Principles of Ethics of Medical Professionals

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All medical professionals, including certified medical assistants (MAs), nurse practitioners (NPs), and physicians, swear to abide by ethical practices. The principles of ethics apply to all care team members and must be upheld by those in leadership through established codes of conduct. Non-malfeasance, beneficence, autonomy, and justice are ethical principles, while laws and regulations define consequences for violations. In this scenario, the medical assistant, Stephanie, practiced outside the scope of practice outlined in the Code of Virginia. The Virginia Department of Health Professions states that a certified nurse aide (CNA) practicing unauthorized tasks, such as providing medical triage or other action requiring clinical judgment, is subject to disciplinary action (2023). Disciplinary action includes suspension or revocation of licensure without a hearing before the Board if proof of danger to the public is provided (2023). Stephanie's actions could have caused severe harm to the patient if she were to have an allergy or reaction to the Amoxicillin. In addition, her actions are illegal as she signed as a nurse practitioner, practiced medicine without a license, and overrode the clinical judgment reserved for a provider. Even though she likely acted with intentions of beneficence, her actions could have been responsible for a bad outcome.
The implications for the nurse practitioner, medical director, and practice are very similar. Because the nurse practitioner's name is on the prescription, the provider is responsible for any adverse consequences and must alert the patient to the error. Also, the medical doctor supervising the nurse practitioner is now looped into the ethical and legal implications. The legal charge could be labeled as negligence in practice for allowing an unlicensed individual to prescribe medication. If harm had occurred, this would have been labeled as malpractice (Buppert, 2018). The effect of one action causes a domino effect where the entire practice is at risk for fines and litigation should the patient decide to pursue legal action. Stephanie may have been advised to provide refills for prescriptions in the past, as long as they were not narcotics, but we need to find out if this is the first occurrence. It is the responsibility of the practice, medical director, and all clinical staff to examine the assigned responsibilities of each member and see where the gaps exist. The providers in the clinic and the medical director should review current practice guidelines to learn from this situation.
As nurse practitioners, we are expected to show competency in advanced communication, educating and empowering patients to adopt lifestyle changes to prevent chronic illness (Schlunegger et al., 2022). Similarly, we must use communication skills to address this situation to prevent additional incidences through the education of staff members. Effective immediately, all prescriptions, including refills, must be filled by a licensed provider. Medical assistants may continue to perform administrative support, provide medical intake during appointments, and alert a provider if medical triage is needed via telephone. In addition, leadership needs to review each staff member's scope of practice in a roundtable setting with feedback from the medical assistants for concerns they may have regarding delegated tasks. Examining the current workflow, seeking buy-in from staff, and implementing changes without playing the blame game would benefit the practice as a whole. The primary goal is to create a safe environment for staff members to come forward and express concerns while providing safe and effective patient care. To accomplish this task, every team member needs to work together with patient safety in mind.
Creating a collaborative culture begins with every clinical care team member. In organizational settings, becoming a mentor for the medical assistants or registered nurses on the team is a critical leadership quality (Lamb et al., 2018). Leading by example, the nurse practitioner can model appropriate patient-clinician interactions for other staff members to witness. In addition, advanced practice nurses develop advanced communication skills to educate their patients and consult with other medical providers. A positive environment where medical assistants feel valued and essential to the care team is necessary for continued success in any practice.