New LPN in ambulatory care, I'm doing the same job as the MA's.

[Rivalicious]

I'm a LPN in a large dermatology clinic. Just started a few weeks ago. The doctor I work for has me, and 3 MA's. The MA's have been there for quite a while and are very good at what they do, and actually trained me. I thought that once I was up and running, I would be taking over more of the clinical aspects and tasks that require a higher level of critical thinking-Patient teaching, assessments, wound care, etc. But in reality, I'm pretty much doing the exact same thing as the MA's. We basically take turns rooming patients, helping with biopsies, doing assessments (!), returning phone calls, removing sutures, and anything else that comes up during the day. The MA's even call themselves nurses when they talk to patients, which makes me really uncomfortable and more than a little resentful. But being so new to the position, I don't know how to bring this up or if it's even worth it to do so-it seems like this is just how things have always been done in this particular practice.

I'm just wondering if this is how it is for other nurses in the ambulatory care setting, and what if anything I should do about it?

[jaratarRN]

I was in a similar situation, but on the other end, as a MA in a busy surgical practice. Myself and the other MA trained the RN, and resentments built up over the years. Being that we were there for a longer time and went above and beyond, the docs often came to us first, which worsened the situation. I was also in nursing school at the time, so that too blurred the line. It was difficult for our RN, but she wasn't the best communicator and on the downside of her career. My advice to you would to be constantly communicating with your manager and the docs, and looking for opportunities. As the newer person, you may have a fresh set of eyes and be able to critically think about how to approach aspects of patient care and policies better. In a clinic, there aren't as many oversights and regulations, and perhaps you can help create some to promote safety and improve patient care. Identifying needs and then acting on them will help set you apart. Educating and helping your MAs will help them to see you as a valuable resource, and not an overpaid MA. Anything you can do to be proactive will help, just be careful to not make the MAs feel like you think you are superior to them. (Not that I think you would do that; I'm sure you are a fabulous person! I just know from experience that it can be a sticky situation!). Good luck!

[joyfullpn]

Unfortunately at my new job I feel the same way!

[Asystole RN]

The MAs are doing to same job as you, not the other way around.

[Rivalicious]

Sorry for the late response, I couldn't find this thread for some odd reason.

"I was in a similar situation, but on the other end, as a MA in a busy surgical practice. Myself and the other MA trained the RN, and resentments built up over the years. Being that we were there for a longer time and went above and beyond, the docs often came to us first, which worsened the situation. I was also in nursing school at the time, so that too blurred the line. It was difficult for our RN, but she wasn't the best communicator and on the downside of her career. My advice to you would to be constantly communicating with your manager and the docs, and looking for opportunities. As the newer person, you may have a fresh set of eyes and be able to critically think about how to approach aspects of patient care and policies better. In a clinic, there aren't as many oversights and regulations, and perhaps you can help create some to promote safety and improve patient care. Identifying needs and then acting on them will help set you apart. Educating and helping your MAs will help them to see you as a valuable resource, and not an overpaid MA. Anything you can do to be proactive will help, just be careful to not make the MAs feel like you think you are superior to them. (Not that I think you would do that; I'm sure you are a fabulous person! I just know from experience that it can be a sticky situation!). Good luck!"

Thank you so much for you reply! This is great advice, and very valuable to hear from the "other side". I have been trying to get more proactive about taking on as much responsibility as I can, and it's gotten better in some areas but worse in others. This week has been especially frustrating, so be warned, I am about to vent!

So in order to clear up some of my confusion over my role at the clinic vs. theirs, I read up on my facilities job descriptions (which are very detailed, almost like a mini scope of practice) to better understand the differences between what a MA and LPN are supposed to do. In a nutshell, the MA's are supposed to be responsible for doing minor patient procedures (injections, vitals, suture removal etc.) as ordered by the MD, but the majority of their job description is clerical-doing pre-authorizations, transcribing orders, calling in prescriptions, that sort of thing. The LPN's job description includes more advanced office procedures, including assisting in surgeries (we perform excisions in our office) and sterile dressing changes, as well as doing patient assessment, phone triage, and answering patients questions/giving medical advice either directly or after consulting with the physician. It of course also says that we may do the "office" work as well, but there is much less of an emphasis on it.

