Nurse Impersonators

[NancyRN]

Am I the only one who resents the "nurse impersonators" who abound in the health care field?

Everyone who works at a doctor's office or in a hospital wears scrubs and seems to pass themselves off as a nurse. Of course, the hospital doesn't mind. Visitors and patients don't realize how few nurses are actually on the unit if the unit clerks, nursing assistants, housekeepers, and technicians are all wearing scrubs.

It seems harmless enough, this generic flowered jacketed scrub outfit, until you think of the harm it does to nurses' reputation as a whole. I just wonder what people think when they see two or three "nurses" ambling around the hallways or sitting at the nurses station while their family member waits for pain medication!

I have to think the doctor's offices are the worst. The doctors will actually refer to the medical assistant as "the nurse". I wonder if a doctor would appreciate an employee passing himself off as a doctor?

Last month I was in a doctor's waiting room with my son when a man came in holding his hand wrapped in a towel. He announced that he'd cut his hand and needed to see the doctor ( ok- dont ask me why he didn't go to the ER!) . The "nurse" told him to have a seat. The waiting room was crowded and it was obvious he was in for a very long wait. I saw the towel becoming saturated, and I couldn't help going over to him and telling him to hold his hand above heart level, apply pressure, try some deep breathing, etc. I told the "nurse" to let him go in and be seen, but she said, "He has to wait his turn, it wouldnt be fair to the patients who had appointments."

Driving home, my son asked, "Why didn't that nurse help that man?" I told him, "Because she's not a nurse!" But I wonder how many people in that waiting room went home with the story of the nurse who wouldnt help a bleeding man.

I know nurses don't want to go back to the days of wearing caps (even though I love my cap), but shouldn't we be more concerned about people in scrubs making us look bad? Shouldn't a nurse on duty be as easily recognizable as an EMT, a Firefighters, or a Police Officer?

[thisnurse]

no you get over it.

im not saying my job is better than your job or that i work harder than you...your job is DIFFERENT than mine.

the way you talk you have a much broader scope of practice. you do assessments, you give meds, you do treatments, triage, and you whip out the insurance forms too. do you write scripts as well?

[NRSKarenRN, BSN, RN]

The term medical assistant is exactly that---" to assist a medical professional", mostly physicians. This position was created by physicans and administrators as it's focus is heavily on working in an office/clinic environment especially the need for business office skills e.g. billing operations the 99% of LPN's/RN"S have NO idea about unless they work in a smaller physicians office and are given training.

Nurses have a different focus of care: assisting and treating patients clients through nursing interactions. What we do and how we perform our care especially using independent judgement is the essence of our profession. We are NOT downing any of the ancillary personal that assist patients. WHAT WE ARE STEEMED about is the increasing perception by administrators and physicians that ANYONE can be trained to perfrorm "nursing tasks", do not have to complete a nursing education program yet can be considered to be "nurses"-----this is being done to SAVE A BUCK.

Due to all the insurance regulation's/HMO'S paperwork etc a clinical person was needed to handle all the paperwork in an office environment. RN + LPN have no experience with this---that meant training someone to do this. Nurses felt increasing pressure/demands to be "paper pushers" in offices taking time away form assisting/teaching patients---their salary too high to performing this task so the medical assistant was created ---INSTEAD of having TWO people to perform this work in an office.

Soon nurses frustrated trying to perform TWO JOBS with their license on the line left or their positions were cut when the docs saw that they could hire someone cheaper...in these days of 5 or 10 min office visit what time is left for patient teaching anyway so a nurse really isn't needed. That is what has happened over the past 10-15 years - the creation of the Medical Assistant. Yet the public is perceiving MA's, receptionists, nursing assistants , anoyone in a doctors office or clinic to be nurses---cause that's all they had in their offices up to 10-15 years ago. When patient's receive an expected response/ medical adivce from these individuals, they think they are getting advise from a "NURSE" and if the response is NOT what they expected blame it on "THE NURSE" in the office. THAT is what has us upset.

Yet the RN's are the ones responsible for implimenting and directng ALL care clients receive AND resposible for ancillary staff assisting a patient, even loosing OUR license over improper care given by ancillary staff yet we have MINIMAL input into what these persons are permitted to perform or what their training is like especially in a hospital/SNF/clinic/doctor's office environment.

Nursing is not just:

A. passing pills

B. wiping backsides

C. performing wound care

D. telephone triage

E. intructing clients

Nursing IS:

A. administering the right medication, in the right dose, at the right time to the right patient AND understaning the side effects and drug interations that may occur and assessing the patient during our encounter and through out a shift for side effects, understanding how that med interacts with the other meds patient is taking or affect on the body as the client has a other disease processes that the medication might interfere with, teaching WHILE discussing with PT/CG the medication use/side effects.

Especially in doctors office/homecare: evaluating patients compliance with the medication--did they ever get RX filled?, is some one able to pick-up from pharmacy as rare delivering pharmacy these days (norm prior to 15 years ago), is prescribed drug on insurance companies formulary or can they afford to pay for medication AND what can the nurse do to assist client to obtain needed med, or assist the doctor/NP in decision to change/forgo medication.

