NR 506 Week 5: Ethical and Legal Implications

Sample Answer for NR 506 Week 5: Ethical and Legal Implications Included After Question

Preparing the Discussion

You are a family nurse practitioner working in an outpatient primary care office of a large hospital system. The practice has been operating for over 15 years, and many of the administrative and clinical staff were hired when the practice opened. You have been in the practice for less than 3 months. In that short amount of time, you have witnessed several of the clinical staff engaging in heated arguments with each other, sometimes in patient areas. You overhear an argument occurring today between two staff. You pick up a patient’s chart and notice a very low blood pressure that the medical assistant failed to notify you about. When you confront the MA, she states that she was going to report the vital signs to you when she became engaged in the heated argument you overheard and forgot to notify you. 

Unfortunately, this pattern of behavior is not unusual in this practice. Working with staff who cannot cooperate effectively can negatively influence your ability to spend time with patients, can impede the flow of patients through the office, and could impact patient safety. 

Case Study Responses: 

1. Analyze the case study for potential issues for members of the healthcare team from office conflict. Contrast the potential effects for each member of the healthcare team based on the required readings from the week. Discuss the potential ethical and legal implications for each of the following practice members: 
   1. Medical assistant
   1. Nurse Practitioner
   1. Medical Director
   1. Practice
2. What strategies would you implement to prevent further episodes of potentially dangerous patient outcomes? 
3. What leadership qualities would you apply to effect positive change in the practice? Focus on the culture of the practice.
4. A scholarly resource must be used for EACH discussion question each week.

A Sample Answer For the Assignment: NR 506 Week 5: Ethical and Legal Implications

Title: NR 506 Week 5: Ethical and Legal Implications

It is difficult to work in an environment that is considered toxic due to verbal confrontations, unprofessional behavior, and heated disagreements. This environment can make workers feel unhappy when entering work, reduce efficiency, and severely impact patient safety. In the situation with the patient’s low blood pressure, I as the nurse practitioner was not alerted to the blood pressure due to a heated argument that the medical assistant got pulled into. In a professional environment there should be a leader that guides the practice, in order to prevent workplace conflicts from spinning out of control.

Medical Assistant-

Medical assistants in an office environment are responsible for checking patients in, obtaining vital signs, and assisting with clerical duties (AAMA, 2023). It is therefore important for them to be able to communicate data to the nurse or nurse practitioner responsible for patient treatment. The medical assistant in this scenario failed to deliver important information about the patient’s blood pressure. This is all we know about the situation with the patient. The patient may be having an emergency and low blood pressure is a key indicator of something dire. While the medical assistant is engaged in the heated argument, the patient is awaiting treatment without the information being passed along as it should. As the NP I would be extremely disappointed in the medical assistant for not delivering the important patient information. Through negligence the patient is placed in harm’s way and that would make it very difficult to trust the medical assistant to follow through with their duties. I don’t completely blame the medical assistant but there is a serious issue with this practice due to workplace conflict and lack of leadership. As I stated, the patient could have been harmed and we don’t know what happened to the patient from the low blood pressure being left untreated.

Nurse Practitioner-

According to the AANP (2023) nurse practitioners undergo rigorous national certification, periodic peer review, and training to ensure the highest quality of care to patients. Education is at a master’s level at minimum and involvement in professional development, organizations, and participation in health policy activities adds to their credibility (AANP, 2023). I understand that conflict can occur in any environment where many people come together, all with different personalities. My issue is when these people cannot pull together as a team to care for the patients in a safe and respectable manner. Arguments in the facility work to diminish the credibility of the practice and the nurse practitioner. When a patient is neglected because important information is not passed on, patient harm can occur causing the patient to sue the practice for malpractice related to negligence. It is the nurse practitioner who can be held responsible when all is said and done. When looking at these situations it is important to acknowledge how this situation could impact the patient and the nurse practitioner’s ability to practice because patient treatment is the responsibility of the NP. Being at the practice for 3 months may make it difficult to speak up against the unprofessional behavior but it will be necessary, to protect the NPs credibility and licensure. Patient safety is the most important responsibility of the NP, and failure to preserve that can result in a lawsuit, termination, or imprisonment.

