NR 510 Discussion Part One

Sample Answer for NR 510 Discussion Part One Included After Question

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.

  Discussion Question:

What is your next logically sound course of action? Provide evidence to support your response.

My immediate action is to address the patient’s reason for the visit. According to Mitchell and Oliphant (2016), I have a responsibility to conduct a comprehensive patient interview or consultation before prescribing any medications. While there are ethical issues with what Stephanie did, even though her intentions were good, this must be addressed in private later. Mrs. Smith has already taken a prescribed dose of amoxicillin for her cough. If the amoxicillin has not cleared up the cough, I should not provide her with a refill order just yet. This may have been the wrong medicine to prescribe for a cough in the first place. For one, if Mrs. Smith felt comfortable with Stephanie calling in a prescription order without the doctor’s consent, this may not be the first time she has been prescribed an antibiotic without being checked-out first. Mrs. Smith may have developed a resistance to the antibiotic.  Norris et al. (2013) state antibiotic resistance is a serious, growing threat that causes the bacteria in patients’ bodies to become immune to the antibiotics medicinal properties.

A Sample Answer For the Assignment: NR 510 Discussion Part One

Title: NR 510 Discussion Part One

Many respiratory conditions are viral infections not bacteria-based illnesses, and Mrs. Smith may not have known that antibiotics only work against bacteria. There are many possible factors as to why Mrs. Smith has developed a chronic cough. I should conduct her physical exam and ask her questions about her cough (when it developed, the type of cough like wet or dry, does the patient smoke, any shortness of breath, has she taken any medication other than amoxicillin to treat the cough). I should then draw Mrs. Smith’s blood to send to lab for testing to determine if she has become resistant to amoxicillin. Also, during her physical, I can see if movement or exertion prompt her to cough. Once the physical has been performed and cough symptoms evaluated, I will take medications, past health history, and any present conditions I have recognized during the physical into consideration then decide on the best cough treatment plan. Once the patient has been taken care of, I will create thorough notes to document the visit, my findings and actions, and Stephanie’s actions then report what has occurred to the primary physician and office manager.

Reference

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Mitchell, A., & Oliphant, C. M. (2016). Responsibility for ethical prescribing. The Journal for Nurse Practitioners, 12(3), A20. Retrieved from DOI: https://doi.org/10.1016/j.nurpra.2016.01.008Links to an external site.

Norris, P., Chamberlain, K., Dew, K., Gabe, J., Hodgetts, D., & Madden, H. (2013). Public beliefs about antibiotics, infection and resistance: A qualitative study. Antibiotics, 2(4), 465-476. doi:10.3390/antibiotics2040465

When it comes time to address Stephanie do you think having a staff meeting with all the MAs and providers as opposed to an individual meeting with Stephanie would be a better approach or just a one on one meeting?

Since this is a detrimental mistake and issue, this would require a meeting with all the MAs and providers. However, I believe initially, there should be a private meeting with Stephanie to go over what exactly happened and a followup meeting to discuss the consequences of her action. Usually, when one makes a mistake on the unit I work for, it is brought up during monthly meetings or huddles because the management does not want staff to repeat the same mistake and cause more harm to the patient or even put their job and/or license at risk. For example, a nurse accidentally mixed two patient’s lab draw tubes and put it in one bag and sent it to laboratory. We never saw the actually meeting with the nurse, what the consequence was and management tried to not expose which nurse it was. However, thru gossip, the staff found out who. It was brought up in huddle several times to remind nurses to please remember to label lab draws correctly because this can cause patient harm if mislabeled or sent improperly to lab. I think having two staff meetings is appropriate because there should be one private meeting with Stephanie and another meeting with the staff as a whole to prevent this from happening again. 

I definitely agree with you that two staff meetings would be appropriate, separating one specifically for the whole staff and the other a private meeting with Stephanie.  The meeting with Stephanie should involve reviewing  her scope of practice and reviewing the importance of patient safety and medications. It is important to keep this conversation private so that Stephanie does not feel targeted.  Our unit have staff meetings once a month to remind or update staff on important topics such as changes in policies and procedures or just simply educating staff on things we may not be exposed to as much on our unit.  I feel these are always important to keep your staff knowledgable on important topics.

A good time to address Stephanie would be after the office has closed for the day (Young, 2014). I would not confront Stephanie directly. I would speak with the physician first to inform him/her of the situation (if he/she is not already aware of it) then request a meeting between the physician, myself, the hiring manager, and Stephanie. While it’s better to address workplace conflicts as soon as possible, sometimes help from a mediator will help eliminate further conflict (Young, 2014). I am an advocate of non-confrontational dialogues. Once the situation about Stephanie’s actions have been discussed in private with the persons involved and the appropriate disciplinary measures taken, a meeting with all the MA’s should be set up. This meeting is not to discredit Stephanie or inform the MA’s of Stephanie’s mistake but to retrain them in their scope of practice, remind them of the proper office procedures on how to handle difficult patient requests, and cover the laws regarding prescriptive authority (who is allowed to call in prescriptions and in what capacity).

Reference:

Young, M. O. (2014). Constructive feedback and disciplinary action. American Nurse Today, 9(4). Retrieved from https://www.americannursetoday.com/constructive-feedback-and-disciplinary-action/