...University of Phoenix Prof. Keegan Physician’s assistants and medical assistants both perform vital acts in a physician’s office. However, both positions differ significantly in scope of practice, ethical and practical duties, responsibilities, and legally authorized extensions. Physician’s assistant duties, scope of practice and the laws applicable to each of these areas varies from state to state. While physician’s assistants perform their duties under the direct supervision of a licensed physician in any area of primary care including surgical and surgical subspecialties, family practice, obstetrics and gynecology, etc. Nevertheless, physician assistants in all 50 states, the District of Columbia, and Guam and the Commonwealth of the Northern Mariana Islands have authorization to prescribe medication (Hooker, 2010). Although this policy evolution occurred over the objections of some physician organizations about expanded prescription authority, the reality is that this change is codified (Hooker, 2010). Because of their intermediary placement within spheres of primary care and medicine itself, physician’s assistants are not immune from ethical dilemmas and/or malpractice, negligence and/or liability (PAC, 2011). Physician’s assistant share many duties, responsibilities as their supervising physician, based upon their training, their experience in the practice, ethical duties given the following case study situation. Although medical assistants perform complementary as administrative...
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...Ethics Case Study 1 Lynette A. Volk HCS/335 March 31st, 2-14 Beryl Keegan Abstract Jerry McCall is an employee in a medical office for a Dr. Williams and is professionally trained as both a medical assistant and as a licensed practical purse. While Jerry is alone in the office and the receptionist is at lunch, a patient calls and is requesting a refill for an antidepressant medication, Valium, and states he needs the refill right away, as he is leaving for the airport in 30 minutes. The patient is stating that the doctor is a personal friend of his and that the doctor always orders him a small supply before flying. Jerry must wrestle with the ethical dilemma of what he wants to do and what is legally and ethically the correct thing to do. This paper will determine that Jerry is not legally qualified to refill the valium, or any other medication as it is not within his scope of practice. Ethics Case Study 1 Jerry McCall’s professional training as an LPN and medical assistant does not qualify him to refill the valium order for a patient because it isn’t within a medical assistant’s or an LPN’s scope of practice. Only a physician or physician’s assistant can prescribe and refill prescriptions because they are trained to do so. Jerry has been formally trained and therefore knows what he is not qualified to refill any medications, especially valium, a antidepressant and a controlled substance. It doesn’t make a difference whether it was controlled substance, a blood...
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...involves a health care worker who is a medical assistant and LPN and b faces a legal and ethical decision when a patient insists on a prescription of Valium while Jerry is in the office alone. Jerry must decide how to provide the patient with what he needs while maintaining the law and his ethical values. Jerry McCall, although he received professional training as a medical assistant and an LPN, is not qualified to refill a prescription for a patient. According to New York State Law, LPNs are not allowed to work independently. The law “requires LPNs to practice under the direction of a registered professional nurse, nurse practitioner, physician, dentist, physician assistant, specialist assistant, podiatrist, or midwife” (Office of the Professions, n.d.). Jerry is aware of the rules and regulations concerning prescriptions and should not be intimidated by a pushy patient. Rules and laws are in place to protect both patients from injury and health care workers from malpractice. The law covers all medications because a patient can have an adverse reaction to even a common medication which is why all prescriptions must be ordered by licensed professionals. It does not matter whether the patient requests a daily medication such as a blood pressure medication or Valium as in Jerry’s case. The only legal way that Jerry could call in a refill for the patient is if the physician instructed him to because this would be within the scope of his duties. NYSNA, the New York State Nurses...
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...Title: Nurse Practitioner V.S Physician Assistant Yvonne Barker English: 102 Date4/6/2013 People rarely see medical doctor anymore. Patient is more like to have appointment with a Nurse Practitioners NP, Are a Physician Assistant PA. Both nursing practitioner and physic assistant can play the roles in healthcare practices. Patient is in good hand, weather we are treated by a PA or a NP. The different between a nursing practitioner and a physician assistant NP favor the nursing model while the PA favor the medical model. Education to become a nurse practitioner (NP) requires coursework and clinical rotations beyond that required of the RN. Curriculum includes, but is not limited to, courses in epidemiology; nursing theory; health promotion; pathophysiology; physical assessment; pharmacology; differential diagnosis and laboratory/radiography diagnostics; statistics and research methods; health policy; role development and leadership; acute and basic chronic disease management (e.g., adults, children, women's health, geriatrics, etc.); and, clinical rotations, which varies depending on the program. MSN programs also require a clinical research project. There are a variety of paths to becoming a licensed nurse practitioner in the United States. Typically, the process begins with obtaining a Bachelor of Science in Nursing (BSN, usually 4 years), followed by a Master’s of Science in Nursing (MSN, usually 50 credits). The flexibility of the MSN degree allows students to...
