Another rant regarding MA's and Nurses

[samirish]

I know I've read on here multiple times regarding MA's calling themselves nurses but now its not even the ma's but the doctor's office they work in calling them nurses. I feel this is so misleading and done deliberately. I called my doctors office today (she is part of the Advocate system here in Illinois) and the recording said "press 2 to speak with a nurse" so I pressed 2 and the person answering my call said "Hi this is Ashley, can I help you?". Well after spending a few minutes telling her my issue and her giving me advice I said "You are a nurse.....right?"

She went on to explain that no she isnt a nurse but a ma. When I asked to speak to a nurse instead, she said they don't have any that work there, they only have ma's.

Is this reportable? I felt really misled by the office recording and I'm sure other patients think they are talking to a nurse when in fact they are talking to a ma.

[birdie22]

I once spoke with an MA and we were basically comparing our jobs. She said "I'm a nurse without the letters after my name".

I asked....how long did you go to school? 11 months

do you even have an associates degree? no, its a certificate.

"but we basically do the same thing you do except get paid less"

[kcmylorn]

The problem is with the system. The healthcare system allows this fraud to go on because it is cheap. It is cheaper to hire a non licensed personel than to hire a licensed RN. I say Rn because and LPN is not leagally allowed to triage either by state laws.I am 100% sure of this- I work in a clinic, I do telephone triage and I am an RN. We have protocals also. They are not on a computer screen. They are the hard copy books of the 2 authors who are the authories on telephone triage protocals for ambulatory care. When we get calls from patients requesting "nursing consultation" which is the offical, correct term for the triage call, we follow the book protocal that is sitting on our desk in front of us and open to the appropriate cheif complaint. The nursing assessment aka the phone interviewing of this patient( only an RN can do by state law) is the RN asks interviewing, probing, clarifing questions. It is at this point that the RN's judgemnt, clinical decision making and critical thinking comes into play and based on alot of RN bedside experience. This is why it is state regulated. MA's, LPN's CNA's,secretaries are not RN's and do not posses the body of knowledge to make these clinical decisions. That body of knowledg, when assimilated together form a rational for the clinical judgement which only comes from the pulling from pathophysiology, pharmacology, sociology,psychology public health regulations. These courses are not taught in 11 month certificate programs.A patient may complain of something such as heart burn- an anterior MI will present it self as heart burn. An anterior MI involves the cardiac vessel that passes by the epigastic area. That is not knowledge possessed by an MA.If an MA is following that computer protocal for heartburn, that MA is jeapordizing the life of that patient- Oh just take some Maalox and if it persistes- call for an appt??? That is clinical sceince/aka pathophysiology. Another example:a pt complains of legcramps, just key in in leg cramps?? Are those leg cramps related to low potassium. Does an MA know how serious low potassium is?? what medsis that patient on- a statin- does the MA think to have a BUN/Creat and a CK drawn on the patient? How many MA's, CNA's, NA, techs know what these labs are and why they would be important. It's not "just following prompts on a comuter program" This is critical thinking. We RN's do not hold up a flag that state "I'm doing critical thinking now"The process takes place inside the brain.New grad RN's shouldn't be put in positions of triage. It takes alot of years of experience seeing what these disease process lok like, manifest themselves as and their corse of treatments and progression. Youcan jhave a pt on the phone who is a diabetic and say "I have a sore on my leg" OK- what does it look like? You have to be able to ask questions to give you, the triage nurse a visual on a patient you can't see. And you have to have seen a number of "diabetic sores" to know they don't all look alike and have different causes and treatments. Doctor's offices are placing themselves in a very legal sue happy position by continuing to hire only cheap healthcare labor. It a system problem that needs to be fixed.

Those protocals( Woodke and Barton Scmidt) are also avail in computer program format.

[FocusRN]

As a medical assistant in a doctors office everything that I can tell the patient I do, I have the right and knowledge to tell them what they need to know if its within my scope of practice.

Medical assistants are unlicensed assistive personnel (UAP). To have a "scope of practice" one must be a professional, being a professional requires licensure. ALL professionals can practice autonomously on some level. Professionals can be sued for "malpractice" of their profession. UAPs are not professionals, can never practice autonomously, do not have a scope of practice, and therefore can not be sued for "malpractice" (although they can still be sued.)

This is what California says about medical assistants, and telephone triage:

Are medical assistants allowed to perform telephone triage?

No. Medical assistants are not allowed to independently perform telephone triage as they are not legally authorized to interpret data or diagnose symptoms.

[kcmylorn]

Triage is the process of determining the priority of patients' treatments based on the severity of their condition. It is a sorting or allocating prioity .

Triage involves clinical judgement.

Medical assistants are taught 'tasks'( taking BP's, a temp, a pulse, respirations, and how to operate a pulse ox,taking a patient's weight, and height how to draw blood) not the interpretation of the values they obtain.

The "knowledge"the MA has about a BP is: I put the BP cuff around your arm in this specific place, I pump up this cuff with this ball, and let the air out noting where I hear the pulse start and the pulse stop- That is a task not a body of knowledge about hypertension, hypotension or normotension, the biochemical alterations or structural alterations in normal anatomy and physiology of the peripheral vascular system,the pulmonary system, pressures and it's vessels, it's effects on the myocardium, hemodynamic pressures and on perfusion including the chemical alterations in cellular physiology. I won't even getinto the "task of drawning blood and the interpretation of lab values related to cardiac, renal and metabolic lab values. MA's are taught tasks and tasks only-

Nurses are not on a triage computer program "just reading" off the computer . They are listening to what a patient is reporting to them,processing it against a lot of formally taught subject matter and formulating a judgment. Those computer triage programs are only guidelines. The RN is formulating a judgment against those guidelines. We just make it look easy. It's not.

