"I'm an uncertified medical assistant"

[Freedom42]

I had a curious encounter at the doctor's office today. When I went in for my physical, a woman in scrubs came in ahead of the doc. She was wearing scrubs but no name tag. We hadn't met before, so I asked if she was a nurse. Yes, she replied.

I then presented her with paperwork outlining the shots I needed for school. As she looked over the paperwork, she volunteered that she was not a nurse but, in fact, a medical assistant. Oh, really? I replied. Where do you go to school for that? (I was genuinely curious.)

Well, she replied, she didn't go to school. She wasn't a "certified medical assistant," in her words, but "had a lot of experience." In fact, she'd been a CNA for 16 years, but this particular medical practice, as she explained it, "isn't like a hospital and doesn't care if you're ceritified." Hmm. Later on, the doctor sent her back to draw blood.

What would your reaction be? Obviously, she called herself a nurse, and she isn't one. (I wonder if she would have volunteered that info had she not seen my paperwork.) She called herself a medical assistant, then volunteered that she wasn't credentialed. I know nothing about MAs. Is that kosher? And what level of license does someone have to hold to be allowed to draw blood? (For what it's worth, this is the only person I've dealt with in many years at this doctor's office who wasn't wearing a name tag with credentials. Is there any kind of identification requirement?)

[TazziRN, RN]

I think that the public feels nurses are not "real professionals", and most of our knowledge is OJT, rather than a college education. They think that nursing is bringing ice water, fluffing pillows, following doctors orders, handing patients pills, and to climb on my soapbox again, we have brought this on ourselves- three levels of entry into practice, only one a four year college degree,

So.......this is bringing on the ADN/Diploma/BSN fight again? You cannot separate the three paths for obtaining an RN license when all three lead to the exact same NCLEX!! For someone to pass him/herself off as having a cert/license that does not exist is WAY different than what letters follow the RN after one's name.

[TazziRN, RN]

And what do I, as an ADN, need to be grandfathered in to? I have my license, have had it for many years. Did I miss something?

[firstaiddave907]

all the medical assistants ive ever known were certified. Huge red flag when she said the words "this practice doesn't care if you are certified"-eek get out of there!

i agree with you about the huge red flag when she said this pratice doesnt care if she is cerfitied i would be like i am out of here.

[firstaiddave907]

I have to say this. Many of these things are completely inappropriate tasks for an MA. Phone triage, patient education and presricption approval? ( I am assuming that you mean you ASSIST with EKG's, stress testing, suturing etc... at least I HOPE that is what you mean) It is not a reflection on you personally, but an MA education does not supply the education and knowledge base to perform these tasks competently. Now perhaps what you meant was the basic hand out brocheures, read what the provider wrote in the discharge summary, and make phone appointments. Again this is NOT meant to bash or slam but...I have taken the MA pharmacology class...there is no way they are qualified to approve presciptions (unless this means something far different than what I am imagining), phone advice alone is a HUGE liability, sigh... An MA can be a valuable coworker in an office setting, but you can't take someone who only takes very basic level classes for 6 months to a year and have them effectively triage and educate the public about medical issues.

you made some very good points in your posting. im going to college to get my associates degree medical assiting the thing i wished they did was have a lab for A&P 1 and 2 because i want to further my eduication and go to school to get my BSN and become an RN.

[reesern63, RN]

What I am saying, though is those of us that are there, NOW...what do you suggest should be done? I can understand being grandfathered in, but, this is not the current reality. I am getting a better picture of what you are thinking, but, is this to demean LPNs and Associate Degree RNs that are currently working? And, how should we be grandfathered in? Should it be additional training, or automatic acceptance into RN programs? There are LPNs (I admit, I am not one of them), that have really wanted to move on to become RNs on any level, and are facing severe competition to enter into the RN programs, especially if they have not acquired college credits or an incredibly high GPA.

From what I am reading in your post, and please correct me if I am wrong, you feel that nursing is being undermined because the level of education is varied, and that the only way to obtain that respect is to raise the standards of education.

Of course, I advocate for the LPN because I am one, but, from what I have seen, many RNs are annoyed at having one work with them is the limits of our scope of practice. That may be true, but the limits are placed by the state and the facilities, not necessarily us. The more recent programs do teach assessments/data gathering, and many other things, but the practice allowed varies by the state boards of nursing. Of course, it is not as in depth as with an RN, but, those that practice well do know that if certain things happen or are done incorrectly, there is a poor outcome and know when a situation is out of our hands, thus requiring the guidance and intervention of a higher licensed nurse. In any event, I am not challenging you to change your mind, nor trying to initiate another LPN vs. RN war, I just want to comprehend better. It actually helps me to practice better if I understand a bit more of how some people think the way that they do.

Having spoken with linda privately on this issue, I can tell you that she does not at all mean to belittle LPNs or ADN/Diploma nurses.

I'm a diploma nurse and have just started going back to finish my BSN. I had a "moment of clarity" one day at work that made me realize that I had to get that degree. For me, there was no other option.

I have come around to agreeing with linda that we do need to raise the bar. Part of what changed my mind was what happened to me and part of it was the slow realization that we really need some unity somewhere in this profession.

