Ethical Challenges in Health Care for Nurse Practitioners
Nursing professionals face different dilemmas in their clinical practice and home settings. Most of them wonder how to handle the scenario of a sick friend or a relative, whom they can assist and prescribe medical drugs. In some cases, they prescribe drugs to themselves without necessarily visiting other professional when sickness strikes them. All these factors are a major source of serious ethical issues facing nurses and other healthcare practitioners (Hamric, Hanson, Tracy, & O’Grady, 2014). According to Bird (2016), some states have permitted the prescription of drugs to friends or relatives and self-medication, while others prohibit this behavior due to common unhealthy consequences associated with it.
A response to the dilemma whether nurse practitioners are justified to prescribe for family members and friends or not varies. MidlevelU (2014) explains that prescription laws differ from one state to another, despite most of the states permitting nursing professionals to prescribe to family members when emergencies occur. This provision ascertains that prescription to friends and relatives is justified only in emergencies in all states (MidlevelU, 2013). In others, it is allowed only if a member visits a practicing relative for medical help in the clinical settings just like other clients. MidlevelU (2014) reiterates that nurse practitioners can subscribe to any individual as long as they provide a written record of an examination and treatment, since federal laws provide for the prescription of controlled substances in the presence of a bona fide patient-provide relationship accompanied by documentation. As such, the establishment of such relationship commits practitioners to accountability for their actions, whether prescriptions were written informally or formally.
Basically, the decision on whether to prescribe drugs to relatives or not should be based on ethical provisions and nurses’ core competencies. Thomas et al. (2012) assert that nurses should use clinical competencies to analyze ethical, social, and legal factors when performing their clinical functions. MidlevelU (2014) adds that although it may not be legally wrong to prescribe drugs to family members and friends, nurse practitioners should consider the position of insurance providers who prohibit payments for care where clinicians serve immediate family members, even in formal clinical settings. Further, clinicians should consider legal outcomes of their actions seriously. Therefore, an ethical dilemma manifests itself when prescribing drugs to friends and relatives; however, practitioners should use their clinical judgment to make legal and ethical decisions.
In the case of Mrs. ABC who schedules an appointment with her mother being a nurse practitioner for the treatment of her sore throat, an ethical dilemma arises coupled with writing the wrong prescription for a non-diagnosed illness. The mother is surprised to see her daughter at the office and is compelled to assist. The ethical dilemma is that on the one hand the mother could have left her daughter to suffer or unattended after visiting her office for care, which is unethical. On the other hand, she could have provided care for her daughter as a patient, which many perceive as ethically wrong too. Making a choice between the two options is difficult. According to Minnesota Statutes, it is technically legal to prescribe drugs for friends and relatives since the laws do not limit such actions (The Revisor of Statutes, 2016). Furthermore, practitioners can only prescribe if qualified without any restrictions of the relationship with the patient. Although the laws might have permitted to prescribe, it was ethically wrong to do so for the daughter when the laboratory test was negative.
In conclusion, nurse practitioners are legally allowed to treat and prescribe for their friends and relatives. However, this poses an ethical dilemma, which can only be unraveled if ethical, legal, and social factors are addressed. In the case of Mrs. ABC, the moral dilemma arose when the nurse was compelled to assist her daughter, and it compromised the quality of care; however, she could not have refused since this patient had visited her office.
Bird, S. (2016). The pitfalls of prescribing for family and friends. Australian Prescriber, 39(1), 11–13. doi: 10.18773/austprescr.2016.002
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Advanced practice nursing: An integrative approach (5th ed.). St. Louis, MO: Elsevier Saunders.
MidlevelU. (2013, January 14). Should providers treat their friends and family? [Web log post]. Retrieved from http://midlevelu.com/blog/should-providers-treat-their-friends-and-family
MidlevelU. (2014, October 22). Writing prescriptions as a nurse practitioner: The FAQ’s [Web log post]. Retrieved from http://midlevelu.com/blog/writing-prescriptions-nurse-practitioner-faqs
The Revisor of Statutes. (2016). 2016 Minnesota Statutes. Retrieved from https://www.revisor.mn.gov/statutes/?id=151.37
Thomas, A. C., Crabtree, M. K., Delaney, K. R., Dumas, M. A., Kleinpell, R., Logsdon, C., … Nativio, D. G. (2012). Nurse practitioner core competencies. Retrieved from http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/competencies/npcorecompetenciesfinal2012.pdf