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...2012 Ethics Case Study Case Study Jerry McCall is Dr. William’s office assistant. He has received professional training as both a medical assistant and a LPN. He is handling all the phone calls while the receptionist is at lunch. A patient calls and says he must have a prescription refill for Valium, an antidepressant mediation, called in right away to his pharmacy, since he is leaving for the airport in thirty minutes. He says that Dr. Williams is a personal friend and always gives him a small supply of Valium when he has to fly. No one except Jerry is in the office at this time. What should he do? (Fremgen, 2009). Overview Health care providers are faced with making difficult ethical decisions everyday. Moral and value systems influence the ethical decision process, but the law and licensure regulations do as well. This case study is an example of a potential ethical dilemma and a possible breach of the law. The following questions will be explored: 1. Does Jerry’s medical training qualify him to issue this refill order? 2. Would it make a difference if the medication is for controlling high blood pressure that the patient critically needs on a daily basis? 3. If Jerry calls in the refill and the patient has an adverse reaction while flying, is Jerry protected from a lawsuit under the doctrine of respondent superior? Scope of Practice Jerry has had training as both a medical assistant and as a Licensed Practical Nurse (LPN). Medical assisting as an occupation...
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...care system is larger and busier than ever. Increased demand for services coupled with a limited number of providers, creates unique demands on an already strained system. Medical practices rely heavily on staff members to perform a myriad of function, both clinical and administrative. Occasionally, staff members may be asked by either physician or patients to perform duties that fall outside their scope of practice. Should an unqualified employee choose to operate outside his or her scope of practice, they run the risk of committing both negligent and criminal acts. In the case study of Jerry McCall, an office assistant with limited medical training, one sees a clear case of negligent and criminal conduct. The case study presents a scenario where an office assistant in a private physician’s office is asked by a patient to authorize a prescription for a Schedule III controlled medication. Additional information reveals that he is currently the only person in the office. Although Jerry is a Licensed Practical Nurse and medical assistant, his training does not permit him to prescribe medications of any type. Medications may only by prescribed by licensed providers who hold a valid registration with the Drug Enforcement Administration. This is typically limited to physicians, physician assistants, and nurse practitioners. There does however, exist a situation win which it would be permissible for Jerry to provide the patient with a valid prescription. This would require him...
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...more Nurse Practitioners (NP) being employed in community health and primary care facilities. This need requires expansion in the NP’s scope of practice and educational requirements but is essential to providing comprehensive care in our communities. Nurse Practitioners in Primary Care Nurse practitioners currently account for 83,000 of primary care providers, along with 287,000 physicians, and 23,000 physician assistants, which is an increase in ratio from 0.23 to 0.48 in NP’s per physicians between 2005 and 2009. (IOM, 2011) Considering the significant decrease in medical students entering into primary care and the increased need for primary care in the patient center care model presented by projected healthcare reform, NP’s are needed more than ever before. (IOM, 2011) If NP’s take on the majority of cases in primary care that are of low to moderate complexity it will leave more availability for physicians to work with patients with higher complexity. NP’s have a reputation for taking a holistic approach to patient care and give better counsel in total lifestyle changes to better the health of their patients. Physicians tend to focus more on the problem, not the person (AMA, 2009). In the IOM’s purposed reform in healthcare to patient centered care, the NP’s holistic approach to primary care would be most beneficial. Physician’s are threatened by the increase...
