Medical Assistants in the office

[SHELLYBELLYRN]

This is probably going to open a can of worms.............but how do you all feel about replacing nurses in the office setting with Medical Assistants? How (if at all) do you feel it affects patient care?

Do any of the MA's in your offices refer to themselves as "nurses"? Have you had any problems with the knowledge base of the MA's? How are they with patient education?

May be just my situation, but I have run across some significant problems in this area................and not sure how to address it...........or even if I can address it.

[Sekar]

Well, someone out there will probably flame me for this BUT I think you are taking the right stance in this instance. You have 6 Nurses on staff, you don't need a Medical Assistant doing nursing tasks. While it is true that the law allows medical assitants to do whatever tasks the doctor feels they are capable of doing, that is in reality a very dangerous practice. This issue has debated ad infinate nauseaum in the "medical assistants giving IV medications" thread. Your MAs role is clearly defined by YOU, your Medical Director, and hopefully with some input from your Nurses. She is filling a vital role in your clinic. If she is feeling too limited in that role, then she needs to get further education and get her Nursing license. If she doesn't want to do that, then she will have to settle with her current duties. You should stand firm on your position. She is NOT a Nurse, you have made it clear that she won't be allowed to do certain levels of Nursing duties, that is the end of the discussion.

If she is very valued employee, you could offer to assist with tuition, allow time to attend classes, things like that. That way you are not stopping her upward mobility, just making her getting an education a requirement of it.

[ImaEMT]

I am a medical assistant and have been for 7 years. I can say most adamantly that CMA's should NOT be doing IV's in any way shape or form UNLESS they have taken a certification course to start IV's and run hydration. When I worked in Virginia I was given the opportunity to take an IV class through the clinic/hospital system that I worked for, but would only be allowed to start them as part of an "IV team". I would not have been allowed to hang any meds, except for NS to keep the line. As an EMT who does IV's and runs NS, lactated Ringers and boluses some meds, I know the dangers of IV's, and how to manage them. These are not things CMA's are taught or usually have experience with.

With all my work experience, I still have very mixed emotions about the whole CMA/LPN/RN issue. I feel I definetly have my place in the clinic where I work. I do injections, triage, handle all my own patient care...but there are several times every week where I run into something that is not in my scope and I need the RN to help me. I work with a lot of OB patients, and I can't help them with their IV hydration for hyperemesis, or help my urology patient with a cath. It's just not stuff I learned, not what I'm paid to do, and frankly, not what I'm comfortable with.

I don't think CMA's should be used above their scope,and I know they often are. This is one of the BIG reasons I'm back in school. I want the responsibility of being an RN, and I want the skills, but not before they are rightfully mine. I know LPN's and RN are frequently frustrated with CMA's being used & referred to as nurses. I work with a lady who is a "regualr joe" off the street w/ no medical exp or training who has been in-house trained and is called and paid like a CMA/ I know how mad I get everytime I think about that. So, I know how the nurses feel.

Hopefully CMA instructors will start emphasizing the difference between the professions and start preparing students accordingly. ANd hopefully employers will to.

Lisa

[Hellllllo Nurse, BSN, RN]

Originally posted by Darlene K.

In our urgent care facility we utilize RN's, LPN's, MA's, and X-ray techs. I believe there is a need for all of us. The important thing to remember is your scope of practice and too make sure that the patients are care for and safe for harm.

Good post. I once had dealing on a job w/ an NP, whom I mistakenly called "doctor." He never corrected me. I think he liked it.

I had several interactions w/ an MA who kept referring to herself as "Nurse Polly". My husband was to have a physical and some labs for a life ins policy. This girl kept calling the house leaving messages, calling herself "Nurse Polly". When I called her back, I told her that I'm an RN and asked how a nurse gets a job working from home for ins companies, like she had.

She expalained how she got the job, then said "I need to get a urine sample form your husband for an AIDS test and a blood sample to check for nicotine."

I told her that the blood was for the AIDS test and the urine was for the nicotine test. She started arguing w/ me that she was correct- that it was the other way around.

I finally asked her if she had a license to practice nursing. She said "No, I'm an MA." And she had referred to herself as "Nurse Polly" several times!

