This is more of a vent, but I need a way to figure out how to handle this situation. I've been an LPN for 14 years. I worked in MedSurg & LTC until 2 years ago when I found a great office job. Its close to home I have holidays and weekends off. I'm able to drive my kids to school in the mornings, and I'm able to be at all their activities. I make less money, but it was worth the trade off. It's a small Family Practice office, and my docs are fantasic, as are all the girls I work with, personality wise. Great, right?
My job there is to call the abnormal test results, among about a million other things. This can get complicated if other people that don't have the experience to explain whats going on with the labs get a hold of them. Or the experience to know what can wait and what can't. For example, last Friday the lab called with a critical K+ level of 2.9 on a pt. while I was at lunch. The doc took the call, but since I wasn't around he asked the MA to find out what the BUN/CRT was. She tried to look it up in the computer, and when she couldn't find it, she let it sit. All weekend. I got the final lab report on Tuesday and nearly fell over. Luckily this particular pt. had home health that had been notified of the result, and they called her to see what we had told her, and when she said nothing, they encouraged her to go to the ED, and she refused and went to the local pharm and bought some OTC K+. Not the greatest solution, but better than doing nothing. I called her as soon as I saw what happened and got her a stat BMP, but sheesh, it was Tuesday! This is not the only example, but probably the most extreme. Both MAs in our office have graduated in the last year.
The other problem is that every staff member in the office is referred to as a nurse. I feel thats misleading to pts. They think the women answering the phone is a nurse, they think the MAs are nurses, and I'm really trying hard to not let it bother me, but the more these MAs are trying to assert that they can do my job the more annoyed I'm getting. I really feel these MAs are trying to assert themselves, and I understand they make less money, and they're on their feet all day, but they aren't nurses. They've never been on a floor. There's a difference between asking to learn how to do something and just taking it over and doing it wrong out of pride. Any ideas?
Just need to ask in case I overlooked something...tetorifice-allergy to eggs? I thought it was flu where we have to check for egg allergies. I double checked my drug book and immunize.org and didn't see where egg allergies was contraindicated.
Just flu, not tetorifice.
I don't want everyone to be down on MAs. :yeah:The girls in my office are great at their jobs. They draw blood well, they give injections well, and they are pleasent to the pts. If you've ever been to an office with a miserable staff you will appreciate how hard it is to find decent MAs. Its appropriate for them to do those things.
I guess after 12 years (the last 2 have been at the office) of literally running my behind off on various floors, timing med passes, glucometer checks, meal tray passes with insulin injections, hanging IVs, answering call bells, wiping behinds, getting puked on, taking flak from doctors, pts., families, whoever, and working weekends, holidays, and mandatory overtime, and don't forget charting, maybe the word :nurse:"Nurse" would mean something. And maybe that when I was hired for this job (because its been noted not many offices bother with nurses anymore because of the cost) it was because of all that hard work and experience, and because not just anyone should be doing it. Again, this is my first office job. I'm still adjusting!
I guess if you're not a nurse you really just don't get it!
Specializes in Community Health, Med-Surg, Home Health.
Just flu, not tetorifice.
I don't want everyone to be down on MAs. :yeah:The girls in my office are great at their jobs. They draw blood well, they give injections well, and they are pleasent to the pts. If you've ever been to an office with a miserable staff you will appreciate how hard it is to find decent MAs. Its appropriate for them to do those things.
I guess after 12 years (the last 2 have been at the office) of literally running my behind off on various floors, timing med passes, glucometer checks, meal tray passes with insulin injections, hanging IVs, answering call bells, wiping behinds, getting puked on, taking flak from doctors, pts., families, whoever, and working weekends, holidays, and mandatory overtime, and don't forget charting, maybe the word :nurse:"Nurse" would mean something. And maybe that when I was hired for this job (because its been noted not many offices bother with nurses anymore because of the cost) it was because of all that hard work and experience, and because not just anyone should be doing it. Again, this is my first office job. I'm still adjusting!
I guess if you're not a nurse you really just don't get it!
About the flu, I was aware of that, as a nurse myself...the person said tetorifice should be avoided if one has allergies to eggs and I have never heard of that...but, just to be sure, I checked.
I do agree, while Medical Assistants may share many of the skills of nurses, their tasks are more skill based and usually limited to the physician's office; who is responsible for what they do...a nurse stands on her own scope of practice and standards dictated by the BON of their state. In addition, nursing education (may it be LPN or RN) is given in the 4 major domains; med-surg, pediatrics, women's health and psych, while the MA is primarily trained for working in the medical office. I have seen some phenomenal MAs...they know their office well, are organized and can probably show a nurse who is not familiar with such a setting a thing or two for sure. I have seen it and don't doubt it. But, the careers are apples to oranges.
Specializes in Ambulatory (Urgent care) & Home Health.
When i was MA (my last job ended on 4-1-09, going to school fulltime), I gave everything from a flu shot to demerol AND i drove to pts homes to do vitamin C I.V's none of the Doc's i've worked for were present. They were to busy and they trusted me , thats why i believe there should be at least one licensed person in an office BESIDES the doc. Luckily i never overdosed anyone or had major problems due to lack of knowledge , sometimes i would have to say to Doc's " I'm not a nurse" .
Were you able to do an IV push as a MA? This is crazy what I'm learning about the role of a Medical Assistant. I honestly wouldn't feel comfortable for a Medical Assistant to give an IV push to anyone in my family. I'd request a RN for that. Well here in California they do have to have a MD present. As far as I know, they're not allowed to give IV pushes here in California.
