Unlisenced assistive personell replacing nurse positions - page 2

hello all! i am currently an lpn/lvn student. i went to college for my associates degree in medical assisting. here is the problem, while in school for my ma we were told time after time that ma's... Read More

  1. by   lillymom
    Quote from tewdles
    Trust me, if there is no nurse in the doctor's office there will be no nursing diagnosis on the chart and the doctor will not "do it".
    This is confusing but I think it may be directed to me. Why would there be a need to have a nursing Dx if there is a medical Dx by the MD and they "do it" (make Dx) all the time, at least everywhere that I have worked. None of the nurses I have ever worked with would Dx a pt. unless they were a NP or PA, the nurses also let the MD assess the pt's condition because that is why the MD is there. I am speaking only from a general practice or specialty office point of view, not urgent care or hospitals.
  2. by   TonyaM73
    There really would be no need for a nursing diagnosis in a doctor's office. The MD is coming right in and then the pt will go right out. There is no managing care in between MD visits like in the hospital. In the hospital we do use nursing diagnosis, even though it may be a little more flexible than in school, due to the fact that we are the primary care giver in the hospital and we need to keep in mind what the pt was admitted for and symptoms to watch out for. Also, we would need to use non pharm. methods of managing their care as well as what is prescribed by the doc.

    As far as MAs verses nurses in the doc. office setting....the MD will get what he pays for. If he wants a complete nursing assessment, then they will hire a nurse. If all he wants is for someone to collect vitals, specimens and administer treatment then he will hire a MA.

    I do have to say though that I would be very concerned with an MA administering anything other than a breathing treatment for my family or myself, due to the fact that anything could go wrong with administration of meds and the nurse would be more prepared to look for signs/symptoms and know how to treat them.
  3. by   BabyLady
    [quote=lillymom;4824784]
    Quote from italia23
    2 lillymom-

    nurses are expected to do assessments. for rn's it's called nursing assessments and for lpn's it's data collection. nurses need to know that if someone is having a cardiac issue then you need to do a cardiac assessment and assess for things such as pedal pulses. an ma is not allowed to do that no matter what the dr says. it isn't in their scope of practice. when you get into nursing school you will see the medical field with a whole new set of eyes! (nursing eyes lol) a nursing diagnosis is not the same as an md's medical diagnosis. you have to have the understanding of the theory behind things. for example, if a pt has pneumothorax an appropriate diagnosis may be impaired gas exchange r/t pneumothorax. a nurse is supposed to know if they suspect a pulmonary embolism they need to get the pt positioned in trendelenburg stat. these are things that they just don't teach you in ma school or that ma's are even allowed to do. you get a microscopic taste of the clinical setting.

    thanks for your response! i do understand that rn/lpn school is completely different and more in depth than ma school. that is one reason i'm going back. i just don't see the need to know nursing assesments in the md's office since, at least with the 3 offices that i have worked at, go straight to the doctor anyway so they make the decision. most people who are having serious problems go straight to the er anyway so i see no need for it in the md office.
    wow...just seriously...wow.

    this post is not meant to be offensive in any way, but it is this very train of thought why ma's should not be the only workers in a physician's office..and it can be a very dangerous practice.

    the nurse that originally takes the health history and asks the initial questions upon arrival to the physician's office and i cannot tell you how subtle certain comments can be that can clue you into something else that needs to be investigated.

    it is typically the nurse that gives the physician a quick briefing on what needs to be investigated and gives him/her a place to start. the physician expands on that.

    sometimes what someone comes to the physician's office with is not even the most serious consideration when the patient arrives. physician's offices and urgent care centers also refer to the er on occasion as sometimes people do not realize their own healthcare crisis.

    good example: a friend of mine about 4 years ago took her son to the pediatrician for the flu. he was laying down on the exam table when the nurse walked in because he felt so bad...because the nurse was at the foot of the exam table, she noticed the child grimacing any time he looked down in her direction. the nurse asked the child to sit up and asked him to try to touch his chin to his chest..which he could not do.

    the nurse knew that this was a cardinal sign of meningitis...which the child did have and it was good assessment skills that picked up on that. had the physician came in and the child remained laying down, it could have been missed....but with two trained eyes, the child was properly diagnosed.

    i also had a similar experince a few years ago with a cancer screening at a physicians's office...i could not get past the ma because she did not realize the seriousness of some of my labs and i kept asking her to get a nurse or the physician to call me back and day after day, it was blown off.

    to make a long story short, i finally had to drive down there and demanded to speak to the physician immediately and he had no clue that i had been calling for days...turned out i needed a biopsy, which had not been scheduled...he was counting on the ma to give him the lab results and apparently she had filed them away because everything was "within normal range".....she did not understand that there were certain labs that even though they were in normal range a combination of higher range of values were indicative of a serious condition that i was eventually treated for....thank god i did not have cancer.

    i told the physican, "if i ever call here again and ask to speak to you or the nurse and cannot get past your gatekeeper, i will be finding another physician."

    he addressed it immediately with his staff and i never had another problem with it.
  4. by   kids
    Quote from tewdles
    Trust me, if there is no nurse in the doctor's office there will be no nursing diagnosis on the chart and the doctor will not "do it".
    Having worked as an RN in multiple doctor's offices I have never seen a nursing diagnosis in a chart nor have I ever written one.

