LPN versus CMA

pagandeva2000, LPN · Oct 30, 2008

And, there is a big difference between certification and licensure. Certification means that this person works under the auspice of another, and that person, may it be a MA for the physician or the CNA, etc...under the RN, the a licensed person is responsible for them. Therefore, yes, the physician would be on the line as the licensed professional for the MA. A licensed person is more independent and bears their own responsibility. If I screw up; it is ME. Everything I worked for goes out of the window. And another distinction is that physicians, as educated as they are, do not fully comprehend the world of nursing outside of: "I wrote this order, do it". We have the right to question and even refuse if it is out of our scope of practice as well as the possiblity of an unsafe outcome for that patient.

Again, no one is putting down Medical Assistants! I can even attest to some of the really good ones that can show many of us a thing or two and have acquired skills that some nurses have not been exposed to in the physician's office. But, they are not nurses.

txspadequeenRN, BSN, RN · Oct 30, 2008

another issue is that the doctor is suppose to be with the cma/rma when they perform clinical procedures. meaning they are not suppose to be doing injections or other things while the doctor is out of the office. nurses do not have this restriction.

txspadequeenRN, BSN, RN · Oct 30, 2008

i just went back and looked ..i was the 6th poster in this thread 3.5 years ago...why are we still talking about this mess...

nursingis4me · Oct 30, 2008

that's why i said new posters need to be sure they read all previous posts (starting with the ones from 2005) before they decide they want to put up a comment-more times than not, that comment-or a variation or it-has been posted and debated numerous times.

Boog'sCRRN246, RN · Oct 30, 2008

Over the past several months, I have read most, if not all, of this thread. While I am so bored with the whole argument, it's out of morbid curiosity that I keep coming back to read more! I am a LPN in an outpatient clinic and I will admit that I am doing exactly the same thing as the MAs I work with. I do not, however, walk around telling everyone I am a medical assistant. I can legally say "I'm Amanda and I'll be your nurse today." I did not spend the last year of my life waking up everyday at 5AM, studying for 5-6 weekly exams, wiping a** in clinicals, and, finally, passing the NCLEX, just to go to work and hear a medical assistant tell a patient that she is a nurse while conveniently not wearing her nametag. I can be anyone I want to be as long as I don't wear my nametag!

Maybe I am being overly sensitive, but anytime I hear a non-nurse say she is a nurse, I feel...yucky. I feel like all of my hardwork and determination to make it through nursing school are being taken away from me and I'm just so sick of that feeling. I think that if one wants to be called a nurse, paid like a nurse, and do things that only nurses are supposed to do, then they should go to nursing school! I know we are supposed to have respect for our co-workers, and I do, for the most part, but how am I supposed to respect someone professionally when they don't even extend the courtesy of using their REAL title with patients? :twocents:

nursingis4me · Oct 31, 2008

over the past several months, i have read most, if not all, of this thread. while i am so bored with the whole argument, it's out of morbid curiosity that i keep coming back to read more! i am a lpn in an outpatient clinic and i will admit that i am doing exactly the same thing as the mas i work with. i do not, however, walk around telling everyone i am a medical assistant. i can legally say "i'm amanda and i'll be your nurse today." i did not spend the last year of my life waking up everyday at 5am, studying for 5-6 weekly exams, wiping a** in clinicals, and, finally, passing the nclex, just to go to work and hear a medical assistant tell a patient that she is a nurse while conveniently not wearing her nametag. i can be anyone i want to be as long as i don't wear my nametag!
maybe i am being overly sensitive, but anytime i hear a non-nurse say she is a nurse, i feel...yucky. i feel like all of my hardwork and determination to make it through nursing school are being taken away from me and i'm just so sick of that feeling. i think that if one wants to be called a nurse, paid like a nurse, and do things that only nurses are supposed to do, then they should go to nursing school! i know we are supposed to have respect for our co-workers, and i do, for the most part, but how am i supposed to respect someone professionally when they don't even extend the courtesy of using their real title with patients?

here's my 2 cents :twocents: on this matter:

