Student Nurse who needs some input/advice

Nurses General Nursing

Published

:madface: hello all...i am in my last quarter of lpn school. 7 more weeks-but who's counting?? i am currently doing a rotation through a pediatrician's office. on my first day, the office manager was telling me about a "typical" day and letting me know who i would be working with. she then stated that the nurse would be there shortly, as she was running a little behind. when i asked her about the nurse-if she was rn/lpn, she said "oh, she's a medical assistant-we just call her our nurse". i was slightly insulted. then i met the"nurse". really nice, very personable. everyone in the office refers to her as the nurse. even herself-and her patients. she even has a personalized frame on her desk that reads "Nurse @#$&%#" so-i am supposed to be working with this "nurse". and the doctor is my preceptor. all i am doing there is rooming patients and taking vital signs while the "nurse" gives all the injections, administers the medications, wound care, etc... while i do the "grunt work". i want a challenge-i want to learn. and i want to say something to this M.A. that represents herself as a nurse. is there a polite way to address this to the M.A.? i am going to try speaking with the head of the nursing department and see if i can be moved to a different clinical site-but in case i get stuck there...what do i do? any input would be greatly appreciated!

Hmmm...sounds like that pediatrician's office is getting a quite a deal with only having to pay MA wages rather than LPN or RN wages.

I agree with the others. Alert your instructor as she/he may not be aware that the office's "nurse" is a MA.

0 Votes

Find your state laws on nurse as a protected title. Print them out. Present your concern to the MA. "I'm afraid you might get in trouble if people think you are representing yourself as a nurse. These laws specificy that it's actually illegal. Did your MA program ever address that?"

In no way imply that you're threatening her or criticizing her. She'd probably just get defensive and tune you out. You're not out to get her in trouble or to rub her face in the fact that you are training to be a nurse and she's "only" a MA. You're informing her of the law.

If she continues to allow others to refer to her as nurse without correcting them, and especially, if you hear her refer to herself as a nurse, then consider taking it further.

0 Votes
Specializes in med/surg, telemetry, IV therapy, mgmt.

It seems to me that if you want to be doing injections and dressing changes, the person you should be talking to is the physician. It is common practice for MAs to do all the things this MA is doing under the supervision of the physician in the medical office. This is permitted by law. Your beef should be with the doctor, the medical practice or your nursing school. Your nursing school probably has some kind of arrangement with this physician that the LPN students would be allowed to do some procedures in his office. If this is not happening then two things need to be done, and in this order: (1) you need to tell the doctor that you are not getting the clinical experience you are expecting, and then, if the doctor does not respond to your complaint (2) you need to let the nursing school know that the doctor is not providing you with the clinical experience you are supposed to be getting.

Why are you having difficulty figuring out how to address this with the MA? Weren't your objectives and goals for being in the office discussed on the first day you met her? She can't supervise or instruct you in any procedures. Only the physician can do that. At this point as a courtesy to her because you two do work together now and you don't want any bad feelings between you, I would just tell her you're disappointed because you haven't had a chance to do some of the injections and dressing changes and you'd like to discuss the chance of doing that with the doctor. This is a matter of your being assertive and growing a backbone. Regardless of what her response is, you need to talk to the doctor because he is the one who has to supervise you doing these procedures when there is no licensed nurse around, not the MA. Just make sure that when you speak to him you do it succinctly and get to the point because he is a busy guy.

If you go to your nursing instructors, the first thing they are going to ask you is "did you tell the doctor you wanted to do some of these procedures? And, what did he say when you asked him?" You're going to feel pretty (you fill in the word) when you have to stand there in front of your instructors and say you didn't discuss this with the doctor. One of the rules we nurses have to follow when we see a problem, is that we need to do whatever we can that is within our knowledge and scope of practice before we move on to the next step of passing the buck on to the next person up the ladder. This is how you take responsibility for your own practice.

A lot of doctor's MAs are referred to as their nurse. It's not right and it's not exactly legal, but I wouldn't start trouble in an office over it. You are, after all, a visitor in that office.

It seems to me that there was a big communication breakdown here.

0 Votes
Specializes in nursery, L and D.

I think I would have to say something about this MA calling herself a nurse. If you like her, you don't want her to get into trouble over it, do you? She probably really doesn't know that she shouldn't do this, and the doc is probably clueless too. I have seen it happen, the doc has no idea that the MA shouldn't be calling herself a nurse.:rolleyes:

0 Votes
Specializes in Community, OB, Nursery.

As I understand it, MA's are working directly under a physician's license. They can't work under a nurse's. But in any case, anyone representing themselves as a nurse must have the license to back it up according to our BON. (NC)

0 Votes
Specializes in Nursing Ed, Ob/GYN, AD, LTC, Rehab.

A student nurse cant not work in the clinical setting under a MA. I would report this to your school and not go back until a real Nurse is provided for you to work under. If something went wrong you would be in trouble for not being properly supervised. Also be aggressive with skills. Ask if you can give the injections change dressing ect. Some people wont let you do it unless you ask. So be direct and firm. Remind them you are here to learn and need these hands on experiences. I had this problem in Peds and was firm and finally got the staff to let me actually touch the kids. Good luck

0 Votes

Daytonite, I think you give some good advice there!

