boards need to regulate MA's

DutchgirlRN, ASN, RN · Aug 22, 2007

I can recall ten who referred to themselves as nurses, gave patient's information and explanations that were in error. And several who called in prescriptions that were incorrect in dose and frequency.

All the more reason to regulate MA's but we both know it's not happening.

I worked Med/Sug Charge, 20+ yrs, and had constant issues with MA's returning calls with orders. I had to ask name? LPN? RN? "um....no...medical assist". Sorry I cannot take an order from you if you are not licensed. "But I am the doctors nurse", No you are not. "yes I am", No you're not. It was never ending. I complained to several doctors with no results. Finally I went to administration and they listened. A policy was formulated and sent out to all physicians. No orders can be taken from an unlicensed person. That put a stop to it except for one particular MA who still grates my nerves.

Working in home health I dealt with MA's also on a daily basis. Wrong orders, wrong doses, incorrect medical advice to patients...yada yada, just as you say. All the more reason to regulate MA's.

Currently working in medical imagining I deal with MA's almost daily. I have such a problem making them understand that a diabetic, pt with ESRD, over the age of 65 must have a BUN/Creat not over 30 days old. Some don't even know what a BUN/Creat is.

Very occasionally I luck out and get an office person who tells me "I cannot give you the results since I am not qualified to interrupt them so I have to fax the results to you". Cool!

My PCP has only MA's in his office and I have to honestly say they are totally awesome. They wear name tags with Medical Assistant plainly visible and they do not give medical advice nor call in or approve refills without the doctors written permission.

Again, all the more reason to regulate MA's but we know it's not happening.

This doc offered me a job in his office but I told him I didn't want to work 5 days a week. He offered to match what I make in medical imaging, $32/hr.

DutchgirlRN, ASN, RN · Aug 22, 2007

i can do ekg's however i am not comfortable reading them

:eek: :eek: :eek: I take it that you are not kidding????? OMG! I have ACLS and I do not read EKG's. That's left to the cardioligist. Of course I can monitor a patient using telemetry as a tool and administer ACLS as warranted but read an EKG, nor sirreeee, not this RN.

I applaud you heartily for refusing to read EKG's. You're a smart cookie and will make a good nurse. Good luck with your studies.

smk1, LPN · Aug 22, 2007

With respect, as i stated in my previous post. There is no difference in an RN and MA responsabilities in a Doctors office setting. Im sure in a hospital setting there is a great difference. In a doctors office however, there is none.

I don't mean to sound rude, but until you become licensed as a nurse you really don't have a clue about the true responsibilities that the nurse will carry even if you perception is that they do the "same job". I don't even want to get into MA's disussing test results and giving advice. Let's just say that out of the past 2 years probably 75-80% of the advice/information given to me by MA's was incorrect and some of it down right dangerous. I seriously doubt these people were malicious and trying to harm my health, but they don't know what they don't know. This is not to say that there aren't plenty of nurses and doctors who ALSO give incorrect information and step outside of their professional roles, however these people have demonstrated competency and the knowledge and abilities to perform these roles. They also can not only lose their licenses, practices, homes, cars and livelyhood, but they can also face criminal charges for their malpractice in certain circumstances. I would expect the comparison and skills and knowledge between MA's with no formal training and those who went to school for CMA to be a bit irritating to many of those with your title. On the same token it shouldn't be hard to see that nurses aren't happy about anyone and everyone taking the title nurse without having earned it. THe length of school differs as does the nurmber of credits required and the level of classes. No matter what the setting, it truly isn't the same responsibility.

crackerjack · Aug 22, 2007

I resent the fact that CMA'S are looked upon as cheap substitutes. I am very passionate about my job and the care my patients receive from me. I WILL NOT PERFORM SOMETHING THAT IS OUT OF MY POTENTIAL FOR A DR. OR ANYONE! And yes, I have been fired from jobs because of this. But you know what, I am the one that can lay my head down at night knowing that if that patient dies during the night, IT WILL NOT BE BECAUSE OF AN UNSKILLED PROCEDURE THAT I PERFORMED.
Also, not everyone has the opportunity to go straight into nursing school, working as a medical assistant is paying my way through nursing school now as I try to further my career. Also, If it were not for MA'S or CNA's. then that would be more work for you all to do, and give you all something else to gripe about.
I am very offended by the comment that we are cheap labor. If you know so much, then why did you stop at your nursing degree? Why did you not go on to become the DR?

The problem is that in my experience, MA's generally do not limit themselves to performing tasks within any set of boundaries at all. What I've seen are MA's performing duties limited to LPN/RN scope of practice, calling themselves nurses and outright dangerous because they lack the education and training to understand the rationale and complex effects of what they are doing, handing out medical advice and so on as the OP posted. *YOU* are one of the few....it isn't that we as RNs do not value the work of an MA, it is that we see so often MAs performing in dangerous ways outside their training and knowledge base. The fact that MDs find an MA as a cheap substitute for hiring a real RN and 'training' them to perform advanced skills without the license or knowledge to understand what they are doing...is what scares and angers RNs. It is a matter of patient safety....patient safety is crucial above all else, above the desire to get to do 'fun stuff' like a nurse without understanding the implications. It totally irks me that my own doc's office uses MAs trained in the office and refers to them as nurses and here they are taking phone calls as 'the nurse' to relay to the doc and so on. I don't have a problem with them getting vitals and placing patients in rooms but they are taking history, the c/o for the visit and so on. It is just dangerous, they don't know the appropriate questions to ask to even get crucial information that a patient might not mention. If I didn't love my doc I'd leave....