:typing

i have posted numerous times in this forum in an attempt to only enlighten those who feel so passionate about the job they do.

yes, it is indeed a wonderful function that many ma's perform-and perform quite well i might add-but at the end of the day, we only serve to demean those professionals who took the time and effort to go to school for for more education/training that for 1 reason or another we didn't, when we must constantly try and prove that a medical assistant can work as a licensed professional nurse, when that is just not true.

we (ma's & lpn's) may work side-by-side, but believe me, the job functions are quite different-even if they look similar to you; administration definitely knows the difference, and they pay accordingly, so don't con yourself into believing that they pay ma's & lpn's the same (trust me-they don't).

believe me, i don't belittle what ma's do-i'm one myself & have been for 20 yrs. after years in the trenches of various dr's ofcs/facilities, i kinda know my limitations and don't try and do something just to impress the "higher-ups"-they won't notice you when you do something right 'cause you're only a "lowly ma", but as soon as you do something outside what a ma is legally allowed to do & they don't like the reaction, you'll get screamed at that "you don't have a license to do that- so what on earth were you thinking? you're a medical assistant, not a nurse!". (i've actually witnessed this type of occurrence a number of times, and the end result is always the same-the ma is normally fired & can't get a good recommendation from that employer when applying elsewhere.)

i just wish other ma's were proud of the things they can do, & appreciate/take advantage of the learning opportunities that they have when in the presence of a lpn, yet knew their limitations also; maybe this whole discussion would become redundant and the moderator could then finally close this post/forum. :)

MontanaNurse78 · Nov 4, 2008

First: Boog'sGirl, it is illegal for someone who is not a nurse to represent themself as one. This is considered nursing without a license and it should be reported. We are actually leagally obligated to report this to the board of nursing. It would be the same as us telling our patients that we are doctors. You don't need to feel sick about it, because you can and should deal with that situation.

Second: Nursingis4me, I applaud your posting! Very professional of you to look at this subject objectively. We all have limits to what we are allowed to do and it is our responsibility to know those limits. With your outlook I would be very happy to work side by side with you.

I've never worked with MA's, but what I do know is that their training is very different from ours. Their scope is very different than ours. I can't really comment on their practice as I have not been exposed to it first hand. However I do feel that it is important to comment on our practice as nurses. We do not practice under Medical, but under Nursing as its own practice. As nurses we must collaborate with medical staff, but neither should be considered above or below the other because they really are suposed to be 2 separate professions working on the same goal from very different approaches. I know that is not always the case in "real world practice" but it is what we should be striving to uphold no matter what. We are an independent profession which regulates itself. This whole discussion is like comparing the advertising guy with the floor clerk. Both sell the same product with a different approach. Which one is above the other? There is a lot to nursing that others do not see or understand because they haven't been trained as nurses. This is why the nurse is paid more, can work in various settings, and can function more independently; because of our Nursing judgement and Nursing practice. I do feel that the nursing scope tends to be limited by the office setting and I think that is where some of this debate stems from. The tasks performed by the MA's are largely those that fall into a gray area where Nursing and Medical overlap. In many settings we have nurse's aides that for instance take vitals for us but we are still responsible for the assessment of that data (please don't take that wrong-nurses aides do much more than just that). The MA's are performing basically in the same capacity for the physician. We need to remember that even though there are some gray areas where certain procedures overlap, we still perform Nursing duties, while the physician (and the MA's under him/her) practice Medical duties. The two are different.

sharona97, BSN, RN · Nov 4, 2008

don't get it twisted--ma's do not work in the same places as lpn's (not in the same capacity). case in point:
places where a ma can work:
dr's ofc--yes; hosp (direct pt care)--no ; hosp (outpt ofc)--yes/no;clinic--yes/no;nursing home--no ; home health care--no ; private duty/1 on 1--no
places where a lpn can work:
dr's ofc--yes; hosp (direct pt care)--yes; hosp (outpt ofc)--yes; clinic--yes; nursing home-yes; home health care--yes; private duty/1 on 1--yes
out of 7 possible job settings, a lpn can legally work in all 7, while a ma can legally work in only 3 (but sometimes only 1); so please explain, in what universe can a ma can practice anywhere and perform the same functions/duties as a lpn (who is a licensed individual) can-as many of your previous posts have implied?

