Physician and nurse practitioners

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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.
Case Study Questions:
1. What are the potential ethical and legal implications for each of the following practice members?

o Medical assistant
o Nurse Practitioner
o Medical Director
o Practice
2. What strategies would you implement to prevent further episodes of potentially illegal behavior?
3. What leadership qualities would you apply to effect a positive change in the practice?  Be thinking about the culture of the practice.
4. A scholarly resource must be used for EACH discussion question each week.

 

 

Sample Solution

Medical Assistant

The medical assistant, Stephanie, could be accused of practicing medicine without a license. She is not authorized to prescribe medications, and she did so in this case by forging the nurse practitioner’s signature on the prescription bottle. She could also be accused of fraud, as she was essentially billing the insurance company for a service that was not rendered.

Nurse Practitioner

The nurse practitioner could be accused of negligence for not properly supervising the medical assistant. She is ultimately responsible for the care of her patients, and she should have ensured that Stephanie was not practicing medicine without a license. She could also be accused of fraud, as she was essentially signing off on a prescription that she did not authorize.

Medical Director

The medical director could be accused of negligence for not creating a culture of safety in the practice. He or she is responsible for ensuring that all staff members are properly trained and supervised, and that they are following the appropriate protocols. He or she could also be accused of fraud, as the practice is essentially billing the insurance company for services that were not rendered.

Practice

The practice could be accused of negligence and fraud. The practice is responsible for the actions of its employees, and it should have taken steps to prevent this incident from happening. It could also be accused of violating patient safety regulations.

Strategies to prevent further episodes of potentially illegal behavior

Here are some strategies that could be implemented to prevent further episodes of potentially illegal behavior in the practice:

  • Create a culture of safety and compliance. This means ensuring that all staff members are properly trained and supervised, and that they are following the appropriate protocols.
  • Have clear policies and procedures in place for handling prescription requests. These policies should be communicated to all staff members and should be strictly enforced.
  • Conduct regular audits of prescription records to ensure that all prescriptions are properly authorized.
  • Have a zero-tolerance policy for any illegal or unethical behavior. This means that any staff member who violates the policies will be disciplined, up to and including termination.

Leadership qualities to apply to effect a positive change in the practice

Here are some leadership qualities that could be applied to effect a positive change in the practice:

  • Be a role model for ethical and legal behavior. This means setting a good example for your staff and demonstrating that you are committed to following the rules.
  • Be open and transparent. This means communicating openly with your staff about the importance of safety and compliance.
  • Be fair and consistent. This means enforcing the policies and procedures fairly and consistently, regardless of who is involved.
  • Be willing to listen to feedback. This means being open to hearing from your staff about any concerns they may have.
  • Be willing to take action. This means taking steps to address any problems that are identified.

By implementing these strategies and applying these leadership qualities, you can help to create a culture of safety and compliance in your practice. This will help to prevent future episodes of potentially illegal behavior and protect your patients.

 

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