NR 506 Discussion Ethical and Legal Implications

It is difficult to work in an environment that is considered toxic due to verbal confrontations, unprofessional behavior, and heated disagreements. This environment can make workers feel unhappy when entering work, reduce efficiency, and severely impact patient safety. In the situation with the patient’s low blood pressure, I as the nurse practitioner was not alerted to the blood pressure due to a heated argument that the medical assistant got pulled into. In a professional environment there should be a leader that guides the practice, in order to prevent workplace conflicts from spinning out of control.

Medical Assistant-

Medical assistants in an office environment are responsible for checking patients in, obtaining vital signs, and assisting with clerical duties (AAMA, 2023). It is therefore important for them to be able to communicate data to the nurse or nurse practitioner responsible for patient treatment. The medical assistant in this scenario failed to deliver important information about the patient’s blood pressure. This is all we know about the situation with the patient. The patient may be having an emergency and low blood pressure is a key indicator of something dire. While the medical assistant is engaged in the heated argument, the patient is awaiting treatment without the information being passed along as it should. As the NP I would be extremely disappointed in the medical assistant for not delivering the important patient information. Through negligence the patient is placed in harm’s way and that would make it very difficult to trust the medical assistant to follow through with their duties. I don’t completely blame the medical assistant but there is a serious issue with this practice due to workplace conflict and lack of leadership. As I stated, the patient could have been harmed and we don’t know what happened to the patient from the low blood pressure being left untreated.

Nurse Practitioner-

According to the AANP (2023) nurse practitioners undergo rigorous national certification, periodic peer review, and training to ensure the highest quality of care to patients. Education is at a master’s level at minimum and involvement in professional development, organizations, and participation in health policy activities adds to their credibility (AANP, 2023). I understand that conflict can occur in any environment where many people come together, all with different personalities. My issue is when these people cannot pull together as a team to care for the patients in a safe and respectable manner. Arguments in the facility work to diminish the credibility of the practice and the nurse practitioner. When a patient is neglected because important information is not passed on, patient harm can occur causing the patient to sue the practice for malpractice related to negligence. It is the nurse practitioner who can be held responsible when all is said and done. When looking at these situations it is important to acknowledge how this situation could impact the patient and the nurse practitioner’s ability to practice because patient treatment is the responsibility of the NP. Being at the practice for 3 months may make it difficult to speak up against the unprofessional behavior but it will be necessary, to protect the NPs credibility and licensure. Patient safety is the most important responsibility of the NP, and failure to preserve that can result in a lawsuit, termination, or imprisonment.

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Medical Director-

A medical director is responsible for the patient’s best interest through use of medical knowledge to provide competent medical care with compassion and follow medical principles (AMA, 2023). Through these principles it is clear that the medical director should have respect for patients and colleagues by upholding standards of professionalism in the practice (AMA, 2023). If this is true of the responsibilities of a medical director then it is safe to assume that this medical director is not holding up to the standards, ethical principles, and responsibilities bestowed on a physician assuming this responsibility. There is poor leadership in this practice, and it shows through the numerous conflicts, heated arguments, and patient safety concerns that are occurring. As the NP new to the practice, I am now observing the toxicity of the working environment but question how staff members feel comfortable enough to have heated arguments close to patient areas. What are the consequences for such behaviors? How long have these conflicts been occurring? The medical director shares responsibility for negligence resulting from information not being shared, and possible patient harm. The medical director is also responsible for conflict resolution, which is not happening in this case study. When there are a multitude of problems in a facility, the first person held responsible during a malpractice suit is the leader, and in this case, it is the medical director. The medical director in this case study could be held responsible, could be terminated, and could face charges related to negligence.