Well, we declined the ins and told the company that we would not purchase ins from a company who had an MA calling herself a nurse in their employ. They really did not know what we were talking about.

It has nothing to do with ignorance, elitism or ego. I know some nurses who are sharper than doctors, but still, none of these nurses would ever refer to themselves as a doctor.

A legal sec'y is not a lawyer.

A security guard is not a cop.

A nurse is not a doctor

And an MA (or CNA) is not a nurse.

[Hellllllo Nurse, BSN, RN]

Originally posted by ImaEMT

I am a medical assistant and have been for 7 years. I can say most adamantly that CMA's should NOT be doing IV's in any way shape or form UNLESS they have taken a certification course to start IV's and run hydration. When I worked in Virginia I was given the opportunity to take an IV class through the clinic/hospital system that I worked for, but would only be allowed to start them as part of an "IV team". I would not have been allowed to hang any meds, except for NS to keep the line. As an EMT who does IV's and runs NS, lactated Ringers and boluses some meds, I know the dangers of IV's, and how to manage them. These are not things CMA's are taught or usually have experience with.

With all my work experience, I still have very mixed emotions about the whole CMA/LPN/RN issue. I feel I definetly have my place in the clinic where I work. I do injections, triage, handle all my own patient care...but there are several times every week where I run into something that is not in my scope and I need the RN to help me. I work with a lot of OB patients, and I can't help them with their IV hydration for hyperemesis, or help my urology patient with a cath. It's just not stuff I learned, not what I'm paid to do, and frankly, not what I'm comfortable with.

I don't think CMA's should be used above their scope,and I know they often are. This is one of the BIG reasons I'm back in school. I want the responsibility of being an RN, and I want the skills, but not before they are rightfully mine. I know LPN's and RN are frequently frustrated with CMA's being used & referred to as nurses. I work with a lady who is a "regualr joe" off the street w/ no medical exp or training who has been in-house trained and is called and paid like a CMA/ I know how mad I get everytime I think about that. So, I know how the nurses feel.

Hopefully CMA instructors will start emphasizing the difference between the professions and start preparing students accordingly. ANd hopefully employers will to.

Lisa

Lisa,

Great post. I admire your attitude. I bet you're great to work with.

[ImaEMT]

Thanks! I do have a great time at work and we all get along great! I think for the most part we all know whats expected of us!

When I'm the RN, I hope it's still as easy as it is now to work along side the CMA's and LPN's in our office. Politics is starting to get in the way of that, but we'll see how it all pans out!

Lisa

[Big Bab's]

I am in total agreement that MA's, CNA's, RN's, LPN's...etc. are all importanat jobs, but they all need to function within their scope of practice....and if they "want more" then get the schooling and licensure to do so!!....It seems to me that this could become a huge liability issue when you have people misrepresenting themselves to patients ie. "Nurse Polly" who in fact isn't a nurse.....and other such examples....we have 2 MA's in our office and they do "call-backs", vitals and answer general questions....but they have been told by the docs to never say they are nurses and if a patient assumes they are, then they are to correct them.....Our docs just see it as too much of a liability to open the HUGE can of worms this can turn into.......We also have a PA, and he HATES being called Dr. for the same reasons, its misleading.......Our MA's are a VERY important part of our TEAM, but they are required to stay within the scope of practice that our Docs have set for them, just as I am by the BON......that's how it should be, but that's just my opinion!!!

[RN8Last]

Medical assistants know basic nursing care ( nursing 101), but they are not trained to think critically. I believe they don't really get into diseases and they pathophysiology. So I still believe that Rns should be in Physician's Offices. It'll be safer. I agree, the word Nurses should only pertain to "Rns and LPNs."

[WA-Educator]

Medical Assisting Programs don't include any nursing courses because there is no reason for CMAs to know basic nursing skills. Don't confuse medical assistants with nurse assistants. Certified Medical Assistants (CMAs) do need to learn basic medical assisting skills though. Any acredited medical assisting program includes pathology, psychology, patient education, symptom analysis, therapeutic relations, law and ethics, and all the technical skills such as minor surgery assisting, urinalysis, venipuncture, ECG, blood tests, etc. None of those technical skills are included in nursing and that is a major difference between the two professions. I have seen so many nurses botch ECGs and blood draws and lab test because they simply don't know how to do them. Those are the technical skills needed for the doctors offices which is why CMAs do them and nurses don't. As far as the assessment skills, RNs do learn a much higher level of patient assessment than the CMA or the LPN. This is because in the hospital setting the RN needs to be able to assess the patients and alert the physician if needed or making nursing decisions as indicated. It all make perfect sense if you think about the basic of the curriculum linked to the jobs performed. Great conversation!!

