Running head: REFLECTION PAPER: ETHICAL AND LEGAL ASPECTS OF 1

Reflection Paper: Ethical and Legal Aspects of Healthcare and the Role of the Advanced

Practice Nurse

Jill Collins

Washburn University

September 17, 2012

 Reflection Paper: Ethical and Legal Aspects of Healthcare and the Role of the Advanced

Practice Nurse

Healthcare providers are faced with many obstacles and struggles as they attempt to

provide competent and quality care to their patients. There are many legalities to consider

that often become part of these obstacles. There are also several ethical concerns a

provider must consider which may or may not hinder what the provider considers to be

competent and quality care. This paper will reflect on the legal and ethical aspects of

healthcare for the advance practice nurse as viewed by this author.

There are three ethical principles that primarily guide my practices as a student and

will continue to provide guidance in my future role as an advanced practice nurse. I think

these three are primarily what most providers take into consideration when providing

healthcare. Those three principles are beneficence, autonomy and justice.

Autonomy refers to an individual’s right to make his/her own decisions in regard

to healthcare. This principle initially was the hardest for me as a provider to acknowledge.

The reason for this is that I personally believe science and medicine have proven that certain

actions have been shown to produce the greatest results and that people should want to follow

these recommendations. I initially had the expectation that every patient would always make the

choice to do what I told him/her was best. I soon found out this was not the case and although I

am getting better about accepting this fact, it sometimes still remains a struggle for me to let it

go. For example, we know that people with paroxysmal atrial fibrillation (PAF) should be on an

anticoagulant unless they can always specifically tell when the irregularity begins and are able to

see a healthcare provider within 48 hours if it has not resolved. Science and research tell us that
after this 48 hour period, blood clots are likely to form in the atria and increase an individual’s

risk for stroke, pulmonary embolism and myocardial infarction. I had a patient in clinical not

long ago who had PAF and his current episode had been going on longer than 48 hours. He was

not willing to be hospitalized for anticoagulation because he did not have insurance. For the

same reason, he did not want to start warfarin therapy. He felt that the frequent blood draws

would be too expensive. As a provider, I really wanted him to either agree to be hospitalized or

start warfarin before leaving but I realized that all I could do was give him any and all

information in regard to his situation and then let him make his own decision. This happened

over a month ago and I still think about him on almost a daily basis and hope he is doing okay. I

often wonder if there was more that I could do to convince him to change his mind. Although

these types of situations still bother me, I feel I have grown throughout my practicums. I have

gone from doing everything I can possible do short of begging someone to do the “right” thing to

now providing the appropriate education and asking the patient how he/she wishes to proceed.

Beneficence is essentially doing no harm, being kind and promoting the good in

others. I feel this is the reason why many people go into healthcare fields and is certainly

the reason why I chose this particular career path. An example of this in my current

practicum would be whenever I have patients who do not have insurance, I will often go out of

my way to find resources for them to get medications, additional follow-up care and any other

resources they may need. I also very carefully consider my plan of care for each and every

patient. I am constantly thinking about what I may be missing of if there is any possibility that

what I am considering may cause problems for the patient. I do this from a legal aspect as well

but I primarily do it because I would absolutely be devastated if I were ever the cause of harm to

anyone. I know this will continue into my future practice.

 Justice, in my own words, is simply doing what is right and treating everyone fairly

and equally. I don’t know that I can give a specific example of this I just know that I give

the same attention, respect and thought into the plan of care for the homeless alcoholic

drug-addict in one room as I do the well-respected member of the community in the next

room. I may have to help the homeless person more in regard to finding resources to carry out

my plan of care but the plan would still be the same for any given diagnosis and the way I treat

them as a human-being would be the same. This will remain the same for me in my future

practice.

The legal aspects of healthcare are much more confusing and probably worry me more

because I realize that one mistake could mean the end of the career path that I have chosen.

There are so many rules and regulations to be aware of. I think I will likely never learn them all!

There are several considerations in this area that I specifically take into account and will

continue to do so in the future. First of all, I feel is important to be familiar with the state nurse

practice act. This essentially outlines what you can and cannot do as a nurse practitioner in your

current state of residence. Many items vary in regard to practice guidelines so I feel it is of

utmost importance to be familiar with this wherever one may choose to practice.

Secondly, one needs to always be familiar with the specific rules and regulations in the

facility he/she practices in. Legalities can vary from facility to facility depending on the level of

care that is provided and it is important to be familiar with the specifics. Not only are the

specifics of the facility one is working in important, it is also essential to be familiar with

common practices and treatment guidelines within the community/area you are practicing in. An

example of this would be knowing what infectious agents are common in the community you are

working in so that you can develop an appropriate treatment plan. Pneumonia for example may
be treated with a certain group of antibiotics in Kansas but may be treated differently in the New

England states because the common offending organisms may be different. If one were to move

to one of these states and apply the same plan of care as they would have in Kansas, they may

end up causing more problems for the patient and eventually end up in trouble.

Another legal aspect would be to know what the expectations and practices are of your

supervising physician if your state requires you to have one. It is important to be familiar with

this because if you make an error, you may be jeopardizing your supervising physician as well as

yourself. It is important that any decision you make as a provider will be supported and

defended by your supervising physician.

Finally, it is obviously very important to practice evidence-based guidelines and know

current recommendations. It is important for to be familiar with medications I commonly

prescribe and know what their labeled and off-label uses and recommendations are. I must be

aware of what is reasonable and prudent within my scope of practice and maintain these

boundaries at all times. These steps don’t guarantee that I will be covered if something goes

wrong but the likelihood of losing my license or causing serious harm to someone greatly

decreases.

This reflection paper addresses course outcome number seven which is incorporating

principles of ethical and legal practice in primary care settings. This reflection paper also

addresses program outcome number six which is incorporating ethical and legal principles in

healthcare policies.