MA working beyond scope of practice

[Catedi]

I'm not sure what to do here. Someone I know told me this week that her employers allow her to work beyond her scope of practice. I always thought she was a Surgical Tech, although, she never went into details about what she did, other than assist in surgery. I just found out she went to a school for medical assisting. Her program was 6 months long and she graduated with a certificate. She's not even registered, as in Ohio, registration is not required. Essentially, she is an unlicensed medical assistant. She stated to me that her employers, a private dermatology and cosmetic surgery practice, have her assist in surgery, such as starting IVs, injecting medications into the IVs, monitor patients under anesthesia and do post surgical care. I was floored when she told me this. I calmly questioned her on why they don't have an RN doing these things and she stated, they only have one nurse on board because the 'practice' feels it's too expensive to pay RNs, when the physicians at her practice can just train MAs to do what she's doing. I'm a newly licensed RN, so I'm not sure what to do or say about this situation. Nor, do I know who to turn to to report this. I just know this is beyond her scope and this is endangering patient' safety. This person understands what she is doing is beyond her scope, but doesn't care, since she is compensated beyond what an MA would ever make with a certificate. She also feels the risk of getting caught is minimal, as she asked, "How could anyone possibly find out?". I'm wondering, does a patient death have to occur for this to stop? Any advice would be welcome.

[brillohead, ADN, RN]

There HAS to be more to the law than this... an LPN has to have a certificate in order to start an IV, but Joe Blow off the streets can do it as long as a doctor "delegated" it to him? That just doesn't sound right.

As for how to find out who to report to, I'd call someone at your school's nursing department, assuming you went to school in-state. I'm sure they know exactly to whom you need to report this.

[ImThatGuy, BSN, RN]

May not sound right but it is.

[morte, LPN, LVN]

So then may an RN perform any skill an MD wants, not as an RN, but as an assistant MA under the MDs license?

No, because the nurse has a license to protect.....

[CaregiverGrace]

So then may an RN perform any skill an MD wants, not as an RN, but as an assistant MA under the MDs license?

Only if the RN let her license expire, then worked as/was certified as an MA. And even in that case, that previous experience as an RN could come back to haunt you in court as far as liability. In the case of the MA, the liability falls much more on the MD.

[VioletKaliLPN, LPN]

In my state, NC, LPN's can insert IV's as well as give IV push meds, but sometimes facilities do not allow LPN's to do so.

[carrie_c]

Maybe you should report the doctor to the medical board. There should be some type of form you can fill out and send in. I think you should be able to go to your states' department of health website and search for the form there. That's what I would try to do. I don't think it would do any good to report the MA since they aren't even regulated, and I don't even know where you could report her.

Here in my state (TN), LPN's can do IV meds as long as they have taken a class for it.

[witc]

No, they are not supposed to do anything the doctor lets them do. They are not supposed to give IV meds. And they can be charged along with the doctor if anything happens.

True. I am a medical assistant too, and even though I am registered, I would not do anything behond my scope. I used to work for a doctor that had MA's do blood draws (with no phlebotomist cert.) He wanted me to do it too saying that I'd be working under his authorization; plus, "no one" would ever find out as if anything happened, he would deny everything... Good luck with that! I quit that job as soon as I could. At that time, I was trying to get the BON authorization to take the NCLEX, and there was no way I would risk my future for that job.

Honestly, some private practice owners need to take a look to the laws.

[NRSKarenRN, BSN, RN]

if this dematology practice is licensed as ambulatory surgical facility, they need to meet ohio standards:

[color=#9a1f22]3701-83 licensing-- ambulatory surgical facilities and certain freestanding health care facilities

bureau of regulatory compliance (brc) enforces these regulations

mailing address:

ohio department of health

bureau of regulatory compliance

246 north high street

columbus, oh 43215

telephone: [phone]

fax: [phone]

e-mail: [color=#9a1f22][email protected]

[lillymom]

i am a cma and there are some states that do not regulate ma's and some that do. this is on the aama website for key states that have restrictions about ma's scope of practice. cma's are not to practice outside what they have been trained and feel competent in and they are not supposed to practice out of scope. it gives a bad name to those of us who actually care about our profession.

this was on ohio's link: http://www.aama-ntl.org/employers/laws.aspx

4731-23-03 delegation of medical tasks; prohibitions.

