MA working beyond scope of practice

kam2011 · May 23, 2011

hi im a l surgical tech and yes ma"s and surg tech can do alot of things under the supervision of a doctor. as long as a doctor or Rn delegated the tasks and oversees it. Although i have said no to alot of things because the dr said or they were trained at thier facility they do it . Doctors are sometimes lazy and cheap and they only want to complete the task and collect the pay. u see this a lot in surgery especially in urban communities. Also what many folks dont know is that surgery runs hospital so surgeons in particular are allowed to get a away with murder. ive seen it 1000 times. sad but true.

Catedi · May 23, 2011

hi im a l surgical tech and yes ma"s and surg tech can do alot of things under the supervision of a doctor. as long as a doctor or Rn delegated the tasks and oversees it.

In Ohio, there is a bit of confusion. There are two MA designations. One, like this person I am reporting about, goes to school for 6 mo. and leaves the technical school with a certificate. The other, goes to College, takes a year of prereqs and enters a two year MA program. They leave school with an Associate's Degree. The confusion is, they have different scopes but nothing like a separate suffix, like RN opposed to LPN, to identify them. I have a family member working in a hospital who has the Associate MA degree, and they can do allot of what an RN can do, like assist with surgeries, dressing changes, post-surgical monitoring, etc. But, they are not allowed to start an IV or give medications through an IV. I am determined to not drop the ball on this. I appreciate the input, and use it as a start.

Thanks.

BabyLady, BSN, RN · May 23, 2011

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.

The person playing Russian Roulette, is not your friend, it is her employers.

She has never claimed to be a nurse nor presenting herself as a nurse, so the BON could not even have her charged with claiming to be a healthcare professional.

Your friend works under the license of the physicians, which means...THEY get sued if she screws up anything...not her.

In the vast majority of states there is NO SUCH THING as a medical assistant license. "Certification" programs are granted by the school and in the world of academia...worthless.

Laws in most states 100% allow this practice and it is legal...however, most physicians are also smart enough to hire RN's because if they are LICENSED, they function under their own license, thus, lowering the physcian's liability for certain tasks.

Most states do not have a license for surgical techs...it is very common for private surgeons to train their own...I went to high school with a friend who started doing this when she was only 16 years old for her father who was a surgeon that did plastic surgery...she is now a Pediatric Surgeon herself.

However please do consider that your friend may be exaggerating her role. I have found this to be very, very common with MA's. She may "think" she is monitoring anesthesia and post-op care, but she may be doing nothing more than documenting vital signs and the physicians may be no more than two steps outside her door.

carrie_c · May 23, 2011

She may not get sued, but she could still be charged and go to jail for negligent homicide if something were to happen. And I agree, she may be exaggerating her role.

Rob72, ASN, RN · May 23, 2011

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.

Most things are knowing how and what to document. Policies (who does triage, who reads TB tests, etc..) must be within the scope of practice of the staff. When they are not, the Medical Director who signed off on the policy is liable as are the managers/supervisors.

Bottom line, if an unlicensed individual is trying to tell you what to do or make a clinical judgement, it is always valid to state that they are not competent to make that decision. DVRs are your friend, especially if your state is a single-party-knowledge state.

Elleveein, LVN · May 23, 2011

@Rob I always document different from the MAs, they ask me why and i tell them "thats the way i was taught" . It's really strange on our system because when anyone gives and injection and you try to document it, you cant type your name, it automatically puts "injection given by RN" theres no RN at my facility. The first time i saw that i almost tossed my cookies and they say "thats just how we do it", I'm like "that looks like im saying im an RN" but again thats the way they do it. I am gonna talk to my boss about changing it, Ive even been asking someone else to do the injections because i cant stand to do them and have to chart it. I have found that its really just ignorance and they honestly dont know, i remember before i went to the VN program i was doing IV's and all kinds of crazy stuff because i just didnt know. I really believe that ALL doctors in every state should have to have at least 1 LVN or RN on staff.

selkie · Jun 1, 2011

Hm... in WA state, the Dept of Health has it clearly spelled out in writing what the scope of practice for an MA is. MA's are not even legally allowed to do phone triage in clinics (though it happens all the time, since doctors are hiring them now instead of LPN's or RN's). They cannot do narcotics counts, they cannot start IV's, they could in theory scrub during surgery IF they did online cert test and were trained, and.. omg NO they could absolutely NOT do anesthesia. Nor could they recover a patient. This should be reported to the State Nursing Board, to the Scope of Practice Advisor- that would be a good place to start. I do not think in any state that an MA is protected only because there's no 'defined scope.'... makes no sense at all. This makes my blood run cold- the woman sounds dangerous.

akulahawkRN, ADN, RN, EMT-P · Jun 3, 2011

That sounds very much like an undefined scope of practice. Most "medical" people have a defined scope. The Medical Assistant's scope can vary from pretty much whatever the Physician approves of, to only certain tasks that may be delegated. Does anyone have a problem with Navy Corpsmen doing their jobs? They're not PA or RN or LVN/LPN licensed or certified... yet they can have an incredibly wide scope...

Also, just remember that just because an RN has it in their scope of practice does not automatically mean that RN's "own" that task or procedure. Remember that just because an RN can't delegate that task to an "unlicensed" person that a Physician isn't authorized to delegate that task out...

It's a good idea to know what YOUR scope of practice is and what's allowable for other personnel in your work environment. Once you know that, you'll be able to spot violations and be able to report them to the appropriate authority.

Being that MA's work under the direct supervision of a Physician, I would expect that the same licensing body for Physicians and Surgeons in each state is where you'd report problems with a MA...

And I just gotta say it again: EACH STATE IS DIFFERENT!!!!

amybeets05 · Jun 5, 2011

(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.

This is from the Ohio State Medical Board website. It is located under the heading of "Delegation by a Physician".