Washington state to make Medical Assistants work under RN license?

[Psychtrish39]

Hi all. This is for Washington state RNs in particular and I am sure in coming years other states are going to attempt this in state BONs. The DOH ( which is our BON here in Washington ) has proposed draft rules about credentialing medical assistants in my state. I am all for this credentialing mandate so there will be a high quality work force. However, it has been my experience that MAs work in an office under a physician license and he or she is responsible for delegation and overseeing their work.

I get a newsletter (link.serv) from my state and they sent us a copy of these proposed changes which of course lie in an RN's scope of practice and the DOH credentialing person said in the body of the email that they sent us these proposed rule changes because we oversee them.

My questions to you fellow nurses in Washington and elsewhere because I don't work in a physician office environment is this correct?, or are RNs once again being dumped on by 1. Having a person who will have a credential but does not have a quarter of the clinical hours being trained even a new graduate RN does but I will be responsible to oversee her care of patients. There are items in the proposed rules that talk about allowing MAs to do IV pushes, start and stop IVs etc all under a RNs supervision. I am enclosed a doc file of the proposed rules including where Washington RNs may email the DOH and state what they think. I hope that RNs here dont once again let the powers that be take away even more of the RN scope of practice to less educated professionals. I realize there is a "nursing shortage" haha but this to me is just another example of replacing highly skilled and educated medical professionals with less educated ones and also making us responsible for delegating our own scope of practice to them. Any thoughts everyone?

Medical Assistants DRAFT Rules.docx

[applewhitern, BSN, RN]

We have MA's that work as nursing assistants at our hospital. They only take vitals, and do general patient care, such as clean-up, baths, etc. They do not give any meds whatsoever! After working with many of them for several years now, I can say I would be very hesitant to have them give meds, esp. IV push meds! Most of them have no idea what the RN is doing, and we have to explain everything to them! World of difference between hospital and doctor's office duties.

[tewdles, RN]

Hospitals will replace RNs with CNAs and MAs at the expense of the health status of their patients.

Their CEOs etc may improve their bottom line, but will not improve their patient care...

Nurses who believe that MA practice being proposed in their facilities is unsafe should communicate that in writing to their administrators and then let them "own" the heat and repercussions.

[herring_RN, ASN, BSN]

No nurse shoul let anyone work "under their license"!

When I was an LVN I had my own license. it requires that I be clinically supervised by a registered nurse.

If I liven in Washington I would be working with my stste nurses association or other group to collectively fight this.

If I read it correctly the letter writing time is NOW.

I would take paper, pens, stamped envelopes and ger fellow nurses to write a factual letter opposing the law.

[Paul'in'FL]

No med tech is ever working off of MY license, I gar-un-TEEE you!

[MunoRN, RN]

We were actually just discussing the potential to give a portion of our jobs to techs; #121

This is the direction our Nursing leadership has been moving for some time so I'm not sure they're really all that opposed to this sort of thing.

[BrandonLPN, LPN]

Well, I just hope this nursing leadership realize that raisng the education level for entry to practice (ie phasing out LPNs and ADNs) will result in nurses being pushed away from the bedside.

I wonder if nurses will become like "consultants" for all the UAP who will be working the floor, doing all the actual bedside care?

Or are some nurses who actually *want* that to happen? Maybe then they'll feel like they're being seen as the "professionals" by all the doctors and physical therapists. They can say: "See, I got a pager, too. I don't wipe butts or pass pills."

[Ginger's Mom, MSN, RN]

I worked as Case Manager who interfaced with primary care offices, the offices that had MAs had poorer patient outcomes, reason is that they did not have the training to teach or advocate for their patients.Use of nurses improves patient outcomes.

[MunoRN, RN]

Well, I just hope this nursing leadership realize that raisng the education level for entry to practice (ie phasing out LPNs and ADNs) will result in nurses being pushed away from the bedside.

I wonder if nurses will become like "consultants" for all the UAP who will be working the floor, doing all the actual bedside care?

Or are some nurses who actually *want* that to happen? Maybe then they'll feel like they're being seen as the "professionals" by all the doctors and physical therapists. They can say: "See, I got a pager, too. I don't wipe butts or pass pills."

I can't avoid thinking of e-icu's every time this topic comes up. I think someday Nurses will sit in a little room off-site with video and data feeds of each patient, we'll then put tasks on a list that will come up on a display in the Nursing unit, sort of like what's already used in ER's (or McDonalds). At some point Nurses won't even need to be in the same country as our patients.

[BrandonLPN, LPN]

There's a role for everyone. MAs, LPNs, ADNs and BSNs. If certain people's goal of having the only level of nursing be the BSN.... well, that's going to leave a vacuum that's going to be filled by.... what? Employers are NOT going to fill the old LPN/ADN slots with BSNs. At least, not for long. By making the nurse too expensive an option for LTC, clinics and, eventually, hospital floors, we will see MAs and techs rise up to replace them.

