I know a CNA who's name badge says nurse!

keasc20 · May 6, 2008

Okay, my relative by marraige is a CNA II. She works for a Dr's office that is owned by a larger hospital coorporation. Since she has worked for this office she has called herself a "nurse" and she does get to administer IM injections and do lab draws, EKG'S, immunizations, and she says she even does patient teaching. Her husband told all the parents on our ball team that if any emergency arose not to worry because his wife is a nurse. This truely irritaes me to no end because I worked my butt off to get through nursing school and sacrificed so much to get my RN. I hate the fact that she has no idea what nursing is all about. Well, the other day she got off work and I saw that her badge said nurse, not LPN or RN just nurse. Not only am I offended that she uses this title but I feel like it is very misleading to patients who see Dr's at this practice. I know there are some good unlicensed health care workers but they still do not have the background, education or right to call themselves nurses. I have not confronted her about calling herself a nurse but I see this happening in the future. Makes me wonder if the "nurses" in the office that I go to are really nurses. I think from now on I will ask, "Where did you go to nursing school," just to be safe.

She could get in felony trouble here for presenting herself as a nurse. I would report her for pt safety sake!

meandrog02 · May 6, 2008

a couple of notes: i'm in ny, and there's a technical loophole that, while stating it is illegal for anyone who is unlicensed to call him or herself an rn or lpn, the actual word "nurse" is not included. it's been a bit of a snag here, as the popularity of "baby nurses" (ie: nannies who people think are somehow more educated in infant care--as a nurse would be) keeps the issue popping up from time to time. as of last year, it wasn't yet resolved; hoping it gets that way sometime soon.
however, and it's a big however, in ny anyone who works in a medical or healthcare setting is required to wear a namebadge that states not only their name, but professional title. i would think that if you are in ny, having janet jones, nurse on her badge would not be allowed, as it is not a professional title for the healthcare setting.
we're not required to carry a card of any type, with licensure information. when working in a healthcare setting, the facility is required to keep a copy of our licensure on file, so that it can be presented to a patient in the unlikely event that someone actually wanted to see a nurse's particulars.
also, i'm guessing you're not in ny, as even medical assistants are prohibited from administering any medication of any type whatsoever. they cannot do this under the supervision of an lpn, an rn, or an md, period. if i find an ma attempting to stick my child with anything, there's gonna be h*ll to pay.

from the aama:

clinical duties vary by state and include...

taking medical histories
explaining treatment procedures to patients
preparing patients for examination
assisting the physician during the exam
collecting and preparing laboratory specimens
performing basic laboratory tests
instructing patients about medication and special diets
preparing and administering medications as directed by a physician
authorizing prescription refills as directed
drawing blood
taking electrocardiograms
removing sutures and changing dressings

we are allowed to give meds :nuke:

BinkieRN, BSN, RN · May 6, 2008

The BON does not regulate MA's because it is the board of nursing and they are not nurses. That pretty much sums it up for me :nurse:

pagandeva2000, LPN · May 6, 2008

What I wonder, then, is if a medical assistant is allowed by the physician in a private practice to administer medications, teach and do procedures and a nurse is on the premises, and something goes wrong, then, WHO is liable? Is it the physician who delegated the task? Or, the nurse, who is not allowed to supervise, but is AWARE that this practice is going on? This makes me not want to work in a private office if an MA is there, unless it is specifically addressed by the BON.

meandrog02 · May 7, 2008

What I wonder, then, is if a medical assistant is allowed by the physician in a private practice to administer medications, teach and do procedures and a nurse is on the premises, and something goes wrong, then, WHO is liable? Is it the physician who delegated the task? Or, the nurse, who is not allowed to supervise, but is AWARE that this practice is going on? This makes me not want to work in a private office if an MA is there, unless it is specifically addressed by the BON.

If you feel like you do not want to work along side of an MA then I suggest you not go to work in an office setting... My office has 8 physicans, 4 LPNS and 7 CMA's... if that tells you anything...

Seems like you have something against CMA's??? I hope I have that wrong, but I have worked just as hard as the next person.. .2 years of school and hard classes and clinicals and I deserve to be in the office helping patients just as much as the next CMA, LPN or RN... I am trained in administering medications, assisting in minor office surgerys, vital signs, venipuncture, handling medical records, and the list could go on. Its a shame that you do not feel "safe and secure" with a CMA being in the office... we are trained also.. and in my office... I do everything the LPN does... I had a LPN train me the first week I was there.... Please do not act like we are not properly trained to handle patient care, because we are

Most MA's have malpractice and Liability Insurance... but if not, then the physican will be liable, usually.... however, I know the nurse will not be liable.....

