Clinical Supervision of Medical Assistants

[twoangels]

I am hoping for insight here. This is my second job- I work in a pediatric clinic. My first job was in the hospital, L&D; I've seen how management and supervision work in the hospital and know what a highly professional setting feels like.

Now, at the clinic- there's a much more laid-back feel overall which I love. What I am caught up on is that there are a fair number of RNs that work there and there are anywhere from 4-7 RNs on at any given time. There are about 10 MAs on each shift and they are supervised by another MA even though the RNs work right alongside the MAs. I would think that the natural nature of this setting would put the RN in a leadership role and the physicians would want to use their RN staff as "quality control" and as ambassadors for consistency.

The RNs are seen as a separate entity by the MAs even though culturally, in our clinic- the MAs and RNs are lumped together into what is called "nursing" there. However, it feels like the RNs' job is just to help out the MAs as needed and do those tasks which are outside of their scope or that the physicians would like to have the RNs do.

Those of you who may be RNs ro MAs who have worked in a similar setting- how does it work usually? Any insight would be VERY MUCH appreciated!!

[Jory, MSN, APRN, CNM]

It's my understanding, and I'm sure someone will correct me if I am wrong, that a clinic that employs medical assistants, that the physicians, not the RN's, are accountable for what they do from a legal standpoint. That makes sense considering it's the physician's choice (generally speaking) of what all they are permitted to do. ie. states allowing them to give injections.

[twoangels]

It's my understanding, and I'm sure someone will correct me if I am wrong, that a clinic that employs medical assistants, that the physicians, not the RN's, are accountable for what they do from a legal standpoint. That makes sense considering it's the physician's choice (generally speaking) of what all they are permitted to do. ie. states allowing them to give injections.

I understand that part of it- the physicians have decided what the MAs can and can't do there. I'm talking more about how the RNs could be better utilized in a supervisory role and a quality control role in our situation- and I wonder if others have experiences where the RNs supervise MAs or if the MAs have their own supervisor who is also a MA.

[nursel56]

In California Medical Assistants are governed by the State Medical Board as an extension of the physician and nurses are governed by the Board of Nursing. But there is a wide variety of interpretations based on your particular state. Generally, their tasks are dependent on being directly observed by the nurse or the MD. If the doctor is present then he or she will be responsible to assign what they do. The procedures they can be legally tasked with are actually pretty wide as I discovered the other day when I was looking for information on it.

Having worked in many clinics this doc is to be commended for hiring RNs. It would be better for quality control, but it would add a layer to the RN's job there, so I would hope they would be compensated for it.

[spooky64]

Hi there! I am a clinical supervisor in a large urology practice. I supervise 3 offices staffed with MAs and LPNs. We only have one other RN and she is responsible for patient calls for 1 of the offices. I agree that RNs should play a supervisory role in such a setting. Before I became supervisor, I worked alongside the MAs doing the exact same tasks. I'm actually feeling stretched thin and ineffective at the moment. I do feel there should be more regulation for MAs.

[HouTx, BSN, MSN, EdD]

PP is correct - you need to refer this issue to your own state's BON to get clarification. In Texas, our BON has actually produced a formal position paper outlining the responsibilities of RNs who work with personnel that are functioning under the physician's license. Basically, the nurse is accountable for observing and intervening if there are any indications of the unlicensed person exceeding their scope of authority or evidence of incompetent performance.

[twoangels]

PP is correct - you need to refer this issue to your own state's BON to get clarification. In Texas, our BON has actually produced a formal position paper outlining the responsibilities of RNs who work with personnel that are functioning under the physician's license. Basically, the nurse is accountable for observing and intervening if there are any indications of the unlicensed person exceeding their scope of authority or evidence of incompetent performance.

That makes sense to me. It's been an issue where the MAs will give medication IMs without aspirating and the RNs find it difficult to exert improvement in this area since the MAs are supervised by another MA who doesn't understand the importance of aspirating when giving Rocephin, Bicillin, Lupron, etc... This is why clinically, I think the practice should utilize the RNs as clinical supervisors since they pay us more anyway.