[Stitchie]

Originally posted by Hellllllo Nurse

Good post. I once had dealing on a job w/ an NP, whom I mistakenly called "doctor." He never corrected me. I think he liked it.

I had several interactions w/ an MA who kept referring to herself as "Nurse Polly". My husband was to have a physical and some labs for a life ins policy. This girl kept calling the house leaving messages, calling herself "Nurse Polly". When I called her back, I told her that I'm an RN and asked how a nurse gets a job working from home for ins companies, like she had.

She expalained how she got the job, then said "I need to get a urine sample form your husband for an AIDS test and a blood sample to check for nicotine."

I told her that the blood was for the AIDS test and the urine was for the nicotine test. She started arguing w/ me that she was correct- that it was the other way around.

I finally asked her if she had a license to practice nursing. She said "No, I'm an MA." And she had referred to herself as "Nurse Polly" several times!

Well, we declined the ins and told the company that we would not purchase ins from a company who had an MA calling herself a nurse in their employ. They really did not know what we were talking about.

It has nothing to do with ignorance, elitism or ego. I know some nurses who are sharper than doctors, but still, none of these nurses would ever refer to themselves as a doctor.

A legal sec'y is not a lawyer.

A security guard is not a cop.

A nurse is not a doctor

And an MA (or CNA) is not a nurse.

And let's not forget...NP/PA does not equal MD.

[WA-Educator]

And any old "yeah who" off the street is not an CMA. Certified Medical Assistants are formally trained and are professionals. Many people may call themselves (or be referred to as) medical assistants (or nurses) for lack of a better title, but the true nurse has a license and has had nursing training/education. Likewise, the true medical assistant is certified and has had medical assisting training/education. Beware of the training and schools that are not accredited! Those grads may call themselves medical assistants, but unless the program in CAAHEP/ABHES accredited, the grads are not even eligible to sit for the national boards. In other words, the are not CMAs and can never be CMAs without going back to an accredited program. Be proud of the profession you chose, be the best you can be, and respect other members of the health care team.

:)

[MissLizz27]

hello. i just wanted to comment on the issue of medical assistants in the doctor's office. currently i am a nurse technician but am in school to get my associate degree in medical assisting. my private doctor's office has replaced rn's with moa's and i personally dont like the change. however, i think that moa's are qualified to handle many of the same duties as the nurses but without the title. i thought that i would get a little respect as a medical assistant but from what i have been hearing here i guess i was wrong. i agree that sometimes moa's get lumped in with the regular nurses because its easier to explain to the patients. i am offended though that a pt that is a nurse would ask the moa to let her see the vials before administering it. i am in school busting my behind to learn everything i can so that i can be effective in the doctor's office and i would just like to be given the benefit of the doubt. at least give the moa's a chance to prove themselves. anyone just coming out of school whether its a doctor, nurse or moa is likely to need some help as they are just starting out. thank you for listening to what i have to say.

[Used and abused]

My first medical experience was going to school to be a unit secretary. I landed a job in a surgeon's office. I became a so-called MA. I learned on the job how to wash and sterilize instruments, do VS, some patient care, assist with minor surgeries, transcription, billing, etc.

I learned a love of hands on in that spot and went back to school (after a stint in a business office) and got my associate's degree. THere I learned how much I really did not know. I worked for 12 years as an RN on med/surg, endoscopy, hospice, and detox. I learned some of the most wonderful things from the CNAs, and the long timer LPNs. BELIEVE ME- experience is the best teacher.

Now am a director of nurses and going forward to get my BSN/MSN. The learning never stops and mastery comes with experience. TOO bad there are those out in our field who need to eat our young and pump thier egos up at the expense of other human beings.