NURS 6521 wk 2 Essay Discussion
Ethical Challenges in Treating Friends and Family
Scenario #3 describes a nurse practitioner writing a prescription for her husband who is not a patient, for a narcotic. This scenario is troubling on multiple levels. To be a judicious provider, it is the advanced practice nurse’s responsibility to perform an extensive physical and review the patient’s history before a diagnosis is obtained and a treatment plan devised. Writing prescriptions involves the responsibility of being confident in assessing the patient and ordering or administering the correct diagnostic tests and measurements, then creating a plan of care based on these factors (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). NURS 6521 wk 2 Essay Discussion
Ethical Issues
Treating family or friends involves several ethical dilemmas, and increase in severity the closer the relationship is (husband/wife). Conflict of interest arises when the provider has a dual role and loses objectivity, often treats outside their scope of practice, and potentially puts the patient at risk. Issues of non maleficence and beneficence are introduced in this type of situation due to the fact proper evaluations may not be completed or appropriate diagnostic testing performed (Gold, et al., 2014). When prescribing narcotics, proper assessments need to be completed and recorded on the patient’s chart. Clinically validated tools such as SOAP (Screener and Opioid Assessment for Patients in Pain) are important to utilize to develop a plan of care, proper dosing, and assessing the patient’s level of tolerance (Woo & Robinson, 2016).
The advanced nurse practitioner’s responsibility entails adhering to a standard of care; if you treat a treat a family member, ethically, it should be done in the same manner as a patient seen in the clinical setting. This standard of care includes ordering any necessary testing and providing documentation of an exam and the thought process behind the clinical decisions made (Zilber, 2016). The conscientious provider will refer the patient to an urgent care location, colleague, or an emergency department if narcotic prescriptions are warranted.
Legal Implications
Legally, if a provider issues a narcotic to a family member, the state licensing board can become involved to review the provider’s prescribing practices. Treating family members not only raises ethical flags, but legal issues including potential billing issues, insurance claims, and possible Medicare improprieties (Gold, et al., 2014). With the increasing national opioid crisis, advanced nurse practitioners need to be ever mindful of their prescribing power. While all states may vary on the limits to the power of narcotic prescription authority, most have adopted new rules and regulations related to the prescribing of opioids and can be located on each state board website. If the practitioner is found non compliant or not acting in accordance with the law, they could potentially lose their license or face legal proceedings (Stokowski, 2018). NURS 6521 wk 2 Essay Discussion
Ramifications
This scenario involves several parties. The patient potentially could have a substance abuse problem that the provider is enabling; this could result in overdose, impaired driving, and the vicious addiction cycle. The perpetual access to drugs and substance abuse affects family members, community safety, increased patient mortality and the increase in insurance premiums due to potential high-risk behavior resulting in injury. The pharmacist is putting their license on the line providing the patient with narcotics because they are administering the provider’s script on good faith that it was prescribed under the appropriate standard of care. If this prescription was a one-time dose, without proper assessments or referral to appropriate specialties, the pain could be a sign of something that needs further medical attention outside the advanced practice nurse’s scope of practice or specialty.NURS 6521 wk 2 Essay Discussion
Strategies
First, I would approach my superior. I would not approach the co-worker writing the prescription directly. I would review with my supervisor what I saw, and voice my concerns as this is not only an ethical violation but a legal issue as well. If I did not feel comfortable going to my superior and felt my job may be in jeopardy, I would look for other avenues such as an ethics hotline or an anonymous risk management number. I would ensure what I saw was legitimate and could be proven with prescription verification (Philipsen & Soeken, 2011).
If I had no options available to me, I would research how to contact the board of nursing discretely. Due to the opioid crisis making the national spotlight with laws and regulations recently enacted, this type of scenario would more than likely be handled without much of the reporter’s participation. Prescriptions are easily tracked through state databases and the provider number. If this was indeed a blatant abuse of power and an addiction situation, or a one-time lapse in judgment, it is up to the facility’s administration and the board of nursing to distinguish. NURS 6521 wk 2 Essay Discussion