[bbmtnbb]

I'm not sure I truly get the mentality of this. Yes, we all know it revolves around cutting expenses--BUT--weren't LV/LPN or CNA's less expensive? They definately have more clinical time than any MA program. I speak from experience as I have taken an "Clinical Medical Asssiting" program and had the added course of Phlebotomy CPT-1 in California. I am waiting on my CPT-1 (phleb lic) to come in the mail from the state but did not even sit for my national certification exam for MA ( I still can if I wanted to). I did not feel a non licensed position was my best bet. I did learn some pharmocology, but not contradicitons, side effects, indications--just names, common generics, general classification and main reason for use (not really indications as it only addressed a dx and not symptoms). I would actually feel better having an MA just take vitals (and am not really sure on that one too) As for the phlebotomy course, that was quite different. I had to understand A LOT more and had much more rigid testing and clinicals. I had an externship that req'd 100 blood draws at a minimum and most of these were the elderly with poor veins and "ex" junkies with no veins. My skills at blood drawing are excellent and that is ONLY due to my training and practice. Here is the thing, an MD can say HE trained the MA in the skills of phlebotomy. HUH? Really, I wonder how long teh MD had in training for blood draws much less for training others WHILE he is at the office?

So, we left the trained LVN/LPN's behind in many hospitals and are now going to the poorly trained MA? So why did they get rid of the LVN's then? Don't get it. They were already saving money paying a nurse--lower level than ADN or BSN but still a NURSE. BTW, I do feel even more confident in my EMT skills from the course I am currently in. I have had the full semester of Anatomy and trying to get into the full semester of physiology for prereqs. That helps my understanding a lot too. I just don't have trust that an MA has the skills.

I also thought they were supposed to be there to assist setting up patient rooms and doing vitals but the MD was the one doing the exam. If you have a nurse in a hospital doing these things SHE IS examining the patient and relaying it to the doctor. She gets to make some nursing based decisions. An MA is NOT trained to do this. So, now nurses won't be going into see their patients just telling the MA to do it and overseeing it? Or do the nurses follow the MA into the room and tell the MA what to do? See, the MA may go in first to set up, but the doctor always goes in to assess.

Hope I can figure out what to do when I get my BSN that is not pencil pushing! I did not want a desk job. Hoping for NP eventually but in emergency care setting. (I think) Those with the know how and licensure should protest this. Hahaha maybe all the MA's and doctors can work at the hospital now and we nurses will retire or just do the paperwork.

[mariebailey, MSN, RN]

I know of a medical practice who let their medical assistants administer vaccines. When I worked in that state, I was able to review the records via the state immunization registry because they were often mutual patients. The number of vaccine administration errors we came across from that practice was substantial and concerning.

[netglow, ASN, RN]

In the Chicago area they have been doing this for several years now in a few hospitals. Remote Doctors and NPs etc. who run ICUs consulting via video and computer in each room. They watch an RN treat a patient and the RN can speak directly with the consultants if they push a button and visa versa. It's only a matter of time when the RN will be eliminated and replaced with a tech who need not think, just do.

Also one large network hires a few RNs for a call center that handles all incoming patient "nursing" triage for it's physician offices. All the physicians are employed by the network. A patient calls his primary or specialist office expecting to talk to nursing staff that they have met and are comfortable with and believe know their condition, but instead the call is picked up by a call center RN who triages him and makes an appointment or not. This way the individual practices, all owned by the network, have no need for a local triaging RN - they have the call center. Also and more importantly, the MD has no control over his schedule. He has to work as long and as hard as the call center (network admin) decides. His productivity, his metrics are controlled. This eliminates "the talk" about needing to produce that went on just a year or two ago when MDs joined the networks. Back then they could sort of control office volume as employes of the networks, but that was not working for the network. So, now patients are scheduled without MD control, and that MD needs to keep up with the volume given him or lose his job. I remember reading blogs where MDs would talk of mysterious big brother calls checking on doctors and whether or not they were scheduling as productively as the network expected, with bogus patients (checking to see if they tell the patient no there's no room on the schedule today, when admin knows that there is - all computers are linked). Now it's out of their control completely.

So this is proof of the change. Nursing is already on it's way out. Just think. If most of the MDs in your area work for a large network, then as a nurse you're screwed as far as job prospects go. All of it, acute care, SNF, HH, H, primary care, all of it is controlled by the network and all you can do is apply on that one website for a job - which means you have no job prospect at all. When I first got my license I tapped my references (some MDs) who said sure they'd get me a interview because it's all about who you know, all very excited to be of help. Funny how they all learned that they have no "status" anymore and are considered grunts, whose referral means nothing - I will always remember the defeated conversations with them, on how they were ignored and couldn't get even a return phone call or a quick meet with HR or a NM to give a reference. Times have changed.