B. Performing or assisting in personal care while maintaing that persons dignity, teaching persons how to again perform care after serious illness/injury or making arrangements for therapists; assess for skin changes due to medications clients are on; evaluating skin integrity and the potential for skin breakdown, and evalutaing need for incontince training, product selection (need for RX for chux, incontinent supplies/ diapers including appropriate size for some states MA patients); teaching the patient/care giver about skin care issues or desiging a care plan to address these issues-----all within the 5 to 10 minutes it might take to assist a patient on and off a bedpan or change a diaper.

C. Performing wound care involves infection control issues: hand washing before and after care, maintaining clean or sterile work space, gathering and evaluating supply needs, assessing wound for signs and syptoms of wound infecion, surounding skin breakdown, evaluating effectivess of care--is a different product needed due to wound healing or failure to improve and teaching the patinet how to perform care or identifying caaregiver to do the care if client unable and properly disposal of contaminated supplies.

In home care: who is to be taught this care; can an agency take on responsibilty for a client living alone who needs 2x or 3x a day wound care ( adequate staff, if unable to get paid, can agency absorb cost); who will pay for wound care supplies AND does the DME company assigned by insurance carrier even stock the supplies needed?

D + E. Telephone triage: Which one of the callers IS the sickest patient that needs to be seen NOW, which ones can be defered till later in day or tomorrow, later in week...the chronic caller--what is different in tone of voice or subtle way the client is breathing, way they are speaking that makes you want to have them seen as soon as possible? Taking down complete messages and asking the appropriate quesions so it doesn't take 3 or 4 phone calls to accoplish what one call would have done. Instructing: Understanding how clients culture or social situation will intact on advice given...does patient have cognitive ability to understand instructions or does interactions need to be interpretur/written material in clients own languageaddressed to caregiver OR is it even legal to do so?? Need to rephrase/ restate the meesage so persons are HEARING what you are saying....are they accepting the meassage/instruction or will followup be needed, emotional support over life altering medical news etc.

Using our personal self to help someone learn to life with a changed life/body.

This is nursing.

[pandora]

Jessy, it's a pity you felt that you had to bow out of this thread, but, as you can see from the number of postings and the things nurses have to say - it's a very emotive issue for us. We work very hard too, and it's hardly surprising that we get so peed off and defensive, is it? Nobody ever worries about being politically correct when discussing what nurses do, but we have to be careful all the time not to tread on other people's toes and be seen to devalue their skills. It does concern me that you refer to your work as an "industry". Caring for patients is just that; a 'caring' job. Good luck with your studies.

[mattsmom81]

Originally posted by Susy K

I agree. In MY clinic and in MY area, the LPNs make $11.00/hour and the RNs make $16.00/hour.

Why is an MA being paid more? That goes against logic.

I think the reason the MA is CA is making 19/hr is due to cost of living issues. She did say the office nurse was making 27/hr if I recall. Everything in California, I've heard, is higher in cost and price. Florida and Texas have a much lower cost of living than Cal and our wages reflect that (unfortunately LOL) I can only make 27/hr as a prn nurse here--never as full time base wage here in Texas. But then, my modest 100,000 home in Texas would cost three times that much in Ca! Probably 2 bucks/gal gas, much higher utilities, blah blah. You get my drift. MA's here in Texas make approx. an LVN wage, some docs pay even better for a sharp one.

I guess RN's have priced themselves out of most office jobs (some specialists still want RN's) Most GP's don't want to pay an RN wage and will advertise for LVN's and/or MA's. Of course, I don't want to work for 11/hr so I'll stay in the hospital!LOL!

I think Docs do pay their MA's well and that is good--they are "jills of all trades" in the office environment and that is valuable to Docs. They give injections, immunizations, draw blood, file insurance---A LITTLE of everything in the office setting. And that's fine. I draw the line when they want to be called NURSES. Sounds like almost all agree there.

Mattsmom81

[Q.]

Yes I noticed that too. California has a higher cost of living and I forgot to include that in my interpretation.

I am still confused why this thread got out of hand and why Jessy thought to respond to a discussion entitled "Nurse Impersonators." While I value everyone's opinion, I wonder what drew her to the discussion in the first place. Clearly nurse impersonation is a Nurse's issue and should be able to discussed by nurses without walking on eggshells.

I will reiterate to any nursing assistant or any medical assistant: this discussion is NOT about you. This discussion pertains to you ONLY if you impersonate a licensed nurse - not in your duties, but in identifying yourself or purposely misleading someone into believing that you hold a license to practice nursing in any state.

Again - this is a nursing issue. Not a Medical Assistant issue, not a Nursing assistant issue- a Nursing issue.

Please, I beg you....allow us to discuss this independent of you. You constantly asking us to defend ourselves against you is only hindering our discussion of an important issue for us.

Thank you.

[mattsmom81]

Hi Susy K--enjoy this thread and your posts,

I 'lurk' on the AOL nurses boards frequently and the MA's bust in there too and spew their venom at nurses. (???)They claim to NOT WANT to be called nurses, but I think they 'doth protest too much'. One could ask why they are in a nurse's forum at all, but I suspect we already know the answer to that one too....

