The preciseness and legibility of nursing practice are of high importance. Legislations provide rather comprehensive guidelines for almost every case. However, the ethical reasonings sometimes lead to controversial decisions which require extensive revisions, for example in the assigned case of writing a prescription to a family member who is not a patient. The stakeholders need to take into consideration possible risks related to both medical errors and illegal actions. This paper will provide an analysis of the case, including presumable consequences for all the participants, and discuss the strategies of disclosure or nondisclosure and of minimizing medical errors with a justified explanation.
In the discussed scenario, the prescribed medicine is alprazolam which belongs to Schedule IV substances (Drug Enforcement Administration, n.d.). This fact makes it extremely dangerous to prescribe without proper medical records of the patient and sufficient expertise of the nurse in psychiatry. The study by Sabatino, Pruchnicki, Sevin, Barker, Green, and Porter (2017) mentions that nurses often overestimate their knowledge and expertise, so their initiative in prescribing causes a high percentage of errors. If the husband is going to use the drug for the first time, and the nurse is mistaken in the dose, amount, or directions, it may cause severe complications. The patient’s state might become inadequate, and his family would not be able to manage it themselves, possibly leading to tragic developments. Additionally, in most states prescribing alprazolam to family members is illegal, so if disclosed, it results in criminal penalties for the nurse. If the pharmacist sells this drug with a fraudulent prescription, he will also take legal responsibility for that. With that in mind, it is clear that the consequences of those actions are not safe neither from a legal nor from an ethical perspective.
The question arises for the witness of this incident, whether it should be reported to the authorities or not. The arguments for disclosure might be the apparent violation of Massachusetts state law, which states that «a nurse authorized to prescribe medication is prohibited from prescribing drugs in Schedules II, III, and IV for personal use» (Advanced practice registered nursing, 2014). Also, since the patient’s condition and symptoms are not aware to the witness, suspicions may arise on the purpose of the prescription. According to Drug Enforcement Administration (2006), as a Schedule IV substance, alprazolam is very likely to cause dependence, indicating that the patient might already be addicted and needs proper withdrawal treatment. On the other hand, the strategy of disclosure might be motivated by the possible conflict of interests between nurses and neglect of patient’s interests, which, according to Fowler and the American Nurses Association (2006), is unacceptable. If the patient actually requires this medicine, it should be provided to him immediately not to disrupt the course. Nevertheless, it can be seen that arguments for nondisclosure outweigh the potential reasons for not preventing the actions of that nurse.
Regarding my presumable strategy for the described scenario, it would be generally based on legal instructions and authoritative guidelines. The best acceptable method of resolving a conflict of interests for nurses is examining it properly (Fowler and the American Nurses Association, 2006). With that notice, I would use any available instruments to research the husband’s medical records and his former prescriptions. I would come to direct communication with the nurse, and if they were unable to justify their actions, I would warn them about resorting to the law. If possible, I would persuade the nurse to disclose the conflict to the relevant parties (the hospital, psychiatrists). In that case, they would be to resolve the situation, nurses would be to withdraw, and nobody receives punishment, according to Fowler and the American Nurses Association (2006). I believe this action plan would effectively prevent illegal activity and, presumably, provide the patient with a proper medical examination.
Another significant point for discussion is the process of prescribing itself since it often relies on controversial decision-making methods and results in medical errors. The prescribing strategy includes evaluating and defining the patient’s problem, specifying a therapeutic objective, selecting and initiating the appropriate drug therapy. Ladd and Hoyt (2015) mention that nurse-practitioners could be «vulnerable or «soft targets» to industry’s promotional activities», meaning that pharmaceutical marketing can influence the choice of medication. To evaluate this problem, one could use electronic prescribing tools that imply a systematic approach to avoid drugs that have not been appropriately tested. Computer-based prescribing also anticipates and prevents adverse events of drug interactions as well as simple errors caused by poor handwriting or misuse of abbreviations. Given these points, the practitioners need to be particularly attentive and impartial while prescribing drugs and do not hesitate to use external automatic tools.
To summarize, the work of a nurse practitioner requires knowledge and expertise in medical, ethical, and legal fields simultaneously. If a certain scenario might seem suspicious from an ethical point of view, they need to consult laws and guides to form an acceptable resolution method. Every nurse needs to take responsibility for their actions while prescribing a drug and not act outside the law because the laws are intended to protect patients’ interests in the first instance.
References
Advanced practice registered nursing, Code Mass. Reg, § 4.27-244 (2014). Web.
Drug Enforcement Administration. (n.d.). Mid-Level Practitioners Authorization by State. Web.
Drug Enforcement Administration. (2006). Practicioner’s manual. Web.
Fowler, M. D. M., & American Nurses Association. (2015). Guide to the code of ethics for nurses with interpretive statements: development, interpretation, and application (2nd ed). American Nurses Publishing.
Ladd, E., & Hoyt, A. (2015). Shedding Light on Nurse Practitioner Prescribing. The Journal fro Nurse Practitioners, 12(13), 166-173. Web.
Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist-led educational intervention for nurse practitioner students. Journal of the American Association of Nurse Practitioners, 29(5), 248–254. Web.