Anyway, it isn't that we dislike or don't value the work of a dedicated MA who knows her limits and is knowledgeable in her area, not at all.

CarVsTree · Aug 22, 2007

Heck no! Why would the BON want to get involved? Should the BON also regulate PA's? They do a lot of stuff.

MD's use MA's let MD's regulate them.

txspadequeenRN, BSN, RN · Aug 22, 2007

i think back now and i want to crawl up under a cough or something. there is no such thing a a pharm class in ma school (for those of you that are ma's and think you have been through a pharm class wait until you have hit nursing school) we had very simple dosage calculations for like a day and that is pretty much it... there was no drug cards, no knowing every drug by heart or you go home for the day....but when you start working you are giving all these injections and have no clue anything about the pharm behind the drug... for me when i was a ma i knew what i was doing, but didn't know why.

i've had to correct many ma's over the years when they call me with changes to my patients... and they get mad ...life goes on honey . like the one that tried to call in dig 25mg instead of 0.25mg or the one that kept telling me that the patient needed vicodin when they had a known allergy to tylenol... i could go on and on here....

all the more reason to regulate ma's but we both know it's not happening.
i worked med/sug charge, 20+ yrs, and had constant issues with ma's returning calls with orders. i had to ask name? lpn? rn? "um....no...medical assist". sorry i cannot take an order from you if you are not licensed. "but i am the doctors nurse", no you are not. "yes i am", no you're not. it was never ending. i complained to several doctors with no results. finally i went to administration and they listened. a policy was formulated and sent out to all physicians. no orders can be taken from an unlicensed person. that put a stop to it except for one particular ma who still grates my nerves.
working in home health i dealt with ma's also on a daily basis. wrong orders, wrong doses, incorrect medical advice to patients...yada yada, just as you say. all the more reason to regulate ma's.
currently working in medical imagining i deal with ma's almost daily. i have such a problem making them understand that a diabetic, pt with esrd, over the age of 65 must have a bun/creat not over 30 days old. some don't even know what a bun/creat is.
very occasionally i luck out and get an office person who tells me "i cannot give you the results since i am not qualified to interrupt them so i have to fax the results to you". cool!
my pcp has only ma's in his office and i have to honestly say they are totally awesome. they wear name tags with medical assistant plainly visible and they do not give medical advice nor call in or approve refills without the doctors written permission.
again, all the more reason to regulate ma's but we know it's not happening.
this doc offered me a job in his office but i told him i didn't want to work 5 days a week. he offered to match what i make in medical imaging, $32/hr.

DutchgirlRN, ASN, RN · Aug 22, 2007

Heck no! Why would the BON want to get involved? Should the BON also regulate PA's? They do a lot of stuff.
MD's use MA's let MD's regulate them.

Of course PA's are regulated:

All states, and the District of Columbia, have enacted statutes and regulations that define PAs, describe their scope of practice, discuss supervision, designate the agency that will administer the law, set application and renewal criteria, and establish disciplinary measures for specified violations of the law. http://www.aapa.org/gandp/statelaw.html

And so should the MA's be regulated...

time4meRN · Aug 22, 2007

Of course PA's are regulated:
All states, and the District of Columbia, have enacted statutes and regulations that define PAs, describe their scope of practice, discuss supervision, designate the agency that will administer the law, set application and renewal criteria, and establish disciplinary measures for specified violations of the law. http://www.aapa.org/gandp/statelaw.html
And so should the MA's be regulated...

Yes, thank you!

PA's are regulated, if you look at their scope, it is as if not more defined than nursing. If NP's , CRNA's and for heaven sakes, even dialysis techs are regulated. Iv's seen MA 's who do more to pt's than a dialysis tech. And dial. tech.'s are responsible for some pot. dangerous procedures. I feel that if MA's are regulated by the BON's, it will help further define nursing.Now it seems we have office workers who can do a few select techniquies who manage to somehow enter into what they think is nursing. The thing is , many Dr's pt's etc,... also think they are nurses. That needs to change. I like what others said here, if a PA introduced themself as the DR. or heaven forbid a RN, introduce them as the DR. The DR would have an absolute fit. As well they should, but when RN's have issues with MA"s well then we should just be quiet and deal with it.:trout:

nurz2be · Aug 22, 2007

I know for a fact that at the uni. I attend, the MA course is 8 months. Is it really, in the scope and realm of anything, possible to "Know" what you are doing? There is a HUGE difference between someone teaching you, by repetition what you should do, but do you KNOW the what and WHY you are doing it? I feel, IMO, the MA program at my school teaches them, by repetition, what to do. If you ask them WHY they are doing it, or What the class of medication and the contraindications are, I don't think the majority could.

