Reply to Kales

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Reply to Kales
This is an informative post. Nurses are frequently faced with challenges that need decision-making. One of the most challenging concerns is ethical dilemmas. Although nurses strive to avoid it, ethical breaches tend to occur. These breaches, depending on the incident, are associated with significant consequences for nurses (Usberg et al., 2021). They can result in disciplinary actions by employers or state boards of nursing. Nurses can also face litigation for ethical violations. I agree with you about the strategies you have suggested for preventing further episodes of potentially illegal behavior. I would also recommend the creation of a written code of conduct to provide nurses and leaders with an impression of the kind of behaviors and conducts expected from them. The code of conduct usually outlines the unaccepted behaviors and the kind of measures taken when an employee breaches the code (Johnstone, 2022). The other strategy is to reinforce the consequences of ethical violations. Organizations need to hold nurses accountable for unethical actions. When nurses have been made aware of the rules and proceed to act unethically, necessary actions must be taken based on the code of conduct.


Indeed, nurse leaders need to drive difference in the workplace and promote positive changes in healthcare organizations. As such, effecting positive change in the practice requires a leadership style that engages nurses and other healthcare providers as full partners in a perspective of collaboration and mutual respect. Nursing leadership is vital in enhancing work processes, collaborating with others, formulating policies, and developing new integrated practice models that advance positive changes and enable nurses to operate at their fullest capacity (Wei et al., 2019). When a team esteems the qualities of its leader, it enhances morale and fosters a psychologically safe work environment that leads to higher employee satisfaction and retention rates.
Johnstone, M. J. (2022). Bioethics: a nursing perspective. Elsevier Health Sciences.
Usberg, G., Uibu, E., Urban, R., & Kangasniemi, M. (2021). Ethical conflicts in nursing: an interview study. Nursing ethics, 28(2), 230-241.
Wei, H., Roberts, P., Strickler, J., & Corbett, R. W. (2019). Nurse leaders’ strategies to foster nurse resilience. Journal of nursing management, 27(4), 681-687.


Medical Assistants are not allowed to perform tasks such as independent medical assessments, prescribing medications, or giving expert medical advice without the supervision of a licensed medical professional (Chapman, and Blash, 2017). Therefore, when Mrs. Smith was prescribed medication by the Medical Assistant without the approval of the Nurse Practitioner or medical director, it was a violation of the code of ethics and was illegal. This action puts the Nurse Practitioner’s job and license at risk and could cause potential harm to the patient. Furthermore, the Nurse Practitioner and medical director are responsible for the oversight of the Medical Assistant and would be equally liable for the illegal actions taken. The ethical and legal implications of this situation reflect poorly on the practice as a whole and jeopardize the integrity of the facility.

To prevent further episodes of potentially illegal behavior, I would implement a number of strategies. First, I would ensure that clear protocols and policies are in place for how medical assistants should handle calls from patients. This would include a clear understanding of what types of advice can be provided and when a provider should be consulted. I would also provide training to medical assistants on legal and ethical considerations when providing care to patients. It is important that they are knowledgeable of their responsibility to patients and sensitive to medico-legal issues in order to ensure that quality health care is provided (Barnie et al., 2015). Moreover, I would create a system of checks and balances to ensure that any medication prescribed is done so with a provider’s order. Finally, I would ensure that there is adequate supervision and oversight of medical assistants to ensure that protocols and policies are being followed.

To effect a positive change in the practice, I would apply leadership qualities such as flexibility, collaboration, communication, and accountability. I would foster an environment of collaboration and communication by encouraging open dialogue and feedback among staff members. This would increase awareness among staff of each other’s type of skills and knowledge, resulting in continued improvement in decision-making (O’Daniel, and Rosenstein, 2008). I would also be flexible in adapting to changes in the practice, in order to ensure that everyone is on the same page and that protocols and policies are being followed. Furthermore, I would ensure that everyone in the practice is held accountable for their actions and that any disciplinary action is done fairly and consistently. Finally, I would strive to create a culture of respect and appreciation for the roles of each staff member, in order to create a positive and supportive work environment.


Bernad Asamoah Barnie, Paa Kobina Forson, Mercy Naa Aduele Opare-Addo, John Appiah-Poku, Gyikua Plange Rhule, George Oduro, Yaw Adu-Sarkodie, and Peter Donkor, 2015. Knowledge and Perceptions of Health Workers’ Training on Ethics, Confidentiality, and Medico-Legal Issues.

Michelle O’Daniel, and Alan H. Rosenstein, 2008. Professional Communication and Team Collaboration.

Susan A Chapman, and Lisel K Blash, 2017. New Roles for Medical Assistants in Innovative Primary Care Practices.

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