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...Nursing and Its Future The Institute of Medicine (IOM) recognizes the need for an advancement of the Nursing practice and medicine. Nurses compromise a huge portion of the medical population; they are trained to react to multiple situations routine or emergent. Nurses are trained to act beyond their scopes of practice in many states ("IOM Report," 2010). The IOM is proposing for nationalized educational standards, practice standards and licensure standards. Currently there are about three million Registered Nurses nationwide, of those there is only about 60% who work in the acute care setting (Rosseter, 2011). Nurses create the largest portion of most staffing in any medical facility, yet they are the most limited with their various Practice Acts. Nurses are practicing on the “front lines” of health care, yet they are unable to lead care given to a patient without a Physicians order or directive. Even those who are Advanced Practice Registered Nurses (APRN’s) are still limited in the tasks they are able to perform. They are not allowed to prescribe Class II Narcotics, nor admit patients to the hospital or Hospice services, without the further dictation of a Medical Doctor (MD). Nursing would be significantly impacted by the advancement of the educational process and the ability to take charge of primary health care. APRN’s would be able to take charge of general health needs and maintenance, through education and mentoring. Nurse’s out number physicians by about four to one...
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...“Jerry McCall is Dr. Williams’s office assistant. He has received professional training as both a medical assistant and a LPN. He is handling all the phone calls while the receptionist is at lunch. A patient calls and says he must have a prescription refill for Valium, an antidepressant medication, called in right away to his pharmacy, since he is leaving for the airport in thirty minutes. He says that Dr. Williams is a personal friend and always gives him a small supply of Valium when he has to fly. No one except Jerry is in the office at this time” (Fremgen, Chapter 4, 2009). A prescription can be prepared by a nurse, secretary, or any other agent in the office for the physician’s signature but cannot be called in or dispensed by no one other than the physician. There are certain rules and regulations that control issues like the one Jerry is faced with. The United States along with each state individual have set for rules and regulations for situations as this. By not following the guidelines it could cause many risks and it also goes against the code of ethics. There are code of ethics set forth not only for doctors but also nurses, physician assistants, and even medical assistants. If I were Jerry I would tell the patient that legally I cannot call in any prescriptions or medications without the authority of Dr. Williams. Calling in the prescription would put me at great risk for many legally issues because I do not have the permission of the physician to call...
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...Ethics Case Study Jennifer Edwards HCS/335 February 20, 2014 Dr. Lena Watson University of Phoenix Ethics Case Study: Background and Medical Training In the case study Jerry is an office assistant for Dr. William’s office. Jerry’s professional skill and training is in medical assistance and licensed practical nurse (LPN). At the time of day, the receptionist in Dr. Williams’s office was at lunch. In Jerry’s satisfaction he was in the position where he could be used the most, answering phones. A patient calls asking for a refill on the prescription drug Valium an antidepressant medication. The patient is asking for this prescription called in right away before leaving for the airport in thirty minutes. The patient states he is a personal friend of Dr. Williams and the doctor has always given him a small supply of Valium when he has to fly. Jerry’s training does not qualify him to make refilled medication request for patients. Because Jerry is not trained to look at the last clinical from the doctor, the dosage Jerry may or may not give the patient will cause an adverse effect. Prescription management based on the patients’ needs will be based on the recommendation of the physician. One must take in to account the age of the patient, disorder and other important information (not mentioned), Jerry may find it hard to give the correct dosage to the pharmacists. Valium and Controlled medications The issue of calling...
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...more substantial role? In 2010, the In Institute of Medicine (IOM) released a report that provided an outline on how to successfully transform the nursing profession. The motives for professional change include the emphasis on healthcare reform and public access to quality of care practices. Some of the recommendations of the IOP report include removing barriers to practice and care, more opportunities for nurses to become leaders, and increase nursing education (Robert Wood Johnson Foundation and Institute of Medicine, 2010). The IOM report suggests that nurses should practice to their full range of their education and training. Guidelines regarding a nurse’s scope of practice vary because licensing and practice rules are different in each state. For example, some states allow Advanced Practice Nurses to treat patients and prescribe medications without a physician’s supervision and some states do not allow this practice. As a result, the tasks Advanced Practice Nurses are allowed to perform are not determined by their education and training but by the particular states law. The IOP recommends that the barriers to scope of practice eliminated so that advanced practice nurses have the ability to practice as they have been educated and trained to do. According to the IOM report, there is a necessary need for more nurses to be involved in leadership roles. Nurses have...