Medical Director-

A medical director is responsible for the patient’s best interest through use of medical knowledge to provide competent medical care with compassion and follow medical principles (AMA, 2023). Through these principles it is clear that the medical director should have respect for patients and colleagues by upholding standards of professionalism in the practice (AMA, 2023). If this is true of the responsibilities of a medical director then it is safe to assume that this medical director is not holding up to the standards, ethical principles, and responsibilities bestowed on a physician assuming this responsibility. There is poor leadership in this practice, and it shows through the numerous conflicts, heated arguments, and patient safety concerns that are occurring. As the NP new to the practice, I am now observing the toxicity of the working environment but question how staff members feel comfortable enough to have heated arguments close to patient areas. What are the consequences for such behaviors? How long have these conflicts been occurring? The medical director shares responsibility for negligence resulting from information not being shared, and possible patient harm. The medical director is also responsible for conflict resolution, which is not happening in this case study. When there are a multitude of problems in a facility, the first person held responsible during a malpractice suit is the leader, and in this case, it is the medical director. The medical director in this case study could be held responsible, could be terminated, and could face charges related to negligence.

Practice-

It says in the case study that this is not the first-time arguments were observed and at this point, it is a possibility that patients have heard disagreements. I know that as a patient if I went to a facility and the staff were having heated arguments, I would not be confident in their care for me. I would feel that they are unprofessional and incapable of treatment due to distraction not appropriate for the working environment. Knowing that conflicts are resolved through arguments that have no boundaries is concerning for a patient and can make it difficult for other staff members to take pride in working there. The practice would be held ultimately responsible for any damages that occurred through patient harm because it is through the practice that malpractice insurances are obtained. They would need to reconsider the type of staff members working there and work on conflict resolution to change the environment. The credibility, safety, and reputation of the practice could be called into question if more than one patient has experienced the arguments happening. Within a 3-month period the new NP has already seen several arguments. Now a days the internet is important and negative reviews could greatly influence the ability of the practice to generate income. If they have had more than one issue with patient safety, they could face issues with insurance reimbursement. Worst case scenario is the practice could be shut down.

Strategies-

In the health professional environment, conflict can be disruptive, inefficient, and greatly impact patient safety. Healthcare systems are more complex than ever before, and it is necessary to change how professionals engage and work together. Stating that everyone should be friends is a simple way to understand that performance is correlated to teamwork (Eichbaum, 2018). The initiation of open discussion can be helpful in the correct environment, such as during a team meeting, where everyone is able to state their concerns. The effectiveness of the team’s ability to collaborate directly affects performance and team member frustration. Conflict is not always a bad thing and when controlled it can help to become a source for learning and new ideas, for example, an argument about a safety concern can help staff to come up with ideas to fix the issue together. Building trust is necessary to assist staff in working as a team and engaging constructively to find solutions. An issue that can occur in a working environment is power hierarchies where older staff may assume they are in charge, instead of participating in a democracy to work out issues. Conflicts can arise in these situations when those who haven’t established status speak up. A strong leader will encourage all parties to communicate, giving new employees a voice and minimizing domineering tendencies of older staff (Eichbaum, 2018).

Leadership-

Finding a leadership style that will assist with conflict management is necessary in this case study. I suggest democratic leadership because it is a style that allows for increased communication with leaders and staff to ensure open communication. Democratic leadership follows an egalitarian point of view, with the principal belief being equality and participation (Barthold et.al., 2022). In this leadership style the leader allows and welcomes team participation, opening discussions to help with decision making. I feel that this type of leadership is beneficial to conflict management and will help to channel the voices of the frustrated office staff in a way that is more constructive to their working environment and beneficial to the practice. According to Barthold et. al. (2022) the duty of leaders is to remove barriers that prevent open dialogue. In this case scenario an issue may be that some of the staff is domineering newer members and the leader is not allowing for new staff to have a voice. This would cause a conflict in the office when newer staff speak up. Opening an arena where voices can be heard reduces conflict and frustration through communication. Lack of communication will damage team member trust and collaboration resulting in internal and external conflicts, burnout, and frustration for the work environment. Having democratic leadership will change the culture of the practice to a culture of sharing information, good communication, trust, and collaboration. The leader should establish meetings where staff can speak up each month. Keeping an open door policy to hear concerns can be helpful in resolving conflicts before they turn into heated arguments. New policies can be developed to let employees know that certain behaviors are not tolerated but there is an outlet for communications to build trust.