I was a CMA in Oklahoma and have had that CERTIFICATE, not LICENSE (BIG Difference) since 1995, in a nursing home, and I was allowed to do wound care, vitals, give injections of B-12 and insulin, start Foleys, chart and yes, sadly give meds. I had a 1 day-8 hour class on meds. Now that I am in nursing school, I can look back and realize just how much I had NO BUSINESS doing those things. Especially the Meds. We have a 2 month, 6 hour a day course at my school JUST for pharmacology and you have to test out at 95% or you are out. I was D@#$ lucky nothing went wrong with what I was doing back then.

I feel myself to be a competent person, but let me tell you, now that I am on the REAL side of medicine I was foolish to do, what I was in the legal right of my job to do, most of the things my certificate said I could do.

I am speaking from personal experience and I do know that the HUGEST difference between what an MA thinks and what an RN knows is the true RESPONSIBILITY of having someones life or death in your hands. As an MA we did not, and were told from the start we work under a doctor or nurses license, actually have the TRUE RESPONSIBILITY like the nurses and doctors do. We were blanketed under someone else's license.

I COMPLETELY AGREE, as a certified (not licensed) medical assistant that there should be a rigorous list of what can and cannot be performed and that DON should hold physicians and the MA responsible for going beyond that scope of assistance. If you look at the last word in that title it says ASSISTANT, not nurse, not doctor, not healer, not giver of advice.....assistant!!!!!!!!!!!!

nurz2be · Aug 22, 2007

I am a certified MA and I know they THINK they do. I just read what you posted there are you are ABSOLUTELY 100% correct. I, as an RN student and CMA, find that people who post and Believe for some unfathomable reason, that they are "Doing nurse work but aren't getting the pay they deserve (Insert wahhhh here)" the reasons nurses do not and will not have a positive outlook on the CMA, and for good reason. People who wag their tongues saying "I do what a nurse does" is DELUSIONAL!!!!!!!!!!!!!!!! Their ass is too big for their shorts and they need to grow up. If they want to CALL themselves nurses they should go to nursing school and become a REAL nurse and THEN AND ONLY THEN can they realize what horse crap all that is. I believe in being nice and in being civil but this makes me crazy. (Someone better Baker act me!!!!!!!) LOL. Nowhere and NOONE IN THE KNOWN UNIVERSE DOES the work of a nurse BUT A NURSE!!!!!!!!!!!!! PERIOD.

(Insert jumping off soap box)

spydercadet · Aug 22, 2007

i am shocked that everyone on this thread is completely unaware of what is going on with all of this. the state nursing boards have narrowed each level of education and practice so that the lines are well defined. that sets up a cost structure that can be cost-prohibitive to a physicians practice. then what do people really want, more affordable healthcare or a higher standard of healthcare?

most states say you need to be a rn to start an iv and begin iv medications, esp. first doses. how many rn's out there want to work for $12-15/hr, not many? most of us can go to a hospital and make much more. look at surgical techs, not far off either, twenty years ago the only surgical techs were in the military, now there are almost no hospitals in the u.s. that don't have surgical techs. what's next? there are, i believe, ten states right now that have instituted med-techs who will pass medications on patient care units. i think that the ama is tired of waiting for nursing to get its house in order, so they have taken it upon themselves to do it for us.

in our state boards desire to make sure that we are "professional”, they are requiring higher and higher levels of education to educate and to practice. that is great as an idea, but in reality, patients are not being cared for. i was just discharged from the hospital after a major operation and there are just not enough nurses to care for the patients that are in the hospitals now.

ma's, surgical tech's, med. tech's, they are all certified but not licensed, because they are not licensed, they do not fall under the state board’s jurisdiction. as far as what they can do and under whose direction? that will depend on the setting, but generally it will be a physician’s office and it will be the practice that will be held liable for any wrongdoing.

i hope nursing starts to realize that we are standing on the wrong side of the branch that we are cutting off. the physicians are not sitting by anymore and are developing new "tech's" to make sure their patients get the care they need and nursing isn't or can't provide. we need more nurses, at every level. we are professionals, we always were. it makes me feel sad that our nursing boards don't know that. i have always known who i was and am and what role i play in the care and well-being of my patients. the doctor may have to write the order but it was always up to me if i should give it and to make sure my patients and their loved ones understood what and why i was giving it to them. who has the more important role? neither of us, we are both vital to the process. so, no matter what letters come after my name as long as the rn is there, i will make sure my patients get the care they need and deserve.

DanisTeeta · Aug 22, 2007

Well, I disagree! I was a Med Asst for more than 14 years before I went to Nursing School and I was one of "those" MA's that did everything. I had incredible MD mentors who taught me things that I didn't even learn in nursing school. I would have kept doing it if it wasn't for the fact that I was really limited to doctor's offices. There are alot of MA's that do not have the experience or the knowledge but there are also that are smarter and have better skills than some nurses I have worked with.