Across the United States, nurse practitioners have some extent of prescriptive authority over drugs, controlled substances, medical services, and medical devices (de Araújo et al., 2019). NPs and other healthcare professionals with legal authority to prescribe medication are required to observe legal and ethical guidelines to safeguard the patient from harm. However, the regulations governing prescriptive practice among NPs vary across different states. For this discussion, the ethical and legal implications of the provided case scenario will be illustrated based on the New Jersey NP’s scope of practice.
Ethical and Legal Implications
The provided case study demonstrates an ethical dilemma of whether or not to report an NP who prescribes narcotic medication to her husband. The laws and regulations regarding prescribing medication to a family member or a friend differ by st
ate as it is forbidden in other states, whereas in some states, it is only advised against. In New Jersey, NPs are required to collaborate with physicians to enjoy prescriptive authority privileges (Ellenbogen & Segal, 2019). When prescribing controlled drugs such as narcotics, the NP is required to consult with the supervisory physician and complete must have completed education in the pharmacology of drugs listed under controlled substances. Consequently in New Jersey, prescribing controlled substances to self, family member, or friend is prohibited.
The prescriber, which in this case is the NP, violated all the regulations for prescribing controlled substances as required by the New Jersey state laws. For instance, she failed to consult the supervisory physician before prescribing the narcotic medication to her husband, which is also against the law. Prescribing medication to a family member undermines the professional objectivity of the prescriber in addition to compromised professional medical judgment (Phillips, 2020). Legally, the prescriber can end up losing their prescriptive authority or even the practice license. The pharmacist, on the other hand, must ensure that the prescription from the NP has met all the requirements as per the prescriptive practice protocol before dispensing the medication to the patient. Failure to do so, the pharmacist can also face legal charges.
Finally, the patient in this scenario may fail to disclose all the required information to promote the safe use of controlled substances, to her wife, who is the prescriber. Due to patient privacy and confidentiality, most couples fail to share their full medical history, especially the ones that they consider embarrassing such as addiction. Failure to disclose such information may promote the risks of adverse events and negative treatment outcomes (Squellati et al., 2022).
Disclosure and Nondisclosure
The nurse who witnessed her colleague violating the prescriptive authority of state laws and regulations was faced with an ethical dilemma of disclosure and nondisclosure of the incident. According to the Patient Safety Act, N.J.S.A. 26:2H-12.23, healthcare professionals are required to report any form of medical malpractice including prescription malpractice, to the department head and the patient (Ellenbogen & Segal, 2019). Doing so will help prevent such issues from taking place in the future. However, failing to disclose the matter can lead to legal implications, in addition to being unethical primarily to the patient. As such, in the provided case study, it would have been necessary for the nurse to approach the prescribing nurse, and inform her about the implications associated with her actions in addition to the adverse outcomes associated with the use of narcotics. The prescribing nurse should also be advised against failing to adhere to the outlined prescriptive practice protocols to promote patient safety and positive treatment outcome. If the prescribing nurse ignores these concerns, she should then be r
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