Doing what's right even if it ends a friendship.

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I work in a very rural area. We rely heavily on unlicensced personel who like to do more than their scope of practice allows. I was talking to a physician the other day who has a special clinic that he runs outside of the facility but with our funds. He admitted to me that he allows a nursing assistant to give injections of medicine at this clinic. He is a very headstrong guy and since we have hung out away from work, I knew that no matter what I say, he would argue that he is right. We work for a federal agency and people are constantly bending the rules. They even want to just tap our nursing assistants on the forehead with their magic doctor wands and give them the ability to practice as medical assistants. Interpreting labs, giving injections, and doing patient teaching all without any more training that what they have. Our assistants do not have to go through the state for a certificate or anything. I reported it to Quality Management and her supervisor. I am pretty sure I ruined my friendship with this doctor. We are not close but I feel like I had to betray his trust because this person should not be giving medication.

Nothing will come of it except I will look like a jerk. :zzzzz But, what would you do??

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Specializes in Plastic surgery and Med/surg.
I work in a very rural area. We rely heavily on unlicensced personel who like to do more than their scope of practice allows. I was talking to a physician the other day who has a special clinic that he runs outside of the facility but with our funds. He admitted to me that he allows a nursing assistant to give injections of medicine at this clinic. He is a very headstrong guy and since we have hung out away from work, I knew that no matter what I say, he would argue that he is right. We work for a federal agency and people are constantly bending the rules. They even want to just tap our nursing assistants on the forehead with their magic doctor wands and give them the ability to practice as medical assistants. Interpreting labs, giving injections, and doing patient teaching all without any more training that what they have. Our assistants do not have to go through the state for a certificate or anything. I reported it to Quality Management and her supervisor. I am pretty sure I ruined my friendship with this doctor. We are not close but I feel like I had to betray his trust because this person should not be giving medication.

Nothing will come of it except I will look like a jerk. :zzzzz But, what would you do??

When I became a medical assistant, after 1 year of school, I had my certificate and everything. I started my first job at a doctor's office and found that every other medical assistant that I worked with did not go to school and were taught by their doctors because they had been with them 9 years, 25 years, and 4 years. 1 out of 4 of us which I was the 1 had a medical assistant certificate. They were all giving medicine, taking vitals, calling in prescriptions, etc, etc. It is the doctor's license that medical assistants work under, so if they are ok with their medical assistants not having an actual certificate, then it is their board in their state that they have to answer to.

You had a right to voice your concern no matter how difficult it is. I hope everything works out for you.

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I don't know what the rules are in the state where you reside. I have heard that in some states it is illegal to do what he does. Remember when legislation about nursing is written, big healthcare interest control what is legislated. However, when legislation reflecting scope of practice reguarding things affecting MDs the AMA controls the show. So the docs usually get things the way they want it. In our state the docs can do a lot of things under their own licesne with unlicesnsed personel. By the way some might point out that the docs in my state have been unable to get tort caps passed. That is because the lawyers are just as powerful as they are.

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Specializes in Med Surg, Nursing Administration for SNF.

Kudos to you! :yeah: Obviously, you take your job as a nurse seriously and therefore act as a pt advocate first and foremost. I once worked at a place that was under an agency (we'll leave the name out) that supposedly policed facilities that housed and cared for persons with disabilities. They hired "Resident Assistants" to work in the group homes AND dispense medication (no injections or prn psych, thank goodness) after a class of a few hours. As the RN and ADON it was my job to review their MARs, etc. What a mess! I cd not believe the utter lack of baseline knowledge that these people had! Not to mention the total disregard and displeasure regarding any additional training I tried to give them. No clue regarding side effects, adverse reactions, proper technique, etc. Bottom line, no license to be accountable for. If they screwed up (most of the time they covered for each other tho) they were at the max, out of a job. Period. I finally left, but not without voicing my concerns to the agency that policed the agency that policed the homes - whew! This is just one more example of the shoddy ways that CEOs and upper mgt cut costs. I hope it doesnt get worse, but I am adamant that we as professional nurses have a duty to do the right thing for our pt, because it is the right thing to do!

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Specializes in Cardiac, ER.

