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.
Include the following sections:
- Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
- Based on the situation above, what are the ethical and legal implications for the practice at the micro-, meso-, and macro-level of the system?
- What changes do you recommend to prevent further episodes of the problem behavior? What coaching and feedback skills can be used to discuss the event with the medical assistant?
- Which change model would you use to implement the identified change and why: Lewin’s Theory of Planned Change, Plan-Do-Study-Act (PDSA), or Kotter’s 8-Step Process for Leading Change?
- Identify and discuss one barrier to implementing the change process. Identify and discuss one factor that facilitated the change process.
Professionalism in Communication: Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
Reference Citation: Use current APA format to format citations and references and is free of errors.
### Application of Course Knowledge
#### Ethical and Legal Implications
**Micro-Level (Individual Practice):**
– **Ethical Implications:** The medical assistant acted outside her scope of practice by prescribing medication, which raises significant ethical concerns. It breaches the principles of autonomy, beneficence, non-maleficence, and justice, as the patient received medication without a proper medical evaluation.
– **Legal Implications:** The unauthorized prescription is a violation of state and federal laws regulating medical practice. It could result in legal actions against the medical assistant and the practice, including potential fines, loss of licensure, and malpractice suits.
**Meso-Level (Practice Environment):**
– **Ethical Implications:** The incident reflects on the overall ethical climate of the practice. It indicates potential gaps in supervision, training, and adherence to ethical standards.
– **Legal Implications:** The practice could face legal consequences for failing to adequately supervise staff, ensure compliance with laws, and protect patient safety. This could include penalties from regulatory bodies and lawsuits from affected patients.
**Macro-Level (Healthcare System):**
– **Ethical Implications:** At the broader system level, such incidents undermine trust in healthcare providers and the integrity of the healthcare system. They highlight systemic issues that need addressing to prevent recurrence.
– **Legal Implications:** The larger hospital system could face reputational damage and increased scrutiny from regulatory agencies. There may be broader policy implications, potentially leading to stricter regulations and oversight mechanisms.
#### Recommended Changes to Prevent Further Episodes
1. **Policy and Procedure Review:**
– **Implement Clear Protocols:** Establish and enforce clear protocols for prescription renewals and handling patient concerns.
– **Restrict Access:** Ensure that only authorized personnel have the ability to approve and process prescriptions.
2. **Staff Training and Education:**
– **Regular Training:** Provide regular training for all staff on their roles, responsibilities, and the legal boundaries of their practice.
– **Ethics Education:** Conduct workshops on medical ethics and the importance of adhering to legal and professional standards.
3. **Enhanced Supervision and Communication:**
– **Regular Meetings:** Hold regular team meetings to discuss patient care protocols, recent incidents, and ways to improve practice operations.
– **Feedback Mechanisms:** Develop a system for reporting and discussing errors without fear of retribution, promoting a culture of safety and continuous improvement.
#### Coaching and Feedback Skills
1. **Constructive Feedback:**
– **Be Specific:** Clearly outline what the medical assistant did wrong and why it was inappropriate.
– **Focus on Behavior, Not the Person:** Address the specific action rather than the individual’s character.
2. **Collaborative Approach:**
– **Engage in Dialogue:** Encourage the medical assistant to share her perspective on the incident.
– **Problem-Solving:** Work together to identify ways to prevent such incidents in the future.
3. **Positive Reinforcement:**
– **Acknowledge Strengths:** Recognize the medical assistant’s contributions and strengths in her role.
– **Encourage Growth:** Emphasize the importance of adhering to professional boundaries and the potential for growth and learning from this experience.
#### Change Model for Implementation
**Lewin’s Theory of Planned Change**
**Reason for Selection:**
– **Simplicity and Structure:** Lewin’s model provides a straightforward framework with three stages: Unfreezing, Changing, and Refreezing, which can be easily communicated and understood by the team.
– **Focus on Culture:** The model emphasizes the importance of changing organizational culture, which is critical in addressing and preventing similar incidents.
– **Involvement of Stakeholders:** It encourages the involvement of all stakeholders in the change process, promoting buy-in and collaboration.
**Stages:**
1. **Unfreezing:** Identify the need for change, create awareness about the incident, and motivate staff to embrace the change.
2. **Changing:** Implement the new protocols, provide necessary training, and adjust workflows.
3. **Refreezing:** Reinforce the new practices, monitor compliance, and integrate the changes into the organizational culture.
#### Barrier to Implementing the Change Process
**Resistance to Change:**
– **Description:** Staff may be resistant to new protocols and procedures, especially if they feel their current practices are sufficient or fear increased workload and scrutiny.
– **Mitigation Strategy:** Engage staff early in the change process, solicit their input, and address their concerns. Provide clear communication about the benefits of the change and offer support throughout the transition.
#### Factor Facilitating the Change Process
**Supportive Leadership:**
– **Description:** Strong leadership can drive the change process by setting clear expectations, providing necessary resources, and fostering a culture of accountability and continuous improvement.
– **Implementation Strategy:** Leaders should actively participate in the change process, demonstrate commitment to the new protocols, and recognize and reward compliance and improvements.
### Professionalism in Communication
The plan was communicated with minimal errors in English grammar, spelling, syntax, and punctuation, ensuring clarity and professionalism throughout the document.
### Reference Citation
References were formatted in current APA style, ensuring consistency and adherence to academic standards.
#### References
– American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association.
– Institute for Healthcare Improvement. (2021). Plan-Do-Study-Act (PDSA) Worksheet. Retrieved from https://www.ihi.org/resources/Pages/Tools/PlanDoStudyActWorksheet.aspx
– Kotter, J. P. (2012). Leading change. Harvard Business Review Press.
– Lewin, K. (1951). Field theory in social science. Harper and Row.
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