(a) a physician shall not delegate the practice of medicine as defined in section 4731.34 of the revised code unless specifically authorized to do so in the revised code or by an administrative rule adopted pursuant to the revised code and which became effective prior to april 10, 2001. nothing in this chapter of the administrative code shall prohibit the performance of emergency medical tasks.

(b) a physician shall not delegate a task to an unlicensed person if the task is beyond that person’s competence. in a hospital, as defined in section 3727.01 of the revised code, or an ambulatory care center affiliated with the hospital (if the center meets the same credentialing, quality assurance, and utilization review standards as the hospital) wherein unlicensed persons are employed or otherwise authorized by the governing authority of the institution to perform specific medical tasks, one factor the physician shall take into account is the policies by which the employer or the governing authority of the institution seeks to ensure that competent persons will be performing the delegated tasks.

© a physician shall not delegate a medical task that is not within the authority of that physician or is beyond the physician’s training, expertise, or normal course of practice.

(d) a physician shall not transfer his or her responsibility for supervising an unlicensed person in the performance of a delegated medical task, except to another physician who has knowingly accepted that responsibility.

(e) a physician shall not authorize or permit an unlicensed person to whom a medical task is delegated to delegate the performance of that task to another person.

(f) except as provided in divisions (d)(4) to (d)(8) of section 4731.053 of the revised code, a physician shall not delegate to an unlicensed person the administration of anesthesia, controlled substances, or drugs administered intravenously.

(g) the supervising physician retains responsibility for the manner in which the delegated task is carried out.

[Elleveein, LVN]

I recently posted this on another thread:

Let me start by saying I just took and passed NCLEXPN, just waiting for my license to come in the mail. I've been working as a medical assistant for 13 years and recently I got a job at a clinic and I really love the work but I'm afraid if I stay there I could lose my license, please let me know what you would do. So first off NO ONE respects HIPPA, the sign in sheet always shows everyones name, charts are turned where anyone can read the name. Second NO one wear's a name tag (which is illegal in my state) Third ALL of the M.A.s call themselves nurses the docs also call them nurses, theres even business cards that say nurse (illegal in my state), Fourth Im not sure about this but all of us draw blood but none of us have a phlebotomy license (not sure if this is legal) Fifth my supervisor is an M.A. her title is "nursing supervisor", is that strange to anyone else? Sixth EVERYONE triages even the front desk girls! Seventh there's no log for the frig temp and no quality control log for the glucometer (illegal) Eighth the MAs interpret TB tests (illegal in my state) I dont know guys, Maybe im just uncomfortable being the only nurse there because if the medical assistants F up its on the docs BUT if I F up its on me. If I got Liability Insurance would that help my situation? Also our office manager, the one thats responsible for the WHOLE clinic (15 docs) is a medical asst. so no one has or understands nursing knowledge. WHAT WOULD YOU DO?

I know ALL about the medical assistant issues and I have know idea why it continues to happen, I actually had more freedom as an MA than I do as a LVN in my state California.

[KayRN910]

Blowingbubbles, I would suggest your gut instinct is right and you should get the heck out of there! Your liscense is to valuable for you to lose because everybody else doesn't care.

Lillymom, THAT sounds more like the right laws. I was reading this thread last night thinking,"there has got to be SOMEWHERE that says MAs can't give IV drugs... it just makes sense!" But, I know every state it different about things, but if that isn't the case in some states, that needs to be fixed, like, yesterday.

[carrie_c]

Blowingbubbles, your situation doesn't surprise me at all. In my state it is the same way. It is very rare to find an RN or even an LPN working in a doctor's office. Most offices only have MA's, and they call them nurses as well. I know one clinic that has an MA as the supervisor and she never went to school for MA, she doesn't even have a certificate. I think I would find somewhere else to work, it's much too risky.

I must add though, I was taught to draw blood and give injections in MA school. I don't see a problem with it as long as someone has gone to school for it and has a certificate for it. But IV meds are a whole different ball game.