Ethical Issues In Nursing

When making the decision to prescribe there are a number of influence you have to consider. It is important to have an awareness of these influences and take them into consideration when issuing a prescription. It is importance to have knowledge of the DOH (2006) Medicines Matters this give guidance on the mechanisms available for prescribing and administration and supply of products. Team trends and external company’s and there representatives promoting their products have a big influence on your prescribing practice Bradley (2006) found that these influences were of concern to some nurses feeling that their colleague may ask them to prescribe for patients they haven’t seen. Thomas (2008)

Jerry has been trained as a medical assistant and well as LPN or licensed practical nurse. Having an occupation as being a medical assistant is regulated loosely in the U.S. In addition, many states lack medical assistant certification and training requirements. It may be surprising that licensing for medical assistants does not exist. Despite inconsistent regulation, every state mandates by law that whenever a medical assistant provides any type of direct patient care, the supervising physician or licensed health care professional must be physically present in the office or building (medicalassistant.net website, 2012). Another law that is consistent in every state is one that prohibits medical assistants from independently prescribing or refilling medications (medicalassistant.net website, 2012). Licensed Practical Nurses have a broader scope of practice than medical assistants do, but prescribing or refilling medications is not included. In this case study, only Dr. Williams is able to refill the medication. If Jerry decides to call in a refill he will be practicing outside of his professional scope and breaking state law.

The Texas Nurse Practitioners firmly support allowing APRNs to practice to the full extent of their clinical ability without any arbitrary barriers. A state regulatory system that allows patients to have full and direct access to all of the services that APRNs

been restricted on what they can and can’t do including signing certain documents and orders they can prescribe. With the Affordable Care Act the demand for primary care providers is growing (Gadbois, Miller, Tyler, & Intrator, 2015). This means that the need for APRNs is rising and the need change is approaching. In the primary care setting, there is a variety of medical staff working including medical assistance, LPNs, and RNs. This can become more for the APRN when delegating medication administration. When the APRN cannot delegate medication administration the quality of patient care is sacrificed and is not productive in providing care to the patients.

State law is made up of two different forms: statues and regulations (Buppert, 2015). Under the established rules and regulations, an ARNP can: (a) monitor and alter drug therapies; (b) initiate therapies for certain diagnosis’; (c) perform additional functions as may be determined by rule; (d) and order diagnostic tests and appropriate therapies (The Florida Legislature, 2016). A practitioner licensed under chapters 458, 459 or 466, must maintain supervision for directing certain course and medical treatment (The Florida Legislature, 2016). Within the context of advanced nursing practice and the Florida Statues chapter 464.003(2), an ARNP may diagnosis, treat, alter medication regimes, diagnose, prescribe and operate, which are approved by a joint committee composed of three members appointed by the Board of Nursing, three members appointed by the Board of Medicine and the State Surgeon General or his/her designee (The Florida Legislature, 2016). On the other hand, the federal government regulates nurse practitioner practice through statutes passed by Congress and regulations (Buppert, 2015). According to Buppert (2015), federal law can override state law, and when federal and state law conflict with one another, federal law usually triumphs. Due to these state and federal statutes and regulations, this can impose a huge threat and impact to NP practice since the BON and the Nurse Practice Act usually help

According to American Nurses Association (ANA), (2010) “the nurse promotes, advocates for and strives to protect the heath, safety and right of the patient” (p. 6). Nursing responsibilities should be acted at the highest standard and must be based on legal and ethical obligations.

As a certified registered nurse practitioner (CRNP) practicing in the state of Pennsylvania, the current prescriptive authority limits prescribing narcotics to a 72-hour supply. This includes any Schedule II medication regardless of the patient and their pain regimen. Working under a collaborative practice agreement, the nurse practitioner (NP) can prescribe chemotherapy, treat and prescribe for most symptoms and side effects the oncology patient may encounter, but not treat pain with Schedule II narcotics (Leahy, 2007).

