So why even bother with getting an RN?

Nurses General Nursing

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[h=2]Saw an ad for urgent care wanting to hire MAs. They want you to be able to provide compassionate nursing care, assessing patients & taking effective action. They also want you to be able to triage critically ill patients and prioritize patient care appropriately as well as have skills in assessing, prioritizing many requests by patients, families, physicians, staff. You have to have skill in their EMR & infection control. You gotta coordinate care between clinic and other facilities such as hospitals or physician offices & do telephone triage and call backs ...among many & assorted other requirements.[/h]

Oh, ok.

well I said it was a stupid question, after all. :)

There were posts somewhere upthread that questioned whether a NP could function as a staff nurse in a clinic. That's what got me wondering.

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Specializes in Med-Surg, NICU.

I don't understand why some RNs fear that they will be replaced with techs, etc. It will NEVER happen, from a liability standpoint. Just imagine the number of (med) errors. They would be through the roof if we allowed improperly-trained staff do what a nurse SHOULD be doing.

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Specializes in RN.

Even if I know that techs will never take my RN job from me, the more they are qualified/ allowed to do makes them more valuable, and me less valuable...or stated another way; the gap between the 2 jobs narrows. So $$ is used to pay MA's and less is available for,RN's. comparatively then, why go to school to be an RN, if this gap continues to close up? The amount of schooling an RN gets through compared to an MA isn't even comparable.

I guess it's really not a battle of mine. I don't work in a private practice anyway...

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Specializes in FNP, ONP.

Sam Adams:

MAs do not assess heart and lung sounds in our office and neither does the RN, but I'm assuming that was a hyperbolic comment. I certainly know how to assess heart and lung sounds and am quite expert at it. I don't know what the rest of paragraph 1 was about, but certainly not about anything I've written in this thread.

Regarding the next section- Are you suggesting we don't want to have a RN because we are afraid of being contradicted by her in the medical record? Nurses don't do patient assessments or document in the patient charts beyond entering the chief complaint and the VS. That is truly baffling. That is simply not how primary care operates, man.

skipping to here:

Quote: "There's a big difference in the (functioning and) thinking of most MAs to most experienced RNs."

I completely agree with most of this comment. My point of contention is, no, there is not a big difference in the function between the two in a primary care office. In the thinking, yes, I'm sure that is true. However, there is very little we need that the MAs cannot do. They can do the tasks. They may not understand the rationale, the pathophysiology involved, or implications of said tasks, but I don't care if they do or not. I don't need them to understand, because I understand. Understand? ;)

Quote: "In my practice, at least I'd try and I'd bite the bullet and use highly experienced RNs."

I submit that your practice would be broke and out of business in less than 6 months.

I think that members of this site get overly defensive on the issue of Medical Assistants. The role of the MA in the outpatient setting is not comparable to the role of the Registered Nurse in an acute care setting. The scope of practice, tasks, expectations, and responsibilities are so different as to be totally unrelated. Outside of taking vital signs, I cannot think of much else they would have in common.

This reminds me of a conversation I had with recently my sister-in-law. One of our children is a graduate "teaching assistant" to a distinguished professor/department chair at one of the best Universities in the world. My sister-in-law said, "Oh, is a teaching assistant too!" She marveled at how amazing it was that our children had had such diverse paths in school (ahem) and ended up "doing the same thing" at age 23. My niece is a teaching assistant in a Day Care Center.

Now, I submit that my daughter is overqualified to be a teaching assistant at a Day Care Center. They could hire her, but why on earth would they? Would she be happy at a day care center? Fulfilled? I doubt it. My niece seems to like it. She was apparently employee of the month recently, and is much loved by the children and parents. If she is good at it, likes it, is appreciated by the people she positively impacts, should be be denigrated because she is potentially taking a job away from my daughter, who is arguably better qualified for it? After all, my daughter is a mathematician, and could surely teach those 2 year olds to count better than my niece!

The University is unlikely to hire my niece. She can call herself a TA if she wants to (although by law MAs can not call themselves nurses, due to laziness more than anything, many people-patients, providers, etc., do use the label 'nurse' inappropriately) but she isn't qualified to try to teach undergraduate math and stats courses at UC Berkley.

The cousins have similar titles, and on the surface, vaguely similar job descriptions ("teacher's assistants"). They both do various scut work their superiors do not want to have to bother with, or do not have time to do, or that has been deemed an inefficient use of their more valuable time.

By the same token Sam, why would I hire you to take VS and send faxes to the pharmacy in my office? I could, but why? Would you be happy and fulfilled with that kind of work? Like my daughter, aren't your talents put to better use in the environment you are in now?

It's the same thing. No one is going to put my niece in charge of teaching college algebra to undergrads at Berkley and no one is going to let MAs start operating balloon pumps and otherwise running ICUs. But my niece deserves to be respected for the good work she does, and so do the MAs.

I am not my sister-in-law, and I am not pretending that the two roles in this case (nurse and MA) are remotely the same. What I am saying is that in the primary care office, the MAs can assume all of the tasks that we require, perform them well, and as a part of the team, help us to deliver safe, high quality care while keeping health care costs from becoming even more unmanageable than they already are. They deserve a high five for that, and not petty derision.

