NR 582 Week 5 Discussion

Student Name

Chamberlain University

NR-582: Leadership and Role Development for Advanced Nursing Practice

Prof. Name

Date

NR 582 Week 5 Discussion

General Instructions

As a nurse practitioner in a primary care setting, you hold responsibilities not only for patient care but also for supervising medical assistants (MAs). These assistants manage tasks such as charting, responding to patient calls, processing lab results, and handling prescription requests. Your practice is part of a larger hospital system.

A situation arises when a patient requests an amoxicillin refill during her visit. Upon review, the prescription bottle reveals it was refilled a week earlier under your name, despite you not having seen the patient. The patient explains that she spoke with a medical assistant over the phone and was assured the prescription would be sent. Neither you nor any other provider recalls authorizing this medication.

1. Application of Course Knowledge

a. Ethical and Legal Implications at Micro-, Meso-, and Macro-Levels

To properly analyze this incident, the ethical and legal responsibilities at each level of the healthcare system must be considered.

Table 1
Ethical and Legal Implications of the Case

Level	Implications
Microsystem	The medical assistant acted beyond her scope of practice by initiating a prescription without provider approval. According to the American Association of Medical Assistants (AAMA, n.d.), medical assistants can only process prescription refills under explicit provider direction. Independently writing a prescription constitutes both an ethical breach and a legal violation, endangering patient safety and exposing the assistant to disciplinary action.
Mesosystem	The nurse practitioner’s ethical duties of beneficence (doing good) and nonmaleficence (avoiding harm) were compromised (Haddad & Geiger, 2020). Since the prescription was recorded under the nurse practitioner’s name, liability risks include adverse reactions, inappropriate dosing, and potential professional sanctions. Legally, the incident could result in disciplinary action by the nursing board, fines, or even temporary suspension of licensure (NCSBN, 2021).
Macrosystem	At the organizational and systemic level, the practice and hospital system face regulatory consequences, malpractice exposure, and reputational harm. In states without full practice authority, the supervising physician or medical director may also bear responsibility (Trulove, 2015). The event could jeopardize accreditation, trigger audits, impact insurance coverage, and reduce public trust in the institution.

b. Recommended Changes and Coaching/Feedback Skills

To prevent future occurrences, both policy improvements and effective staff coaching are necessary.

Policy and Procedure Enhancements:

Implement strict policies that clarify only licensed providers can authorize prescription renewals.
Mandate documentation of provider approval for every prescription request.
Conduct ongoing staff training on state-specific scope of practice regulations.
Engage staff in ethics committees to strengthen awareness of professional and patient safety responsibilities.

Coaching and Feedback Strategies:
When addressing the medical assistant involved, communication should remain professional, constructive, and supportive.

Provide non-punitive feedback emphasizing the seriousness of the issue rather than personal blame.
Practice active listening to uncover whether stress or miscommunication contributed to the incident.
Use collaborative problem-solving to improve workflow and minimize future risk.
Offer continuous mentorship to encourage professional growth while reinforcing accountability and boundaries.

c. Change Model for Implementation

Among various change management approaches, Lewin’s Three-Step Change Model is most appropriate for addressing this issue, as it supports gradual adoption of new processes and reduces resistance.

Unfreezing: Emphasize the risks linked to unauthorized prescribing and highlight the importance of patient safety to create a sense of urgency.
Change (Moving): Introduce revised policies, conduct staff training, and modify workflows to ensure provider involvement in all prescription activities.
Refreezing: Reinforce new standards by embedding them into organizational policy, monitoring adherence, and recognizing compliance.

This model ensures the sustainability of improved, safer practices by promoting acceptance and integration into daily operations (Hussain et al., 2018).

d. Barriers and Facilitators to Change

Barriers	Facilitators
Resistance from long-term staff who perceive the policy as limiting their autonomy.	Strong leadership and open communication that foster trust and teamwork.
Fear of punitive measures, discouraging staff from reporting near-misses.	Comprehensive training that clarifies the reasons and benefits behind the changes.
High workload and time pressures reducing adherence to new protocols.	Staff involvement in decision-making, enhancing ownership and accountability.
	Continuous monitoring and feedback that reinforce the goal of improving patient safety rather than assigning blame.

References

American Association of Medical Assistants. (n.d.). What is a medical assistant? AAMA. https://www.aama-ntl.org/medical-assisting/what-is-a-medical-assistant

Haddad, L. M., & Geiger, R. A. (2020). Nursing ethical considerations. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054/

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123–127. https://doi.org/10.1016/j.jik.2016.07.002

National Council of State Boards of Nursing. (2021). Disciplinary actions. NCSBN. https://www.ncsbn.org/discipline.htm

Trulove, W. G. (2015). Legal issues for the medical director. Clinical Journal of the American Society of Nephrology, 10(9), 1651–1655. https://doi.org/10.2215/CJN.06440614