NR 506 Discussion Ethical and Legal Implications

Practice-

It says in the case study that this is not the first-time arguments were observed and at this point, it is a possibility that patients have heard disagreements. I know that as a patient if I went to a facility and the staff were having heated arguments, I would not be confident in their care for me. I would feel that they are unprofessional and incapable of treatment due to distraction not appropriate for the working environment. Knowing that conflicts are resolved through arguments that have no boundaries is concerning for a patient and can make it difficult for other staff members to take pride in working there. The practice would be held ultimately responsible for any damages that occurred through patient harm because it is through the practice that malpractice insurances are obtained. They would need to reconsider the type of staff members working there and work on conflict resolution to change the environment. The credibility, safety, and reputation of the practice could be called into question if more than one patient has experienced the arguments happening. Within a 3-month period the new NP has already seen several arguments. Now a days the internet is important and negative reviews could greatly influence the ability of the practice to generate income. If they have had more than one issue with patient safety, they could face issues with insurance reimbursement. Worst case scenario is the practice could be shut down.

Strategies-

In the health professional environment, conflict can be disruptive, inefficient, and greatly impact patient safety. Healthcare systems are more complex than ever before, and it is necessary to change how professionals engage and work together. Stating that everyone should be friends is a simple way to understand that performance is correlated to teamwork (Eichbaum, 2018). The initiation of open discussion can be helpful in the correct environment, such as during a team meeting, where everyone is able to state their concerns. The effectiveness of the team’s ability to collaborate directly affects performance and team member frustration. Conflict is not always a bad thing and when controlled it can help to become a source for learning and new ideas, for example, an argument about a safety concern can help staff to come up with ideas to fix the issue together. Building trust is necessary to assist staff in working as a team and engaging constructively to find solutions. An issue that can occur in a working environment is power hierarchies where older staff may assume they are in charge, instead of participating in a democracy to work out issues. Conflicts can arise in these situations when those who haven’t established status speak up. A strong leader will encourage all parties to communicate, giving new employees a voice and minimizing domineering tendencies of older staff (Eichbaum, 2018).

Leadership-

Finding a leadership style that will assist with conflict management is necessary in this case study. I suggest democratic leadership because it is a style that allows for increased communication with leaders and staff to ensure open communication. Democratic leadership follows an egalitarian point of view, with the principal belief being equality and participation (Barthold et.al., 2022). In this leadership style the leader allows and welcomes team participation, opening discussions to help with decision making. I feel that this type of leadership is beneficial to conflict management and will help to channel the voices of the frustrated office staff in a way that is more constructive to their working environment and beneficial to the practice. According to Barthold et. al. (2022) the duty of leaders is to remove barriers that prevent open dialogue. In this case scenario an issue may be that some of the staff is domineering newer members and the leader is not allowing for new staff to have a voice. This would cause a conflict in the office when newer staff speak up. Opening an arena where voices can be heard reduces conflict and frustration through communication. Lack of communication will damage team member trust and collaboration resulting in internal and external conflicts, burnout, and frustration for the work environment. Having democratic leadership will change the culture of the practice to a culture of sharing information, good communication, trust, and collaboration. The leader should establish meetings where staff can speak up each month. Keeping an open door policy to hear concerns can be helpful in resolving conflicts before they turn into heated arguments. New policies can be developed to let employees know that certain behaviors are not tolerated but there is an outlet for communications to build trust.

References:

American Association of Nurse Practitioners (AANP) (2023) What’s a Nurse Practitioner. Retrieved from https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner

AAMA. (n.d). What is a Medical Assistant. Retrieved in 2023 from https://www.aama-ntl.org/medical-assisting/what-is-a-medical-assistant#:~:text=Preparing%20patients%20for%20examinations,about%20medication%20and%20special%20diets

AMA. (2023). Ethical Obligations of a Medical director. Retrieved from https://code-medical-ethics.ama-assn.org/ethics-opinions/ethical-obligations-medical-directorsLinks to an external site.

