NR 506NP Week 5: Ethical and Legal Implications

Sample Answer for NR 506NP Week 5: Ethical and Legal Implications Included After Question

NR 506NP Week 5: Ethical and Legal Implications

Case Study Responses:
1. - Medical assistant: The MA involved in workplace conflict may experience decreased job satisfaction and poor mental health stemming from this problem (Cullati et al., 2019). From the case study description, the MA failed to fulfil her job responsibilities when she did not notify you of a vital sign within an appropriate amount of time. This can have legal implications for the MA as well. While it may seem harsh for the MA to lose her job over not fulfilling her responsibilities this one time, if this is a problem that is occurring regularly, then she may need to be dismissed or potentially lose her MA license. Additional implications for the MA include depression and fatigue due to poor mental health from stress of conflict at work, to decreased self-confidence due to lack of job performance.
  - Nurse Practitioner: The NP can experience decreased job satisfaction due to this office conflict as it is impacting her job performance and office cohesiveness (Bryant and Parker, 2020). This dissatisfaction can contribute to reduced job retention and may inspire the NP to search for another position elsewhere (Bryant and Parker, 2020). Legal implications include decreased patient safety due to failure to act from lack of information of hypotension. If I were in this position, I would write an incident report on the MA for failing to report this vital sign to me in an appropriate amount of time. This could potentially cover my license if the patient experienced harm and this ever went to court. This potential patient harm and the liability surrounding this is a significant legal implication that would have me considering working with a new MA.
  - Medical director: The medical director has to deal with the ethical implications of decreased patient satisfaction and decreased personal job satisfaction from repeatedly having to let go, hire and train new employees. This cycle of hiring and firing could lead to anger and irritability from the medical director which could further contribute to the cycle of workplace conflict. Legal aspects of this problem can lead to potential lost revenue from having to invest time into hiring and training new staff as well as lost efficiency and time management from conflict. Another legal implication is the potential for litigation if patient safety is disrupted.
  - Practice: The Practice could experience potential litigation from dissatisfied or harmed patients due to the lack of communication stemming from workplace conflict. While lost revenue could stem from loss of efficiency and time management, it could also come from lack of patients as they seek care elsewhere. The Practice will also experience lost revenue from dissatisfied employees leaving the clinic in search of a more cohesive work environment. It will take an investment of time, money, and effort to train new employees and integrate them into the Practice.
2. What strategies would you implement to prevent further episodes of potentially dangerous patient outcomes?
  - It is concerning that you several incidents of workplace conflict have already been witnessed just in the three short months you have been there. This leads me to believe that this is a deep-rooted problem if employees care so little about expressing conflict that they are doing so in front of you. Opening the lines of communication and addressing problems directly may help reduce conflict. What are employees arguing about? Are there problems with the functionality of the clinic that are disrupting workflow or is the conflict stemming from personal problems? Addressing workplace flow, cohesiveness and functionality of the practice may help reduce some of the problems. This can be done by ensuring every employee understands their responsibilities and feels empowered to communicate important patient data to the right provider.
  - Taking a conflict management course can help employees to learn different attitudes and perspectives to improve communication and reduce conflict (Kay and Skarlicki, 2020). As an APRN, you could find an online conflict management course to enroll employees in or even print out a list of conflict management strategies to review with employees. Another communication concept to encourage in the clinic is mindfulness (Kay and Skarlicki, 2020) Encouraging mindfulness and discussing ways to cultivate mindfulness can decrease workplace conflict and increase conflict resolution (Kay and Skarlicki, 2020).
  - Finally, a reminder of professionalism in the workplace is essential. These employees have forgotten that patient safety is their first priority. This needs to be emphasized. It may be necessary to permanently remove employees that cannot support this priority. While hiring and training new employees may be a costly investment up front, having a cohesive unit will pay for itself in the long run.
3. What leadership qualities would you apply to effect positive change in the practice? Focus on the culture of the practice.
  - Leadership qualities that can effect a positive change in this Practice include cultivating team mindfulness, encouraging constructive conflict management, and leading by example through trust, reliability, and professionalism (Ni et al., 2021).
  - Cultivating a culture of team mindfulness begins by encouraging individual mindfulness (Ni et al., 2021). This can be extremely challenging to introduce in the workplace as work is already consumed with other, more pressing activities. Methods to encourage individual mindfulness can be supported by ensuring employees have time for uninterrupted breaks during working hours and enough time off work to manage an appropriate work-life balance. While mindfulness can be difficult to achieve, it has been shown to increase flow of work and reduce relationship conflict (Ni et al., 2021).
  - Constructive conflict resolution can be achieved through defining clear plans and goals (George, 2020). Defining clear plans for the team encourages focus on the goal and can reduce emotionally variability while improving organizational performance (George, 2020).
  - Finally, as an APRN, you are in a position to lead the MAs. Leading through example can be done by remaining calm during conflict, maintaining open lines of communication, setting clear boundaries and role responsibilities, and emphasizing the importance of maintaining patient safety.