A nurse is given an opportunity to help patients, either if its by helping them through a very serious sickness or just helping a patient get to the bathroom on time, or a time when happiness is overfilling the room and a child is being born. Registered nurses provide a wide variety of patient care services (Mitchell, p.12). A Nurse must always know where to begin and where to stop, as any other career in the health field there is always something that cannot be done by everyone but only the certified person, a nurse must always remain inside her scope of practice to prevent any misunderstandings. A nurse must also follow a code of ethics , the code of ethics of the American Association of Medical Assistants states that a nurse should at all times render service with full respect and dignity of humanity, respect confidential information obtained by a patients file, uphold the honor and high principles the profession and accept its discipline, and last but not least always want to improve her services to better serve the health and well being of the community. (Mitchell, p.65).

While in the hospital APRNs can prescribe schedule two substances and must be filled in the hospitals pharmacy. The APRN is restricted in which they cannot write these prescriptions for patients to fill in an outside pharmacy (TNA, 2016). TNA states the Following:

Also, she mentioned the law regarding practicing as an APRN in TN. According to the Tennessee’s Nursing Practitioner Supervision Laws, a nurse practitioner is required to be supervised by a physician. It is mandatory for the physicians to visit the site and review the charts that APRN has been working. Nurse practitioners can prescribe controlled substances in TN. She practices with a collaborating physician, and he is available for the clinical resources. I inquired about inter-professional role conflict between APRN and physician since this is a typical situation in the clinical setting. She thought about it before starting the current position, but she felt all the physicians are helpful and understand of APRN’s role. However, she emphasized the need for more independence and autonomy for the better

The statutes lay out the rules for collaborative practice and prescriptive authority. A written collaborative practice between the APRN and a physician must be in place for an APRN to work beyond a nursing license. The collaborative physician must be within geographical proximity thirty to fifty miles. There is an exception to the mileage rule for qualifying rural facilities. The physician must review ten percent of all of the APRN’s charts every two weeks and twenty percent of charts/patients that are receiving controlled substances. The written agreement must contain a list of prescriptive medications the physician will allow the APRN to prescribe in agreement with state prescriptive laws. The physician must document a minimum of thirty days of full supervision of the APRN before allowing the APRN to practice without the physician present. And finally, CRNAS are allowed to administer anesthesia without a physician physically present as long as there is one that could be available if

APRNs require licenses to make them qualified to practice care to patients within their roles and patient population focus. The license is granted by the State Board of Nursing. Possessing a master’s degree is the minimum requirement for APRN licensure. APRNs are allowed to prescribe medication and practice independently without physician

Clearly on the agenda nowadays, prescribing in advance practice registered nurse (APRN), most particularly of clinical nurse specialist (CNS) in Michigan, is a new, timely and rapidly growing area of practice with the potential to further advance practice role. Thus, the writer’s knowledge and understanding of the prescriber role of the CNS really requires advanced knowledge in physical examination, medical diagnoses, pathophysiology and pharmacology with respect to the rational drug selection as described in APRN Consensus Model (NACNS Position Statement on Prescriptive Privilege for CNS). The consensus model was created to line up the connections among licensure, accreditation, certification, and education to craft a more uniform practice

According to information found on Leginfo.ca.gov, existing laws allows RNs working in primary care clinics to dispense drugs or other devices only upon an order by a physician and surgeon. This law expands the number of practitioners under whose orders an RN may dispense medications to include CNMs, NPs, and PAs (AB 2348 Assembly Bill Bill Analysis). This law was cited on Rand.gov as an improvement to the Affordable Care Act which is a health care reform law passed under President Obama. The goal of the Affordable Care Act was to reduce the amount of uninsured people while improving the quality and affordability of health care across the nation. The Affordable Care Act provides preventive care, including

There are many rules and regulations governing each state concerning the scope of practice. Independent prescribing is prohibited; Florida Nurse Practitioners may not prescribe controlled substance. This is a disservice since these providers have gone to school and have had the proper education to practice and provide care as well as prescribe medication to patients. As a registered nurse and as a nurse practitioner you have taken pharmacology and studied medication, their class, action, mechanism, and side effects, as well as passing boards. This encompasses all the things needed to become an advance practice nurse, service, provide treatment and prescribe medication. This is an ongoing issue and nurse practitioners are