Barthold, Checchi, M., Imas, M., & Smolović Jones, O. (2022). Dissensual Leadership: Rethinking democratic leadership with Jacques Rancière. Organization (London, England), 29(4), 673–691. https://doi.org/10.1177/1350508420961529

Eichbaum. (2018). Collaboration and Teamwork in the Health Professions: Rethinking the Role of Conflict. Academic Medicine, 93(4), 574–580. https://doi.org/10.1097/ACM.0000000000002015

Thank you for sharing this video. It is a reminder of the dangers of healthcare and how risk is present even without intent. I am relieved to know that Logan was okay, and it was in part to his mother stopping the IV infusion of potassium. The layperson would have not known to stop the IV and their child might have died. It is hard to hear that the anesthesiologist was not aware of Logan’s prior kidney issues. It is hard to hear because, from a mother’s viewpoint, it is unbelievable but from a healthcare provider’s viewpoint. I can see how easily it could have happened.

There was one time I picked up potassium from the electronic medication cabinet and I clicked on potassium 10 mEq/100 ml but when I looked at the bag it was 20 mEq. I entered the patient and only certain cabinets open containing the medication selected, it is a safety measure. I guess the pharmacy tech stocked the potassium in the wrong cabinet. Thank goodness I looked, and this was before we started to scan medications in the ED. In the busy ED, this patient could have gone into cardiac arrest because I gave her too much potassium. Many ED nurses and staff were against scanning medications, but I am relieved it is a standard now.

The problem in this situation was the communication. The anesthesiologist was not aware of the kidney issues and if the nurse had communicated to the mother, she may have been alerted. As a nurse, I explain to my patients what the effects of the medication are and why we are using it. If the patient is a minor, the parent needs to be involved. Communication is truly the key to better safer care for patients. I understand it can be time-consuming to explain the tasks to the patients and their families but it does keep patients safe.

Thank you for sharing your near miss. Unfortunately, I do not think there is a practicing nurse that hasn’t heard of or experienced a similar situation. We are all human, and even with our current systems in place, there are so many opportunities for errors to occur. When I was just a brand-new nursing student in my first semester, I had kind of a similar situation happen to me. My husband was in the hospital after having an emergency bowel resection surgery. Following surgery, he had been receiving 0.9% NS solution continuously as he was not allowed to eat or drink until his bowel sounds returned. But one time when the nurse changed the bag out, I noticed that the label on the bag stated it was 3% saline. Having just completed a section in nursing school on fluid and electrolyte balance, I remembered my instructor saying that 3% saline was generally reserved for high ICP in head trauma as it caused a massive fluid shift from swollen brain tissue into the circulatory system. I immediately called the charge nurse into the room when I noticed the change in the fluid, and she corrected the mistake. But I often think about what would have happened to him if I had not been a student at the time and had not known something was wrong with the fluids. Most likely he would have been ok since he was otherwise healthy. But what if he was not? It is something I remember every time I am giving a patient any medication. And like you, I too explain everything to my patients and to their families. I also make sure I always scan the medication because pharmacists as well as the pharmacy techs stocking the pyxis can make mistakes too. When the medication error happened to my husband, the hospital was utilizing scanning technology. The nurse just failed to use it that time, highlighting to me just how important it is to scan medication.

MA (medical assistant)

It failed to maintain a balance between benefits and harms, which is one of the ethical principles of beneficence. A conflict arose between the MA and the NP, which potentially compromised the patient’s safety. It is the MA’s responsibility to ensure that a patient is protected from harm when there is a conflict between their responsibilities and the patient does not only face potential harm but also the chance of suing the MA for negligence or malpractice.

NP (nurse Practitioner)

It is the NP’s responsibility to ensure the patient is cared for, even though the NP did not report low blood pressure. A legal and ethical dilemma presented itself to the NP in this situation. Due to the fact that the nurse practitioner has now worked at this practice for three months, during which time she has seen several of the clinical staff engage in heated arguments with each other, sometimes in inpatient environments. Depending on the patient outcome, the NP could be sued for negligence or malpractice if they permitted the issue to continue.

