MA in charge of clinic?

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I work for a primary care clinic in TN. I am finding that I am having a very difficult time swallowing the fact that my clinical supervisor is a Medical Assistant. When it comes to the administrative side of the house I have zero qualms with receiving correction or guidance. On the other hand, when it comes to clinical practice or assessing my clinical competency I cannot seem to process how I am under the supervision of someone who does not have a license. I have looked up the Nurse Practice Act for our state but cannot find anything that gives a direct answer. If anyone can tell me their experiences or if this is even legal/acceptable or if I am being unreasonable not wanting to take direction clinically from a Medical Assistant it would be greatly appreciated. Thank you in advance!

I completely agrees I completely agree they shouldn't be triaging. When I was told they do the triaging I had to pick up my jaw from the floor.

An MD office is a whole different world. MA's work under the direction of the MD. They have their own scope, and every scope is different in just about any office.

But, when you add a licensed nurse in the mix, that is an issue that could more than likely be answered by the BON or your .

In other types of care, even as an LPN, the only consistent in the state to state practice act is that one couldn't clinically direct an RN. But, when you get into a private practice, it is on the MD.

What is your role in the office? If it is as the supervising nurse, then you should have the authority to delegate appropriately.

The newest thing in my area is MA's that are charged with doing medication reconciliations, and calling in refills from verbal MD orders. I am all for information gathering, but as a licensed nurse being left out of the loop--no thank you. And the whole answering the phone, claiming to be a nurse, (or not identifying that they are not one) and giving advice. YIKES!

Which is all whatever, the MD responsibility, UNTIL such time as I am the "token nurse" for the purpose of license responsibility as if I am the "delegating" party.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.
I realize nothing stated requires a license but I am at a loss having to defend doing something correctly. Someone who does not have a license has nothing to lose.

It sounds as if she's in a position to observe, critique and evaluate your clinical practice? That would be very irritating to me unless the provider has instructed her to do that, in which case I would most likely want to talk to that person about their concept of your role at the clinic.

On the other hand, she may genuinely believe she is trying to be helpful and it's best not to create a scenario where she may become defensive. Then you have a dispute instead of a collegial atmosphere. You could say, "Let's see what the latest CDC recommendations are for xyz vaccine", for example.

Most of the things on your list I would not deem to be a problem, with a couple of exceptions. Specifically, I wouldn't think it appropriate for her to be micro-managing your med calculations at all. I would also hope she isn't in the room evaluating your performance as you catheterize the patient.

Hope it all works out for you!

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I understand that they are competent in taking vital signs and other skills but when there is a dispute on procedure and whether or not something is being done correctly I have a hard time understanding how someone without a license can override someone that does, especially when it comes to patient care.

It's money. That MA comes at a far lesser price than an RN in the same position.

I don't think the OP is discrediting MAs. My friend is an MA; she's smart, capable, and good at her job. But would any LPNs and RNs here have a problem if I (a CNA) was in charge of doing your skills check offs for vitals? That's just a bit odd.

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Specializes in Pediatrics Retired.
It's money. That MA comes at a far lesser price than an RN in the same position.

I don't think the OP is discrediting MAs. My friend is an MA; she's smart, capable, and good at her job. But would any LPNs and RNs here have a problem if I (a CNA) was in charge of doing your skills check offs for vitals? That's just a bit odd.

Yea, it's budget driven or the MA is big buds or related to the owner. As long as you stay in your practice act you're fine. Otherwise the physician is responsible for everybody else. Not a good patient care or advocacy model but not illegal. Sorry you're in that situ.

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MA'S triage all the time here in Texas. Some clinics don't even have a nurse and if they do their role is telephone triage. I even hear the docs and MA'S refer to themselves as nurses

Which is illegal in Texas. The Texas BON has procedures for reporting this.

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For the private doctor's office, it's definitely a matter of money. The MAs have been trained in all the clinical skills the OP have stated. If the MA is in a supervisory position the MA had to have proven experience and competence. Respectfully, it's the OP's ego that's getting in the way. Having a license doesn't necessarily make you competent. The doctor obviously has confidence in the MA's clinical skills and critical thinking ability - I doubt the MD would jeopardize his practice. Ego is saying, "I worked long and hard to EARN my RN degree, paid $$$$ dollars, stayed up late at night studying for tests, to maintain a 3.8 GPA, sacrificed time with my family, then the time preparing for the NCLEX; and the MA just spent 10 months to get a certificate." It just doesn't seem fair somehow.

I'm one semester from completing an LPN program. I'm 2 months into working as an PCT in a hospital. I know a PCT (CNA) who's worked in CCU for 10 years and can interpret all the common ECG disrhythms, know all the most common drugs relating to the most common cardio and respiratory ailments (knows interactions, contraindications), correctly anticipates RN's interventions and actions. I would trust my health in her hands as much as an RN, and more so than a new grad RN.

