Make a follow-up of a student’s weekly discussion and respond with your opinion regarding to her post

——You don’t have to post this in APA format necessarily, it’s just giving feedback to the student .

Thomas Russo

Good day,  

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: 

Medical assistant

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· The medical assistant (MA) is the representative of practice just as much as any nurse, nurse practitioner (NP) or physician. They are medical professionals and the patient population would not distinguish between these roles in the overall view of the practice and their individual health outcome. The scenario indicates that they failed at their role which could potentially lead to harm to the patient. This may also lead to the negative effect to the practice, the NP, and the physician. The reason they failed to report the vitals to the NP does not matter in the final legal and ethical implications. The MA has an ethical obligation and should have placed a priority on the patient’s care and safety over the interpersonal relationships of the office (Varkey, 2020). When and if the case is reviewed for legal purposes, they would have been found to not meet the legal or ethical standards of their profession and would be held to account by both the legal system and privet office. Additionally, the conflict in the office setting may lead to a negative effect on the quality of care as the healthcare team is not functioning effectively. Should harm come to the patient due to delayed care or incorrect diagnosis be pursued, the physician and NP could also be held to account legally which might cause the office to reduce staffing which might lead to loss of their job.

Nurse Practitioner (NP):

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· The NP has a different level of care responsibility for the patient and is held to a higher standard ethically and legally. The patient, the certifying board, or the courts would not care about the MA’s argument or the office dynamics that lead to the altercation when deciding the level of responsibility the NP has on the harm inflicted to the patient due to untreated low blood pressure. The NP may have noticed the low blood pressure, however the time between the vitals being obtained and treated is the significant aspect, not when the health care professional finally got the information. The investigating authorities would hold the NP accountable but the degree for this would vary by the legal obligation of the NP in that state, which varies. As only 17 of 50 states allow the NP to practice independently to varying degrees (Salvant Valentine, 2022). Florida for example allows for autonomous practice for primary care but requires a supervisory agreement for specialty care (FLANP, 2023).

· The primary ethical issues are beneficence and nonmalefeficence as the care and treatment for the patient should take top priority (Varkey, 2020). Verify their historical blood pressure to see if this incident is abnormally low for them, then stabilize and get the proper treatment started to include all necessary labs, tests, and imagery based on the other signs and symptoms. Once that is accomplished, the NP has attempted to met the minimal legal and moral obligations. The scenario might lead to further investigation and litigation which would need to see that they prioritized the patient’s safety and care over the inner office workings. These might lead to loss of license, suspension from employment, or restrictions placed on the NP for unsafe practice for not providing urgently needed care, preforming accurate and effective examinations, and properly informing the physician of needed information in a timely manner.

Medical Director

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· This role is typically held by a physician and holds a significant level of responsibility for their direct patient care, but the care and treatment of all those seen in their practice by all other medical professionals. The vital signs are some of the basic information in determining diagnosis and treatment to include what priority is placed on the interventions needed. The delay in reporting the vitals would result in delay of care which could lead to medical errors and legal actions. The court case of Gates v. Jensen found that the physician was aware of the patient’s condition but failed to enact timely care and treatment leading to significant harm to the patient. As the MA has the vitals, the chart indicates the physician is aware, or should be aware. The ethical action needed is must primarily be focused the patients current urgent needs in this scenario. Once that is met, then the director might focus on the legal aspect. They would then need to evaluate to see if there was any misdiagnosis or needed treatment administered to the patient as a result of the MA’s actions. Once that is determined, then corrective actions need to be taken to verify the condition of the patient was not harmed by the delay and finally, the legal department of the office needs to be made aware. If there is any legal action taken against the practice and its personnel, the medical director will be the ultimate authority held accountable even if they never actually cared for the patient directly. As such, deferring to the properly trained and educated personnel in legal would be similar to referring a specific ailment to a specialist instead of attempting to handle the issue alone.

Practice

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· The scenario places the practice at high risk for legal issues in that the licenses, jobs and certifications of the office and its personnel are placed under scrutiny and risk for suspension or revocation. The patient would not need to experience harm due to the lack of urgently needed action for their low blood pressure, they would be able to sue based on the increased risk and lack of confidence in the practices capability which could be costly to the practice and its employees. It would also call into question the ability of the practice to operate as intended. The patient population might see the office as a place to not be treated which would hold a fiscal penalty for their level of care provided. This would stem from the practice not meeting its ethical obligation to provided quality care to each patient. It is not the patient’s responsibility to accept lesser care and treatment due to the inner turmoils of the office. It is the obligation of the practice and its staff to be professionals and provide the services and treatment to their patients, despite any and all issues amongst the personnel.

2. What strategies would you implement to prevent further episodes of potentially dangerous patient outcomes? 

· The practice has been in operation for 15 years with a majority of the clinical staff having been on board since the start. This indicates a culture in the office that has developed over time and would need time to change and improve. The first thing is to have a the staffing informed that the patient’s care and safety must be their top priority over all other issues as it pertains to the practice. Then there needs to be a root-cause investigation to determine what the current issues are, when they started, and why this has been not properly addressed prior to this event. Involvement and use of the hospital’s resources such as the quality improvement team and ethics committee would be helpful to get an objective point of view. This would help to identify the level of intervention and course actions needed to fix the issues and adjust the culture to mitigate or prevent further incidences. The more immediate actions would need to involve the MA and the other staff involved in the incident. They would need to have written and documented counseling at a minimum. Further punitive actions awarded would take into consideration the harm that came to the patient and the number of prior times their lack of professionalism has occurred. These could include suspension or termination from employment. The office needs to have the culture adjusted to reduce the tensions and hostility in order for it to function effectively or incidences such as this will occur and might not always be caught before harm comes to the patient.

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

· The office is in need of positive changes to the interworking and culture which comes from transformational leadership. The culture has developed over time and is now ineffective and possibly toxic. An improved office culture leads to increased staff communication, reduced tension and increased patient satisfaction (Robbins, 2020). There needs to be an understanding built into the updated culture that this is a team and every person will affect the overall results for the patient, either positively or negatively. The root-cause investigation would help to find what processes are working and which need change. The leadership must be able to gain or already have the trust of the staff in order for them to be confident in their intentions to make the office a better place to work and for the patient’s to receive care. The leader would need to motivate the team and garner their buy-in to the needed changes since the staff would need to be willing to adjust how they work and what they need to do in the process of their jobs. There might be restructuring of the office and practice with positions added or removed and personnel might have to be let go or some promoted over others which could worsen the climate under a weak and undisciplined leadership. This indicates leadership would need to be strong to handle the resistance to changes.