hi, i just wanted to respond to your post. as a cma ( i am now an lpn) i worked in a cardiac cath lab, scrubbing left and right heart studies. i started out transporting patients to the lab, picking them up out of icu, getting sometimes 2 - 3 iv pumps twisted around the gown and getting them transported safely. at times i went up to the telemetry floor and saw rn's or lpn's feverently trying to get an active pt with extreme cp to scoot over on my cart. having to call the lab and the doctor coming up and yelling at the nurse for obvious ignorance. i also participated in codes, bagging, recording, calling stat for more iv pumps. this was in 1982 to 1984. i clearly did not exceed my scope of practice. i was then given the first collected scholarship from the hospital to go to school for 2 years and was hired back as a licensed nurse.

i totally get that there are some ma's or cma's that may be disallusioned about the scope of their work, but there are many who respect the scope of practice and use due diligence and common sense that helps a licensed or professional nurse to make their day easier. and also to learn from, not necessarily meaning that they can practice what they've learned, but hopefully to aspire these co-workers to further thier education. i worked 7:30 - 3:00 m- f. the experience i gained in that cath lab, the monitoring that i kept up on, the surgical theory i learned in ma school and instrumentation absolutely qualified me to work in that capactiy. and it spurred my interest in cardiac and intensive care that i practiced as a lpn, always under the supervision of rn's, pa's, and docs.

i really believe that the holder of a certificate for ma is truly individual in how well they perceive their scope of practice. do many think they can do anything an lpn or rn can do, of course. is it true? absolutely not, by law, by theory, by the scope of practice. just because i could have been able to start an iv doesn't mean i should. i did however draw bloods in the sterile cath lab for patients going straight to surgery from the lab. totally different. i then went on to become certfied in iv therapy as an lpn.

i am 1 class away and the clinicals from achieving my rn.

i too have a few friends who are cma's and speak about things that make me cringe. i took personal responsibility in my cma expereince and as well in my lpn, and i always will. i do wish that that was for all, but i know i'm dreaming. just as rns and others who have made bizarre decisions to end peoples lives in the hospital, to me it does not reflect on rn's as a whole.

just my point of view,

sharona

nursingis4me · Nov 5, 2008

perhaps you didn't notice my many other posts where i stated i had numerous friends in other areas of healthcare, and it is through them that i have been able to provide some of the insights i previously talked about. in any event, as i have repeatedly said, can't we all just get along? if those of us who chose to remain na's or ma's (certified/registered or not) do so with pride, and don't misrepresent themselves as "nurses" (although i personally know that this can be very hard when the docs you work for constantly refer to the na's/mas as "nurse", which in turn causes elderly pts to refer to you in the same manner-which could lead to a discipline problem if you "politely correct" the dr's "favorite" pt), yet those who have chosen to become lpn's or rn's remember that na's/ma's are healthcare workers too, and not every time they do something are they purposely trying to diminish the role of the nurse-& they provide a very valuable service, for without them, the nurse/pt ratio that receives so many complaints would just skyrocket. in addition, many of the tasks that na's/ma's do are considered menial by administration and not worthy of the salaries that someone who has a professional license would command; yet administration wants that "lowly na/ma" to perform not only the job duties of 3 or more na's/ma's, but to also at times behave as a lpn/rn-even though she's not licensed (i.e. admin "we don't shut the office down for lunch, so a ma needs to be here if someone comes in & they're in distress." ma "we can't assess the pt or give a breathing tx w/o a dr-will a dr be on hand?" admin "no. the dr has to go to lunch; you will be here to call 911." ma " calling 911 is something any staff member could do, can't we rotate office coverage?" admin "no, we-admin-want a ma/nurse to make the call"). the world isn't fair, but since it's the only one we've got---can't we all at least act civilized?!