I don't know what state your in, but where I am, medical assistants aren't required to be certified. They aren't required to attend school and may be completely "on the job" trained. Most physician offices in my area have these medical assistants that are legally able to do almost anything the Dr. delegates to them, as long as the Dr. is physically in the building.

They way I understand the legality of this, is that they are working as an extension of the Dr. license, similar to EMT's/Paramedics. I worked for an office where there were no licensed staff. The medical assistants did everything! Injections, called in scripts, drew blood, ran the blood in chemistry machines, dipped urine, ran strep screens, did pt teaching, dressed wounds, took Xrays, placed sutures, collected various cultures, etc. This is very common, and legal.

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Specializes in L&D, PACU.
I don't know what state your in, but where I am, medical assistants aren't required to be certified. They aren't required to attend school and may be completely "on the job" trained. Most physician offices in my area have these medical assistants that are legally able to do almost anything the Dr. delegates to them, as long as the Dr. is physically in the building.

They way I understand the legality of this, is that they are working as an extension of the Dr. license, similar to EMT's/Paramedics. I worked for an office where there were no licensed staff. The medical assistants did everything! Injections, called in scripts, drew blood, ran the blood in chemistry machines, dipped urine, ran strep screens, did pt teaching, dressed wounds, took Xrays, placed sutures, collected various cultures, etc. This is very common, and legal.

YIKES! What state are you in?
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Specializes in Plastic surgery and Med/surg.
I don't know what state your in, but where I am, medical assistants aren't required to be certified. They aren't required to attend school and may be completely "on the job" trained. Most physician offices in my area have these medical assistants that are legally able to do almost anything the Dr. delegates to them, as long as the Dr. is physically in the building.

They way I understand the legality of this, is that they are working as an extension of the Dr. license, similar to EMT's/Paramedics. I worked for an office where there were no licensed staff. The medical assistants did everything! Injections, called in scripts, drew blood, ran the blood in chemistry machines, dipped urine, ran strep screens, did pt teaching, dressed wounds, took Xrays, placed sutures, collected various cultures, etc. This is very common, and legal.

You said it even better than I did. My state that does the same thing is Texas for those that want to know.

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You will NOT look like a jerk! You are so awesome! It takes a lot of courage to do what you did, particularly when you are not in a large facility where you can duck under the radar.

If people think you were wrong and are ugly to you - they obviously are not the ethical professionals they claim to be.

I have noticed that so many people are doing things and don't even realize that what they are doing is illegal or unethical. They compromise in one thing, then another, and before they know it, their sense of right and wrong is so distorted that they believe they are doing people a favor.

Hang in there and keep fighting for what is right! As a Christian, I believe that the road to heaven is narrow and difficult to follow - and I remind myself of that when I am in situations such as yours. Feel good that you did not compromise just because it was convenient.

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Thanks for the encouragement! I don't mind the idea of medical assistants if they go to school and know "the WHY" of what they are doing. This person is working as a nursing assistant not a medical assistant. So, she is working under our licensces not his.

I am a new nurse, 19 months on the job and just frustrated with the way medical care works. I was one of those taught in the ivory tower, I guess. It is just frustrating working in a rural area.

In the past, this facility only used unlicensced personnel to do all the things some of the people were talking about such as: suturing, giving meds, and so forth.

I was told even as late as 1998 every one would go home at night leaving the unlicensced personnel to do everything including diagnose and give patient meds. The only time a doctor was called was to rescuscitate patients or sign birth certificates.

I have a contract here but I won't stay here after my time is up. ONE MORE YEAR. I am learning very bad habits that I try to stay out of but it doesn't work. My assessment skills suck because I get yelled at for assessing the patient myself. They are always telling me I am wrong.

I just feel like a failure here. :crying2: I wanted to be part of making this place great and it is not happening.

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Specializes in Ante-Intra-Postpartum, Post Gyne.
This person is working as a nursing assistant not a medical assistant. So, she is working under our licensces not his.

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Exactly what I wanted to say. You need to say something because unless this person is actually working under the title of medical assistant (who work under the Md's license) then they are your liability...magic wand or not! You need to say something, this is not just about risking a friendship its about risking your license

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Specializes in Med-Surg.

Doning the right thing is always the right thing to do. It can be tough sometimes.

True friendships can withstand "doing the right thing".

You did the right thing.

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You need a lawyer to see whose license the aides "work under".

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