Nurses cannot take orders from MA's, what is your protocol?

mattsmom81 · Feb 20, 2005

I think we'll be seeing more and more of this happening with docs having MA's in the office. used to be I WOULD take an order this way, because I knew the office nurse WAS a nurse, and I believed her when she said 'I asked him and he said to-----". We were covered taking a 3rd person order IF we were all licensed.

I like the way you handled it too, and I agree risk management at the hospital needs in on this. The docs who let their MA's handle hospital phone calls are dufuses for not knowing what their office staff is up to IMO and need to be reprimanded. Are they really so stupid they don't know what MA's can and cannot do or are they hoping nobody cares and just 'goes along'? Scary thought eh? :stone

adidas99 · Feb 21, 2005

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allnurses Guide · Feb 21, 2005

So basically an MA in a doctor's office is pretty much equal to a nurse's aide in the hospital then. I have worked with aides at my hospital who have gone on to work in doctor's offices.

I guess I'm lucky that I don't have to deal with snarky office personnel, since I work nights! I'm pretty well guaranteed that when I have to call someone, the person on the other end of the line is someone who is perfectly qualified to give me an order! Granted, they may be a tad UPSET about being woke up at 2am, but... whatreyagonnado? :coollook:

mwbeah · Feb 21, 2005

First thing i ask is for the last name (and first) and the job title of the "nurse" i'm speaking to, to make sure the person i'm talking to is an LPN or an RN.
(We have a policy against taking VOs through and MA.)

Always know who your talking to, it only takes a second to get someone's name and will save you much headache later.

Mike

nursenatalie, ADN, RN · Mar 8, 2005

Since I work 7p-7a I dont have to deal with MA's but I dont personally take an order from a nurse for a doctor either. We have a surgeon who has his nurse first assist and she is an RN the same as I am so if she answers his pager I ask to speak to him. If the doc is in surgery then our OR's have speaker phone and I ask them to put me on speaker phone. I do not take an order from a nurse and especially not a MA! If I took an order from either of these people then I might as well look at my co-workers and ask them for an order. In a court even if an RN is a middle-man in the ordering process the nurse who obtained and carried out the order is the one with their hiney in a sling.

mattsmom81 · Mar 9, 2005

Nursenatalie, in a perfect world we would not have to take third person orders, but I disagree with your analogy 'you might just as well take an order from a coworker'. That simply doesn't apply to all situations.

This may be the way its looked at in YOUR facility but in MINE it is expected we will allow 'special' doc's nurses to give/write orders and not 'demand to speak to the doc'.

They have privileges from administration to do so.

Yes its always our prerogative to insist on speaking with the doc, but if policy allows for their special nurses to act as go-betweens and we refuse, there's a risk there too isn't there.

Our cardiologists (and some surgeons) have 'special' RN's who round for them, write orders and give orders, and have permission from administration to do so, as well as write certain orders for their docs, order certain tests, etc. The docs know they must cosign within 24 hrs.

So...different hospitals handle this situation differently.

nursenatalie, ADN, RN · Mar 10, 2005

I am not sure where there may be a risk in refusing to take an order from a nurse because of policy? The administration in my hospital doesnt have beans to do with my license! I prefer to comply with the board of nursing. If I have a patient doing poorly then I want orders from their surgeon. We have standing orders and protocol to follow for the simple stuff but if I call the surgeon it is a situation that needs a doctors attention. I value my license too much to risk it for something administration says is okay. Oh, and my analogy is a little off but I doubt that it is legally any different, because that doctor deems that nurse to be his "special" nurse doesnt mean that she has the credentials to prescribe.

queen mother · Mar 10, 2005

I am not sure where there may be a risk in refusing to take an order from a nurse because of policy? The administration in my hospital doesnt have beans to do with my license! I prefer to comply with the board of nursing. If I have a patient doing poorly then I want orders from their surgeon. We have standing orders and protocol to follow for the simple stuff but if I call the surgeon it is a situation that needs a doctors attention. I value my license too much to risk it for something administration says is okay. Oh, and my analogy is a little off but I doubt that it is legally any different, because that doctor deems that nurse to be his "special" nurse doesnt mean that she has the credentials to prescribe.

Nursenatalie, there is nothing wrong with your anaology. When in front of the judge and jury it will be your (our) license on the line. Love your response

Queen Mother

barefootlady, ADN, RN · Mar 11, 2005

We usually have no problems getting to talk to our doctors, if I get an order from the office nurse it is usually because the doctor is doing a procedure in the office and I can hear him in the background telling her what he wants. Sounds nuts to some, but remember it is a little less formal here. The one time I have had a problem recently was with a doctor, a well liked physician and a good doctor, who was really overworked and overwhelmed the day I needed him for a patient problem. I kept calling, getting the assistant, not even the nurse, no answers to my questions, and she sort of implied the same thing you stated this MA said. Well, my fuse was short too, so I picked up the phone and called his wife, we had worked together for years, she listened while I explained the situation, she just told me to hold on and I would hear from someone shortly. Well, within 20 minutes the doctor was on the phone, asked for me personally, gave me the orders I needed, aploigized for my trouble with his assistant. Later in the week, we were finishing with a bedside I & D and sterile dressing, he looked at me and laughed. He told me his wife gave him a good "talking to" and told him NEVER to do that to me or other nurses again. He said his wife really told him about some of the things I have done to help her in the years we worked together, and that if I called, it was something that needed looked at seriously. I thanked him for the vote of confidence, laughed and told him I could handle his assistant, later I sent a little cup of flowers with a thank you balloon to his wife. Sometimes we have to use the back door but whatever it takes to get the patient taken care of works for me.

