Purpose

The purpose of this discussion is to discuss organizational changes and ethical-legal influences in a clinical scenario at an out-patient family practice. Students will explore potential effects on patient outcomes and ethical and legal implications for members of the heath care team as a result of illegal behaviors. Students will develop strategies that result in prevention of untoward outcomes that result in a positive practice culture.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1. Demonstrate effective leadership styles in the management of organizational change (CO3)
2. Interpret various forms of ethical theories and application into practice (CO4)
3. Discuss practice guidelines and malpractice prevention (CO2)

Requirements:

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?
   • Medical assistant
   • Nurse Practitioner
   • Medical Director
   • 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.