References:

American Association of Nurse Practitioners (AANP) (2023) What’s a Nurse Practitioner. Retrieved from https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner

AAMA. (n.d). What is a Medical Assistant. Retrieved in 2023 from https://www.aama-ntl.org/medical-assisting/what-is-a-medical-assistant#:~:text=Preparing%20patients%20for%20examinations,about%20medication%20and%20special%20diets

AMA. (2023). Ethical Obligations of a Medical director. Retrieved from https://code-medical-ethics.ama-assn.org/ethics-opinions/ethical-obligations-medical-directorsLinks to an external site.

Barthold, Checchi, M., Imas, M., & Smolović Jones, O. (2022). Dissensual Leadership: Rethinking democratic leadership with Jacques Rancière. Organization (London, England), 29(4), 673–691. https://doi.org/10.1177/1350508420961529

Eichbaum. (2018). Collaboration and Teamwork in the Health Professions: Rethinking the Role of Conflict. Academic Medicine, 93(4), 574–580. https://doi.org/10.1097/ACM.0000000000002015

In the scenario listed above, there seems to be a breakdown in a healthy work environment that has been noticed since arriving as a new FNP to the practice over the three-month period.  After assessing the current situation, it would be my responsibility to focus immediately on the patient’s safety.  This would include retaking the patient’s blood pressure, providing appropriate treatment while involving necessary team members.  Once the patient’s condition is under control, next would be to evaluate the situation more clearly.  Who was involved and under what context did the situation arise that impacted patient safety.  While talking privately with each participant, documentation of the incident needs to be clear with all parties involved with detailed account of the facts and potential consequences.  According to DuBois et al. (2018), by tracking professional violations, it allows for transparent evaluation and steps can be recommended to improve quality of care.  There are several ethical and legal implications included for the medical assistant (MA), Nurse Practitioner (NP), Medical Director, and practice. 

Ethical implications for the MA include being able to prioritize patient well-being.  As the FNP was not notified of a decreased blood pressure, it put the patient’s health at risk. While it is the role of the FNP to promote competent care, it is also their responsibility to provide the framework of ethical caring behaviors amongst staff members (Martinez, 2021). For medical directors, it is ultimately their responsibility to ensure quality of care and patient safety while upholding professional standards.  This includes staff with a commitment to core values including caring for persons, competence, altruism, and compassion.  (DuBois, 2018).  Finally, the practice must ethically be responsible for having policies and procedures in place to face ethical issues, especially handling potential breakdowns in ethical guidelines by staff members.    

Legal implications must be considered as well.  For the MA, FNP, MD, and practice, all must maintain professional standards.  If any team member demonstrates disregard for the well-being of others, they pose a threat to patients that can easily lead to legal issues.  Patterns of behavior that go against the goals of medicine should be considered gross negligence thus allowing medical and nursing boards to suspend or permanently revoke licenses (DuBois, 2018).  This includes the licenses of participants in the care of this individual especially if harm was caused.  According to Sage et al. (2020), when there is a continued history of medical malpractice, there may be a larger medical liability problem in the future.  This can harm the practice as medical lawsuits are expensive and malpractice insurance may not cover high damage awards resulting in substantial financial loss. 

Strategies to implement in the current situation would be to first take disciplinary action if the investigation confirms neglect.  These measures would depend on the policies and procedures of the practice.  Other measures that can be taken would be to use this situation as an education lesson providing reinforcement on expected professional conduct.  This may include retraining staff members, counseling, suspension, and maybe termination depending on the severity of the situation.  It is important that open communication be open throughout the process. 

Next, a new culture may be necessary for improving positive work environment within this setting.  As the FNP, behaviors that promote incivility cannot be ignored. According to Martinez (2018), incivility can affect recruitment as well as staff making medical errors. There should be clearly defined policies that describe bullying behaviors, how to report, and penalties for perpetrators.  Facilities should provide competencies that include healthy team collaboration. 