And again, if i mis-interrpreted your post, then I'm sorry, but that is the vibe you threw out there...

BinkieRN, BSN, RN · May 7, 2008

Its a shame that you do not feel "safe and secure" with a CMA being in the office... we are trained also.. and in my office... I do everything the LPN does... I had a LPN train me the first week

I didn't interupt the last post as she/he not feeling "safe and secure" with a CMA being in the office. I interupted it as a safety issue regarding her nursing license.

I'm a newbie nurse, I've never worked in a doctor's office but the doctor I go to uses CMA's. I feel very comfortable with their skills and I like them very much personally but I would never ask them for any advice. Being able to physically do nursing duties is easy. Passing the NCLEX is just the first step on the way to becoming a nurse and one you cannot pass over on the way.

I'm not being critical of you or saying you're not good at your job. I'm sure that you. Just realize in your career that although you are very capable don't refer to yourself as the nurse. I'm not saying that you do, just commenting :nurse:

RubyRN,CHPN · May 7, 2008

I think several of the posters have missed the point here.

Your cousin's wife works in a clinic under the supervision of a physician and the umbrella of a hospital clinic. She is serving as an employee per her job description there but on the baseball field, sitting in the bleachers, does her MD supervision umbrella protect her with the nametag "nurse" on it? She is really overstepping her boundaries to give medical advice and practicing her skills out on the ball field without oversite and supervision. As for your cousin, he is just proud of his wife. We have one of those in my family too......a longtime LTC facility employee who thinks they know more about running the facility than most of the RN's there. Families can be so weird sometime.

pagandeva2000, LPN · May 7, 2008

If you feel like you do not want to work along side of an MA then I suggest you not go to work in an office setting... My office has 8 physicans, 4 LPNS and 7 CMA's... if that tells you anything...
Seems like you have something against CMA's??? I hope I have that wrong, but I have worked just as hard as the next person.. .2 years of school and hard classes and clinicals and I deserve to be in the office helping patients just as much as the next CMA, LPN or RN... I am trained in administering medications, assisting in minor office surgerys, vital signs, venipuncture, handling medical records, and the list could go on. Its a shame that you do not feel "safe and secure" with a CMA being in the office... we are trained also.. and in my office... I do everything the LPN does... I had a LPN train me the first week I was there.... Please do not act like we are not properly trained to handle patient care, because we are
Most MA's have malpractice and liability insurance... but if not, then the physican will be liable, usually.... however, I know the nurse will not be liable.....
And again, if i mis-interrpreted your post, then I'm sorry, but that is the vibe you threw out there...

I did not say that you did not work hard to get your CMA, or that you do not deserve to work in the office, what I said, or rather asked is that if a CMA is working in an office and makes a mistake, then, WHO is responsible, the physician who delegated the task, or the nurse? And, that is not a question that a CMA can answer, because we are not governed by the same agency. If the nurse is aware that a person is doing a task the wrong way and can compromise patient safety, then, is constrained by the physician, whose license the CMA is working under, then, the nurse may possibly made liable. If this is not going to be illustrated, then, NO, I would not work there. I did not 'act like a CMA was not properly trained to perform a skill' nor did I say that I had anything against CMAs. And, sorry, whomever certifies the CMA cannot tell me where MY liability begins regarding the BON. I do work in a hospital clinic with patient care associates, however, their scope of practice is clearly defined by a job description that is clear on who is ultimately responsible for what.

I can only be 'safe and secure' as you put it, when MY governing board alerts me of what, if any, would a nurse be accountable for, because it is them that I have to face.

pagandeva2000, LPN · May 7, 2008

I didn't interupt the last post as she/he not feeling "safe and secure" with a CMA being in the office. I interupted it as a safety issue regarding her nursing license.
I'm a newbie nurse, I've never worked in a doctor's office but the doctor I go to uses CMA's. I feel very comfortable with their skills and I like them very much personally but I would never ask them for any advice. Being able to physically do nursing duties is easy. Passing the NCLEX is just the first step on the way to becoming a nurse and one you cannot pass over on the way.
I'm not being critical of you or saying you're not good at your job. I'm sure that you. Just realize in your career that although you are very capable don't refer to yourself as the nurse. I'm not saying that you do, just commenting

You are absolutely correct...that was the question I was asking;what is the safety of the nurse's license. I said nothing about the quality of the individual CMA. The same as there are some unscrupelous nurses, that either portray ignorance, the same goes for anyone else. Nurses are trained to be patient advocates, and not doing so can be determental.