References:

Bryant, S. & Parker, K. (2020). Participation in a nurse practitioner fellowship to instill greater confidence, job satisfaction, and increased job retention. Journal of the American Association of Nurse Practitioners, 32 (10), 645-651. doi: 10.1097/JXX.0000000000000313.

Cullati, S., Bochatay, N., Maître, F., Laroche, T., Muller-Juge, V., Blondon, K. S., Junod Perron, N., Bajwa, N. M., Viet Vu, N., Kim, S., Savoldelli, G. L., Hudelson, P., Chopard, P., & Nendaz, M. R. (2019). When team conflicts threaten quality of care: A study of health care professionals’ experiences and perceptions. Mayo Clinic Proceedings. Innovations, quality & outcomes, 3(1), 43–51. https://doi.org/10.1016/j.mayocpiqo.2018.11.003Links to an external site.

George, B. (2020). Successful strategic plan implementation in public organizations: Connecting people, process, and plan (3Ps). Public Administration Review. https://doi.org/10.1111/puar.13187Links to an external site.

Kay, A. A., Skarlicki, D. P. (2020). Cultivating a conflict-positive workplace: How mindfulness facilitates constructive conflict management. Science Direct: Organizational Behavior and Human Decision Processes. https://www.sciencedirect.com/science/article/abs/pii/S0749597817306957Links to an external site.

Ni, D., Zheng, X., Liang, L. (2021). Rethinking the role of team mindfulness in team relationship conflict: A conflict management perspective. Journal of Organizational Behavior. https://doi.org/10.1002/job.2588Links to an external site.

NR 506NP Week 5: Ethical and Legal Implications

Discussion

A Sample Answer For the Assignment: NR 506NP Week 5: Ethical and Legal Implications

Title: NR 506NP Week 5: Ethical and Legal Implications

Purpose

Discuss potential complications in a clinical scenario at an outpatient family practice. Students will explore potential effects on patient outcomes and implications for members of the health care team as a result of conflict among the healthcare team. Students will develop strategies that result in the prevention of untoward outcomes that result in a positive practice culture.

Activity Learning Outcomes

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

· Recognize potential areas of conflict in NP clinical practice (CO1)

· Determine methods of data collection to assess the conflict (CO3)

· Examine corporate compliance and its effect on clinical practice (CO2)

· Understand risk management in clinical practice (CO4)

Due Date: Wednesday by 11:59 PM MST of Week 5

Initial responses to the discussion topic must be posted by Wednesday 11:59 pm MT. Two additional posts to peers and/or faculty are due by Sunday at 11:59 pm MT. Students are expected to submit assignments by the time they are due.

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday of week 5, regardless of the number of days late. NOTHING will be accepted after 11:59 pm MT on Sunday (i.e. student will receive an automatic 0).

Total Points Possible: 100

Preparing the Discussion

You are a family nurse practitioner working in an outpatient primary care office of a large hospital system. The practice has been operating for over 15 years, and many of the administrative and clinical staff were hired when the practice opened. You have been in the practice for less than 3 months. In that short amount of time, you have witnessed several of the clinical staff engaging in heated arguments with each other, sometimes in patient areas. You overhear an argument occurring today between two staff. You pick up a patient’s chart and notice a very low blood pressure that the medical assistant failed to notify you about. When you confront the MA, she states that she was going to report the vital signs to you when she became engaged in the heated argument you overheard and forgot to notify you.

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Unfortunately, this pattern of behavior is not unusual in this practice. Working with staff who cannot cooperate effectively can negatively influence your ability to spend time with patients, can impede the flow of patients through the office, and could impact patient safety.

Case Study Responses:

1. Analyze the case study for potential issues for members of the healthcare team from office conflict. Contrast the potential effects

for each member of the healthcare team based on the required readings from the week. Discuss 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 dangerous patient outcomes?

3. What leadership qualities would you apply to effect positive change in the practice? Focus on the culture of the practice.

4. A scholarly resource must be used for EACH discussion question each week.

Category Points % Description

DISCUSSION CONTENT

Potential ethical & legal

implications for healthcare

team members 30 30% Provides relevant evidence of scholarly inquiry of the potential ethical and legal implications for each of the practice members. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.