orthopod1 · Dec 15, 2008

I can only give my opinion. I am a CMA I have found in the state of FL one does no more than the other. Around here we treat each other as equall. I have noticed I do tend to make more money than my friends that are LPN and it does seem to be eisier for me to get clinic jobs. With that said I also went and got my basic x-ray license, which is seperate from the CMA. The CMA can take a class in x-ray but it does not allow them to do anything with x-ray. I amso am an orthotech too. I think whatever you do if your an LPN or a CMA if your good, can multi task and are effeciant your oppertunities are great.

prairie14, BSN, RN · Dec 16, 2008

I have worked as an LPN "NURSE" for 4yrs in an internal medicen dept. an which is an office branch of the local hospital. What I know is that LPNs, RN, ARNPS are all legaly "nurses" though obviosly alot more training as you move up the Nurseing food chain. A CMA " certified medical assistant" may not identify them salfs as a nurse and doing so would be illegal. The CMA I work with have no problems correcting thier pt. that they are CMA. likely I have had to correct pt who ask if I am an RN and then I have to explaine the difference because people don't know and don't realy care as long as they feel like they are being cared for competently.

There is a difference in education at least in WA I had 1yr of prereq which we all started togeather english, math ,cell bio, anatomy phy, phyc. then we spent 2yrs in class from 8am to 4pm studying nurseing theory, assesments, nurseing plans, triaging, inj on each other as well as NG tube placement on eachother before doing it on a pt, we studied in depth desies process, and all the systems in the body, lab values and phlebotomy and I.V certification. our clinicals were held in different settings depending on the quarter nurseing home, hospital, mother baby unit, doctors offices. The CMAs I work with only do clinicals in DR. offices and ussualy they do them at the facillity that they are going to work in so they can be trained specificly to that office. I however will say I notice a huge difference in knowlege and skill from a new nurse based on a new CMA but as the years go on some people just get it while others don't either CMA or LPN and even RN. I had an RN ask me how to write out an rx for a doc. at the same time I have gone to CMAs for opinions or questions. there are some skills that cmas do not have. I think ultimately it comes down to how you think and work, there are great nurses out there and ther are some you wonder how on earth did the pass thier NCLEX. by the same token though I get torn I feel the main differnce besides the years in school is CMAs have the front office skills but LPNs have the desiese process, this make big differnce when phone triaging someone as I have seen a few CMAs put scuicedal, cardiac and pt who have been unble to urinate for three days in apt 3days out or in the after hours clinic which I work alot. this is dangerous, i feel this is the biggest difference not knowing the right questions to ask.

Like the above writter I to get so sick of all the who's who and what letters are behind your name what matters is that you do your job to the best of your ability and with in the scope of your licence. my facility I always have to cathaterize people but there are some nurse at my facility who will not do it because the are not comfortable because thy never got the oppertuniy to do so in clinicals, I just pull them in with me and walk them through it because they want to but are nervous. CMAs don't to caths,trachc, ngs, iv. and if they want to get their RN CMA have to either go through alover again to get thier LPN then an RN bridge OR start from scratch and redue all classes nad attend a 3yr program specificaly for thier RN. I am working on my RN and it is only 3quarters part time to finnish my RN. Sorry to rant I just think people should be clear LPN has a license to practice medicine under thier owen name whre as CMA's practice under a doctors licencens and this is not to be confused with a PA pyscicians assistant which also practices under a doc's licences but they are more lik ARNP's and doctors they have thier own clinic base and usualy have CMA working for them because most docs only want a "nurse" working thier desk even though I don't think they know th difference beteeewn all of us. I say practices safe and be proud of your proffession and if don't like it change it education is a great thing.

