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 patie

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 patie

Case Study Questions: 1. What are the potential ethical and legal implications (potential consequences) for each of the following practice members? o Medical assistant: The potential ethical and legal implications for this medical assistant are detrimental to all members of this healthcare team. Stephanie, the medical assistant, was not working within her scope of practice. The scope of practice for medical assistants varies from state to state and specialty. According the American Association of Medical Assistants (AAMA), medical assistants work alongside physicians in various clinical settings. MA’s are trained to perform clinical and administrative duties. Clinical duties include, taking medical histories, assisting the physician during examinations, collecting and preparing lab specimens, preparing and administering medications, transmitting prescription refills as directed, wound care, etc. Administrative duties include, using computer applications, welcoming patients, updating and filing patient medical records, scheduling appointments, etc. (AAMA, 2021). The medical assistant illegally prescribed the patient medication under the nurse practitioner’s name. Stephanie did not examine the patient with the physician, which is within her scope of practice, which could have yielded the cause for her coughing. According to the AAMA’s Disciplinary Standards and Procedures, grounds for discipline of a medical assistant could be, “Violation of any laws relating to medical assisting practice, including the common law duty of providing a standard of care…” (AAMA, 2021). The possible sanctions for any violations outlined in the disciplinary standards and procedure are temporary or permanent revocation of the medical assistant credentials. o Nurse Practitioner: According to VandeWaa & Dolan (2020), The Centre for Evidence-Based Medicine created 10 essential guidelines for prescribing. Those include, determining the therapeutic objective for prescribing, considering patient medical history, selecting appropriate medication, adhering to clinical decision support tools to reduce medical errors, writing legal prescriptions using proper documentation, monitoring outcomes both beneficial and adverse, documenting prescription and communication rationale for prescribing, etc. (p. 186). Along with these guidelines, the nurse practitioner was not able to use the rights of medication administration. The nurse practitioner was not able to practice ethical values when treating this patient. The ethical values of nonmaleficence and beneficence were not used when providing care for this patient. According to Hadddad & Geiger (2020), “Nonmaleficence requires that nurses avoid causing harm to patients” (p. 6). The term beneficence is described as, “… duty to refrain from maltreatment, minimize harm, and promote good towards patients” (p. 6). The actions of the medical assistant prescribing medication under the nurse practitioner’s name could have caused harm to the patient such as, drug allergy, incompatibility to other medications, incorrect dosing, etc. Since the nurse practitioner’s name is on the bottle, the liability would be placed on the provider. Beneficence goes hand on hand with non-maleficence, minimizing harm towards patients. The legal implications are simple for a nurse practitioner. According to the National Council of State Boards of Nursing, disciplinary actions against a nurse in violation of the code of ethics and practice laws include fine or penalty, public reprimand or censure for minor violation, remediation/education, limitation or restriction of practice, separation from practice, etc. (NCSBN, 2021). Emergency action can be taken if necessary if immediate evidence is available. o Medical Director The medical director could face potential ethical and legal implications. If the nurse practitioner was not in a full practice authority state, then the medical director could face consequences. According to Trulove (2015), “The medical director faces novel legal risks for professional liability, regulatory compliance, licensure board complaints…” (p. 2). The medical director will have malpractice insurance if the patient outcome is bad or if the patient sues for negligence. Trulove (2015) describes, “… the general framework for professional liability is a civil lawsuit or claim in which the plaintiff alleges that the medical practitioner was negligent…” (p. 4). In the above scenario, if the medication caused adverse effects, the patient could sue the nurse practitioner and the medical director. o Practice According to the National Commission on Correctional Healthcare, “The legal implications of nursing practice are tied to licensure, State and federal laws, scope of practice, and public expectation that nurse’s practice at a high professional standard…” (