Dutchgirl, you did a good job handling the problem. More importantly, you educated the physician on what was facility policy. You deserve a pat on the back and a balloon too. :balloons:

Marie_LPN, RN, LPN, RN · Mar 11, 2005

I am not sure where there may be a risk in refusing to take an order from a nurse because of policy? The administration in my hospital doesnt have beans to do with my license! I prefer to comply with the board of nursing. If I have a patient doing poorly then I want orders from their surgeon. We have standing orders and protocol to follow for the simple stuff but if I call the surgeon it is a situation that needs a doctors attention. I value my license too much to risk it for something administration says is okay. Oh, and my analogy is a little off but I doubt that it is legally any different, because that doctor deems that nurse to be his "special" nurse doesnt mean that she has the credentials to prescribe.

That's why our surgeons don't give any beef to any nurse who pages him and wants to talk directly to HIM (or her). We can hold the phone up to their ear.

Sierralee · Mar 11, 2005

I called a doctor today about his patient (labs) just to let him know a panic level. I was told by his "nurse" that she would let him know. I called back later because the IV came out and the patient said she was going home and wanted the IV to stay out. I called again. The "nurse" asked him, came back to the phone and said you can leave it out. I called later in the day to let him know that the lab value had gone up even further and did he want to cancel the discharge? The "nurse" came back to the phone and said cancel the discharge. Then she say's I'm tired of you calling. Were trying to see patients here and you're bothering the doctor. I am his nurse and the next time you call I'll decide if the question warrants asking. I wish you would quit calling. I said I'll call when I think it's necessary and I said you are not his "nurse" are you? She said yes I am. I said RN or LPN? It got quiet. I said you're an MA right? Yes she said. I said don't tell me that you'll make that decision. I am the nurse and you will ask the doctor what I tell you to or put him on the phone if I need to talk to him. She was really rude. Later the doctor called himself and I happened to answer the phone. We talked about the patient and then I told him about what happened with his "nurse". I told him. "You know Dr. Lee we as nurses here at the hospital cannot take verbal orders from medical assistants" and I would appreciate your MA telling me not to call and that she will make the decision as to what is or isn't important. He said "I'm so sorry, I promise I will talk to her about that and no I didn't know you couldn't take orders from a medical assistant". I talked to risk management then and they said I could take down her name and title and write the order then write the doctors name behind that but that we should be asking the doctors if they would be willing to sign orders behind the MA's. Do any of you have a protocol or a yes we can take their order or no we can't. I had never thought about it before. I did ask several doctors about it today and they said if I say something to the MA and she tells you what I said yes I would be willing to sign behind that order. Then how do you know the order has been conveyed word for word and nothing important missed in the translation? He said that I don't know. I am going to take this up with the CNO on Monday. Let me know how you handle this so maybe I can get some good ideas before Monday. Thanks!

I was a MA for 8years in Family Practice and that MA was out of line and very unprofessional. I have worked with alot of LPN when I was an MA and I found they treated me as their equal and were always willing to help with information that wasn't familar to me and I have received many of compliments from them on what I did know and my professional manner, in fact many people did think I was a LPN when I wasn't and I always made sure they new that I was an MA. I would have handled that situation the same way.

R2MD · Apr 13, 2005

Well, no, actually, they don't. And, in fact, early on, many PA programs offered, at most, a bachelor's degree. The PA program associated with Stanford actually runs through a community college, so guess what? Associate Degrees for them! Over the years, more and more PA programs have gone to (appropriately, I think) offering master's degrees. Like master's in nursing (MSN), the pa masters have their own set of initials, it is not considered to be a Master of Arts or Masters of Science degree.
NurseFirst

A Maters degree in nursing (MSN) is not equal to M.S. or M.A. as a PA. Those with an MSN are not automatically nurse practitioners. There are many different specialties and subcategories with MSN.....can be nurse practitioner, CRNA, businesss/administration, clinical nurse specialist etc. etc. I am trying to say that all Masters degrees are not created equal. Also please check your facts regarding the physician assistant profession. I think that you will find that only a very small percentage hold a degree less than a Bachelors. The majority of PAs according to the recent numbers show more most PAs more than 50% hold masters degrees. These nondegree and associate degree PAs make only a fraction and that does not make them incompetant. This goes back to the foundation of the PA practice and history that you can read about if interested. These associate degree programs that now exist often require at least 65-70 college credits prior to entrance and they award you with a associate degree after going through another rigorous 24 month continuous full time program. Personally I would never attend one of those programs I want credit for what I earn. If you do the math that is more than the amount of education some nurse practitioner programs offer and grant a Masters degree. Associates, Certificate, Bachelors, Masters prepared....same board! I originally received a Bachelors degree and since have attained a Masters degree. I had 70 prerequisite college credits (the same prereq. required for med school plus countless hours of medical experience) I then went through 24 months of FULLTIME PA school consisting of class M-F and sometimes Sat. ALL DAY and I mean all day sometimes until 9 at night pending lecturers schedules for 12 full months. I had 21 credits at a time mandated (prescheduled) Then 12 full months...everyday clinical rotations. Not just 40 hours per week either. We worked on the residents schedules. After all was said and done I was awarded a Bachelors degree which as you can see was more than most go through to earn a Masters degree! I know a girl now going through NP school and it is all distance based. I really dont understand that concept but I am not here to do any questioning. I am here to correct the false ideas about PAs that circulate by people who have no idea what they are talking about! It is complete ignorance to compare PAs to MAs! It is the quality and quantity of the education not the degree granted. You can basically get a masters degree from a cracker jack box these days!!!!! If you have any further questions about the PA profession, I would be glad to educate you and provide you with clear evidence of the competancy of the programs!