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Brandon up here RNs are at $50/hr and LPNs are $33.[/quote']

Where is up here? Just wondering

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Specializes in Complex pedi to LTC/SA & now a manager.

Where is up here? Just wondering

I believe Fiona is Canadian.

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Specializes in NICU.

I believe Fiona is Canadian.

I believe Fiona is in Alberta...i'm in Ontario and it's a little less but yeah.....still up there.

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It seems it is essentially the "economic nurse". It looks like from what I have researched that MAs are the NPs and PAs of the nursing field. Sucks being on the other end of the spectrum. Although, I will concede that PAs and NPs aren't really hurting the medical field as there is a doctor shortage in many areas and PAs and NPs are limited in their scope of practice.

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Specializes in Emergency Department.

I would say that MA's, RN's, LVN's, EMT's, Paramedics, NP's, PA's, and MD's are all very different... yet they can all do some things in common. In an office setting where the provider goes from room to room, it's good to have "the basics" of things already done, such as vitals and the chief complaint. Because it's an office, the provider is available to provide the education for whatever injections the MA is going to give. The MA doesn't need to do interpretation of anything.

I'm a Paramedic. I'm also an athletic trainer. Would I be very useful in a clinic setting? Yes. I can do basically all those things that an MA can do, and then some. That's the problem. My knowledge and skill base greatly exceeds what's necessary to perform the functions of an MA. Given what I know, I very easily could exceed the MA scope simply by taking vitals, chief complaint, and asking questions that clarify the issue at hand. That could be considered assessing, especially if it results in my reprioritizing who gets seen next by the provider. The clinic could possibly find a way to enter into an agreement with the local EMS system and suddenly I'd be authorized to utilize my entire Paramedic scope of practice and I'd be able to assess... except now I'd be "stuck" following my local EMS protocols, not the office ones without an agreement with the EMS agency. Instead, the clinic could hire me as an MA and use the Paramedic license as evidence of training (somehow) but great care would have to be taken by all parties. Now then, in some clinics, primarily ones that do orthopedics, I'd be quite useful because of my exam skills... except that I can't do those exams because I'd be an MA that isn't allowed to assess. I'd have to be hired on as an athletic trainer specifically for that orthopedics assessment role and then I'd be unable to do some of what MA's are allowed to do as then I might be role-confused with them and that might cause an issue unto itself.

MA's are absolutely wonderful for what they're set up to do. In the office setting, they're what allows the office to function smoothly at a minimal cost. They're not the provider. They do the tasks that the provider needs them to do, as long as it doesn't involve interpretation or assessment, and it's not considered invasive (outside finger sticks and injections). Now if an office patient needed on-going assessment/monitoring/whatever then you'd be needing a Nurse to do that or dedicate a medical provider (like a mid-level or above) to doing that stuff.

It's just that for those settings, certain jobs aren't needed because they're overkill for the skillset that's needed. Now if the MA's describe themselves as Nurses or if they're tasked with things that are (essentially) within the exclusive domain of Nurses, then I'd have a problem with that.

And I'm sticking to only the office/clinic setting.

Here's another description of what MA's are allowed to do, from the same site as above: http://www.mbc.ca.gov/allied/medical_assistants_training.html

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The school district that my daughter attends is looking for a LPN or RN and the pay offered is $13.00 per hour. Really. I know. It for a one on one with my daughter. They have had the position open for 2 years and until they hire someone they use a lpn from an agency paying the agency $45 per hour. The principle and I are fighting the district to hire a nurse for $20 per hour and cut the cost in half. I wonder if a MA could do the job for less and if so how much.

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The school district that my daughter attends is looking for a LPN or RN and the pay offered is $13.00 per hour. Really. I know. It for a one on one with my daughter. They have had the position open for 2 years and until they hire someone they use a lpn from an agency paying the agency $45 per hour. The principle and I are fighting the district to hire a nurse for $20 per hour and cut the cost in half. I wonder if a MA could do the job for less and if so how much.

I'm sure if you posted your question in the School Nursing Forum you could get much more in-depth an answer than I can give you, but I don't know why any school district would risk legal liability for having an unlicensed "helper" in charge of your daughter's medical care while in school--or, for that matter, why you as the parent would allow it.

Children require 1:1 nursing care, I believe, because they might just need the skills of a nurse. Did I get something wrong?

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I am sorry I was not clear, I do not want a MA as a one on one I just think we as nurses have "farmed out" so many task that we need to be careful what we allow to be done by unlicensed people. I fought very hard to have a one on one assigned so she would not be home bound. I have read a lot on the CA schools wanting to allow teachers, secretary s etc to give insulin etc. I am a school nurse and I have been asked by administration why a teacher could not give perinatal feedings or do insulin or other care. I explain that while the steps to do it may seem simple it is the ability to put the whole picture together in assessing the student and in being able to recognize and react to a emergency. A friend of mine sued the school for a injury to her child by non medical personnel. They won 1 mill. I make $30k year. you do the math on how many years I could work for the money lost in a suit. Bottom line is school nurses are vital for safety of the kids.

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