Bottom line in this thread to all MA's, PCA's and CNA's: If ya want to be a nurse, then go to school and train to be one. Don't impersonate us!!

Mattsmom81

"Take your life in your own hands and a terrible thing happens: no one else to blame" ----Erica Jong

[Peeps Mcarthur]

Jessi,

102 credits in a year?

Sounds kind of like the one year program I went through. I got 62 credits in a year to fulfill requirements for an Occupational Associates in Respiratory Therapy. You would be as surprised and dismayed as I was if you took some prerequisite courses for LPN,RN,BSN programs.

The Anatomy I took in the one year school was comparable to identifying the parts of a stick man:rolleyes: Yet when I was on the hospital units I auscultated without knowing the lobes of the lungs, so how could I have given report or known the proper position for percussion? I even intubated pt's ( I was ACLS certified where they assumed I had A&PI,APII)

A&P

Pharmacology

Microbiology

Algebra

Chemistry

English composition

Lifespan

Pathology

6 months of clinicals during the second half concurrent with classes.

Even though the courses were packed with information(7 days a week study) it was not humanly possible to do any of the courses the way they were supposed to be. None of the classes were transferable to nursing. Once I took my first college level course I knew why and was thankful for it.

You sound alot like I did. You study and get great grades and are surronded by less motivated students that you think give MA's a bad name. You think you're covering required courses so why should you have concern about your skill level? What you don't learn there you can always learn later right? You work hard you study outside of the curriculum to broaden your knowledge and yet with those professions you think you're on an equal footing with your not.

You may discover "holes" in your knowledge base you never knew existed from time to time. You might find yourself stuggling in a conversation suddenly with a doc or an RN or even a pt, and not know why. If your trained and hold the proper certificate then why these "holes"?

I quit Respiratory Therapy because I was not what I thought I was when I started. I realized that what training I had didn't compare to the kind of healthcare provider I wanted to be. The professionals I wanted to be compared to were so much more qualified than I, that it was shameful:imbar

A five year absence from healthcare and one full year of prerequisites later I'm ready to enter LPN school this next fall. I have a 4.0 GPA though 16 credits and I'm taking 10 this semester with an Honors section in A&PII. My goal is to be a Nurse Practitioner.

I've learned more about science in this past year then I ever learned before. I learned alot about myself too.

It takes a truly wise person to have an understanding that they don't know everything.

Brad

[Q.]

Originally posted by Peeps Mcarthur

It takes a truly wise person to have an understanding that they don't know everything.

Brad

Excellently put.

Know what you DON'T know.

Mattsmom81 - thanks for enjoying my posts. :)

[RNPD]

I hope no nurses or MAs are dispensing meds. You could go to jail for that unless you are also a licensed pharmacist! We administer meds, and apparently so do some MAs.

As far as this discussion, no one said anyone is better than anyone else. The title "nurse" is a legally protected one and only can be used by an individual who is a licensed nurse. CNAs & MAs may think they know and do everything that a nurse does, but until they have completed an approved course of study and taken an NCLEX-RN or -LPN/LVN) they are NOT nurses and can not legally call themselves such.

As far as MAs go, it is a similar situation as with PAs. When nurses became NPs the MDs had a fit and didn't want to give up their control. So since they can not "control" an NP's practice, they came up with PAs to retain control. When they didn't want to pay an RN's salary, but wanted a person to do an RN's work, they came up with MAs. It's all about money & control-the 2 main concerns of the AMA & AHA.

[Q.]

Originally posted by RNPD

I hope no nurses or MAs are dispensing meds. You could go to jail for that unless you are also a licensed pharmacist! We administer meds, and apparently so do some MAs.

I think they mean administering meds, P. I don't know of any nurse or MA who actually dispenses them in the truest sense of the word. The dispensing actually comes from a pharmacist, or a AccuDose, I guess.

[P_RN, ADN, RN]

i contacted the california board of nursing. this is the reply i received today:

the law requires 51 months of bedside nursing experience on a general hospital ward. typically medical assistants do not perform hospital bedside nursing functions. (i.e., bathing, bedmaking, position & transfer,etc.).

experience as a medical assistant in an outpatient clinic, or doctor's office is limited to a maximum of 8 months credit toward the 51 month requirement. the remaining experience must be in a general hospital setting.

from reading this e-mail i believe that the california bon has a good understanding of what is happening with the ma --> nurse issue.

p

[MickeymomRN]

I understand the fascination with being a nurse and wanting to look like one. But I agree, it's very frustrating that we worked very hard to achieve our title only to be lumped together with those who aren't even qualified to be called a nurse. I still see nurses wear their whites and their caps. It's neat. But I think that wearing name tags and pins will be our only resort to distinguish ourselves from the fake ones.

Just a need to vent, I don't like MAs too well. Why do they think that they can fake taking vitals? Pulse and resps are easy. But I love how they make up my b/p. I have a low one usually 80/60. They don't even get that low to listen. And they don't even recheck it when I tell them that what they reported is much higher than my norm. They're dangerous. Not only to the pts but to the MDs and RNs who rely on their findings and place their license on the line.