However, what is on paper isn't what it is in reality. Not even close. Like I said, our MA's do everything that is included in my job description, including things that are excluded in their own. Including things that would seem to be outside their scope of practice and beyond what they are trained or qualified to do. For example-taking patients questions and dispensing medical advice, directly, without consulting with the physician. Often while presenting themselves as nurses-or at the very least not correcting the patient when they are called one. And while it's usually accurate information, sometimes it isn't, and there have been a couple cases where I've overheard one MA in particular telling patients things that are downright dangerous. For example, she recently told a patient to d/c an antibiotic before therapy was complete because of a yeast infection, without even consulting the doctor. Tried to explain that yeast infections can be treated, drug resistant infections not so much, and that in any case it was the MD's call-and she just rolled her eyes and said "oh well, I'm sure she will live"

I want to get along with my co-workers and have a respectful professional relationship with them, but it's obvious they have very little respect for me, or nursing as a profession. And it sucks because we are all on the same team, and should have the same goals- to give our patients the best care possible. I'm certainly not above doing any of the "dirty work" of a MA, or a CNA-Heck when I worked in a SNF I was everyone's favorite nurse because I would always help the CNA's with their assignments once I was done with my own work. And I don't have a problem with "sharing" the clinical duties either, especially if it helps us get our work done on time. But when we take the office tasks and divide them up equally like this, it means that MA's are taking on nursing responsibilities while I'm being taken away from them because I'm doing work that they are not only capable of doing, but have the specialized training and knowledge perform. I know I can't delegate to them, nor do I want to, but I would like a division of labor based on what our roles are supposed to be and what is in the best interests of our patients. Unfortunately it seems like they are not open to the idea of changing anything because "that's just the way we have always done it". And much like your experience, I'm up against a brick wall when it comes to the doctor because she has been working with her MA's for so long and she has built up a relationship with them, while she is still getting to know me.

Anyways, I am sorry for rambling-it's been a rough week! I will definitely take your advice to heart. I have a meeting with my supervisor next week and I will talk to her about this, so hopefully she can help me address this with them and come up with a solution. I just hope it doesn't come with too much drama

[MoshRN]

Yep, the MA's do not know what they do not know. They may excel at their jobs, but they are not nurses. Do your job the best you can and teach them things along the way. Sadly, we are not going to change the system. Those of us who try, usually lose our jobs. So, if you are happy there, go with the flow.

[BuckyBadgerRN, ASN, RN]

Make sure YOUR job description is accurate as well. In many states ONLY an RN can do phone triage. I'd hate for your office to expect you to do something that is outside your scope of practice. Yes, they are clearly expecting MA's to do such a thing, but you have a license to protect, they do not.

[Code Red]

Sorry for the late response, I couldn't find this thread for some odd reason.

"I was in a similar situation, but on the other end, as a MA in a busy surgical practice. Myself and the other MA trained the RN, and resentments built up over the years. Being that we were there for a longer time and went above and beyond, the docs often came to us first, which worsened the situation. I was also in nursing school at the time, so that too blurred the line. It was difficult for our RN, but she wasn't the best communicator and on the downside of her career. My advice to you would to be constantly communicating with your manager and the docs, and looking for opportunities. As the newer person, you may have a fresh set of eyes and be able to critically think about how to approach aspects of patient care and policies better. In a clinic, there aren't as many oversights and regulations, and perhaps you can help create some to promote safety and improve patient care. Identifying needs and then acting on them will help set you apart. Educating and helping your MAs will help them to see you as a valuable resource, and not an overpaid MA. Anything you can do to be proactive will help, just be careful to not make the MAs feel like you think you are superior to them. (Not that I think you would do that; I'm sure you are a fabulous person! I just know from experience that it can be a sticky situation!). Good luck!"

Thank you so much for you reply! This is great advice, and very valuable to hear from the "other side". I have been trying to get more proactive about taking on as much responsibility as I can, and it's gotten better in some areas but worse in others. This week has been especially frustrating, so be warned, I am about to vent!

So in order to clear up some of my confusion over my role at the clinic vs. theirs, I read up on my facilities job descriptions (which are very detailed, almost like a mini scope of practice) to better understand the differences between what a MA and LPN are supposed to do. In a nutshell, the MA's are supposed to be responsible for doing minor patient procedures (injections, vitals, suture removal etc.) as ordered by the MD, but the majority of their job description is clerical-doing pre-authorizations, transcribing orders, calling in prescriptions, that sort of thing. The LPN's job description includes more advanced office procedures, including assisting in surgeries (we perform excisions in our office) and sterile dressing changes, as well as doing patient assessment, phone triage, and answering patients questions/giving medical advice either directly or after consulting with the physician. It of course also says that we may do the "office" work as well, but there is much less of an emphasis on it.

