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.
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.
Discussion Question:
What are the potential ethical and legal implications for each of the following practice members?:
Medical assistants
Nurse Practitioner
Medical Director
Practice
What strategies would you implement to prevent further episodes of potentially dangerous patient outcomes?
What leadership qualities would you apply to effect a positive change in the practice? Be thinking about the culture of the practice.
Expert Solution Preview
Introduction:
This scenario describes an ethical dilemma faced by a Family Nurse Practitioner (FNP) working in an outpatient primary care office. The FNP has observed some of the clinical staff engaging in heated arguments with each other and recently overheard an argument between two staff. On investigating, the FNP discovered that a medical assistant had not reported very low blood pressure readings of a patient due to the argument. The FNP must now navigate the potential legal and ethical implications for different practice members and implement strategies to prevent further dangerous outcomes. Additionally, the FNP must apply leadership qualities to effect positive change in the practice culture.
1. What are the potential ethical and legal implications for each of the following practice members?
Medical assistants, Nurse Practitioner, Medical Director, and Practice are all responsible for maintaining ethical and legal standards in their respective roles. The medical assistant violated ethical standards by prioritizing an argument over patient care. Depending on state regulations, the medical assistant may have legal obligations to report vital signs readings to the FNP immediately. The FNP could be held responsible for any harm that comes to the patient as a result of not being informed of the low blood pressure reading. The medical director is ultimately responsible for ensuring that the clinic operations align with ethical and legal standards. Lastly, the practice may face legal and ethical implications for allowing a toxic workplace culture to persist.
2. What strategies would you implement to prevent further episodes of potentially dangerous patient outcomes?
The first step would be to establish clear policies and procedures for communication, patient care, and conflict resolution. Training sessions should be held for all staff to reinforce the importance of patient safety and the negative consequences of workplace toxicity. Additionally, a system of checks and balances should be established to ensure important patient information is shared and nothing falls through the cracks. The practice should also consider implementing anonymous reporting mechanisms to encourage staff to report toxic behavior without the fear of retaliation.
3. What leadership qualities would you apply to effect a positive change in the practice? Be thinking about the culture of the practice.
To effect positive change in the practice culture, the FNP would need to communicate effectively, be accountable, and lead by example. They should establish clear expectations and hold staff accountable for their actions while also being approachable and supportive. The FNP should also work towards creating a culture of respect, collaboration, and communication between staff members by encouraging open communication, providing constructive feedback, and promoting teamwork. A positive workplace culture can ultimately lead to better patient outcomes and employee satisfaction.
