader healthcare system and regulatory environment, the case highlights systemic issues such as the need for standardized prescribing practices, electronic health records (EHR) documentation protocols, and oversight mechanisms. Failures at this level may violate prescriptions regulations established by agencies like the Drug Enforcement Administration (DEA) and require adherence to national standards for medication management (U.S. Food and Drug Administration [FDA], 2021). Non-compliance can lead to sanctions, loss of licensure, or criminal liability for the practice and individual providers.

To prevent further episodes of such problematic behavior, several organizational and individual changes are recommended. First, implementing strict protocols for prescription authorization that require documented verbal or electronic confirmation before prescribing medication ensures accountability (Bauer & Curran, 2021). Incorporating EHR alerts and audit trails can detect unauthorized or questionable prescriptions proactively. Staff training should emphasize ethical and legal standards regarding medication management, documenting every step, and understanding scope of practice boundaries. Regular staff meetings and communication audits can foster transparency, clarify roles, and reinforce adherence to policies. Performance improvement initiatives, such as root cause analyses after incidents, can identify systemic vulnerabilities and foster a culture of safety and accountability (Reason, 2000).

Effective coaching and feedback skills are essential when discussing the event with the medical assistant. Approaching the conversation with a non-judgmental, open-minded attitude helps sustain trust and encourages learning (Kessler et al., 2019). Using the SBI (Situation-Behavior-Impact) feedback model, one might describe the specific situation, observe the behavior objectively, and explain the impact on patient safety and legal risk. For example: “During the review of prescriptions, I noticed a bottle with my name on it that I was not involved in prescribing, which concerns me. This could lead to medication errors or liability for the practice. I’d like to understand what happened and discuss ways we can improve our process.” Providing clear expectations and collaborative problem-solving encourages accountability and continuous improvement.

Regarding implementing change, Lewin’s Theory of Planned Change offers a practical framework for this scenario. This model involves three steps: unfreezing current practices, implementing the change, and refreezing new behaviors (Lewin, 1951). Using Lewin’s approach allows for identifying resistance, engaging staff in understanding the need for change, and stabilizing new practices through reinforcement. For such a sensitive issue that involves professional accountability, Lewin’s straightforward three-step model facilitates manageable and sustainable change, making it preferable over PDSA or Kotter’s model in this context due to its simplicity and clarity.

A significant barrier to implementing change is staff resistance rooted in fear of reprimand or damage to professional rapport, especially given the long-standing relationship and rapport of the medical assistant involved. Fear of blame may inhibit open communication and willingness to adopt new protocols. Overcoming this barrier requires establishing a culture that views errors as opportunities for learning and emphasizes patient safety (Klein et al., 2018). Conversely, a facilitating factor might be the presence of a highly experienced, respected staff member who understands the importance of professional development and is motivated to maintain high standards, which can serve as an internal catalyst for change.

In conclusion, addressing the ethical and legal implications of the medication prescribing incident involves multifaceted system-based interventions, fostering organizational accountability, and promoting professional communication. Applying structured change models like Lewin’s Theory provides a practical pathway for effective and sustainable quality improvement. Overcoming barriers such as staff resistance to change through supportive leadership and a culture of continuous learning is essential for fostering safer, more compliant healthcare practices.

References

• American Medical Association. (2020). Code of Medical Ethics Opinion 9.1: Prescribing medications and controlled substances. AMA Journal of Ethics, 22(1), E36–E40.
• Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
• Bauer, J., & Curran, V. (2021). Safety and quality improvements in prescribing practices: Implementation strategies. Journal of Healthcare Quality Improvement, 35(2), 45–53.
• Kessler, R., et al. (2019). Feedback and coaching in healthcare: Strategies for improving professional performance. Medical Education, 53(3), 219–228.
• Klein, K. J., et al. (2018). Overcoming resistance to change in healthcare organizations. Healthcare Management Review, 43(4), 337–347.
• Kovner, A. R., & Knickman, J. R. (2019). The future of healthcare workforce: Challenges and opportunities. Springer Publishing.
• Lewin, K. (1951). Field theory in social science. Harper & Row.
• Reason, J. (2000). Human error: Models and management. BMJ, 320(7237), 768–770.
• U.S. Food and Drug Administration. (2021). Guidance for industry: Safe use of prescriptions. FDA.gov.