[reesern63, RN]

I have to say this. Many of these things are completely inappropriate tasks for an MA. Phone triage, patient education and presricption approval? ( I am assuming that you mean you ASSIST with EKG's, stress testing, suturing etc... at least I HOPE that is what you mean) It is not a reflection on you personally, but an MA education does not supply the education and knowledge base to perform these tasks competently. Now perhaps what you meant was the basic hand out brocheures, read what the provider wrote in the discharge summary, and make phone appointments. Again this is NOT meant to bash or slam but...I have taken the MA pharmacology class...there is no way they are qualified to approve presciptions (unless this means something far different than what I am imagining), phone advice alone is a HUGE liability, sigh... An MA can be a valuable coworker in an office setting, but you can't take someone who only takes very basic level classes for 6 months to a year and have them effectively triage and educate the public about medical issues.

There's the problem: They can do whatever the doc wants them to do because they operate under his license.

You don't know what you don't know.

[WICCANWAYMA]

I have to say this. Many of these things are completely inappropriate tasks for an MA. Phone triage, patient education and presricption approval? ( I am assuming that you mean you ASSIST with EKG's, stress testing, suturing etc... at least I HOPE that is what you mean) It is not a reflection on you personally, but an MA education does not supply the education and knowledge base to perform these tasks competently. Now perhaps what you meant was the basic hand out brocheures, read what the provider wrote in the discharge summary, and make phone appointments. Again this is NOT meant to bash or slam but...I have taken the MA pharmacology class...there is no way they are qualified to approve presciptions (unless this means something far different than what I am imagining), phone advice alone is a HUGE liability, sigh... An MA can be a valuable coworker in an office setting, but you can't take someone who only takes very basic level classes for 6 months to a year and have them effectively triage and educate the public about medical issues.

After reading this post, I must say that these are well within the scope of practice for medical assistants in the state in which I live. I am responsible for all of these tasks in my office as well. I will say though that I went to school for two years and have an associate degree in applied science majoring in Medical Assisting. I think what she meant by approving prescriptions is when the pharmacy calls the office asking for refills on a patients medication, it is our responsibility to look in the chart, review the necessary information, following our office protocol of course, and approving or denying the medication refill. As far as the EKG and stress testing, I worked for a group of Cardiologists for several years and the MA's responsibilities were phone triage, patient education, vitals, phlebotomy, medication refills, stress testing, starting IV's, EKG's, and assisting with nuclear studies. Aside from the stress testing and nuclear studies, these and suturing and removals are all skills that are taught in a two year MA program, at least mine, and are practiced within the scope of practice for medical assistants. I think most are under the impression that MA's are merely paper pushers and nothing else. In an office, there are front office and back office staff. Some MA's prefer to work in the front office, answering phones, making appointments and such. However, most MA's work in the back office and so nothing of the sort. There responsibilities are clinical and include things I have already mentioned and that were mentioned in the original post. I just thought I would try to clarify what an MA really does and is responsible for in a medical office. Each law has their own scope of practice laws, these only apply to my state.

[reesern63, RN]

After reading this post, I must say that these are well within the scope of practice for medical assistants in the state in which I live. I am responsible for all of these tasks in my office as well. I will say though that I went to school for two years and have an associate degree in applied science majoring in Medical Assisting. I think what she meant by approving prescriptions is when the pharmacy calls the office asking for refills on a patients medication, it is our responsibility to look in the chart, review the necessary information, following our office protocol of course, and approving or denying the medication refill. As far as the EKG and stress testing, I worked for a group of Cardiologists for several years and the MA's responsibilities were phone triage, patient education, vitals, phlebotomy, medication refills, stress testing, starting IV's, EKG's, and assisting with nuclear studies. Aside from the stress testing and nuclear studies, these and suturing and removals are all skills that are taught in a two year MA program, at least mine, and are practiced within the scope of practice for medical assistants. I think most are under the impression that MA's are merely paper pushers and nothing else. In an office, there are front office and back office staff. Some MA's prefer to work in the front office, answering phones, making appointments and such. However, most MA's work in the back office and so nothing of the sort. There responsibilities are clinical and include things I have already mentioned and that were mentioned in the original post. I just thought I would try to clarify what an MA really does and is responsible for in a medical office. Each law has their own scope of practice laws, these only apply to my state.

You practice under the physician's license. Your scope is defined by what the doctor will/will not let you do.

As long as there is no confusion over your title and you're not being called an "office nurse," then it's up to you and your employer what your job description is.

[suebeeg]

I am an RN and have worked in several doctors' offices in Virginia. Medical assistants are much more common than RNs and those that are well trained and know their scope of practice are great to work with and absolutely necessary for any practice to function economically (rather than use only LPNs or RNs). However, it has been my experience that some MAs and most doctors are not aware of the limits of the MA's scope of practice and the responsibilities which fall into nursing's domain rather that that of the MA. Besides a few advanced tasks which require nursing expertise, the most important difference between a highly skilled and experienced MA and the RN and sometime LPN is that the RN (and sometimes LPN) have the education and expertise to ASSESS the patient and his/her family and environmental influences and then provide or obtain the appropriate patient education, care or intervention. I am very uncomforable that any MA would OK refills, even with an office protocol, as that would require nursing assessment and possibly physician/PA/NP assessment (such as have there been any health occurrences since the last refill that might affect medication response or need). And telephone triage is definitely a nursing responsibility, as it involves nursing assessment and judgment.

