boards need to regulate MA's

time4meRN · Aug 15, 2007

Here in North Dakota all CMA's have to register with the board of nursing as a UAP. They also have to have their college transcripts sent to the board proving that they have had pharmacology in order to register as a medication aid III. This is done so that the medical assistant may administer injections as per facility protocol. Most larger clinics do indeed regulate medical assisting practice along with the board of nursing. Privately owned clinics do as they wish.
I also was a medical assistant before becoming a nurse. Most of us practice within our scope of practice. If you would like to know more about medical assistants you can visit the www.aama-ntl.org for more information.

O.K., went on to the web site. I do not see anything that tells me MA's are regulated in any way that is different from an RN being certified as CCRN, ACLS, PALS, TNCC, CFN and so on. Like I said B4, these are just advantages to our job and general knowledge. They have nothing to do with the sate board of nursing. If you do a procedure that is dangerous your MA cirtification may be yanked but you'll still be an MA. That is what worries me , many Dr's use MA's out of cost. Most Dr's have NO , idea of what an RN really does. Therefore, they are more inclined to think, that's no big deal let the ma do it. "I'll watch them. " I feel this has lead to many glitches in health care. It's like I tell my friend that's an MA, she doesn't know what she doesn't know. For just one example, critical thinking. If I'm working with an MA, what I say goes. If a chart goes to depositon, it is my signature that they look at as responsible for the cna's , ma under me. A dr, can ask an ma to do all kinds of things but, there in ,lyes the problem.

CritterLover, BSN, RN · Aug 15, 2007

can do less only because we are intelligent enough to realize those are things we should not being doing. whether or not the doctors allow it doesn't mean it's right. they get what you pay for. lpn's & rn's are very valuable for critcal thinking skills which ma's do not pocess.

i wouldn't be so quick to come to that conclusion.

nurses (rns and lpns) operate outside of the scope of their practice all the time. some get lucky and don't get caught. others get caught and disciplined by their respective bons.

some mas do have very good critical thinking skills. there are mas out there that do realize what they shouldn't be doing, and don't do procedures they shouldn't do. i would venture to guess, however, that the ma that refuses to do a task/procedure, won't find himself employeed at that office much longer. the physician will simply find someone else that is more than willing to do it.

the difference is that nurses have a defined scope of practice, and are held accountable to the bon for their actions (or inactions).

pagandeva2000, LPN · Aug 15, 2007

O.K., went on to the web site. I do not see anything that tells me MA's are regulated in any way that is different from an RN being certified as CCRN, ACLS, PALS, TNCC, CFN and so on. Like I said B4, these are just advantages to our job and general knowledge. They have nothing to do with the sate board of nursing. If you do a procedure that is dangerous your MA cirtification may be yanked but you'll still be an MA. That is what worries me , many Dr's use MA's out of cost. Most Dr's have NO , idea of what an RN really does. Therefore, they are more inclined to think, that's no big deal let the ma do it. "I'll watch them. " I feel this has lead to many glitches in health care. It's like I tell my friend that's an MA, she doesn't know what she doesn't know. For just one example, critical thinking. If I'm working with an MA, what I say goes. If a chart goes to depositon, it is my signature that they look at as responsible for the cna's , ma under me. A dr, can ask an ma to do all kinds of things but, there in ,lyes the problem.

That is basically the bottom line. You can report an MA, but more than likely, they will be able to work elsewhere with no regulation. If a nurse screws up, then, it is our license and livelihood that is at risk. I do wonder if it is true that if a nurse is available and the MA who is supposedly working under the physician's license screws up, who is liable; the physician or the nurse? I guess that the BON of that state would be able to answer that question. I know I would call if it were me in that situation.

Crux1024 · Aug 15, 2007

it isn't just a "cost" issue.
yes, mas tend to get paid less than nurses.
but i think that for physicians, that is only half the issue.
the fact is, nurses are limited by their scope of practice. i've never looked into the specifics, but i'd bet in most states, an rn cannot do a biopsy, along with many other "simple" procedures.
an ma can, if the ma has been trained by the physician, and the physician feels the ma to be capable.
in my state, it is difficult for an rn to be allowed to suture. yet there are physician's offices where mas suture all the time.
not only does a physician have to pay more to use an rn, but they actually end up with an empolyee who can do less.

i have a question. if an ma is under a drs supervision, and they do something such as bx or sutures(under drs orders) and somehow really screw it up, who is resposible since there is no ma governing board to discipline the ma directly? is the dr responsible or the ma personally, and can it lead to something like an assault or battery charge?

just curious.....

