Name
Chamberlain University
NR-582: Leadership and Role Development for Advanced Nursing Practice
Prof. Name
Date
Review the scenario and address the questions below. You are a nurse practitioner employed in a busy primary care office with responsibilities for managing office staff, including medical assistants who support client care, manage records, answer client calls, process laboratory results, and handle prescription renewal requests. The office operates under a larger hospital system.
One of the medical assistants, who has worked in the practice for 10 years, is highly skilled, familiar with nearly all clients, and maintains excellent rapport with providers. During an office visit, a client requested an amoxicillin refill. Upon reviewing the prescription bottle, you noticed the prescription was filled a week ago with your name listed as the prescriber, although you had not seen the client at that time. The client explained that she spoke with the medical assistant over the phone about her cough and was assured a prescription would be sent to the pharmacy. Neither you nor any other provider in the office recall approving this prescription.
To evaluate the situation comprehensively, the ethical and legal implications must be considered across the micro-, meso-, and macro-levels of the healthcare system.
| Level | Implications |
|---|---|
| Microsystem | The medical assistant acted outside her scope of practice by issuing a prescription without provider approval. According to the American Association of Medical Assistants (AAMA, n.d.), medical assistants may transmit prescription refills only when directed by a licensed provider. Independently prescribing medication constitutes an ethical breach and a legal violation. This exposes the assistant to disciplinary actions such as revocation of credentials and damages patient safety by bypassing appropriate medical evaluation. |
| Mesosystem | For the nurse practitioner, the ethical principles of nonmaleficence (avoiding harm) and beneficence (promoting well-being) were undermined (Haddad & Geiger, 2020). The prescription, issued under the nurse practitioner’s name, places liability on the provider for potential adverse outcomes such as allergic reactions, drug interactions, or incorrect dosing. Legally, the nurse practitioner could face disciplinary actions from the nursing board, including fines, restrictions on practice, or suspension (NCSBN, 2021). |
| Macrosystem | At the organizational level, the medical director and hospital system could face regulatory scrutiny and malpractice claims. If the state does not recognize full practice authority for nurse practitioners, accountability extends to supervising physicians or medical directors (Trulove, 2015). This incident increases liability risks, potentially affecting accreditation, compliance audits, and insurance coverage. |
To prevent similar incidents, several strategies should be implemented:
Policy and Procedure Review: Reinforce clear protocols regarding prescription renewals, emphasizing that medical assistants cannot independently authorize prescriptions.
Scope of Practice Education: Conduct training sessions highlighting the state-specific scope of practice laws for all staff.
Documentation Requirements: Mandate clear provider approval in the patient’s chart before any prescription renewal request is processed.
Ethics Committee Participation: Encourage providers and staff to engage in ethics committees to foster accountability and advocacy for safe patient care.
Coaching and Feedback Skills:
When addressing the medical assistant, it is crucial to maintain a supportive but firm approach:
Use constructive feedback that highlights the seriousness of the error without personal blame.
Apply active listening to understand stressors or misunderstandings that may have contributed to the behavior.
Engage in collaborative problem-solving to identify root causes and strategies to avoid recurrence.
Provide ongoing mentorship and monitoring, ensuring the assistant feels supported while understanding professional boundaries.
Among the available models—Lewin’s Theory of Planned Change, PDSA Cycle, and Kotter’s 8-Step Process—Lewin’s Three-Step Model offers the most practical framework for this scenario.
Unfreezing: Acknowledge the unsafe practice, create urgency for change, and emphasize risks to patient safety and legal consequences.
Change (Moving): Introduce new policies, provide training, and restructure workflow to ensure prescriptions are approved only by licensed providers.
Refreezing: Institutionalize the changes by updating policies, monitoring compliance, recognizing staff adherence, and embedding safe practices into the organizational culture.
Lewin’s model is effective because it addresses resistance, fosters acceptance, and ensures sustainability of the change process (Hussain et al., 2018).
Barrier: Resistance to change is common, particularly among long-standing staff accustomed to established routines. Medical assistants may feel overwhelmed or fear punitive consequences, leading to reluctance in adopting new protocols.
Facilitator: Strong leadership and transparent communication act as facilitators. When nurse practitioners and medical directors clearly explain the rationale for change, provide training, and involve staff in decision-making, compliance and engagement improve.
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
