Unlisenced assistive personell replacing nurse positions

[Italia23]

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 are the equivalent of an lpn/lvn. i quickly learned while i worked my first job that this just wasn't true and i didn't understand why i wasn't treated like the "nurses" (lpn/rn). after starting the lpn program my eyes were opened to the world of nursing. and i see everything that it entails. i have learned more in the time i have been at my lpn program and at clinicals than i have learned the whole time i went to school to be an ma and including my work exp. the problem i am seeing is that so many doctors offices are hiring ma's instead of nurses. now i am not saying that there are not good ma's out there. i am sure there are some great ones! but ma's don't have a clue about the nursing process as it is not in their scope of practice. i took a whole pharm course at my ma school and let me tell you it doesn't even compare to the pharm at nursing school. so i don't understand why doctors are allowed to hire ma's instead of nurses???? esp. in my state which is ny. here ma's can't administer medications, draw up injections or administer injections. no triage. no positioning. basically just vitals and phlebotomy. but i feel as tho it is not right to hire them for a nurses role. if my child were to be ill i would want to know that the person on the other end of the phone was a nurse and knew exactly how to assess the situation. ma's are not allowed to do triage of any kind and yet they do it all the time. i am not saying there isn't a place for ma's, because they certainly can do phlebotomy, office work, vitals and a few other basic tasks that don't require critical thinking. so why are doctors opting to hire them instead of nurses??? i just don't understand. at my doctors office the ma introduces herself as a nurse all the time and i even went as far as to ask her where she attended. her response was actually i am an ma. i am sorry but i don't want someone who doesn't have a lisence giving me my family or my child advice when it comes to healthcare. does anyone else agree?? ma's have a certificate. not a lisence. the certificate just means that they have passed an exam. it is not a lisence so why are they being hired to work in a nurses place?? someone please shed some light on this! maybe i am wrong. and i appologize if this sounds offensive as it is not my intention. thank you!!!

[nicurn001]

I believe the crux of the issue here is that if an unlicensed person is representing themselves to be a nurse or is fulfilling procedures outside their scope of practice , then they should be reported , plain and simple .Legally / morally it doesn't matter what we think of that persons ability / knowledge base, if they are completing a procedure outside their ( legally defined ) scope of pracice they and the person whose license they are working under are breaking the law !.

[Orange Tree]

2 orange tree-

i don't think you understand what i am saying. we will use my state for the example. anyways here in nys it is illegal for anyone without a license to administer any medication by any route. it is to protect the patient. so how do you think that it is okay to staff them in a nurses position. i have attached a link so you can take a look at it. after you read it you can give me your take on an ma taking a nurses position. maybe you will be able to understand where i am coming from after reading it. thank you for responding!

http://www.op.nysed.gov/prof/nurse/nurse-medical-assistants.htm

if an ma is hired for the position, i wouldn't consider it a "nurse's position". and if mas are not allowed to give medication where you live, then someone who is allowed should be doing it. scope of practice issues are legitimate. we can agree on that much. mas in my area are allowed to give medication if the physician who they work under has trained them to do so and allows them to do so....and i have no problem with them doing so. thank you for responding back!

[BabyLady, BSN, RN]

I do not even have a problem with the MA drawing blood or giving me an injection (which they are allowed to do in my state) I am sure I will get flamed, but these skills do not require critical thinking or a nursing license. (and yes, they are limited to what they can inject)

I disagree, there is a level of responsibility that goes with it.

When a physician writes an order for an injection or a medication, teaching has to go with it. Side effects/risk/benefit, so the patient can make an informed decision on if they want to accept the med or ask for something else.

Ever look up your states pharmacy, NP, and physician disciplinary actions? Over and over again, you see the same thing: Failure to properly counsel patient...that means that they did not have teaching.

It is NOT legally sufficient to just hand them the drug printout and send them out the door...yes, that happens every day, but it doesn't remove your responsibility to go over it with them and explain it to them and answer questions..you are gambling if you do not.