As a transformational leader, when developing a positive environment there are fewer occurrences of adverse events.  Transformational leadership promotes trust and respect of leadership promoting motivation towards organizational goals.  Building a positive staff culture supports practice environments (Boamah, 2018).

Boamah, S. (2018). Linking Nurses’ Clinical Leadership to Patient Care Quality: The Role of Transformational Leadership and Workplace Empowerment. Canadian Journal of Nursing Research, 50(1), 9–19. https://doi.org/10.1177/0844562117732490

DuBois, J.  Anderson, E., Chibnall, J., Diakov, L., Doukas, D., Holmboe, E., Koenig, H., Krause, J. H., McMillan, G., Mendelsohn, M., Mozersky, J., Norcross, W, & Whelan, A. (2018). Preventing egregious ethical violations in medical practice: Evidence-informed recommendations from a multidisciplinary working group. Journal of Medical Regulation, 104(4), 23–31. https://doi.org/10.30770/2572-1852-104.4.23Links to an external site.

Martinez, O. (2021). Incivility: A Persistent Problem in Nursing. Tennessee Nurse, 84(3), 11–11.

Sage, W., Boothman, R., & Gallagher, T. (2020). Another medical malpractice crisis?: Try something different. JAMA : the Journal of the American Medical Association, 324(14), 1395–1396. https://doi.org/10.1001/jama.2020.16557Links to an external site.

In the scenario listed above, there seems to be a breakdown in a healthy work environment that has been noticed since arriving as a new FNP to the practice over the three-month period.  After assessing the current situation, it would be my responsibility to focus immediately on the patient’s safety.  This would include retaking the patient’s blood pressure, providing appropriate treatment while involving necessary team members.  Once the patient’s condition is under control, next would be to evaluate the situation more clearly.  Who was involved and under what context did the situation arise that impacted patient safety.  While talking privately with each participant, documentation of the incident needs to be clear with all parties involved with detailed account of the facts and potential consequences.  According to DuBois et al. (2018), by tracking professional violations, it allows for transparent evaluation and steps can be recommended to improve quality of care.  There are several ethical and legal implications included for the medical assistant (MA), Nurse Practitioner (NP), Medical Director, and practice. 

Ethical implications for the MA include being able to prioritize patient well-being.  As the FNP was not notified of a decreased blood pressure, it put the patient’s health at risk. While it is the role of the FNP to promote competent care, it is also their responsibility to provide the framework of ethical caring behaviors amongst staff members (Martinez, 2021). For medical directors, it is ultimately their responsibility to ensure quality of care and patient safety while upholding professional standards.  This includes staff with a commitment to core values including caring for persons, competence, altruism, and compassion.  (DuBois, 2018).  Finally, the practice must ethically be responsible for having policies and procedures in place to face ethical issues, especially handling potential breakdowns in ethical guidelines by staff members.    

Legal implications must be considered as well.  For the MA, FNP, MD, and practice, all must maintain professional standards.  If any team member demonstrates disregard for the well-being of others, they pose a threat to patients that can easily lead to legal issues.  Patterns of behavior that go against the goals of medicine should be considered gross negligence thus allowing medical and nursing boards to suspend or permanently revoke licenses (DuBois, 2018).  This includes the licenses of participants in the care of this individual especially if harm was caused.  According to Sage et al. (2020), when there is a continued history of medical malpractice, there may be a larger medical liability problem in the future.  This can harm the practice as medical lawsuits are expensive and malpractice insurance may not cover high damage awards resulting in substantial financial loss. 

Strategies to implement in the current situation would be to first take disciplinary action if the investigation confirms neglect.  These measures would depend on the policies and procedures of the practice.  Other measures that can be taken would be to use this situation as an education lesson providing reinforcement on expected professional conduct.  This may include retraining staff members, counseling, suspension, and maybe termination depending on the severity of the situation.  It is important that open communication be open throughout the process. 

