Medical Assistants in the office

  1. This is probably going to open a can of worms.............but how do you all feel about replacing nurses in the office setting with Medical Assistants? How (if at all) do you feel it affects patient care?

    Do any of the MA's in your offices refer to themselves as "nurses"? Have you had any problems with the knowledge base of the MA's? How are they with patient education?

    May be just my situation, but I have run across some significant problems in this area................and not sure how to address it...........or even if I can address it.
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  2. 208 Comments

  3. by   NurseDennie
    I've noticed it as a patient! As a matter of fact, I'd heard one two many MA's introduce herself as Dr. Somebody's "nurse" that I got fed up and called the BON.

    In my state, the word "nurse" is not protected. I've posted this before, but I'm still gobsmacked about it. Nobody is allowed to call himself or herself an LPN or RN without the license, but "nurse" is up for grabs.

    Yes, I do think it affects patient care. I've seen a MA with totally NO understanding of meds print out an rx for "amoxicillin" instead of "atavan." Hello???

    I've seen it in MY doc's office because he has to be consulted for every bleeding rx renewal. How this is saving him money, I'm sure I don't know. But there's no nurse to look at the chart and say, yeah, this is a HTN med, and per the notes, this patient is still on it, yeah, go ahead and refill it. So sometimes it takes a week or more to get a simple rx renewed.

    I think it's a very bad and scary thing. I went for my flu and pneumonia shot last week, and I made the MA bring the vials to the exam room and I looked at them before I let her give me the injections. I'm very glad that the nurses in my daughters' pediatrician's office were really nurses. But I'll bet that's rare now!

    Love

    Dennie
  4. by   SHELLYBELLYRN
    THANK YOU, DENNIE..........for standing up for your patient rights and making the MA bring the vials into the room!! Maybe if more patients make it known that they won't compromise their care, then MD's will get the message.

    I, too, have witnessed many errors, lack of critical thinking (and some sheer IGNORANCE) on the part of MA's I have worked with. For instance, saying "I don't know why you get paid more than me, we do the SAME JOB" (little did she know I made barely more than her).........................and then turning around the same day and asking....."which of these patients meds are for diabetes?"?!?!?!? So let me get this right..........I have to do MY job, and help you with YOURS, too?

    Sorry to ramble............just glad that you protect yourself when in the office.
  5. by   KeniRN

    We have 4 MA's, 3 LPNs and 5 RNs in our peds office. For the most part, the Docs and the rest of the staff (LPNs and RNs included) refer to the group of nursing staff as "nurses" when speaking to the families for the simplicity of it.
    For example, when a doc is finished with the pt and they are waiting for someone to come into the romm to give them their immunizations the doc will tell the family, "the nurse will be in shortly to give Joey his shots." Most of the time that doc does not know which nursing staff member will be giving the shots. the title "nurse" is used in our office as more of a generic term so that the families know the difference between the clerical staff and the nursing staff.
    The nursing staff all know their responsibilities and limitations as to their licenses and certifications. The MAs never attempt to give meds, treatments or procedures. They do more clerical things than the LPNs or the RNs. They fill out school forms, do heights, weights, vs, hearing and visions screenings and some pt teaching. They also give immunizations, but not abx or allergy inj. They are valuable to our office, enabling the LPNs and RNs more time to do things within their (licensed) scope of practice. For example only the RNs do phone triage in our office. Some places have LPNs that do phone triage.

    But to replace Licensed staff with MAs is not cost-effective nor is it safe


    On a side note...there is 1 MA who has a 'greater than thou" attitude towards the Rns and 2 of the 3 LPNs. The other 3 MAs are going to school to become either a LPN or a RN. The rest of the nursing staff have decided she acts the way she does b/c she feels threatened. Most of us are around the same age. The 1 LPN she is buddy buddy with goes along with her and is easily manipulated by her. This MA is always nosing in everyone elses business. If you leave the floor to pee she is always the first to be hunting you down demanding to know what you were doing and to tell you there were 4 pts waiting and she assessed them all...yadda-yadda-yadda. She and her buddy have the habit of disappearing here and there during the day, taking long lunches or taking 2 lunches and then when you confront her on it she makes a big scene and becomes the "attitude from hell":angryfire and she makes sure she does it infront of at least 1-2 other people. I'm just so tired of it. My last day is tomorrow. (I start a new job on Tuesday). She's not the reason I am leaving but she sure contributes. And I've been telling Nursing management but she's been with this office for 10 years and she makes everything turn into a racial thing and nothing is ever her fault....
    I'm
    just
    plain
    sick
    of it.

