You are a family nurse practitioner working in an outpatient primary care office of an extensive hospital system. The practice has been operating for over 15 years, and many of

 This only needs a response 

Clinical scenario: 

You are a family nurse practitioner working in an outpatient primary care office of an extensive hospital system. The practice has been operating for over 15 years, and many of the administrative and clinical staff were hired when the practice opened. You have been in the practice for less than 3 months. In that short amount of time, you have witnessed several of the clinical staff engaging in heated arguments with each other, sometimes in patient areas. You overhear an argument occurring today between two staff. You pick up a patient's chart and notice a very low blood pressure that the medical assistant failed to notify you about. When you confront the MA, she states that she was going to report the vital signs to you when she became engaged in the heated argument you overheard and forgot to notify you. 

Unfortunately, this pattern of behavior is not unusual in this practice. Working with staff who cannot cooperate effectively can negatively influence your ability to spend time with patients, can impede the flow of patients through the office, and could impact patient safety. 

Case Study Responses: 

1. Analyze the case study for potential issues for members of the healthcare team from office conflict. Contrast the potential effects for each member of the healthcare team based on the required readings from the week. Discuss the potential ethical and legal implications for each of the following practice members: 

• Medical assistant
• The medical assistant's involvement in debates can lead to distractions and neglect of crucial responsibilities, like reporting critical patient vital signs. This issue raises ethical concerns, as it goes against the principle of nonmaleficence, which requires healthcare workers to do no harm and ensure patient safety. Legal issues could arise if a patient experiences harm due to the medical assistant's negligence, potentially resulting in malpractice claims. Loerbroks et al. (2022) state that the he­althcare field can be de­manding, with factors like tight deadlines, limite­d rewards, the nee­d to multitask, little control ove­r one's work, and conflicts with colleagues that can lead to medical errors. Medical assistants are crucial in healthcare facilities, serving as patients' first point of contact. Their primary responsibilities include accurately evaluating the acuity of patients' concerns and prioritizing them. Failing to correctly assess the urgency of patients' complaints during the initial contact with the practice is a critical potential error in general practitioner settings (Loerbroks et al., 2022). Lawsuits can arise from various situations, including carrying out procedures or administering medications without proper training or supervision, failing to accurately document patient information, misinterpreting test results, and lacking effective communication with patients or other healthcare providers (Miller, 2023)
• Nurse Practitioner 
• As a nurse practitioner (NP), observing staff conflicts and communication issues can increase stress and make it more challenging to make critical clinical decisions. Ethically, NPs advocate for patient safety and address any factors that could compromise patient care. Legally, NPs could face liability if patient harm occurs under their watch, mainly due to a failure to supervise or address known safety problems. Healthcare settings, in particular, face several communication challenges. Joint Commission estimates that 65% of healthcare sentinel events are related to communication breakdowns (Catalano, 2008). "The NP is a responsible advocate for patient welfare and upholds ethical and legal standards. As an advocate, the NP influences health policy at the local, state, national, and international levels" (Standards of Practice for Nurse Practitioners, 2022). In this case, the FNP, the delegating provider, may be liable for negligence if a medical assistant performs the task negligently (Balasa, 2018). 
• Medical Director-
• The Medical Director may encounter difficulties maintaining high-quality care amidst staff disputes and could be held accountable for the practice environment. Ethically, the Medical Director fosters a professional, collaborative work setting that prioritizes patient wellbeing. It is possible for the Medical Director to face legal consequences if the practice environment contributes to substandard patient care or if staff is not compliant with standards of care and workplace violence policies. Kim (2020) suggests that healthcare leaders have a crucial responsibility to maintain the safety of their staff while on the job. Hospital administrators should lead in preventing workplace violence and managing such demanding situations efficiently. Ensuring executive support, conducting comprehensive investigations, acting on the findings, and providing ongoing support are effective strategies for addressing workplace violence issues (Kim, 2020).
• Practice- 
• The primary care practice may be affected by a negative reputation due to disagreements among staff, which can impact patient satisfaction and ratings. Ethically, the practice provides a safe, effective, professional healthcare environment. The practice can be legally accountable for issues like staff conflicts that could lead to patient harm, and it may encounter regulatory penalties if it fails to comply with workplace laws. According to the literature, Lim Et al. (2022) state that violence against healthcare workers is unacceptable, and when healthcare staff experience violence, it leads to reduced quality of care and higher absenteeism. As a result, the availability of healthcare services to the public is limited, and healthcare costs rise due to limited resources. The maximum civil money penalty for violating The Patient Safety and Quality Improvement Act of 2005 (PSQIA) is $11,000 as of its last revision on June 16, 2017 (Office for Civil Rights, 2020). PSQIA establishe­s a voluntary system for reporting information to enhance­ data used in evaluating and addressing patie­nt safety and healthcare quality issue­s. It provides federal safe­guards for patient safety details to e­ncourage the reporting and analysis of me­dical errors (Office for Civil Rights, 2020).