Medical Director-

Every member of the practice, including the patient, is ultimately responsible to the Medical Director ethically and legally. Nonmaleficence, beneficence, and justice have been violated by the medical director. A Medical Director must ensure that conflicts between staff do not negatively impact patient care, impede patient flow, and affect patient safety by allowing conflict to continue. In the event of malpractice or negligence, the practice itself may be sued.

Practice-

It is possible that the practice will face legal consequences if a patient decides to take legal action. There is room for improvement in the practice’s operations. Employees who believe that this type of behavior is acceptable will continue to act in this manner. Disputes in the patient area can lead to negative reviews for the practice, which is bad for business. Insufficient and dangerous patient care can result from this kind of behavior. A professional approach to communication, respect, and fruitful communication are all critical to the practice’s success. During a job or business setting, professionalism consists of conduct, attitude, and behavior. In addition to work ethics and competence, strong professional reputations are also outcomes of professionalism (Sherrer & Prelip, 2019). A malpractice complaint may have been filed against the clinic for its delay in treating the low blood pressure.

I consider myself to be a transformative leader. I would use leadership traits like transparency, trustworthiness, and open communication to positively change the world. My encouragement, inspiration, and motivation will motivate others to advocate for change. In addition to influencing or moderating views, values, behaviors, and attitudes, a leader has the power to improve them (Corrie, 2019). An excellent leader can easily motivate and control employees to encourage change by demonstrating excellent leadership qualities. By empowering everyone to promote positive change, I will enhance patient safety, quality care, and outcomes. I would lead with respect, and I would ensure that everyone understood why politeness is important. In addition to communication, all parties involved need to express their frustrations and concerns about the scenario. Feel included in cooperative projects or group meetings with these suggestions. Health leadership involves identifying objectives, providing strategic direction to multiple actors within the health sector, and ensuring that all health sector stakeholders are committed to the achievement of those objectives. By mobilizing and utilizing the health workforce and other resources efficiently, effective management facilitates change and produces results (Figueroa et al., 2019).

Reference-

Corrie. (2019). Transformative Action Learning and Coaching in Healthcare Leadership. Journal of Transformative Learning, 6(2), 39–.

Figueroa, C. A., Harrison, R., Chauhan, A., & Meyer, L. (2019). Priorities and challenges for health leadership and workforce management globally: A rapid review. BMC Health Services Research, 19(1).

Sherrer, & Prelip, M. L. (2019). A Multifaceted Approach to Public Health Career and Professional Development Training. Health Promotion Practice, 20(6), 932–940. https://doi.org/10.1177/1524839918783744

Thank you for your insightful discussion post. The part that stood out the most to me involved your point about all parties expressing frustrations and concerns about the scenario. A policy that was recently emphasized at my workplace involves debriefing to help sustain a culture of safety within the healthcare environment. Debriefing strategies have been seen to improve both clinical and team outcomes in acute care environments (Evans et al., 2023). Since the events of the pandemic, vacancies in healthcare positions, especially in nursing, have skyrocketed. The reason behind the immense rate of resignations lie in emotional exhaustion, burnout, and lack of support following major events (Evans et al., 2023). Techniques surrounding peer support, group debriefing, and team cohesion give healthcare workers a voice and an outlet to discuss positive and negative experiences following traumatic events. Research suggests reflection impacts patient outcomes, healthcare worker satisfaction, and quality of care. Not only should we look to reflect on external situations, but also to practice introspection to ensure that our own biases and judgements do not cloud our judgement throughout the professional environment. Thank you for bringing light to the importance of such an overlooked aspect of leadership and care!

References

Evans, T. R., Burns, C., Essex, R., Finnerty, G., Hatton, E., Clements, A. J., … & Weldon, S. (2023). A systematic scoping review on the evidence behind debriefing practices for the wellbeing/emotional outcomes of healthcare workers. Frontiers in psychiatry, 14.

NR 506 Discussion Ethical and Legal Implications