OgopogoLPN, LPN, RN · Aug 15, 2007

it isn't just a "cost" issue.
yes, mas tend to get paid less than nurses.
but i think that for physicians, that is only half the issue.
the fact is, nurses are limited by their scope of practice. i've never looked into the specifics, but i'd bet in most states, an rn cannot do a biopsy, along with many other "simple" procedures.
an ma can, if the ma has been trained by the physician, and the physician feels the ma to be capable.
in my state, it is difficult for an rn to be allowed to suture. yet there are physician's offices where mas suture all the time.

wow, just wow. i'm in canada and we don't really have ma's at all. we have medical office assistants who do mostly desk/reception and some do stuff like bp, temp, urine dips, weight but that's about it. i've actually been an moa for 12 years, but am starting lpn school in september. anyways, as mentioned previously, i'm sure that 90% of the ma's out there are excellent at what they do, know their stuff and are very valuable, but ma's have their place in the healthcare chain and should be limited to certain duties.

i worked for a dermatologist and saw him do hundreds of biopsies and mole excisions as i would prepare the instruments before hand, hand to him as he needed, bandage up the wound afterwards etc.

i would never ever ever ever allow anyone to do a biopsy or any such thing on me or my children who wasn't an md!!! i am sure many nurses would be more than capable and excellent at doing a simple skin biopsy if trained, but probably wouldn't. i sure as heck would not want a medical assitant doing such a procedure. and i also would never have an ma suture me up afterwards. i saw the difference between and gp's suture technique, a dermatologist's technique and an plastic surgeon's. some of the gp suture scars were horrible. so i couldn't imagine an ma would have a great suture technique for favorable scarring.

i hope i don't sound harsh here, but there are definately duties ma's should not be doing, no matter how "trained" they are by the doctor.

CritterLover, BSN, RN · Aug 15, 2007

i have a question. if an ma is under a drs supervision, and they do something such as bx or sutures(under drs orders) and somehow really screw it up, who is resposible since there is no ma governing board to discipline the ma directly? is the dr responsible or the ma personally, and can it lead to something like an assault or battery charge?
just curious.....

it is supposedly covered under the md's license and malpractice insurance.

i don't think it could be considered battery, unless it was done without consent. battery is a criminal charge, and most cases of malpractice/license issues are civil matters. it would have to be pretty significant to fall over to the criminal part of the justice system.

Home Health Columnist / Guide · Aug 15, 2007

From: American Association of Medical Assistants

What Can Medical Assistants Do?

From: Medical Assistant Net (website for MA's)

MA Scope of Practice

IV administration is outside scope of practice in most states.

smk1, LPN · Aug 15, 2007

Just had an MA call me about some test results and that I should make a follow up appointment. I asked when and he was trying to schedule me out about 8 weeks. I knew this to be extremely inappropriate based on the lab results he just read to me and other findings and asked for the doctor to call me. She did and was dismayed to hear that I was scheduled that far out. Needed me in ASAP and I have an appointment in two days. THe MA also couldn't pronounce my script and had only the very basic knowledge of what it does. I just smiled and went in to ask the pharmacist my questions. He was fine at taking my pulse and BP although because both were quite abnormal he really should have double checked both as he was using the count for 15 seconds and x4 method for the pulse and was re-pumping the BP....Sigh....Nice guy but shouldn't be in a position to answer medical questions or give advice. Basic standard office visits with set tasks are fine, but there is just sooo much room for error... A set scope of practice should be defined for them.

58flyer · Aug 15, 2007

I have a question. If an MA is under a Drs supervision, and they do something such as BX or sutures(under drs orders) and somehow really screw it up, Who is resposible since there is no MA governing board to discipline the MA directly? IS the Dr responsible or the MA personally, and can it lead to something like an assault or battery charge?
Just Curious.....