Strategies to prevent further dangerous patient outcomes 30 30% Provides relevant evidence of scholarly inquiry of strategies to implement to prevent further episodes of potentially dangerous patient outcomes. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.

Leadership qualities to effect positive change 15 15% Provides relevant evidence of scholarly inquiry of leadership qualities to apply to effect a positive change in the practice. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.

75 75% Total CONTENT Points= 75 pts

DISCUSSION FORMAT

Category Points % Description

Interactive Dialogue 20 20% 4 Required Elements: · Responds a minimum of two other posts to peers and/or faculty in the threaded discussion; · Responses to peer/faculty are substantive (adds importance, depth, and meaningfulness to the discussion) · Responds to all direct questions from faculty (if no question asked directly, student responded to questions posed to the entire class) · Summarizes what was learned from the lesson, readings, and other student posts for the week. The summary could be included in one of the three minimum posts.

Grammar, Syntax, Spelling, & Punctuation 5 5% Grammar, syntax, spelling, and punctuation are accurate.

25 25% Total FORMAT Points= 25 pts

100 100% DISCUSSION TOTAL= 100 pts

Week 5- Ethical and Legal implications

It is difficult to work in an environment that is considered toxic due to verbal confrontations, unprofessional behavior,

and heated disagreements. This environment can make workers feel unhappy when entering work, reduce efficiency, and severely impact patient safety. In the situation with the patient’s low blood pressure, I as the nurse practitioner was not alerted to the blood pressure due to a heated argument that the medical assistant got pulled into. In a professional environment there should be a leader that guides the practice, in order to prevent workplace conflicts from spinning out of control.

Medical Assistant- Medical assistants in an office environment are responsible for checking patients in, obtaining vital signs, and assisting with clerical duties (AAMA, 2023). It is therefore important for them to be able to communicate data to the nurse or nurse practitioner responsible for patient treatment. The medical assistant in this scenario failed to deliver important information about the patient’s blood pressure. This is all we know about the situation with the patient. The patient may be having an emergency and low blood pressure is a key indicator of something dire.

While the medical assistant is engaged in the heated argument, the patient is awaiting treatment without the information being passed along as it should. As the NP I would be extremely disappointed in the medical assistant for not delivering the important patient information. Through negligence the patient is placed in harm’s way and that would make it very difficult to trust the medical assistant to follow through with their duties. I don’t completely blame the medical assistant but there is a serious issue with this practice due to workplace conflict and lack of leadership. As I stated, the patient could

have been harmed and we don’t know what happened to the patient from the low blood pressure being left untreated.

Nurse Practitioner-According to the AANP (2023) nurse practitioners undergo rigorous national certification, periodic peer review, and training to ensure the highest quality of care to patients. Education is at a master’s level at minimum and involvement in professional development, organizations, and participation in health policy activities adds to their credibility (AANP, 2023). I understand that conflict can occur in any environment where many people come together, all with different personalities. My issue is when these people cannot pull together as a team to care for the patients in a safe and respectable manner.

Arguments in the facility work to diminish the credibility of the practice and the nurse practitioner. When a patient is neglected because important information is not passed on, patient harm can occur causing the patient to sue the practice for malpractice related to negligence. It is the nurse practitioner who can be held responsible when all is said and done. When looking at these situations it is important to acknowledge how this situation could impact the patient and the nurse practitioner’s ability to practice because patient treatment is the responsibility of the NP. Being at the practice for 3 months may make it difficult to speak up against the unprofessional behavior but it will be necessary, to protect the NPs credibility and licensure. Patient safety is the most important responsibility of the NP, and failure to preserve that can result in a lawsuit, termination, or imprisonment.

Medical Director-A medical director is responsible for the patient’s best interest through use of medical knowledge to provide competent medical care with compassion and follow medical principles (AMA, 2023). Through these principles it is clear that the medical director should have respect for patients and colleagues by upholding standards of professionalism in the practice (AMA, 2023). If this is true of the responsibilities of a medical director then it is safe to assume that this medical director is not holding up to the standards, ethical principles, and responsibilities bestowed on a physician assuming this responsibility.

There is poor leadership in this practice, and it shows through the numerous conflicts, heated arguments, and patient safety concerns that are occurring. As the NP new to the practice, I am now observing the toxicity of the working environment but question how staff members feel comfortable enough to have heated arguments close to patient areas. What are the consequences for such behaviors? How long have these conflicts been occurring? The medical director shares responsibility for negligence resulting from information not being shared, and possible patient harm.

