You are a family nurse practitioner employed in a busy primary care  office. The providers in the group include one physician and three nurse  practitioners. The back office staff includes eight medical assistants  who assist with patient care as well as filing, answering calls from  patients, processing laboratory results and taking prescription renewal  requests from patients and pharmacies. Stephanie, a medical assistant,  has worked in the practice for 10 years and is very proficient at her  job. She knows almost every patient in the practice, and has an  excellent rapport with all of the providers.

Mrs. Smith was seen today in the office for an annual physical. Her  last appointment was a year ago for the same reason. During this visit,  Mrs. Smith brought an empty bottle of amoxicillin with her and asked if  she could have a refill. You noted the patient’s name on the label, and  the date on the bottle was 1 week ago. You also noted your name printed  on the label as the prescriber. The patient admitted that she called  last week concerned about her cough and spoke to Stephanie. You do not  recall having discussed this patient with Stephanie nor do the other  providers in the practice.

Discussion Question:

What are the potential ethical and legal implications for each of the following practice members?:

• Medical assistant
• Nurse Practitioner
• Medical Director
• Practice

What strategies would you implement to prevent further episodes of potentially illegal behavior?

What leadership qualities would you apply to effect a positive change  in the practice?  Be thinking about the culture of the practice.

Discussion Guiding Principles

The ideas and beliefs underpinning the discussions guide students  through engaging dialogues as they achieve the desired learning  outcomes/competencies associated with their course in a manner that  empowers them to organize, integrate, apply and critically appraise  their knowledge to their selected field of practice. The use of  discussions provides students with opportunities to contribute  level-appropriate knowledge and experience to the topic in a safe,  caring, and fluid environment that models professional and social  interaction. The ebb and flow of a discussion is based upon the  composition of student and faculty interaction in the quest for relevant  scholarship. Participation in the discussion generates opportunities  for students to actively engage in the written ideas of others by  carefully reading, researching, reflecting, and responding to the  contributions of their peers and course faculty. Discussions foster the  development of members into a community of learners as they share ideas  and inquiries, consider perspectives that may be different from their  own, and integrate knowledge from other disciplines.