    Thanks for letting me vent.
    I'm sorry this was so long.
    I'll be shorter next time
  6. by   jbeachy
    This is my first time posting, but I have followed along for a couple of months, so bear with me please.
    I recently asked my office manager if we could not refer to everyone as "nurses". She was not too happy to make the front desk change things and didn't understand why I was asking. I wonder if I am overreacting.?
    I work in a smaller practice and am the only licensed nurse (LPN, soon to sit for RN). I have a full time MOA (medical office assistant) that just graduated from school. She had 6 months of classes and then did a 6 week externship in an eye clinic. Needless to say, I am teaching her everything from pronunciations of medications to injection techniques. I find it really irritating to still be paying for school, getting my CE's, staying up on things and then passing this information on to someone who is making the exact same pay as I, and is calling herself a nurse. My OM has just informed me that I will also be teaching her patient education and telephone triage skills. I am concerned re my license as I am supervising her and teaching her the skills, and the liability issues as well as just being so mad I could scream.
    What do you think? Am I overreacting? I love to teach and love to hear people ask questions rather than assuming but...
  7. by   HISSYTHECAT
    I am currently a CMA. The doctor offices that I have worked at...I was not referred to as a nurse. My job duties were to screen patient for the medical hx, check weight, set the room up, assist the dr, call in rx, send lab specimens off, schedule outpt px, call pts for test results, give injections, phlebotomy, check bp, EKGs, (know how to do IVs and Caths but never done them on anybody other than a dummy)and stock supplies. I have even worked in OR a couple of times assisting and I truly loved that. The only thing I could not do that a LPN or RN could not do was ?. I did not want to be referred as a nurse because I felt that I was not licensed. I am also cross trained for the front office as well. I am not putting anybody down, but that is the reason I am trying to go into RN. I want to be somebody with respect. As a CMA I feel like I am nobody but I can do all of the above. Does this make sense?
  8. by   SHELLYBELLYRN
    Makes total sense to me...................but let me clarify..........I do not see the MA's that I worked with as "nobody"........in fact, they have a vital part in the efficient running of a medical office. My problem was with the attitude that "I do the same job as you".........without realizing that I spent YEARS learning about disease processes, pharmacokinetics...............finding out WHY my patients were ill and WHY and HOW their meds worked/interacted, etc. THEREFORE, a CMA with less than 2 years schooling, most of which was in terminology, front office, etc.........CANNOT say that they can do MY job (whether or not they can complete the same TASKS)...........because they do not understand many things vital to interacting with physicians and patients, and vital to providing SAFE "nursing" care.

    I think it's great you are pursuing your RN, if that is what makes you feel better..........but please remember your role right now IS important...........it's just not the role of a nurse.
  9. by   mark_LD_RN
    ma's servea purpose but they are NOT nurses.ANd shouldnot ever be called anurse. that is false representation.I always make a point to point that out if a ma calls and presents there self as such and suches nurse. using the term nurse to refer to them gives the illusion that they are a nurse and things they say and do should care the same weight as anurse
  10. by   EMTMom
    This comes about ALL the time. So, I'll say me peice on it as I usually have to do to clarify my career to others in the medical profession. I am CMA. I do injections, phlebotomy, EKG's, limited X-rays, some triage, RX refills and many other things. I DO NOT, assess a patient, formulate patient care plans or diagnoses, handle IV therapy or meds, triage to a RN ability. I am not a nurse, and I don't portray myself as one. However, the nurses and MD's here all know I am a CMA ( we are a 14 person practice), and they still refer to me as Dr. M's NURSE. I'm thrown in with the general "nursing staff". I am very confident in my ability to treat patients AS DIRECTED by my supervising physician. I do have critical thinking skills and the deisre to always learn, that enable me to know the differences between meds that I handle and call in, know what is urgent and what is not, and when to ask the nurse for help. I would feel very offended if a nurse asked me to show her the vials of medicine I was giving before I gave her the injections. As would you if another nurse asked the same. If this is truely the case, the lack of trust and understanding, or complete apparent lack of education on part of the MA, in your community, you should be bringing it up to the mdical board of that facility. As should anyone who obsereves a medical professional acting unsafely.