2. What strategies would you implement to prevent further episodes of potentially dangerous patient outcomes? 

As a family nurse practitioner new to the practice, I may have limited formal authority, but it is still essential to exhibit leadership qualities that can influence positive change. Prioritizing patient safety through proactive measures to prevent further episodes of potentially dangerous patient outcomes can be possible by demonstrating good communication skills, professionalism, advocacy, and conflict resolution skills. Enhancing communication among the team members by utilizing standardized protocols, clear handoff procedures, and regular team meetings ensures everyone is on the same page regarding patient care and professional expectations. Additionally, it is always important to emphasize the importance of staff engagement in ongoing education and training on workplace violence and zero-tolerance policies. Fostering an environment of trust, with no fear of retaliation, effective communication, collaboration, and accountability promotes a culture where patient safety is the priority. 

This week's course material mentioned, " In order for the APN in the workplace to best engage in continuous quality improvement, it is necessary to seek out a position in an effective work environment in which the focus is one of empowerment" (Chamberlain University, 2024). The lesson encourages nursing leaders to utilize the human relations/quality management approach to increase organizational commitment and job satisfaction and develop problem-solving and decision-making skills (Chamberlain University, 2024).

3. What leadership qualities would you apply to effect positive change in the practice? Focus on the culture of the practice.

After analyzing the practice culture in this scenario, it is evident that conflict resolution, lack of accountability, and resistance to change are factors affecting the effective functioning of the practice, compliance with organizational policies, and jeopardizing patient safety remarkably. In healthcare environments where lateral violence is not addressed and is part of the day-to-day, the quality of accountability in leadership is crucial for promoting positive change. As a family nurse practitioner, you can set an example and establish clear behavioral expectations, stressing accountability for medical errors and unacceptable behaviors among staff. Additionally, allowing employees to modify their conduct and improve their performance to demonstrate leadership quality of emotional intelligence may help avoid further incidents before needing to apply more strict corrective measures. 

Reference:

Balasa, D. A. (2018). Live-ceu-handout-final [PDF]. American Association of Medical Assistants. https://www.aama-ntl.org/docs/default-source/other/live-ceu-handout-final.pdf

Catalano, K. (2008). Knowledge is power: Averting safety‐compromising events in the or. AORN Journal, 88(6), 987–995. https://doi.org/10.1016/j.aorn.2008.06.002

Chamberlain University. (2024). Week 5: the impact of quality improvement on patient safety. https://chamberlain.instructure.com/courses/143137/pages/week-5-the-impact-of-quality-improvement-on-patient-safety?module_item_id=20617725

Kim, L. (2020, September 6). Leaders' role in stopping workplace violence. American Nurse. https://www.myamericannurse.com/leaders-role-in-stopping-workplace-violence/

Lim, M., Jeffree, M., Saupin, S., Giloi, N., & Lukman, K. (2022). Workplace violence in healthcare settings: The risk factors, implications and collaborative preventive measures. Annals of Medicine & Surgery, 78. https://doi.org/10.1016/j.amsu.2022.103727

Loerbroks, A., Vu-Eickmann, P., Dreher, A., Mambrey, V., Scharf, J., & Angerer, P. (2022). The relationship of medical assistants' work engagement with their concerns of having made an important medical error: A cross-sectional study. International Journal of Environmental Research and Public Health, 19(11), 6690. https://doi.org/10.3390/ijerph19116690

Miller, R. V. (2023, March 5). Medical assistant medical malpractice lawsuits. Maryland Medical Malpractice Attorney Blog. https://www.marylandmedicalmalpracticeattorneyblog.com/medical-assistant-malpractice/

Office for Civil Rights. (2020, June 8). Maximum penalty for violation of the patient safety and quality improvement rule remains $11,000. https://www.hhs.gov/guidance/document/maximum-penalty-violation-patient-safety-and-quality-improvement-rule-remains-11000

Standards of practice for nurse practitioners. (2022). American Association of Nurse Practitioners. https://www.aanp.org/advocacy/advocacy-resource/position-statements/standards-of-practice-for-nurse-practitioners