Here is an example just today that almost happened to me. I am an LPN, came to work and was assigned to relieve an RN for lunch. The RN told me that she administered clonidine 0.1mg po for a patient whose blood pressure was 210/108. She told me that she was on her way to redo the blood pressure, and she stated that she didn't document in the computerized chart that she gave the medication, but she told me where she placed a note to herself, so I wouldn't disturb it while she was out of the room. I assumed that the patient was to be sent home by her (she didn't ask me to follow this up-if so, I would have told her to document in the correct place before she left). This nurse returned from lunch very late, and then, someone told me of a patient who was 'waiting for the nurse'. I check the chart and see an order for clonidine 0.1mg po and almost thought it was a new patient, until I checked the doctor's note saying that the medication was administered, and the pressure went down to 150/92. He wanted her to return for a blood pressure check. But, nowhere do I see where a nurse gave the meds.

Then, I realized it is the original clonidine patient. The chart was ready for discharge. Now, if I took the pressure again, and it was still high, and told the doctor, he would have probably told me to give 'another one' , but I have no evidence that anything was administered the first time. There is no time when the medication would have been administered, the doctor just assumed the nurse gave it, but you know "If it wasn't documented, it wasn't done". I told the patient to wait a few minutes for the other nurse who gave the drug came back so she can follow up. I told the nurse when she returned that she didn't make it clear that she wanted me to follow up, and this is unsafe practice., and I told her to follow up, because I DID NOT KNOW WHAT SHE DID...did she REALLY administer it or not?? Can I do that with a CMA? Not really...she isn't licensed. Nursing administration would have told me that I knew better, I have a license. The BON would have laughed at me. The other nurse would have denied giving it. I'm sorry, it is different when the person is totally under someone else's jurisdiction verses someone who is on their own. The BON has to be more specific, and in my area, they are not.

caliotter3 · May 7, 2008

Several years ago I saw a position paper put out by my BON (RN) regarding the supervision of unlicensed personnel. I remember not liking what it said. I know that back then there was quite a bit of questioning going on. I know that if I went into a position where there was such a mix of disciplines, I would not feel comfortable if I thought that I was legally responsible for the actions of the CMAs, or other UAPs. I have enough trouble maintaining responsibility for CNAs, where the supervisory responsibility is clear for licensed nurses. I have read where nurses were concerned because physicians were passing the buck when it came to CMAs when problems crop up. If I ever got into an uncomfortable position like this, I would just change jobs. I worked too hard to get my license to have someone else's actions jeopardize it, when they are supposed to be under the direct supervision of the MD. The MD should take all responsibility for their actions, not just pick and choose what they want. JMO

pagandeva2000, LPN · May 7, 2008

I have seen nurses really JAMMED due to the actions of someone else. I used to be a certified AMAP while working in psych years ago, and the nurse had to come behind us, check to see if the MAR was signed, count the pills and then chase the aides to make them sign or give an explanation of why something was not done. At that time, I was thinking she was being a witch with a 'b', until I got my own license. Now, I think of that woman often, and wish I can go back to her and tell her I am sorry for some of the sarcastic things I used to say to her. In many cases, the medication aides, AMAPs and whomever else may get a slap on the wrist, but the nurse goes through the ringer!!

They tell you throughout nursing school that if you witness a practice that is wrong, you are duty bound to intervene. But, they do not mention how to handle this. These employees are under the license of the physician, the facility or whomever, however the nurse is responsible...that doesn't mix with me. I remember wishing to return to psych and was seaching a web site and saw an ad that asked for an LPN to work in a group home. She/he was to be responsible for counting the medications administered by the AMAPs. That looked like trouble to me...for that, I would rather give it. This way, I answer for my own errors, my own mistakes.

meandrog02 · May 7, 2008

I did not say that you did not work hard to get your CMA, or that you do not deserve to work in the office, what I said, or rather asked is that if a CMA is working in an office and makes a mistake, then, WHO is responsible, the physician who delegated the task, or the nurse? And, that is not a question that a CMA can answer, because we are not governed by the same agency. If the nurse is aware that a person is doing a task the wrong way and can compromise patient safety, then, is constrained by the physician, whose license the CMA is working under, then, the nurse may possibly made liable. If this is not going to be illustrated, then, NO, I would not work there. I did not 'act like a CMA was not properly trained to perform a skill' nor did I say that I had anything against CMAs. And, sorry, whomever certifies the CMA cannot tell me where MY liability begins regarding the BON. I do work in a hospital clinic with patient care associates, however, their scope of practice is clearly defined by a job description that is clear on who is ultimately responsible for what.
I can only be 'safe and secure' as you put it, when MY governing board alerts me of what, if any, would a nurse be accountable for, because it is them that I have to face.

CMA's work under direct supervison from the physician. They physician is responsible for the CMA actions.. have no worries