    I think all MA's should have a minimum 2 years of training. I have an associates degree in medical assisting. I also think all MA's should have some kind of EMT or patient assessment, emergency training to bump up their skills.

    I strongly believe that MA's should not cross the boundaries seperating them and the nurses they work with. Granted, many of our responsibilities are the same, and sometimes there are no lines between the roles, but there are skills and critical thinking that MA's just aren't taught.

    i am considering LPN school to bump up my skills and finally have the title of nurse. I'm tired of having to explain to everyone what I do, and no, I'm not a nurse, even though I work in the clinic and do "nursing" things. I have several friends who are CMA's and I would never distrust them. My Doctor's assistant is wonderful and competent and caring.

    Lisa
  11. by   HISSYTHECAT
    I did not mean to step on anybody toes as I did in my post. I am sorry.
    I wished that I could turn the hands back and what I know about MA, I could have gone for my RN degree then. I realize I learned a great deal in the program and I hope I can use it in school later on, but I feel like I wasted two years in this program for nothing.

    once again, please forgive me if I made anybody mad at me. :O)
  12. by   EMTMom
    I don't think your offending anyone, but stating how you feel. To agree with an above post, I too am 'sick of it'. Sick of being degraded everytime I turn around by nurses because I'm not one. Just the other day I called a patient to tell her her blood sugar results, which were high for the third time in a row. I explained to her that the Dr was concered that she may have pre-diabetes and we needed to do some follow-up. Well, she cursed me out and told me about 10 times that's she's an RN, and she KNOWS I'm ONLY a CMA, and therefor, didn't know what I was talking about. What the *ell?? Ya know, nothing in life is fair. So nurses aren't the only ones in the medical world anymore. I'm tired of it. Well, my DR ended up calling the nurse back, repeating the same things I had told her and she was like, "OK Dr. I understand, blah, blah, blah." I once had an RN with a BSN take a triage call from a patient who stated he'd just done his blood sugar reading at home and it was 825. She asked me if it was OK for him to wait 2 days to see the doctor, or should he come in right away? Hello? Who is supposed to know more??? Stupidity and ignorance can be found on any level. Let's not forget the time an LPN instructed a patient to use an alcohol swab on her bottom for a clean catch urine because she couldn't find the proper swabs, and though it would be just as effective. See what I'm saying?
  13. by   darla80
    I have followed this with interest

    I work in an Internal medicine office.. we see a many sick pateints as well as healthy patients.

    I want to say this........... . the people with chronic health conditions such as Diabetes, CHF, COPD, CAD etc need to have access to a medical professional with a broad knowledge base and good critical thinking skills.

    I deal with questions that utilize not only my anatomy and physiology knowledge but I utilize the skills and education I gained as hospital nurse. The "nursing License" I carry and all the work of obtaining that license enables me to better care for the office pateints. My teaching skills and critical thinking skills were part of my nursing curriculum. My hospital nursing experiences also improve my office interactions with the hospital personnel, pharmacies etc.

    So those of you who have chosen to be Office MAS, should not be offended by the patient who questions you, but simply understand the patient wants advice from a person they view as more knowledgable.

    As Nurses, we are able to frame medical responses differently because of our training and our education. We spent years learning about disease and disease process as well as countless hours administering medications and caring for sick patients in the hospitals. We undestand the BIgger picture.

    So please identify your self by your title and be proud of who you are and what you do..MAs are a valuable asset to most offices but recognize your limitations as an MA and that your effectivenss in some areas will be limited by your background

    GOOOD Medical care is often about the team.. so my goal is to use a team approach and make life better for as many people as I possibly can.

    Thinking it through....sharing my world

    Joy and Smiles*Darla***
    Last edit by darla80 on Nov 3, '02
  14. by   fairyprincess2003
    hey hissy
    a MA cannot do assesments that I know of, or make decisions with regard to the patient

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