The medical director is also responsible for conflict resolution, which is not happening in this case study. When there are a multitude of problems in a facility, the first person held responsible during a malpractice suit is the leader, and in this case, it is the medical director. The medical director in this case study could be held responsible, could be terminated, and could face charges related to negligence.

Practice-

It says in the case study that this is not the first-time arguments were observed and at

this point, it is a possibility that patients have heard disagreements. I know that as a patient if I went to a facility and the staff were having heated arguments, I would not be confident in their care for me. I would feel that they are unprofessional and incapable of treatment due to distraction not appropriate for the working environment. Knowing that conflicts are resolved through arguments that have no boundaries is concerning for a patient and can make it difficult for other staff members to take pride in working there.

The practice would be held ultimately responsible for any damages that occurred through patient harm because it is through the practice that malpractice insurances are obtained. They would need to reconsider the type of staff members working there and work on conflict resolution to change the environment. The credibility, safety, and reputation of the practice could be called into question if more than one patient has experienced the arguments happening. Within a 3-month period the new NP has already seen several arguments.

Now a days the internet is important and negative reviews could greatly influence the ability of the practice to generate income. If they have had more than one issue with patient safety, they could face issues with insurance reimbursement. Worst case scenario is the practice could be shut down.

Strategies-

In the health professional environment, conflict can be disruptive, inefficient, and greatly impact patient safety. Healthcare systems are more complex than ever before, and it is necessary to change how professionals engage and work together. Stating that everyone should be friends is a simple way to understand that

performance is correlated to teamwork (Eichbaum, 2018). The initiation of open discussion can be helpful in the correct environment, such as during a team meeting, where everyone is able to state their concerns. The effectiveness of the team’s ability to collaborate directly affects performance and team member frustration. Conflict is not always a bad thing and when controlled it can help to become a source for learning and new ideas, for example, an argument about a safety concern can help staff to come up with ideas to fix the issue together.

Building trust is necessary to assist staff in working as a team and engaging constructively to find solutions. An issue that can occur in a working environment is power hierarchies where older staff may assume they are in charge, instead of participating in a democracy to work out issues. Conflicts can arise in these situations when those who haven’t established status speak up. A strong leader will encourage all parties to communicate, giving new employees a voice and minimizing domineering tendencies of older staff (Eichbaum, 2018).

Leadership-

Finding a leadership style that will assist with conflict management is necessary in this case study. I suggest democratic leadership because it is a style that allows for increased communication with leaders and staff to ensure open communication. Democratic leadership follows an egalitarian point of view, with the principal belief being equality and participation (Barthold et.al., 2022). In this leadership style the leader allows and welcomes team participation, opening discussions to help with decision making. I feel that this type of leadership is beneficial to conflict management and will help to channel the

voices of the frustrated office staff in a way that is more constructive to their working environment and beneficial to the practice. According to Barthold et. al. (2022) the duty of leaders is to remove barriers that prevent open dialogue. In this case scenario an issue may be that some of the staff is domineering newer members and the leader is not allowing for new staff to have a voice. This would cause a conflict in the office when newer staff speak up. Opening an arena where voices can be heard reduces conflict and frustration through communication.

Lack of communication will damage team member trust and collaboration resulting in internal and external conflicts, burnout, and frustration for the work environment. Having democratic leadership will change the culture of the practice to a culture of sharing information, good communication, trust, and collaboration. The leader should establish meetings where staff can speak up each month. Keeping an open door policy to hear concerns can be helpful in resolving conflicts before they turn into heated arguments. New policies can be developed to let employees know that certain behaviors are not tolerated but there is an outlet for communications to build trust.

References:

American Association of Nurse Practitioners (AANP) (2023) What’s a Nurse Practitioner. Retrieved from https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner

AAMA. (n.d). What is a Medical Assistant. Retrieved in 2023 from

https://www.aama-ntl.org/medical-assisting/what-is-a-medical-assistant#:~:text=Preparing%20patients%20for%20examinations,about%20medication%20and%20special%20diets

AMA. (2023). Ethical Obligations of a Medical director. Retrieved from https://code-medical-ethics.ama-assn.org/ethics-opinions/ethical-obligations-medical-directorsLinks to an external site.

Barthold, Checchi, M., Imas, M., & Smolović Jones, O. (2022). Dissensual Leadership: Rethinking democratic leadership with Jacques Rancière. Organization (London, England), 29(4), 673–691. https://doi.org/10.1177/1350508420961529

Eichbaum. (2018). Collaboration and Teamwork in the Health Professions: Rethinking the Role of Conflict. Academic Medicine, 93(4), 574–580. https://doi.org/10.1097/ACM.0000000000002015