In my state, Florida, The MAs work under a different state statute than doctors. While the MA statute says that the MA works under the direction of the doctor, the doctor statute defines who works under the direction of the doctor, such as RN, LPN, PA, ARNP, etc. No mention of MA. So if the MA screws up, there is no accountability since under the doctor statute, the MA is not mentioned as one who is supervised by the doctor. To take enforcement action against the doctor, there must be a violation of the doctor statute. The doctor is not held to the MA statute.

Interesting Catch 22: The MA works under the supervision of the doctor, who is not required to supervise them.

As far as action against the doctor due to MA incompetence is concerned, it's not going to happen. Medical malpractice may apply, but no disciplinary action can be taken against the doctor for the misconduct of the MA, no matter how egregious the misconduct.

I know this from personal experience when I attempted to take action for MA misconduct which the doctor readily allowed. When I tried to get my state legislator to make changes to the statutes, the medical lobby blocked the efforts and all I ended up doing was :banghead: .

DutchgirlRN, ASN, RN · Aug 15, 2007

nurses (rns and lpns) operate outside of the scope of their practice all the time.

i wouldn't be so quick to jump to that conclusion. this rn does not operate outside the scope of her practice and don't recall any that i've worked with who had gall enough to do it either.

some mas do have very good critical thinking skills. there are mas out there that do realize what they shouldn't be doing, and don't do procedures they shouldn't do.

that does not constitute critical thinking. that's just being smart enough to know when to come in out of the rain.

DutchgirlRN, ASN, RN · Aug 15, 2007

Critical Thinking:

What makes the thinking of a nurse different from a doctor, a dentist or an engineer?

It is how we view the patient and the type of problems we deal with in practice when we engage in patient care. To think like a nurse requires that we learn the content of nursing; the ideas, concepts and theories of nursing and develop our intellectual capacities and skills so that we become disciplined, self-directed, critical thinkers.

Critical thinking is the disciplined, intellectual process of applying skillful reasoning as a guide to belief or action.

In nursing, critical thinking for clinical decision-making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process used to ensure safe nursing practice and quality care.

Critical thinking includes adherence to intellectual standards, proficiency in using reasoning, a commitment to develop and maintain intellectual traits of the mind and habits of thought and the competent use of thinking skills and abilities for sound clinical judgements and safe decision-making.

Nurses use language to clearly communicate in-depth information that is significant to nursing care. Nurses are not focused on the trivial or irrelevant.

Nurses who are critical thinkers hold all their views and reasoning to these standards as well as, the claims of others such that the quality of nurse's thinking improves over time thus eliminating confusion and ambiguity in the presentation and understanding of thoughts and ideas.

All acts in nursing are deeply significant and require of the nurse a mind fully engaged in the practice of nursing. This is the challenge of nursing; critical, reflective practice based on the sound reasoning of intelligent minds committed to safe, effective client care.

http://www.cariboo.bc.ca/nursing/faculty/heaslip/nrsct.htm

time4meRN · Aug 15, 2007

Critical Thinking:
What makes the thinking of a nurse different from a doctor, a dentist or an engineer?
It is how we view the patient and the type of problems we deal with in practice when we engage in patient care. To think like a nurse requires that we learn the content of nursing; the ideas, concepts and theories of nursing and develop our intellectual capacities and skills so that we become disciplined, self-directed, critical thinkers.
Critical thinking is the disciplined, intellectual process of applying skillful reasoning as a guide to belief or action.
In nursing, critical thinking for clinical decision-making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process used to ensure safe nursing practice and quality care.
Critical thinking includes adherence to intellectual standards, proficiency in using reasoning, a commitment to develop and maintain intellectual traits of the mind and habits of thought and the competent use of thinking skills and abilities for sound clinical judgements and safe decision-making.
Nurses use language to clearly communicate in-depth information that is significant to nursing care. Nurses are not focused on the trivial or irrelevant.
Nurses who are critical thinkers hold all their views and reasoning to these standards as well as, the claims of others such that the quality of nurse's thinking improves over time thus eliminating confusion and ambiguity in the presentation and understanding of thoughts and ideas.
All acts in nursing are deeply significant and require of the nurse a mind fully engaged in the practice of nursing. This is the challenge of nursing; critical, reflective practice based on the sound reasoning of intelligent minds committed to safe, effective client care.
http://www.cariboo.bc.ca/nursing/faculty/heaslip/nrsct.htm

Well said, so well said, it could be published.