General instructions:
Review the scenario and address the questions below.
You are a nurse practitioner employed in a busy primary care office with responsibilities for managing the office
staff, including the medical assistants who aid in client care as well as filing, answering calls from clients,
processing laboratory results, and taking prescription renewal requests from clients and pharmacies. The office is
part of a larger hospital system. One of the medical assistants has worked in the practice for 10 years and is very
proficient at her job. She knows almost every client in the practice and has an excellent rapport with all the
providers.
During an office visit, a client requested a refill for an amoxicillin prescription. When examining the empty bottle,
you noted that the date on the bottle was 1 week ago. You also noted your name printed on the label as the
prescriber though you did not see the client last week. The client explained that she called last week concerned
about her cough and spoke to the medical assistant, who assured her that a prescription would be sent to the
pharmacy for the concern. You do not recall having discussed this client with the medical assistant; the other
providers in the practice deny speaking to or consulting about the client.
Include the following sections:
1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
•
a. Based on the situation above, what are the ethical and legal implications for the practice at
the micro-, meso-, and macro-level of the system?
b. What changes do you recommend to prevent further episodes of the problem behavior?
What coaching and feedback skills can be used to discuss the event with the medical
assistant?
c. Which change model would you use to implement the identified change and why:
Lewin’s Theory of Planned Change, Plan-Do-Study-Act (PDSA), or Kotter’s 8-Step
Process for Leading Change?
d. Identify and discuss one barrier to implementing the change process. Identify and discuss
one factor that facilitated the change process.
A.
Microsystem:
The potential ethical and legal implications for this medical assistant are detrimental to all members of this
healthcare team. Stephanie, the medical assistant, was not working within her scope of practice. The scope of
practice for medical assistants varies from state to state and specialty. According the American Association of
Medical Assistants (AAMA), medical assistants work alongside physicians in various clinical settings. MA's are
trained to perform clinical and administrative duties. Clinical duties include, taking medical histories, assisting the
physician during examinations, collecting and preparing lab specimens, preparing and administering medications,
transmitting prescription refills as directed, wound care, etc. Administrative duties include, using computer
applications, welcoming patients, updating and filing patient medical records, scheduling appointments, etc. The
medical assistant illegally prescribed the patient medication under the nurse practitioner's name. Stephanie did not
examine the patient with the physician, which is not within her scope of practice, which could have yielded the
cause for her coughing. The possible sanctions for any violations outlined in the disciplinary standards and
procedure are temporary or permanent revocation of the medical assistant credentials (AAMA, 2021).
Mesosystem:
The nurse practitioner was not able to practice ethical values when treating
this patient. The ethical values of nonmaleficence and beneficence were not used
when providing care for this patient. According to Hadddad & Geiger (2020), “Non-
maleficence requires that nurses avoid causing harm to patients” (p. 6). The term
beneficence is described as, “… duty to refrain from maltreatment, minimize
harm, and promote good towards patients” (p. 6). The actions of the medical
Review the scenario and address the questions below.
You are a nurse practitioner employed in a busy primary care office with responsibilities for managing the office
staff, including the medical assistants who aid in client care as well as filing, answering calls from clients,
processing laboratory results, and taking prescription renewal requests from clients and pharmacies. The office is
part of a larger hospital system. One of the medical assistants has worked in the practice for 10 years and is very
proficient at her job. She knows almost every client in the practice and has an excellent rapport with all the
providers.
During an office visit, a client requested a refill for an amoxicillin prescription. When examining the empty bottle,
you noted that the date on the bottle was 1 week ago. You also noted your name printed on the label as the
prescriber though you did not see the client last week. The client explained that she called last week concerned
about her cough and spoke to the medical assistant, who assured her that a prescription would be sent to the
pharmacy for the concern. You do not recall having discussed this client with the medical assistant; the other
providers in the practice deny speaking to or consulting about the client.
Include the following sections:
1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
•
a. Based on the situation above, what are the ethical and legal implications for the practice at
the micro-, meso-, and macro-level of the system?
b. What changes do you recommend to prevent further episodes of the problem behavior?
What coaching and feedback skills can be used to discuss the event with the medical
assistant?
c. Which change model would you use to implement the identified change and why:
Lewin’s Theory of Planned Change, Plan-Do-Study-Act (PDSA), or Kotter’s 8-Step
Process for Leading Change?
d. Identify and discuss one barrier to implementing the change process. Identify and discuss
one factor that facilitated the change process.
A.
Microsystem:
The potential ethical and legal implications for this medical assistant are detrimental to all members of this
healthcare team. Stephanie, the medical assistant, was not working within her scope of practice. The scope of
practice for medical assistants varies from state to state and specialty. According the American Association of
Medical Assistants (AAMA), medical assistants work alongside physicians in various clinical settings. MA's are
trained to perform clinical and administrative duties. Clinical duties include, taking medical histories, assisting the
physician during examinations, collecting and preparing lab specimens, preparing and administering medications,
transmitting prescription refills as directed, wound care, etc. Administrative duties include, using computer
applications, welcoming patients, updating and filing patient medical records, scheduling appointments, etc. The
medical assistant illegally prescribed the patient medication under the nurse practitioner's name. Stephanie did not
examine the patient with the physician, which is not within her scope of practice, which could have yielded the
cause for her coughing. The possible sanctions for any violations outlined in the disciplinary standards and
procedure are temporary or permanent revocation of the medical assistant credentials (AAMA, 2021).
Mesosystem:
The nurse practitioner was not able to practice ethical values when treating
this patient. The ethical values of nonmaleficence and beneficence were not used
when providing care for this patient. According to Hadddad & Geiger (2020), “Non-
maleficence requires that nurses avoid causing harm to patients” (p. 6). The term
beneficence is described as, “… duty to refrain from maltreatment, minimize
harm, and promote good towards patients” (p. 6). The actions of the medical