I do want to defend the student a little though. Ideally, she should've already demanded that her learning needs be properly accomodated. However, usually in school, the student just needs to show up and be willing to learn. They don't usually need to interrupt the instructor from other responsbilities and ask if they can assist with this or that.

The student walks into an office which has no official role for them, a bunch of different things going on at the same time, and no clear guidance on where their learning fits into the picture. This is very different than most people's work experience. Sure, you may always need to teach yourself new things as you progress in your field, but usually you are given very clear guidelines and roles when you are a beginner. In most environments, learners don't need to so actively seek out and demand learning experiences from day one.

Seeking out learning experiences and advocating for one's learning needs IS an important skill, but nursing school doesn't TEACH it. Instead of just saying "Be proactive" and "Grow a backbone" and "Be assertive" - give some concrete ideas of HOW to be proactive.

Perhaps schools could offer a non-credit elective workshop that specifically addresses situations that students may face (eg asking for help and being ignored; interrupting busy professionals to ask for an explanation; etc).

My two (or three) cents

0 Votes
Specializes in home health, neuro, palliative care.
Perhaps schools could offer a non-credit elective workshop that specifically addresses situations that students may face (eg asking for help and being ignored; interrupting busy professionals to ask for an explanation; etc).

I know many schools offer (or require) communication courses that cover such things, as well as patient/family communication. That said, being able to advocate for your education is an invaluable skill, in any field. I have never just "shown up willing" and expected to learn anything in my life.

~Mel'

0 Votes
Specializes in med-surg.

Scary. Very scary. I'm in nursing school in GA now and our instructors go in with us at the clinical sites. We always work with other RNs and our clinical instructor is the final authority that we report to.

As far as I know, MA's are not allowed to administer meds in GA--only RNs and LPNs. We have to have our instructor present for meds and procedures since we are working under their licenses.

Our family actually quit using our long-term MD some years back when he started letting nurses go and switched to using MAs to save money. Trust an MA to give meds/injections to my elderly mom? NO WAY!!!

0 Votes
Specializes in Emergency.

i found some state laws for georgia regarding registered professional nursing. there is also information on lpn's, but i didn't include it in the links below. read 1, 4, 6, 8:

http://web.lexis-nexis.com/research/retrieve?_m=39f870e6d556454f59b490bbca53f552&csvc=toc2doc&cform=tocslim&_fmtstr=full&docnum=1&_startdoc=1&wchp=dglbvlz-zskat&_md5=5120e845289a2e1d35037b38442b4310

additionally, read letter "a":

http://web.lexis-nexis.com/research/retrieve?_m=2aad06791c8a44bfd4cedd73239a2f31&csvc=toc2doc&cform=tocslim&_fmtstr=full&docnum=1&_startdoc=1&wchp=dglbvlz-zskat&_md5=929a1a6603cf8ff40e5c1ef70718a43f

also, here is a great article on ma's:

http://amt1.com/site/files/315/15341/60000/55084/lawful_scope_of_practice.pdf

you need to talk to the person in charge of assigning clinical sites. tell them that there isn't a licenced nurse at the clinical site you are currently at. you also should emphasize that order to fulfill your education requirements, you feel it is necessary to be paired with a clinical site which challenges you to utilize the nursing process. make sure to emphasize that you deserve a preceptor who practices nursing as an lpn and whose focus of nursing would benefit your nursing practice.

whether the employees at the pediatrician's office are nice or not - that isn't the issue and shouldn't influence your decision to bring up this topic. if you feel like mentioning how the term "nurse" is a protected legal term and can only be used by someone who is licenced to practice nursing, go right ahead. otherwise, just move on to greener pastures. it is the school's responsibility to select appropriate clinical sites and this falls in their hands.

on a side note, people who call themselves "nurse" who do not hold a license are a danger to the public and to the profession of nursing. i read an article which was about a "baby nurse" who shook an infant, causing brain damage. this individual was not a nurse, yet she called herself a "baby nurse". sure, licensed nurses* do malicious things too, but we don't need non-nurses tarnishing the profession. nursing is the most trustworthy profession in the public's eye - if someone is representing themselves as a trained and educated nurse when they really are not, it brings down the integrity of our profession.

good luck to you.

*(and by the term "licenced nurse", i mean anyone who practices nursing, from lpn to rn to crna, etc.)

0 Votes
Find your state laws on nurse as a protected title. Print them out. Present your concern to the MA. "I'm afraid you might get in trouble if people think you are representing yourself as a nurse. These laws specificy that it's actually illegal. Did your MA program ever address that?"

In no way imply that you're threatening her or criticizing her. She'd probably just get defensive and tune you out. You're not out to get her in trouble or to rub her face in the fact that you are training to be a nurse and she's "only" a MA. You're informing her of the law.

If she continues to allow others to refer to her as nurse without correcting them, and especially, if you hear her refer to herself as a nurse, then consider taking it further.

I don't think the OP should do any confrontation herself. That's the job of her clinical program.

0 Votes
+ Add a Comment