[PsychNurseWannaBe, BSN, RN]

When I answer the phone I say my name and either RN or registered nurse. Ashley and all MA's should be doing the same. If the phone states to talk with a nurse and you get an Ashley, then I would complain to the corporate office and state that it is illegal to mislead the public. Some of the prompts around here have changed, even if it is the same office with multiple doctors the recording will say, to speak with Dr. A nurse press 1, to speak with Dr. B practice associate press 2, etc. So some have changed their recording system.

Nothing ticks me off more than when I call a MD's office to provide an update on a patient and I am getting triaged by a UAP. Sorry...I think I am already 20 steps ahead of you. Not get me the nurse or the MD.

[PsychNurseWannaBe, BSN, RN]

Also, in Wisconsin the term nurse by law means only a registered nurse and nursing means professional nursing (services provided by an RN)

[Kaligirl02, ADN, BSN, MSN, LVN, RN, APRN, NP]

Medical Assistants DO have a scope of practice, I'm not sure where you are looking at, but if you look on the Govt. website...http://www.bls.gov/oco/ocos164.htm it says what medical assistants can do.

On another OFFICIAL site it states What is the scope of practice of a medical assistant? In some states medical assistants have a clearly stated scope of practice, but in some states there is no law on the matter" (http://www.medscape.com/viewarticle/580647_2)

From The Medical Board of California

Are medical assistants required to be licensed or certified by the State of California to perform procedures within their "scope of practice"?

No. Medical assistants are not licensed, certified, or registered by the State of California. However, the medical assistant's employer and/or supervising physician's or podiatrist's malpractice insurance carrier may require that the medical assistant be certified by a national or private association. A medical assistant must be certified by one of the approved certifying organizations in order to train other medical assistants. (Title 16 CCR 1366.3)

(http://www.mbc.ca.gov/allied/medical_assistants_questions.html#2)

As far as INDEPENDTLY doing phone triage , No we aren't supposed to do it. What we do, like I stated previously,is speak with the pt get their signs and symptoms and report back to the doctor on what was documented, then after the MD reviews what they need to review, tells us what to say to the pt. That is what we do. If you wish not to speak with an MA you can always ask to leave a message for the doctor to specifically call you back. You don't have to speak with them.

As far as stating MA's knowledge is as far as knowing how to take an accurate BP is harsh and it's ignorance on people's part to believe that. I don't have a certificate, I have an Associates in Medical Assisting from an accredited junior college. I have taken an passed with a 3.8 gpa total in : Pharmacology, A&P 1,2, Microbology, lifespan,English comp,chemistry, my course also had x-ray,EKG and phlebotomy. A lot of Medical assistants start off this way to make sure they are certain ths is what they want to do.

I understand that some MA's are ok with calling theirselves nurses, and that's not acceptable. But to belittle us, like we are second class citizens is troubling. At the end of the day we are all patient centered.

[BuckyBadgerRN, ASN, RN]

Also, in Wisconsin the term nurse by law means only a registered nurse and nursing means professional nursing (services provided by an RN)

Careful---you'll get jumped on for sharing THAT!!! Ask me how I know....

[luvazsun, RN]

I think the reason BON's do not go after MA's referring themselves as nurses is because MA's are certified, licensed or whatever (depending on the state) by the Medical Board, not nursing, so they do not have any say in the matter. I know 2 offices that have a phone system that say "if you want to speak to a nurse..." and they do not employ RN's. I have heard MA's giving medical advice because " that's what the doctor always orders", so they believe they know what to do. I think the doctors who allow this in their offices should be reported to the medical board, however, the medical board (after I reported a doc), allow the doctor to decided what their MA can and cannot do.

So, why did MA's become so popular - NA's do the same "tasks", but the doctors wanted to control them, and they can't control NA's? Just wondering.

[Kaligirl02, ADN, BSN, MSN, LVN, RN, APRN, NP]

Na's and Ma's aren't the same. Nursing assistants do bedside care, a lot aren't able to draw blood, give injections, remove stitches, x-rays, EKG's etc. As a NCMA and a CNA, I prefer being a NCMA because I love working in an ambulatory care facility than long term care etc. But being both a MA and CNA I think Iam more rounded. Alot of people in my nursing classes don't have experience or are one or the other. With having sufficient knowledge on bedside care and clinical task Iam able to focus more on book work than not worrying if I'm doing the skills right (as of now :-)). I'm hoping it will make a better nurse when I'm done with school next year. HTH

[OCNRN63, RN]

Na's and Ma's aren't the same. Nursing assistants do bedside care, a lot aren't able to draw blood, give injections, remove stitches, x-rays, EKG's etc. As a NCMA and a CNA, I prefer being a NCMA because I love working in an ambulatory care facility than long term care etc. But being both a MA and CNA I think Iam more rounded. Alot of people in my nursing classes don't have experience or are one or the other. With having sufficient knowledge on bedside care and clinical task Iam able to focus more on book work than not worrying if I'm doing the skills right (as of now :-)). I'm hoping it will make a better nurse when I'm done with school next year. HTH

Please tell me you really didn't just say that. And you only have one more year?

[PsychNurseWannaBe, BSN, RN]

Careful---you'll get jumped on for sharing THAT!!! Ask me how I know....

I'm not a stickler on that portion of the statues. I don't care if an LPN says she is a nurse, because really, she is, the key difference is practical vs professional. I have no problem sharing the sandbox. :)