I also worked at a nursing home where the night shift supervisor was an ADN RN with less than a year's experience - giving clinical direction, discipline to BSNs with several years experience.

With all due respect, humbly accept any direction and correction from your qualified supervisor.

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when there is a dispute on procedure and whether or not something is being done correctly I have a hard time understanding how someone without a license can override someone that does, especially when it comes to patient care.

This is getting all kinds of sticky. I hope that if you know that what you are doing is the best practice regarding nursing care for your patient, then you are not changing it because of your unlicensed and possibly not even certified medical assistant supervisor is telling you she was taught a different way. I would politely show her evidence based research on current standards and if she still won't budge, I'm sure there's another clinic that could use a nurse and also has a nurse as the supervisor

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Specializes in ICU, LTACH, Internal Medicine.

Clinical competencies of MA is a question to Medical Board, not Nursing.

But, given the situation, I would just submit my resignation note and take medical leave for the rest of days.

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MANY of the doctors offices/clinics where I live hire only MA's..sometimes they are referenced by "nurse" or refer to themselves as such..this has been a LONG standing issue in the area I live. I also learned that MA's, until this year, were NOT required to be certified - they could "learn on the job" and many have or have taken a few MA classes. I'm not sure the doctors/practice administrators are even aware how dangerous this can potentially be. I have NO problem w/CNA's or MA's...but a large problem is there are no standards of practice for them, no board that oversees things so much much falls through the cracks. I worked at a multi- doctors office where only one of the 5 MA's was certified..the rest learned on the job..they drew up and gave injections, placed and removed catheters, assisted w/in house surgeries, ordered meds..you name it. Over and over I asked about this..even contacting the state board - was told the same thing..doesn't apply in an MD practice but as of 2016 they must be certified..I have no problem learning from someone on the job who has more experience or knowledge when I am new however I think CNA/MA's should be certified & there should be a scope of practice and regulatory board to oversee it all.

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Specializes in Hospice / Psych / RNAC.

MAs can do anything the doctor trains them to do. The MAs are working under the doctor's license. That's how facilities get away with paying little for lots. It's all about the almighty dollar.

I had an MA at my urologist's office do dynamic testing on me. If that wasn't enough, when she took my blood pressure with a wrist cuff, she instructed me to lay my hand on the table. I have the same cuff at home and you're suppose to raise your cuffed hand to your heart. When I tried to tell her she shushed me... I told the doctor train her again...I no longer go to that urologists.

I've seen MAs do many things that even LPNs can't do. The urodynamic testing; I'm pretty sure an RN would have to be certified to do that (maybe, I don't know). This is the future and has been for over 20 years. It seems that the MAs are coming out of the woodwork now.

They are a financial dream for doctors and facilities who have a medical director willing to put their license on the line for financial gain. It's on the job training at it's very best. Some MAs now go to school for 2 years, just like an associate degree nurse...just saying.

MAs are in the realm of PAs; jobs created to assist docs. Many MAs go on to become PAs. Both need to practice under a doctor's license.

So moan and scream all you want; it is what it is.

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact=8&ved=0ahUKEwiFl5WH69rMAhUK-GMKHccqA_0QFggqMAI&url=http%3A%2F%2Fwww.aama-ntl.org%2Femployers%2Fstate-scope-of-practice-laws&usg=AFQjCNFhOrLuuOq6YbchhdevHvAa8Pjjgg&sig2=oKsHDEuhOEQ55L-wFWCr_A

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Specializes in Med/Surg, Ortho, ASC.
For the private doctor's office, it's definitely a matter of money. The MAs have been trained in all the clinical skills the OP have stated. If the MA is in a supervisory position the MA had to have proven experience and competence. Respectfully, it's the OP's ego that's getting in the way. Having a license doesn't necessarily make you competent. The doctor obviously has confidence in the MA's clinical skills and critical thinking ability - I doubt the MD would jeopardize his practice. Ego is saying, "I worked long and hard to EARN my RN degree, paid $$$$ dollars, stayed up late at night studying for tests, to maintain a 3.8 GPA, sacrificed time with my family, then the time preparing for the NCLEX; and the MA just spent 10 months to get a certificate." It just doesn't seem fair somehow.

I'm one semester from completing an LPN program. I'm 2 months into working as an PCT in a hospital. I know a PCT (CNA) who's worked in CCU for 10 years and can interpret all the common ECG disrhythms, know all the most common drugs relating to the most common cardio and respiratory ailments (knows interactions, contraindications), correctly anticipates RN's interventions and actions. I would trust my health in her hands as much as an RN, and more so than a new grad RN.

I also worked at a nursing home where the night shift supervisor was an ADN RN with less than a year's experience - giving clinical direction, discipline to BSNs with several years experience.

With all due respect, humbly accept any direction and correction from your qualified supervisor.

You are so, so wrong on so many accounts. You scare me. So, so much.

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Roser13, I accept I could be wrong, I'm still new to healthcare as a career. Please , enlighten me where I may need to rethink my position.

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