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

Chamberlain University NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study   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 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study              

Whether one passes or fails an academic assignment such as the Chamberlain University NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study  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 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study              

The introduction for the Chamberlain University NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study  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 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study              

After the introduction, move into the main part of the NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study 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 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study              

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

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

What are the potential ethical and legal implications for each of the following practice members? 

-Medical assistant

The medical assistant works in outpatient, ambulatory care facilities, and medical offices, working with physicians to perform administrative and clinical duties. They are responsible for obtaining medical histories, explaining treatments or procedures to patients, assisting during patient examinations, collecting lab specimens, EKGs, phlebotomy, preparing and administering medications. Administrative duties include computer use, filing, coding, scheduling appointments, and insurance authorizations (AMA, 2023). On a national level they can perform these duties but cannot write prescriptions, treat patients, diagnose, or use other providers’ information to prescribe. This is considered illegal activity and what Stephanie did was unacceptable. As a medical assistant Stephanie is supposed to keep patients safe and she acted outside of her scope of practice. She treated a patient with a medication- Amoxicillin, that she could have mistakenly worsened the patient condition, caused an allergic reaction, inappropriately dosed the patient, and caused irreparable harm to the patient, all while using the NPs information to illegally prescribe that medication. Stephanie could be terminated from her position, lose her medical assistant license, monetary penalties, or face jail time for impersonation of a nurse practitioner. An advanced practice nurse is a person who holds certification in accordance with section 8 or 9 of P.L.1991, c.377 (NJ Division of Consumer Affairs, 2020). Not to mention that if the patient were harmed the medical assistant could face a lawsuit for impersonation of a provider and unintentional harm to a patient. This is unethical as the medical assistant is practicing medicine illegally.

-Nurse Practitioner

The nurse practitioner in this scenario is at risk of losing her license, being involved in a lawsuit, and facing other damages. A national provider identifier (NPI) acts like a social security number, allowing the provider to prescribe medications and place orders. It is dangerous to prescribe medications without seeing your patient and assessing them. In this case study the NP had no idea that the medication was being prescribed to Mrs. Smith without her authority. Although this was fraud, it could become difficult to prove that the prescription was given by Stephanie and not the nurse practitioner. Stephanie committed fraud and theft by using the NPI number of the nurse practitioner and acting outside of her scope of practice. According to Capozzola et.al., 2018) there was a similar situation where a physician prescribed a narcotic and muscle relaxant to a patient without seeing the patient prior to prescribing. The patient had a heart condition and ended up drinking before taking both the medications. The provider who did not see the patient never had a chance to do a workup or assess the patient. The patient involved expired with an autopsy performed, which indicated the cause of death was due to cardiac reasons, drug, and alcohol toxicity. The patient’s daughter sued the physician for negligence and medical malpractice resulting in wrongful death (Capozzola et.al., 2018). This is just an example of what can happen when medications are prescribed unsafely.

-Medical Director

The medical director can face a lawsuit due to patient harm, fraud, and theft. This is the first time that someone caught Stephanie using an NPI number to prescribe medication, act out of her scope of practice, impersonate a provider, and practice medicine illegally. The case study doesn’t reference whether she has done this before or if the patient experienced any harm. The issue is Stephanie is aware of her role, ethics, and her scope of practice, yet she still acted unethically. The medical director will have to decide to protect the practice and its employees. There will need to be a decision about pressing charges for violating the law, impersonation, and fraud. Stephanie will most likely be terminated and could face legal charges.

-Practice

The practice is at risk of malpractice, especially if this patient was harmed or if Stephanie has done this before. This is a serious situation. Prescribing the wrong medication is considered negligence and there is a reason why an individual needs extensive education and to pass the boards prior to being able to prescribe medications. In the case study introduced by Capozzola et. al. (2018) the patient’s daughter sued the physician and the practice for patient harm, negligence, and malpractice. In that situation she didn’t win the lawsuit because the patient was educated on the medication and side effects. In these situations, a practice can face harsh monetary penalties, settlements in favor of the patient, and possible close down. The practice will have to take extreme measures to prevent this situation from occurring. Although Stephanie is knowledgeable and was considered an asset, she has become a liability risk for the practice. She will most likely face termination for what she did. To prevent these issues from happening again, the practice will need to enforce new policies restricting employees.

What strategies would you implement to prevent further episodes of potentially illegal behavior? 

In order to prevent potentially illegal behavior, it is important to understand each individual’s scope of practice and have an appreciation for the code of ethics; doing no patient harm. The practice should hire people with a clear understanding of their role and a commitment to core values evolved from the code of ethics. Recommendations include recruitment of staff that embrace core values of medicine, practicing compassion, re4specft for patient autonomy, competence, and caring for all patients. Educate leaders to create a professional integrity culture within the practice (DuBois et. al., 2018). Through establishing a practice culture, everyone has a clear understanding of professional standards and expectations. Increase oversight from providers on colleagues to prevent mistakes. It is important for staff to work independently but they should be supervised by higher ups to ensure patient safety, adherence to practice policies, and ethics. Tracking serious errors and placing consequences is important to avoid situations where staff work outside of their defined scope of practice. Tracking consequences enables evaluation by state boards and other disciplines (DeBois et.al., 2018).