    My State has regulated MAs for years and in my area the majority of them have an AAS degree (more education than LPNs) and a much broader scope of practice. I've worked with a lot of great MAs and to be honest, in the office setting I prefer working with a good MA over an LPN due to their scope of practice limitations.
  5. by   txspadequeenRN
    please explain the lpn scope of practice limitations in a office environment vs a ma......


    Quote from kids
    i've worked with a lot of great mas and to be honest, in the office setting i prefer working with a good ma over an lpn due to their scope of practice limitations.
  6. by   Mulan
    Quote from tewdles
    Trust me, if there is no nurse in the doctor's office there will be no nursing diagnosis on the chart and the doctor will not "do it".

    I don't even understand this post.

    Are you being sarcastic or what?
  7. by   Dazglue
    Quote from kids
    Having worked as an RN in multiple doctor's offices I have never seen a nursing diagnosis in a chart nor have I ever written one.

    My State has regulated MAs for years and in my area the majority of them have an AAS degree (more education than LPNs) and a much broader scope of practice. I've worked with a lot of great MAs and to be honest, in the office setting I prefer working with a good MA over an LPN due to their scope of practice limitations.


    Can you explain the scope of practice for a MA since they have more education than a LPN? The reason I'm asking is because here we don't have MA's. We have Multi-Care Techs (MCT's) They do blood draws, vitals, etc. In some hospital they are allowed to put in caths. There is no schooling required. Just on the job training. And we also use CNA's for nursing homes and SNF's. Never knew there as an associate degree program for MA. Interesting. Learn something new everyday!
  8. by   mentalhealthRN
    I'm not sure I understand the whole MA thing to begin with to be honest. I would never let anyone who was not a nurse or doc give my child any med, injection or not. And I agree that part of the job of the nurse doing the initial intake and complaint from the pt may notice things or think to ask questions based on certain things they see or are told that an MA is not going to pick on and is not licensed to do. They take phone calls from patients that require triage over the phone, patient education, etc and an MA can't do that either. I just personally don't get the role of the MA. I would leave an office that was not using nurses.
  9. by   txspadequeenRN
    they don't have more education than the lvn/pn . there training is different and geared toward the office setting.


    Quote from dazglue
    can you explain the scope of practice for a ma since they have more education than a lpn?
  10. by   Italia23
    2 orange tree-

    listen, i clearly stated that i was not trying to be mean. how am i "patting myself on the back 2 hard"? i am not sitting here claiming that i know everything there is 2 know about nursing or saying that anyone is better than anyone. if you actually looked into my issue with ma's taking nursing positions you would understand. it would be a totally different story if i was trying to slander someone or making statements as if nurses were better than ma's, which i am not. do you really want an unlisenced person treating your child or loved one? sorry, but i don't and won't put up with it. if that makes me a terrible person then so be it! unlisenced personell should not be doing triage or administering any type of medication. period. end of story. and i do have an aas in medical assisting. so really sorry 2 burst your bubble but i know what is being taught, what is part of the aama cur. and what is not being taught. and @ no point in any ma program be it aas or a vocational program do they teach how to assess patients. it is not their scope of practice. and again i am not trying to be rude. but mistakes can be fatal. how are you supposed to understand if you were never taught and it is not in your sop? in the pharm course in ma school not one time did they discuss the difference b/w heparin and hep-flush. the bottle are almost identical. do you think it is really appropriate to have people who don't understand the pharmokinetics and the importance of the medication, dosage range, route, interactions or usual side effects associated with the medication administering them???? sorry - strongly disagree. no way. peoples lives are at stake!!!!
  11. by   lillymom
    Okay this thread is getting heated so I am just going to say that some schools teach differently and since my state's scope of practice is broader I would guess that they teach more here since I do know the importance of all the meds I give as well as the side effects, interactions, dosages, and routes.

    I also want to add that yes there are some bad MA's but there are also bad nurses. Don't judge all of us because one did something wrong.

    Apparently there are a lot of really bad MD's out there if they are unable to make diagnoses without having someone point out things that they should observe themselves.
  12. by   nicurn001
    If someone is representing themselves to be a licensed nurse , whoever or whatever their role is , the simple answer would be to see the person responsible for supervising their " nursing " activities ( ie the MD. in the case of a Doctors office ) , inform that person to get this behavior to stop ,and inform them you are going to report this problem to the appropriate state authority .
  13. by   Italia23
    Lillymom- i am sincerely sorry if i upset you or if you feel i was trying to put you down. It was not my intention. You are right there are some good mas and i believe you are one of them. Just like there are bad mas there are bad nurses and drs. I really am sorry if i upset you. I was not trying to put you or anyone else down. I wasnt trying to attack your character at all. Please understand that things here are a lot different and it could be very dangerous to pts. Here it is against the law for a non licensed person to administer any type of med or injection and they are doing it anyways. Again i am so sorry if i hurt your feelings. Best of luck in nursing school!!

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