Ethical and Legal Implications of Prescribing for the Advanced Practice Nurse

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?  Ethical and Legal Implications of Prescribing for the Advanced Practice Nurse 

These are some of the questions you might consider when selecting a treatment plan for a patient.

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare
Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
Review the scenario assigned by your Instructor for this Assignment.
Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.
By Day 7 of Week 1
Write a 2- to 3-page paper that addresses the following:

Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
Explain the process of writing prescriptions, including strategies to minimize medication errors.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at All papers submitted must use this formatting. Ethical and Legal Implications of Prescribing for the Advanced Practice Nurse 

JJ is a 7-year-old male that has been dealing with asthma his entire life. Multiple treatments have been tried, which have helped symptoms, but nothing that works completely. You are treating him and know of a study regarding a new asthma medication being developed. This new medication contains a bronchodilator/steroid/antihistamine as an inhalation. None of the drugs being studied have previously been approved for children under the age of 12. The study would last for 16 weeks.

Ethical and Legal Implications of Prescribing for the Advanced Practice Nurse

The advanced practice registered nurse or APRN is a clinician with prescriptive authority. This means that they have been educated and trained at the postgraduate level to assess patients, order investigations, prescribe medications, and follow up treatment. The full extent of this prescriptive authority would be seen in a state that has provisions for full practice authority or FPA (Dillon & Gary, 2017). Full practice authority means autonomous practice t the fullest extent of the APRN’s education, knowledge, and skills. However, this prescriptive authority comes with legal and ethical obligations to respect nonmaleficence or to “do no harm” to any patient. Since the advanced practice nurse with prescriptive authority is also allowed to prescribed controlled medications prone to abuse, they are issued with an individual Drug Enforcement Administration or DEA number that identifies them personally as a prescriber (Androus, 2019). The purpose of this paper is to look at the ethical and legal obligations of prescribing medications, using the case scenario of a 7 year-old boy with chronic recalcitrant asthma.


Explanation of the Ethical and Legal Implications of the Scenario on All Stakeholders Involved

The stakeholders involved in the case scenario are the prescriber (APRN), the pharmacist, the patient, and the patient’s family. The prescriber has an ethical obligation not to cause harm to the child. By prescribing the trial medications off-label, they will be putting the life of the child at risk as there is no FDA data on safety of the drugs on children. This is against the bioethical principle of nonmaleficence (Haswell, 2019). By law, they are also required to disclose this action to the DEA and the prescription Drug Monitoring Program or PDMP (DoH, n.d.). The pharmacist has an ethical obligation to also maintain nonmaleficence by calling the prescriber and warning them of the potential risks of prescribing a non-FDA approved trial medication to a minor. Legally, they are also supposed to report such an incidence to the DEA and the PDMP if the prescriber goes ahead and prescribes the trial medication. They also have the option of refusing to dispense the medication on safety grounds. The patient and the patient’s family have autonomy and can decide to give informed consent or not after getting all the information about the trial drug. They can also legally report anonymously to the DEA if they felt that the prescriber was putting their child’s life at risk.

Strategies to Address Disclosure and Non-Disclosure

The prescription of a trial medication not recommended for children to a minor would constitute an error that needs disclosure to the DEA and the state PDMP. Disclosure in this scenario is obligated and the question of non-disclosure does not arise. The strategy is to disclose to the DEA and the state PDMP that one has as a prescriber decided to try a medication mixture on trial that is meant for adults on an off-label basis on the child with recalcitrant asthma. In the state of Maryland, the specific piece of legislation is referred to as the COMAR 10.07.06 (DoH, n.d.). The other strategy would be full disclosure of the facts to the parents of the child that the medication is a trial one and has inherent risks.  Ethical and Legal Implications of Prescribing for the Advanced Practice Nurse

Strategies to Guide Decision Making

Two strategies that I would use to guide decision making in this scenario are to consider the benefits against the risks; and to take into account the principle of autonomy and the authority to use off-label medications (Mir & Geer, 2017). Since all other medications have failed to bring relief to the child, here is a likely prospect of getting more benefit over the risks involved in the off-label prescription of the trial bronchodilator/steroid/antihistamine combination inhaler. I would also listen to the parents of the child after giving them all the facts. If they do not give informed consent I would not force them with the medication. Lastly, if given informed consent, I would seek to use my prerogative and legal leeway to prescribe the off-label medication since it is not against the law. In all, I would definitely disclose my error.

The Process of Prescribing and Minimizing Medication Errors

To correctly prescribe medications the prescriber needs to first identify the patient, examine them, make a diagnosis, set a treatment objective, prescribe, educate on side effects, and follow up (Pollok et al., 2007). To minimize medication errors, the provider needs to have an integrated computerised clinical decision support system (CCDSS) in the electronic health record (EHR) platform of the facility (Kwan et al., 2020). This will always alert the prescriber when a prescription or medication error is about to be committed.


All prescribers including APRNs have prescriptive authority and an accompanying DEA number to identify them. There are however ethical and legal obligations that must be adhered to when prescribing. Also, when errors occur, it is incumbent upon the prescriber to disclose tem to the relevant authorities for the safety of the patient.


Androus, A.B. (2019). What is a DEA number and how can a nurse practitioner obtain one?

Dillon, D. & Gary, F. (2017). Full practice authority for nurse practitioners. Nursing Administration Quarterly, 41(1), 86-93.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179.

Kwan, J.L., Lo, L., Ferguson, J., Goldberg, H., Diaz-Martinez, J.P., Tomlinson, G., Grimshaw, J.M., & Shojania, K.G. (2020). Computerised clinical decision support systems and absolute improvements in care: Meta-analysis of controlled clinical trials. BMJ, 370(m3216), 1-11.

Maryland Department of Health [DoH] (n.d.). Prescription drug monitoring program (PDMP).

Mir, A.N. & Geer, M.I. (2017). Off-label use of medicines in children. International Journal of Pharmaceutical Sciences and Research.

Pollok, M., Bazaldua, O.V., & Dobbie, A.E. (2007). Appropriate prescribing of medications: An eight-step approach. American Family Physician, 75(2), 231-236.,%3B%20(5)%20give%20information%2C

Ethical and Legal Implications of Prescribing for the Advanced Practice Nurse


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