However, what is on paper isn't what it is in reality. Not even close. Like I said, our MA's do everything that is included in my job description, including things that are excluded in their own. Including things that would seem to be outside their scope of practice and beyond what they are trained or qualified to do. For example-taking patients questions and dispensing medical advice, directly, without consulting with the physician. Often while presenting themselves as nurses-or at the very least not correcting the patient when they are called one. And while it's usually accurate information, sometimes it isn't, and there have been a couple cases where I've overheard one MA in particular telling patients things that are downright dangerous. For example, she recently told a patient to d/c an antibiotic before therapy was complete because of a yeast infection, without even consulting the doctor. Tried to explain that yeast infections can be treated, drug resistant infections not so much, and that in any case it was the MD's call-and she just rolled her eyes and said "oh well, I'm sure she will live"

I want to get along with my co-workers and have a respectful professional relationship with them, but it's obvious they have very little respect for me, or nursing as a profession. And it sucks because we are all on the same team, and should have the same goals- to give our patients the best care possible. I'm certainly not above doing any of the "dirty work" of a MA, or a CNA-Heck when I worked in a SNF I was everyone's favorite nurse because I would always help the CNA's with their assignments once I was done with my own work. And I don't have a problem with "sharing" the clinical duties either, especially if it helps us get our work done on time. But when we take the office tasks and divide them up equally like this, it means that MA's are taking on nursing responsibilities while I'm being taken away from them because I'm doing work that they are not only capable of doing, but have the specialized training and knowledge perform. I know I can't delegate to them, nor do I want to, but I would like a division of labor based on what our roles are supposed to be and what is in the best interests of our patients. Unfortunately it seems like they are not open to the idea of changing anything because "that's just the way we have always done it". And much like your experience, I'm up against a brick wall when it comes to the doctor because she has been working with her MA's for so long and she has built up a relationship with them, while she is still getting to know me.

Anyways, I am sorry for rambling-it's been a rough week! I will definitely take your advice to heart. I have a meeting with my supervisor next week and I will talk to her about this, so hopefully she can help me address this with them and come up with a solution. I just hope it doesn't come with too much drama

I don't see what the big deal is. I was trained as a MA in a 12 month program in Michigan and I find that my LPN school now has is almost not quite but pretty close the same training I got as a MA years ago. Idk who told you that MA's jobs consist mainly of administrative duties because in school we learned way more back office (clinical) experience then that of administrative. Having a MA in a office is like having a nurse with adminstrative skills and not having to pay them as nearly as much money as a LPN I Know several MAs who seem to be brighter as far as skills than most RN'S I suggest you stop crying and work as a team there are other things you can do to make yourself stand out besides crying over titles and trust me you won't win this one doctors rarely like to give up their MAs that they have worked with because they are way to impatient to retrain people.. and they like people that have been with them and know how they do things. So I suggest you just do your job and work together. Crying over titles is so childish!

[BuckyBadgerRN, ASN, RN]

Oh boy. "having an MA in the office is like having a nurse with administrative skills." An MA is nowhere NEAR a nurse. It's not about crying over titles. Not even close...

I don't see what the big deal is. I was trained as a MA in a 12 month program in Michigan and I find that my LPN school now has is almost not quite but pretty close the same training I got as a MA years ago. Idk who told you that MA's jobs consist mainly of administrative duties because in school we learned way more back office (clinical) experience then that of administrative. Having a MA in a office is like having a nurse with adminstrative skills and not having to pay them as nearly as much money as a LPN I Know several MAs who seem to be brighter as far as skills than most RN'S I suggest you stop crying and work as a team there are other things you can do to make yourself stand out besides crying over titles and trust me you won't win this one doctors rarely like to give up their MAs that they have worked with because they are way to impatient to retrain people.. and they like people that have been with them and know how they do things. So I suggest you just do your job and work together. Crying over titles is so childish!

[pfchang]

This is a childish response. Lpns have passed a licensing exam and have a significantly greater amount of education. "An MA is a nurse w admin skills?" Please. MAs are trained to do tasks. There is a huge difference.

If you want others to read your post, you may want to add some punctuation. I struggled through your run-on sentences.

[smartnurse1982]

several MAs who seem to be brighter as far as skills than most RN'S

I do not even know how to respond.

Nursing is way more than skills btw.

[sallyrnrrt, ADN, RN]

for the most part thus is true also at my clinic