There is critical thinking that goes with many medications...if you had someone with a 65 resting HR and a 100/70 BP and were told to administer valium, would you? A nurse knows that the order needs to be questioned...the MA does not. Injections..appropriate needle size/injection landmarks/anatomy behind the landmarks/filtered vs unfiltered/ensuring proper dosage..you can't get all that in a doctor's office and on the job training. What happens if you aspirate (or would an MA even know to aspirate) an injection...would you still give it?

With regards to drugs like Heparin and stories in the media of the wrong dosage being given...that was the NURSE'S FAULT that it happened...in the Dennis Quaid twins case...that all boiled down to the 5 rights..the original physicians order was written correctly in that case..that is why you NEVER saw a physician getting thrown under the bus in that case..the nurse, never checked the concentration of the vial she was drawing from to make sure it was the correct one...who cares if the vials were the same color, who cares if pharmacy placed it in the wrong drawer..it was the NURSE'S responsibility to READ IT..and she failed to do so...that is how that happened.

In our facility, we do not need two nurses to check off for morphine, insulin or heparin...their position that it is not the most dangerous drugs we give and it is our responsibility to check the 5 rights and if you fail to do that, it is not only your job, but your license.

[BabyLady, BSN, RN]

Article that details the Quaid case.

#1 Lesson in pharmacology 101: Never get used to giving medication from that "blue vial" or that a certain medication is that "little pink pill"...hospitals are NOT required to inform you if the packaging or appearance changes...it is your responsibility, to look and read.

http://virginiabeach.injuryboard.com/medical-malpractice/preventable-medical-malpractice-revisiting-the-dennis-quaid-medicationhospital-error-case.aspx

[Mrs. SnowStormRN, RN]

From my understanding, MA's are taught how to run the MD's office and how to do some clinical skills. As previous posters have mentioned, MA's do billing and scheduling, etc. That isn't covered in nursing school.

However, I think there should be RNs in the office for patient education. An MA can't do that, and the MD isn't going to (sometimes I wonder if they even know what to teach the patient). My previous MD didn't have a nurse, so there wasn't any patient education beyond "take this 3 times a day." I now go to an MD that has an MA, LPN, and RN.

And from my understanding, specialty offices use more nurses for that patient education.

You took the words right out of my mouth. Ive seen MAs do "office work," billing, scheduling appointments, and organizing files." I think this is appropriate. Usually the offices Ive been in have nurses on duty as well (LPNs and RNs). Having a MA at the desk is great and cost effective, why hire a nurse to do this job? Usually when Ive gone to the back, the nurses are weighing patients, teaching, and giving injections. This is a good set up for MD offices. I do think that some of the things the OP said could be taken the wrong way, please also note that there are arguments an RN can make in relation to an LPN - whats the point? We are all on this medical team, we can work together. Im sorry, I know my grammar is far from perfect, but you keep talking about education and licensed personal and both of those words are misspelled

[tewdles, RN]

MAs cannot apply the nursing process to the patients who visit the office. They cannot determine what patients require and what they don't. They are dependent upon the MD for all guidance in teaching and prep.

We take RNs out of the PCP setting and then we wonder why our health behaviors and outcomes suffer across the nation. For many people, the only time they interact with an RN is in the acute care or rehab setting.

[jelly221,RN]

2 lillymom-

a nurse is supposed to know if they suspect a pulmonary embolism they need to get the pt positioned in trendelenburg stat.

just to clarify- if the patient has a pulmonary embolism (blood clot that has lodged in the pulmonary circulation), you want to put them in fowlers and apply o2. the trendelenburg+left side is for an air embolus, like you'd see with a central line, to prevent it from reaching the brain and causing the patient to have a stroke. daytonite explains it well here- https://allnurses.com/nursing-student-assistance/pulmonary-embolism-nurses-234013.html#post2282190.