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

Leadership is one of the most important qualities in a medical practice because it defines a standard and helps in the development of a culture. Leading through example can show other staff members the way they should act, interact with patients, handle patient concerns, and follow policy. Center for Creative Leadership (2023) explains that there are 3 Cs of change- Communication, Collaboration, and Commitment. Communication through successful leadership is about understanding organizational values, urgency for change, and the explanation of benefits directing people to embrace a positive change. Collaboration unites people in working toward change. Leaders work with employees to cross boundaries and remove unhealthy competition. Employees should be included in decision making processes early on and commit to the change process. Commitment made through successful leadership is conveyed through support in the change, stepping outside of comfort zones, and embracing common values shared within the facility (Center for Creative Leadership, 2023). It isn’t easy to enact change, especially when a practice has been doing things the same way for a very long time. Having a strong leader capable of listening, understanding, and presenting the way is important to creating change. People are scared of changes and may remain reserved, but a successful leader will guide them and find ways for them to be involved in decision making.

Reference:

AMA. (n.d). What is a Medical Assistant. Retrieved 2023

Capozzola, Jamie Terrence, & Lynch, M. (2018). Physician Defeats Liability for Prescribing Without In-person Consultation. Healthcare Risk Management, 40(8).

Center for Creative Leadership (2023) How to Be a Successful Change Leader. Retrieved https://www.ccl.org/articles/leading-effectively-articles/successful-change-leader/

DuBois, Anderson, E. A., Chibnall, J. T., Diakov, L., Doukas, D. J., Holmboe, E. S., Koenig, H. M., Krause, J. H., McMillan, G., Mendelsohn, M., Mozersky, J., Norcross, W. A., & Whelan, A. J. (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/10.30770/2572-1852-104.4.23 NJ Division of Consumer Affairs. (2020). NJ Board of Nursing Statutes. Retrieved https://www.njconsumeraffairs.gov/Statutes/nursing-law.pdfLinks to an external site.

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

Medical Assistant 

Cross-trained medical assistants are only capable of performing clinical and organizational tasks. As a result of the lack of prescriptive authority, Stephanie, the medical assistant, was practicing beyond the scope of her training. There is a violation of both federal and state laws (AAMA 2019). Patients should be treated with nonmaleficence by a medical assistant. Medical assistants are responsible for keeping patient records, collecting data, and collecting lab specimens in primary care settings. Based on both an ethical and legal perspective, Stephanie behaved outside her field of experience in the case study. Because Stephanie made a medical decision without having the appropriate medical or nursing experience to prescribe amoxicillin to Mrs. Smith, she committed immoral acts that may have resulted in unintended patient damage and maleficence. The nurse practitioner’s license was used to treat Mrs. Smith by Stephanie who impersonated a nurse practitioner, forged the APRN’s signature on the script, and abused her diagnostic and prescriptive powers. In the state of Illinois, Stephanie may be terminated or revoked for her actions, pay monetary penalties, spend time in prison, and be unable to work as a medical assistant (Illinois Department of Financial and Professional Regulation, n.d.).

Nurse Practitioner

Medical Assistant Stephanie’s improper use of authoritarian power has now presented an ethical dilemma for the nurse practitioner. This would therefore constitute malpractice, with legal and ethical repercussions for the nurse practitioner. A nurse practitioner faces legal repercussions for not practicing justice in this case. She should discuss her concerns with her and decide how to handle the situation. It is unknown whether Stephanie knew about the danger she was putting the patient in and she has put the NP profession at risk. A nurse practitioner has an ethical obligation to assess the patient’s condition and choose the appropriate medication before deciding on drug treatment. Liability for negligent supervision is one of the legal consequences for the nurse practitioner (Illinois Department of Financial and Professional Regulation, (n.d.)). When a nurse practitioner forges a prescription on their behalf, they are morally and legally responsible for informing the medical assistant. The NP may be sued for malpractice and/or negligence. The nurse practitioner’s treatment falls short because the patient was not assessed until he was prescribed amoxicillin. We don’t know if the patient needed amoxicillin. The patient was not harmed, according to the case report. If the patient was not harmed, the NP might be charged with neglect rather than malpractice.

