New LPN in ambulatory care, I'm doing the same job as the MA's.

[Rivalicious]

I'm a LPN in a large dermatology clinic. Just started a few weeks ago. The doctor I work for has me, and 3 MA's. The MA's have been there for quite a while and are very good at what they do, and actually trained me. I thought that once I was up and running, I would be taking over more of the clinical aspects and tasks that require a higher level of critical thinking-Patient teaching, assessments, wound care, etc. But in reality, I'm pretty much doing the exact same thing as the MA's. We basically take turns rooming patients, helping with biopsies, doing assessments (!), returning phone calls, removing sutures, and anything else that comes up during the day. The MA's even call themselves nurses when they talk to patients, which makes me really uncomfortable and more than a little resentful. But being so new to the position, I don't know how to bring this up or if it's even worth it to do so-it seems like this is just how things have always been done in this particular practice.

I'm just wondering if this is how it is for other nurses in the ambulatory care setting, and what if anything I should do about it?

[Ann.E]

I have been working at primary care clinic for a little bit and I feel this way as well. That being said, I have identified areas where I feel the nursing judgment would be more appropriate. For example, the teaching that the MAs provide at our clinic here is pretty short and lacks a lot. Mostly because no one has taught them about things such as diabetes or hypertension. Since I know that diabetes teaching is something that our clinic needs, I volunteered to take on this role. In the end it's freeing them up to see and assist patients more quickly, which allows their providers to see patients faster. Also, I have let a few of the providers here know that I am always open to doing things such as IVs or other procedures that MAs are not trained to do. I know a nurse that works at this clinic recently brought up an issue of where the MAs were practicing outside their scope of practice and our supervisors made sure to address the issue. I know that sometimes it's easy for anyone to get comfortable in certain settings, but making sure we practice within our scope of practice is important to make sure we provide quality care. Hope things are going well!

[nursefromcali]

show them that you know your meds and what's that for some comments here were correct. it's okay to be sad and feel upset coz sometime we can blame the MAs who work for so long before you in the clinic to consider themselves as a nurse (even you know they are not) . make sure you'll know the procedures and some skills like blood draw and wound care in that case you're now behind in the skills and doing ekg too and the results as well. telling them about normal and abnormal results. in that case they will know that your printing the the result but kinda explaining them what it is. show them that you have broad knowledge in nursing be professional and stay calm. I work as Clinical Lead LVN i understand what you feel :)

[BuckyBadgerRN, ASN, RN]

Since I first posted on this thread, I have changed jobs. I now work for a multi-specialty practice, in ophthalmology in a further sub-specialty. My MD has 4 RN's and a COA. The COA knows more about what we do than I think I ever will, she's that good. BUT, she's not a nurse and she knows it. And she's cool with that, as are us four RN's. She's been invaluable in helping me learn what I need to, but she can't do the IV's, blood draws and many other tasks that only an RN can do (I am excluding LPN's by default, because they don't hire LPN's in my dept, but I know many other departments do).

Now, the MD's will say "talk to one of the nurses" and they mean the RN's, COA's, COT's and MA's interchangeably, but staff will introduce themselves with their correct title "this is Brenda, one of the techs"

[Mdavi]

I was wondering about this as well because in my state it seems that the MA's can do more than I can as an LPN. So I checked out their scope of practice and lo and behold they do have a larger scope of practice than LPN's and about the same as an RN give or take a few procedures. I am not sure how that happened except that maybe it is because they are under the Medical Board and not the Nursing Board! I think that the Nursing Board needs to take this into consideration and look into how they can expand the role of the LPN and RN, otherwise we are going to be pushed out of the clinics and for us LPN's who are already very limited in where we can work this takes a huge chunk of our employment of the market. In my case I know the docs get frustrated because my scope is so limited and yet I was very well educated in my nursing program and am perfectly able to perform the duties that are needed. Unfortunately my nursing board limits me severly while the MA's are able to perform all of these duties and have a large scope of practice with minimal limitations. The clinics have needs that are not being met by nursing and are turning to MA's to meet these needs.

[caliotter3]

If you do not like the situation as it is, stay where you are while getting your experience and looking for a new job, then move on. You have described how most office nursing environments operate, so either you adapt, or change nursing areas. The doctors invented the MA wheel because that is how they want it.