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...Doctor Shortage Impacts Rural Areas Jean Larsen Senior Project Kristi Hund March 1, 2011 Abstract The United States is experiencing a substantial shortage of physicians, which is creating a severe supply and demand problem in America. Citizens living in rural areas should receive the same quality of care as those living in urban settings. Substantial differences exist in quality and access to health care for persons living in rural America. The shortage of physicians in rural America calls for immediate attention and change, as the inadequate supply of physicians is affecting the quality of patient care. The life expectancy of persons living in rural America is actually declining due to treatable conditions such as diabetes, cancer, heart disease and chronic obstructive pulmonary disease. These illnesses could be managed with proper medical treatment. This paper addresses these issues and recommends two solutions. Healthcare is in crisis in many countries, not least of which is the United States. We hear on the news how health care providers are unable to provide medical care to an increasing number of chronically ill and the aging population. There are a number of systemic failures, none is more difficult to correct than the basic lack of human resources. There are simply not enough physicians to service the needs of the population. The problem is intensified in rural areas, where specialized physicians may not be found within several hundred miles. The healthcare...
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...Primary Care Practices: Their Nature and Importance for the Future of Healthcare Bryan White MGMT 5530 Physician Practice Management November 2015 Abstract The practice of medicine has seen a lot of changes in the last century. In the 1960s, more change was happening than the Cultural Revolution in the United States. Specialized medicine was starting to take shape, altering the size and scope of general practice. From this, there have been unintended consequences to how primary care is practiced. While congress passed the Patient Protection and Affordable Care Act in 2010 to reform healthcare, it was more concerned about tackling health insurance and did little to address the issues facing primary care. This piece is designed to give the reader a look into how the general practice of health care has changed over time, the challenges it still faces, and the resources that could provide the solutions. Main Composition Throughout history, mankind has made leaps and bounds to advance the practice of medicine. Many of these improvements have happened within the last century. When it comes to the practice of generalized medicine, these advances have altered its shape size, scope, and structure. In the United States, there have been some consequences to these changes in primary care that, if the right adjustments or corrections are not made, could be detrimental to healthcare delivery. General Medicine in the Past It would be best to begin with just how the general...
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...Ethics Case Study XXXXXXXXXX HCS/335 May 2, 2011 Beryl Keegan, RN, BSN, MSN/HCE, CCRN, CLNC Ethics Case Study "Jerry McCall is Dr. William's office assistant. He has received professional training as both a medical assistant and a LPN. He is handling all the phone calls while the receptionist is at lunch. A patient calls and says he must have a prescription refill for Valium, an antidepressant medication, called in right away to his pharmacy, since he is leaving for the airport in thirty minutes. He says that Dr. Williams is a personal friend and always gives him a small supply of Valium when he has to fly. No one except Jerry is in the office at this time. What should he do" (Fremgen, 2009, p. 85)? Medical ethics is a subject open to much interpretation and is prone to many grey area's without definite answers. In the case of Jerry McCall, Medical Assistant, Licensed Practical Nurse and Office Assistant the rationale, ethical and legal, for not refilling a prescription without physician consent are justified. If Mr. McCall chooses to refill the unauthorized prescription and the patient has an adverse reaction, his employer, Dr. William's can be held legally responsible for the committed tort even though he is personally without fault (Regan & Regan, 2002). Ethical and legal ramifications are at stake; using effective problem-solving methods to assist with decision making can help to avert a problematic outcome. Qualifications Required for Authorizing Prescriptions ...
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...Dorothy Johnson - Nursing Theorist Biography and Career of Dorothy E. Johnson Dorothy E. Johnson was born on August 21, 1919 in Savannah, Georgia. She earned her Bachelor of Science in Nursing in 1942 from Vanderbilt University in Nashville, Tennessee. In 1948, she received her Master's degree from Harvard University. During her career, Johnson was an assistant professor of pediatric nursing, an associate professor of nursing, and a professor of nursing at the University of California in Los Angeles. She retired in 1978. Dorothy Johnson Works written by Dorothy Johnson include: Theory Development: What, Why, How? Barriers and Hazards in Counseling Dorothy Johnson's Contribution to Nursing: Behavior System Model Johnson is known for her Behavior System Model of Nursing, which was first proposed in 1968. The model advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness. The patient is defined as a behavioral system composed of seven behavioral subsystems. Each subsystem is comprised of four structural characteristics. An imbalance in each system results in disequilibrium. The nurse's role is to help the patient maintain his or her equilibrium. Johnson's theory of nursing defines nursing as "an external regulatory force which acts to preserve the organization and integration of the patients behaviors at an optimum level under those conditions in which the behavior constitutes a threat to the physical...
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