Medical Director

It will be an ethical dilemma for the Medical Director to decide how to deal with the problems. Despite the fact that the patient was in danger, it’s not stated whether or not the situation impacted the patient. Stephanie’s medical assistance was not harmful, and the next question is whether it should be reported or handled in the clinic (Weiss, 2022). The Medical Director may be penalized for violating state and federal laws. In the event that a patient was injured or died, a lawsuit would be filed against the organization, the NP, and the Medical Assistant. It is possible that fraud charges are based on reimbursements for services that did not take place.

Practice

Medical assistants must be disciplined, such as termination and legal action, to avoid the recurrence of this incident. An unethical act could result in the practice being closed if a certain number of complaints are filed with the medical board. Furthermore, ethical issues arise regarding information disclosure and mandatory reporting, as well as patient safety implications. There is a sense of moral obligation associated with medicine prescriptions in this practice. To minimize medication errors and ensure the safety of patients, appropriate technologies should be used, such as prescribing software and electronic drug references. 

• In order to determine the reason Stephanie prescribed Mrs.Smith medication, the first step would be to investigate thoroughly. If an illegal situation arises, such as this one, I will implement a policy. All members should be reminded to review their guidelines and job descriptions. The scope of practice for each employee will be reviewed and explained in meetings with all employees. At that point, I will follow up with all employees to ensure that their understanding has been conveyed properly. An employee will be retrained if he or she needs help understanding. It will be inspected periodically to see if the work environment is conducive to productivity. Every employee will be able to see and read the policies displayed around the office. In order to prevent a similar incident from happening again, a protocol would be developed based on ethical and legal guidelines. If someone breaks the rules, disciplinary action will be taken (Atkinson, 2019).  By leading by example, I would be able to effect a positive change in the practice. In my role as a role model, I will set an example of positive behavior. Respecting all staff members and communicating effectively would be my top priorities. I would also actively listen to all member’s concerns. As part of my efforts to establish a culture of accountability for all actions and failures within the practice, I would also consult with the team about future decisions (Aboramadan & Dahleez, 2020). 

References- 

AAMA. (2019). Disciplinary Standards and Procedures. Disciplinary standards and procedures. http://aama-ntl/cma-aama-exam/faqs-certification/disciplinary-standards.

Aboramadan, & Dahleez, K. A. (2020). Leadership styles and employees’ work outcomes in nonprofit organizations: the role of work engagement. The Journal of Management Development, 39(7/8), 869–893. https://doi.org/10.1108/JMD-12-2019-0499

Atkinson. (2019). Preparing physicians to contend with the problem of dual loyalty. Journal of Human Rights, 18(3), 339–355. https://doi.org/10.1080/14754835.2019.1617121Links to an external site.

Nurses. (n.d.). https://idfpr.illinois.gov/profs/nursing.html

Weiss. (2022). Duty to Report Incompetent Physicians. American Family Physician, 106(4), 450–452.

Sample Answer 3 for NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study

I actually did not know that in some states NPs cannot delegate to MAs. This makes me wonder if an NP were to work in the ER, are they unable to delegate to ERTs? Currently I work in the ER and I see stroke NPs or GU NPs delegate to other RNs, however I haven’t observed any orders given directly to ERTs. Although, this may be because the RN is readily available. I will definitely make sure to inform myself on what MAs can do in the state I practice and if I am able to delegate to them. The llinois Practice Act states, “delegating selected nursing activities or tasks to a license practical nurse, a registered professional nurse, or other personnel” (IPA, 2018). I would assume under that part of the act that NPs can delegate to MAs and ERTs, if needed. As stated in the video, it is important to know your staff and their respective scope of practice. I am used to working in the ER, we all help and work together however possible. However, in a private practice it may not be the same way.

Reference:

Illinois Nurse Practice Act (225 ILCS 65/65-30). (n.d.). http://www.aama-ntl.org/docs/default-source/legal/il-np-delegation.pdf?sfvrsn=4

Sample Answer 4 for NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study

This was a great and informative video to watch. I plan on sharing with friends and coworkers who are NPs and those like myself who are working towards it. I had no idea about the different types of malpractice insurance that were available. As NPs we have  a responsibility in protecting ourselves and our patients, by making sure that the malpractice insurance coverage we have is sufficient for the professional health care services we provide (Heuer, et al., 2019). Many malpractice lawsuits don’t take place until several years after the incident occurred. Pointing out these different types of insurance and how to make sure we are properly covered was extremely helpful. Living in the state of New Jersey and the limitations they have on NPs, we will more than likely work for a group or provider rather than independently. Although an employer may provide malpractice insurance coverage, having the knowledge of what will be covered by the employer is imperative in order to properly protect ourselves and our license and deciding whether or not we will need individual malpractice insurance.

References

Heuer, B., Cavender, J. D., Lofgren, M., & Dihigo, S. (2019). NAPNAP position statement on malpractice insurance for Nurse Practitioners. Journal of Pediatric Health Care, 33(4). https://doi.org/10.1016/j.pedhc.2019.02.012Links to an external site.