NR 582 Week 5 Discussion

Grace J.
September 2, 2025September 2, 2025
CU MSN, NR-582

Student Name

Chamberlain University

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

Prof. Name

Date

General Instructions

You are a nurse practitioner in a primary care setting with responsibility not only for patient care but also for managing medical assistants. These assistants are responsible for charting, answering patient calls, processing labs, and handling prescription requests. The practice is part of a larger hospital system.

A situation arises when a patient presents for a visit requesting an amoxicillin refill. The prescription bottle shows it was refilled one week earlier under your name, though you had not seen this patient. The patient states that she spoke to a medical assistant over the phone and was assured that the prescription would be sent. Neither you nor any other provider remembers authorizing this medication.

1. Application of Course Knowledge

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

To properly assess the incident, ethical and legal responsibilities should be analyzed at all levels of the healthcare system.

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. The American Association of Medical Assistants (AAMA, n.d.) states that MAs can only process refills under a provider’s explicit direction. Writing a prescription independently is both an ethical violation and a legal offense, endangering patient safety and exposing the assistant to disciplinary measures.
Mesosystem	The nurse practitioner’s ethical duties of beneficence (doing good) and nonmaleficence (avoiding harm) were compromised (Haddad & Geiger, 2020). Since the prescription was documented under the nurse practitioner’s name, liability risks include adverse reactions, inappropriate dosing, and professional sanctions. Legally, this could result in disciplinary action by the nursing board, fines, or even temporary loss of license (NCSBN, 2021).
Macrosystem	At the organizational and systemic level, the practice and hospital system face regulatory consequences, malpractice risks, and reputational harm. In states without full practice authority, the supervising physician or medical director may also be held accountable (Trulove, 2015). The event could impact accreditation status, audits, and insurance coverage, while weakening public trust.

b. Recommended Changes and Coaching/Feedback Skills

To avoid repetition of such incidents, clear interventions are needed.

Policy and Procedure Enhancements

Establish strict policies on prescription renewal, clarifying that only licensed providers can authorize refills.
Require mandatory documentation of provider approval for all prescription requests.
Conduct ongoing staff education about state-specific scope of practice laws.
Involve staff in ethics committees to build awareness of patient safety obligations.

Coaching and Feedback Strategies
When addressing the medical assistant, communication should be constructive yet firm:

Provide non-punitive feedback focusing on the seriousness of the violation rather than personal fault.
Practice active listening to identify whether workload stress or misunderstanding contributed to the mistake.
Use collaborative problem-solving to redesign workflows that prevent similar incidents.
Offer ongoing mentorship so the assistant feels supported but remains accountable to professional boundaries.

c. Change Model for Implementation

Among several models, Lewin’s Three-Step Change Model is best suited for this case because it simplifies organizational change while addressing resistance.

Unfreezing: Highlight risks associated with unauthorized prescribing, raise awareness of patient safety concerns, and create a sense of urgency for change.
Change (Moving): Roll out new policies, deliver targeted training, and adjust workflows to ensure provider involvement in all prescriptions.
Refreezing: Reinforce changes by embedding them in organizational policy, monitoring compliance, rewarding adherence, and integrating safety measures into the office culture.

This model is practical as it helps staff gradually accept change and ensures sustainability of safer practices (Hussain et al., 2018).

d. Barriers and Facilitators to Change

Barriers:

Resistance from long-term staff who may feel their autonomy is being restricted.
Fear of punishment may discourage transparency, making staff less likely to report near-misses.
Heavy workloads and time pressures could hinder compliance with new procedures.

Facilitators:

Strong leadership and open communication foster trust and engagement.
Training that clearly explains rationale for change increases compliance.
Involving staff in decision-making enhances ownership and accountability.
Ongoing monitoring and feedback reassure staff that changes are meant to improve safety rather than penalize.

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