Next, a new culture may be necessary for improving positive work environment within this setting.  As the FNP, behaviors that promote incivility cannot be ignored. According to Martinez (2018), incivility can affect recruitment as well as staff making medical errors. There should be clearly defined policies that describe bullying behaviors, how to report, and penalties for perpetrators.  Facilities should provide competencies that include healthy team collaboration. 

As a transformational leader, when developing a positive environment there are fewer occurrences of adverse events.  Transformational leadership promotes trust and respect of leadership promoting motivation towards organizational goals.  Building a positive staff culture supports practice environments (Boamah, 2018).

Boamah, S. (2018). Linking Nurses’ Clinical Leadership to Patient Care Quality: The Role of Transformational Leadership and Workplace Empowerment. Canadian Journal of Nursing Research, 50(1), 9–19. https://doi.org/10.1177/0844562117732490

DuBois, J.  Anderson, E., Chibnall, J., Diakov, L., Doukas, D., Holmboe, E., Koenig, H., Krause, J. H., McMillan, G., Mendelsohn, M., Mozersky, J., Norcross, W, & Whelan, A. (2018). Preventing egregious ethical violations in medical practice: Evidence-informed recommendations from a multidisciplinary working group. Journal of Medical Regulation, 104(4), 23–31. https://doi.org/10.30770/2572-1852-104.4.23Links to an external site.

Martinez, O. (2021). Incivility: A Persistent Problem in Nursing. Tennessee Nurse, 84(3), 11–11.

Sage, W., Boothman, R., & Gallagher, T. (2020). Another medical malpractice crisis?: Try something different. JAMA : the Journal of the American Medical Association, 324(14), 1395–1396. https://doi.org/10.1001/jama.2020.16557Links to an external site.

5. Grading Rubric

Discussion Criteria	 A (100%) Outstanding or highest level of performance 	B (87%) Very good or high level of performance	C (76%) Competent or satisfactory level of performance	F (0) Poor or failing or unsatisfactory level of performance
Answers the initial graded threaded discussion question(s)/topic(s), demonstrating knowledge and understanding of concepts for the week. 16 points	Addresses all aspects of the initial discussion question(s) applying experiences, knowledge, and understanding regarding all weekly concepts.16 points	Addresses most aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of most of the weekly concepts.14 points	Addresses some aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of some of the weekly concepts.12 points	Minimally addresses the initial discussion question(s) or does not address the initial question(s).0 points
Integrates evidence to support discussion. Sources are credited.* ( APA format not required) 12 points	Integrates evidence to support your discussion from:assigned readings** OR online lessons, ANDat least one outside scholarly source.***Sources are credited.*12 points	Integrates evidence to support discussion from:assigned readings OR online lesson.Sources are credited.*10 points	Integrates evidence to support discussion only from an outside source with no mention of assigned reading or lesson.Sources are credited.*9 points	Does not integrate any evidence.0 points
Engages in meaningful dialogue with classmates or instructor before the end of the week. 14 points	Responds to a classmate and/or instructor’s post furthering the dialogue by providing more information and clarification, thereby adding much depth to the discussion.14 points	Responds to a classmate and/or instructor furthering the dialogue by adding some depth to the discussion.12 points	Responds to a classmate and/or instructor but does not further the discussion.10 points	No response post to another student or instructor.0 points
Communicates in a professional manner. 8 points	Presents information using clear and concise language in an organized manner (minimal errors in English grammar, spelling, syntax, and punctuation).8 points	Presents information in an organized manner (few errors in English grammar, spelling, syntax, and punctuation).7 points	Presents information using understandable language but is somewhat disorganized (some errors in English grammar, spelling, syntax, and punctuation).6 points	Presents information that is not clear, logical, professional or organized to the point that the reader has difficulty understanding the message (numerous errors in English grammar, spelling, syntax, and/or punctuation).0 points
PARTICIPATION: Response to initial question: Responds to initial discussion question(s) by Wednesday, 11:59 p.m. M.T.	0 points lostStudent posts an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.		-5 pointsStudent does not post an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.
PARTICIPATION Total posts: Participates in the discussion thread at least three times on at least two different days.	0 points lostPosts in the discussion at least three times AND on two different days.		-5 pointsPosts fewer than three times OR does not participate on at least two different days.