this reminds me of one last differnce CMAs have to get recertified every few years where as LPNs just have to pay a 50.00$ relicencesing few every year,though I hear that soon nurses will be requierd to have 22hr of CME before they get thier liscens renewed, I think this is a good Idea because like I said their are some scrry nurses out there, I had to walk an LPN who has been practicing for 2yrs more then me through a triag call for chest pain. she was just going to schedual them an apt the next day. I went over the question for her to ask first luckily she asked me because the pt had, nausea vommiting, back pain,left arm pain diaphoretic, blurry vison, sob and the wife said a bp of 70/40 and P 50. we called 911 for the pt. but thats the kind of stuff that scares me. :yawn: :bugeyes:

kat7ap · Dec 16, 2008

I have worked as an LPN "NURSE" for 4yrs in an internal medicen dept. an which is an office branch of the local hospital. What I know is that LPNs, RN, ARNPS are all legaly "nurses" though obviosly alot more training as you move up the Nurseing food chain. A CMA " certified medical assistant" may not identify them salfs as a nurse and doing so would be illegal. The CMA I work with have no problems correcting thier pt. that they are CMA. likely I have had to correct pt who ask if I am an RN and then I have to explaine the difference because people don't know and don't realy care as long as they feel like they are being cared for competently.
There is a difference in education at least in WA I had 1yr of prereq which we all started togeather english, math ,cell bio, anatomy phy, phyc. then we spent 2yrs in class from 8am to 4pm studying nurseing theory, assesments, nurseing plans, triaging, inj on each other as well as NG tube placement on eachother before doing it on a pt, we studied in depth desies process, and all the systems in the body, lab values and phlebotomy and I.V certification. our clinicals were held in different settings depending on the quarter nurseing home, hospital, mother baby unit, doctors offices. The CMAs I work with only do clinicals in DR. offices and ussualy they do them at the facillity that they are going to work in so they can be trained specificly to that office. I however will say I notice a huge difference in knowlege and skill from a new nurse based on a new CMA but as the years go on some people just get it while others don't either CMA or LPN and even RN. I had an RN ask me how to write out an rx for a doc. at the same time I have gone to CMAs for opinions or questions. there are some skills that cmas do not have. I think ultimately it comes down to how you think and work, there are great nurses out there and ther are some you wonder how on earth did the pass thier NCLEX. by the same token though I get torn I feel the main differnce besides the years in school is CMAs have the front office skills but LPNs have the desiese process, this make big differnce when phone triaging someone as I have seen a few CMAs put scuicedal, cardiac and pt who have been unble to urinate for three days in apt 3days out or in the after hours clinic which I work alot. this is dangerous, i feel this is the biggest difference not knowing the right questions to ask.
Like the above writter I to get so sick of all the who's who and what letters are behind your name what matters is that you do your job to the best of your ability and with in the scope of your licence. my facility I always have to cathaterize people but there are some nurse at my facility who will not do it because the are not comfortable because thy never got the oppertuniy to do so in clinicals, I just pull them in with me and walk them through it because they want to but are nervous. CMAs don't to caths,trachc, ngs, iv. and if they want to get their RN CMA have to either go through alover again to get thier LPN then an RN bridge OR start from scratch and redue all classes nad attend a 3yr program specificaly for thier RN. I am working on my RN and it is only 3quarters part time to finnish my RN. Sorry to rant I just think people should be clear LPN has a license to practice medicine under thier owen name whre as CMA's practice under a doctors licencens and this is not to be confused with a PA pyscicians assistant which also practices under a doc's licences but they are more lik ARNP's and doctors they have thier own clinic base and usualy have CMA working for them because most docs only want a "nurse" working thier desk even though I don't think they know th difference beteeewn all of us. I say practices safe and be proud of your proffession and if don't like it change it education is a great thing.
this reminds me of one last differnce CMAs have to get recertified every few years where as LPNs just have to pay a 50.00$ relicencesing few every year,though I hear that soon nurses will be requierd to have 22hr of CME before they get thier liscens renewed, I think this is a good Idea because like I said their are some scrry nurses out there, I had to walk an LPN who has been practicing for 2yrs more then me through a triag call for chest pain. she was just going to schedual them an apt the next day. I went over the question for her to ask first luckily she asked me because the pt had, nausea vommiting, back pain,left arm pain diaphoretic, blurry vison, sob and the wife said a bp of 70/40 and P 50. we called 911 for the pt. but thats the kind of stuff that scares me.

Sorry if I sound rude, but pleeeeaaase utilize spell check next time. LPNs have license to practice nursing, not medicine. Thanks for your input on the topic