Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part One

NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study

Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part One

The case study has potential and legal implications for the medical assistant, nurse practitioner, medical director, and the practice. First, medical assistants do not have the legal mandate to engage in activities such as prescribing and refilling prescriptions. Stephanie should understand the consequences of her actions such as her license for practice being revoked because of the safety issues associated with her actions. The nurse practitioner, medical director, and practice administrator have the responsibility of ensuring that each of the personnel in the institution perform as per their scope of practice (Griffith & Tengnah, 2020). They must assess the skill levels and competencies of the medical assistants and other providers to provide the required care and communicate their limitations to them.

I will embrace some strategies to prevent potentially illegal behaviors in the future in the practice site. One of them is clarifying the roles and responsibilities of the different members involved in the patient care in the setting. The roles and responsibilities should be communicated to ensure accountability, transparency and responsibility. I will also administer staff assessment tests to determine their understanding of their expected responsibilities and consider strategies such as training them to prevent similar occurrences in the future (Varkey, 2021). Lastly, I will display the policies, standards, and regulations that guide employee behaviors in the organization to eliminate potential issues in the future.

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One of the leadership qualities that I would apply to effect a positive change in the practice is leading as an example. Nurse practitioners should demonstrate best practices that others can emulate for safety, quality, and efficiency. The other leadership quality I would apply is strengthening open communication, seeking and providing feedback to the other members of the team to ensure continuous quality improvement (Heinen et al., 2019). Lastly, I will advocate the adoption of effective leadership styles such as transformational leadership to encourage the development of the desired competencies among the care team.

Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part One References

Griffith, R., & Tengnah, C. (2020). Law and Professional Issues in Nursing. SAGE.

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Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing, 75(11), 2378–2392.

Varkey, B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical Principles and Practice, 30(1), 17–28.

You are a family nurse practitioner employed in a 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 is your next logically sound course of action? Provide evidence to support your response.

DQ 2 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part Two

Upon further investigation, you learn that Stephanie spoke with the patient and called the medication into the patient’s pharmacy without consulting with a provider. Stephanie claimed that the patient was insistent about needing a prescription. Because Mrs. Smith was coming into the office the following week for an appointment, she didn’t think you would mind if the patient received the prescription early.

Discussion Question:

What are the ethical-legal concerns associated with this situation? What is your liability in this situation, if any? What is the practice’s liability in this situation? What quality improvement strategies might you implement as an APN in this practice to safeguard your role and assure patient safety? Provide evidence to support your response.

  1. What are the potential ethical and legal implications for each of the following practice members?
    • Medical assistant: The goal of a medical assistants in a practice is to develop relationships with patients and reduce the time burden felt by providers, while keeping patients satisfied with the care and service they have been provided. In this case Stephanie has gained a great rapport with the practice patients, but Stephanie engaged in an illegal behavior when went outside her scope of practice and filled a prescription for a patient without my authorization. “The medical assistant can confirm a patient meets the refill protocol, but an authorized prescriber must approve and sign-off on the refill request prior to its transmission to the pharmacy” (Spurlock, 2019). It is not within a medical assistance scope of practice to prescribe medications to a patient. Ethically, although Stephanie attempted to promote beneficence to this patient, patient’s safety was neglected. The patient was prescribed a medication without being examined by myself or any other provider in the practice.
    • Nurse Practitioner: While I was not the one who prescribed the medication my name appeared on the medication bottle, therefore legally I am is still accountable for the care of the Mrs. Smith. Stephanies actions put my license in Jeopardy, had there been any adverse reaction to this medication there’s the potential of being charged with negligence in a malpractice suit. Ethically, as a practitioner, I pledged to do no warm, so my responsibility as a provider will be to notify Mrs. Smith of this situation. This has the potential of having Mrs. Smith seek medical care at another practice as her trust in me to provide quality care may be damaged.
    • Medical Director: The Medical Director over sees all operations to ensure that safest and best practice is being provided in the practice. That being said, this makes them a liable party legally an ethically. When a violation in the practice is committed by an employee, the medical director will be looked at for answers as to why and how this occurred. The medical director can face legal risks, professional liability, regulatory compliance and licensure board complaints (Pawlecki, et al., 2018).
    • Practice: Stephanies actions put legal implications onto the practice including that of healthcare fraud. This practice constitutes healthcare providers that are well respected for the quality of care provided to the patients. Ethically, the moral integrity of the practice is at question due to this action. This can cause patients to become reluctant in entrusting their care to the providers and potentially leave the practice.
  2. What strategies would you implement to prevent further episodes of potentially illegal behavior?

As the Nurse Practitioner I must ensure that my staff understands their role and what is within their scope of practice. Having a Board meeting with all the staff and reeducating on policies and procedures would be an initial strategy I would use in order to prevent from an incident like this reoccurring. According to Jackson (2018) it is important to have a policy in place to prevent any problems with unethical behavior and to set an ethical tone to establish what behaviors are acceptable. Establishing the expectations and setting guidelines for each specific role can also reduce the possibility of any further unethical or illegal behaviors from occurring. Secondly, there needs to be consequences for one’s actions, so written disciplinary actions by the board of directors should be implemented. Lastly, establishing management review boards to explore violations that fail to meet the code of conduct will be imperative.

3. What leadership qualities would you apply to effect a positive change in the practice?  Be thinking about the culture of the practice.

As nurse practitioners we hold and essential role in leadership. To make a positive change, I would first communicate with the staff the issues that can be implicated due to the incident. I would make sure that I  leave the conversation open for them to give any suggestions on what can be done as a team to avoid any further problems. A great way to come together as a team to rectify this ethical dilemma may include a technique called debriefing. Debriefing allows staff to talk about what happened in a safe environment, answer any questions they might potentially have. During debriefing everyone can brainstorm of ways to prevent this from happening again. Debriefing helps bridge any gaps in communication as well as gaps in guidelines (Silva et al., 2020). Furthermore, Leading my practice toward optimal care delivery is one of the most important goals as the nurse practitioner. It is imperative to have my staff understand that this is achieved by upholding ethical nursing standards. The integrity of the practice was jeopardized by this incident, nonetheless as the NP I would continue to provide support to my team through any tough ethical decisions they may be faced with.


Jackson, N. M. (2018). DO THE RIGHT THING: To minimize fraud, institutions are implementing trickledown prevention strategies to promote a culture of ethical decision making and practices. Business Officer, 52(2), 38-41. to an external site.

Pawlecki, J. B., Burton, W. N., Christensen, C., Crighton, K. A., Heron, R., Hudson, T. W., … Roomes, D. (2018). Role and Value of the Corporate Medical Director. Journal of Occupational and Environmental Medicine, 60(5). https://doi:10.1097/jom.0000000000001326Links to an external site.

Silva, M., Tanqueiro, M., Veríssimo, C., Neves, M., Cruzeiro, C., & Coutinho, V. (2020). Evaluation of structured debriefing as a pedagogical strategy in family health nursing. 5(2). https://doi:10.12707/riv19081Links to an external site.

Spurlock, D. (2019). When “Little Is Known” Is Not Entirely True. Journal of Nursing Education, 58(5), 257–259.

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