NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part One
NR 510 Week 4: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Part One
My immediate action is to address the patient’s reason for the visit. According to Mitchell and Oliphant (2016), I have a responsibility to conduct a comprehensive patient interview or consultation before prescribing any medications. While there are ethical issues with what Stephanie did, even though her intentions were good, this must be addressed in private later. Mrs. Smith has already taken a prescribed dose of amoxicillin for her cough. If the amoxicillin has not cleared up the cough, I should not provide her with a refill order just yet. This may have been the wrong medicine to prescribe for a cough in the first place. For one, if Mrs. Smith felt comfortable with Stephanie calling in a prescription order without the doctor’s consent, this may not be the first time she has been prescribed an antibiotic without being checked-out first. Mrs. Smith may have developed a resistance to the antibiotic. Norris et al. (2013) state antibiotic resistance is a serious, growing threat that causes the bacteria in patients’ bodies to become immune to the antibiotics medicinal properties. Many respiratory conditions are viral infections not bacteria-based illnesses, and Mrs. Smith may not have known that antibiotics only work against bacteria. There are many possible factors as to why Mrs. Smith has developed a chronic cough. I should conduct her physical exam and ask her questions about her cough (when it developed, the type of cough like wet or dry, does the patient smoke, any shortness of breath, has she taken any medication other than amoxicillin to treat the cough). I should then draw Mrs. Smith’s blood to send to lab for testing to determine if she has become resistant to amoxicillin. Also, during her physical, I can see if movement or exertion prompt her to cough. Once the physical has been performed and cough symptoms evaluated, I will take medications, past health history, and any present conditions I have recognized during the physical into consideration then decide on the best cough treatment plan. Once the patient has been taken care of, I will create thorough notes to document the visit, my findings and actions, and Stephanie’s actions then report what has occurred to the primary physician and office manager.
Reference
Mitchell, A., & Oliphant, C. M. (2016). Responsibility for ethical prescribing. The Journal for Nurse Practitioners, 12(3), A20. Retrieved from DOI: https://doi.org/10.1016/j.nurpra.2016.01.008Links to an external site.
Norris, P., Chamberlain, K., Dew, K., Gabe, J., Hodgetts, D., & Madden, H. (2013). Public beliefs about antibiotics, infection and resistance: A qualitative study. Antibiotics, 2(4), 465-476. doi:10.3390/antibiotics2040465
I agree that this may not have been the first time Stephanie did this. It would seem unlikely to me that she would tell the patient she was doing it without the knowledge of the NP. I feel like it would of been something she may have mentioned that she was going to have the NP call something in. I also agree that if she is requesting more antibiotic then it was possibly the wrong medication for her cough. Perhaps it was just a virus. I know patients are always requesting an antibiotic for any and everything that is wrong with them. I once had a patient insist on an antibiotic for being dehydrated. Even filed a formal complaint to the president of the hospital because she did not receive the antibiotic. With patients being so quick to threaten legal action or complain, it is likely Stephanie did what she did to attempt to keep the patient from complaining.
Instructor Storm,
You asked if having a staff meeting and addressing it with all the MAs would be a better approach than a one on one meeting. For some things I think this may be acceptable, however in this situation I believe that both would be appropriate. If it was me I would have a meeting with all the MAs and a separate meeting with Stephanie. This is not something I feel should be left to a simple warning. This is too serious of a matter. Having one group meeting would be like giving Stephanie the thinking that it was not that serious and she may continue to do this. Next time it could be a stronger medication or something that would cause a bad reaction. So I definitely think disciplinary action is in order. Even if it is just a first offence.
I am glad that you brought up looking at Stephanie’s reasoning or mindset about the situation. I think you are right that Stephanie was trying to help or avoid a confrontation with the patient, but Stephanie’s decision definitely made the situation worse instead of better. I cracked up about your comments regarding the patient who wrote a letter to the president of the hospital for not receiving an antibiotic for dehydration. That patient should be writing the president a thank you note for your great nursing. What this patient did not realize is that a possible side effect to taking antibiotics is diarrhea. If not monitored properly, diarrhea can cause severe dehydration. Today, patients are so quick to file lawsuits against doctors and nurses if they do not get their way or if the outcome of the medical procedure is not what they expected it to be. Is there a solution to minimizing the number of medical lawsuits filed per year? After researching my own question, I came across an article that discusses the profile of patients most likely to file litigious claims. The article states, respecting patients’ need for information during clinical consultations and disclosing medical errors when they occur is the more patient-centered approach and the best way to lessen the likelihood of a claim (Tsimtsiou, 2014). The point of this statement is that medical staff need to be more forthcoming to patients instead of trying to please them. If Stephanie had politely informed the patient that she would have to wait until her appointment to discuss her refill request for the antibiotic, noted the patient’s file, and forwarded the patient’s request to the NP assigned to the patient, Stephanie would have followed protocol and taken a patient-centered approach.
References Tsimtsiou, Z., Kirana, P., Hatzimouratidis, K., & Hatzichristou, D. (2014). What is the profile of patients thinking of litigation? Results from the hospitalized and outpatients’ profile and expectations study. Hippokratia, 18(2), 139–143.