In the last 2 offices where I have worked I had definite concerns about the MAs being asked to do tasks which were beyond their scope of practice and education, such as: triaging lab results for docs who were on vacation (deciding which needed to be seen by another doc and which could wait until the vacationer returned), telephone triage (some patients were advised inappropriately for the condition), patient education other than that specifically outlined by a pamphlet or office protocol or the provider, providing samples to patients by checking chart but not consulting first with provider, answering patients' questions which should have been referred to an RN or provider.

As to the concerns over calling MAs nurses: one of the doctors I worked with said he never thought of them as MAs, but only as nurses and never considered that they didn't have that expertise. BECAUSE THEY WERE CALLED NURSES HE THOUGHT OF THEM AS NURSES, and he admitted that he must sometimes ask things of them that were not appropriate. But then on the other hand, he objected when I questioned his assigning them to triage the urgency of lab results , saying I didn't trust the MA-- as if that had anything to do with it!! And then to top it all off, he said he didn't have to listen to my concerns because I had "just attended some nursing seminar". And this from one of the best doctors I have ever worked with.

Yes, all medical personnel should understand the importance of delineation of roles and scope and titles. Each of us shouldn't have to keep battling this individually. Patients are at risk.

[LPN2RNdude]

heck, i worked as an LPN in an internal medicine office for 5 years. even the docs would call the MAs nurses. i guess they ddnt want the MAs to feel bad,,,

[lindarn]

heck, i worked as an LPN in an internal medicine office for 5 years. even the docs would call the MAs nurses. i guess they ddnt want the MAs to feel bad,,,

Maybe if nurses started to call the paramedics, "doctor", and followed that with, "well who knows or cares what the difference is"?, they would get the message. They would understand that it is not OK to refer to individuals, who in some states, don't even need a HS Diploma to be a Medical Assistant, as "nurses", and when they don't even have the most basic requirements that nurses must have to even APPLY to nursing school. There is a difference, and it needs to be made an issue, so the public understands, that nursing is a tough course of study, and we take a rigorous licensing exam to be able to practice. We also have to meet a high standard to maintain our license, as well. This is a main reason that the public does not know who, or what nurses are, or what we do that separates us from inlicensed assistive personnel.

This is why hospitals have it easy when they try to deskill our professional practice. We all look the same in our identical uniforms and scrubs. JMHO, and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[smk1, LPN]

I am an RN and have worked in several doctors' offices in Virginia. Medical assistants are much more common than RNs and those that are well trained and know their scope of practice are great to work with and absolutely necessary for any practice to function economically (rather than use only LPNs or RNs). However, it has been my experience that some MAs and most doctors are not aware of the limits of the MA's scope of practice and the responsibilities which fall into nursing's domain rather that that of the MA. Besides a few advanced tasks which require nursing expertise, the most important difference between a highly skilled and experienced MA and the RN and sometime LPN is that the RN (and sometimes LPN) have the education and expertise to ASSESS the patient and his/her family and environmental influences and then provide or obtain the appropriate patient education, care or intervention. I am very uncomforable that any MA would OK refills, even with an office protocol, as that would require nursing assessment and possibly physician/PA/NP assessment (such as have there been any health occurrences since the last refill that might affect medication response or need). And telephone triage is definitely a nursing responsibility, as it involves nursing assessment and judgment.

In the last 2 offices where I have worked I had definite concerns about the MAs being asked to do tasks which were beyond their scope of practice and education, such as: triaging lab results for docs who were on vacation (deciding which needed to be seen by another doc and which could wait until the vacationer returned), telephone triage (some patients were advised inappropriately for the condition), patient education other than that specifically outlined by a pamphlet or office protocol or the provider, providing samples to patients by checking chart but not consulting first with provider, answering patients' questions which should have been referred to an RN or provider.

As to the concerns over calling MAs nurses: one of the doctors I worked with said he never thought of them as MAs, but only as nurses and never considered that they didn't have that expertise. BECAUSE THEY WERE CALLED NURSES HE THOUGHT OF THEM AS NURSES, and he admitted that he must sometimes ask things of them that were not appropriate. But then on the other hand, he objected when I questioned his assigning them to triage the urgency of lab results , saying I didn't trust the MA-- as if that had anything to do with it!! And then to top it all off, he said he didn't have to listen to my concerns because I had "just attended some nursing seminar". And this from one of the best doctors I have ever worked with.

Yes, all medical personnel should understand the importance of delineation of roles and scope and titles. Each of us shouldn't have to keep battling this individually. Patients are at risk.

I agree completely. It is inappropriate for MA's to perform many of these skills and I HAVE seen quite a few eye opening problems that came from this both as a patient and as a student nurse.