Specializes in Ambulatory (Urgent care) & Home Health.
I'm in los angeles Ca:wink2: and even now that i'm not at my last job , the new MA has taken over and is now doing the I.V's:( . When i asked my office manager " is it legal for me to do the I.V's as an MA ?" she said yes, because i was working under the doc's license, so i did what they told me to do and i never had a problem thank goodness for that:yeah: . Now that im in nursing school i'm horrified that i did them:zzzzz , but back then as an MA i didnt have the knowledge:confused: to know it was wrong, that's my whole point medical assistant's learn skills BUT nurses know why:up:. Has for the I.V's i did the doc taught me how and i practiced on him a few times , then i did the fulltime on pt's ( which i now regret). I see now how he was just being cheap:twocents:, he would have had to pay a nurse:nurse: double what i was making, for the life of me i cant figure out why the doc's put their pts in harms way to save a buck.
Specializes in Community Health, Med-Surg, Home Health.
This is the thing...if a person asked to perform a task is not cognizant of the risks involved, they think it is okay to do. The same way I thought as a Certified AMAP (medication aide) it was okay to give meds-when I went to nursing school, I sank in the chair the same way you did and said "Wow...".
At this stage of the game, I am leaning on believing that nursing in general is for the birds. Anyone can do the tasks of the job and many times, that is all they are looking for....someone to DO. And, I don't say this out of disrespect to MAs or anyone else. I really think that one of the reasons why nurses are questioning this (including myself) is that it goes totally against everything we were taught in school and we are flabbergasted that we were taught one way, but in the real world, anything goes...it really does.
You should bring this subject up to the medical director or the office manager. I would not waste my time correcting the individual MAs because if you never get the backing of the people who run the office, then you will get nowhere fast.
is your medical assistant practicing beyond his or her scope of training?
the medical board receives numerous inquiries concerning the use of medical assistants in a physician's office. (by law, a medical assistant may not be employed for inpatient care in a licensed general acute care hospital.)
medical assistants are unlicensed, and may only perform basic administrative, clerical and technical supportive services as permitted by law. an unlicensed person may not diagnose or treat or perform any task that is invasive or requires assessment. the responsibility for the appropriate use of unlicensed persons in health care delivery rests with the physician.
the classification of medical assistant is defined under the provisions of the medical practice act (business and professions code sections 2069-2071) as a person who may be unlicensed who performs basic administrative, clerical, and technical supportive services under the supervision of a licensed physician or podiatrist.
under the law, "technical supportive services" are simple, routine medical tasks and procedures that may be safely performed by a medical assistant who has limited training and who functions under the supervision of a licensed physician or podiatrist. "supervision" is defined to require the licensed physician or podiatrist to be physically present in the treatment facility during the performance of those procedures. the only exception is contained in business and professions code section 2069(a) and relates to clinics licensed under health and safety code section 1204.
prior to performing technical supportive services, a medical assistant shall receive training by either (1) a licensed physician and surgeon or podiatrist or (2) an instructor in an approved school program to assure the medical assistant's competence in performing a service at the appropriate standard of care.
a medical assistant who has completed the minimum training prescribed by regulation may administer medication by intradermal, subcutaneous, or intramuscular injections, perform skin tests, and other technical supportive services upon the specific authorization and supervision of a licensed physician and surgeon or podiatrist.
"specific authorization" means a specific written order prepared by the supervising physician or podiatrist authorizing the procedures to be performed on a patient, which shall be placed in the patient's medical record; or a standing order prepared by the supervising physician or podiatrist authorizing the procedures to be performed, the duration of which shall be consistent with accepted medical practice. a notation of the standing order shall be placed in the patient's medical record.
other technical supportive services which a medical assistant may perform have been established by regulation and include: applying and removing bandages and dressings, removing sutures, performing ear lavage, preparing patients for examinations, and shaving and disinfecting treatment sites. the regulations governing medical assistants can be found in title 16 california code of regulations sections 1366-1366.4. medical assistants who have completed the minimum training prescribed by regulation may draw blood.
medical assistants are not allowed to perform such invasive procedures as:
placing the needle or starting and disconnecting the infusion tube of an iv.
administering medications or injections into the iv line.
charting the pupillary responses.
inserting a urine catheter.
independently performing telephone triage.
injecting collagen.
using lasers to remove hair, wrinkles, scars, moles or other blemishes.
administering chemotherapy.
medical assistants may not interpret the results of skin tests, although they may measure and describe the test reaction and make a record in the patient's chart.
in summary, medical assistants are not licensed, and it is not legal to use them to replace highly trained, licensed professionals. the medical assistant is present to assist and perform basic supportive services in the physician's office.
those duties must be appropriate with the medical assistant's required training.
define acceptable and appropriate training to practice as a medical assistant.
prior to performing technical supportive services, a medical assistant shall receive training, as necessary, in the judgment of the supervising physician, podiatrist or instructor to assure the medical assistant's competence in performing that service at the appropriate standard of care.
such training shall be administered in either of the following settings: 1) under a licensed physician or podiatrist, or under a registered nurse, licensed vocational nurse, a physician assistant or a qualified medical assistant, or 2) in a secondary, post secondary, or adult education program in a public school authorized by the department of education, in a community college program provided for in the education code, or a post secondary institution accredited or approved by the bureau for private postsecondary and vocational education in the department of consumer affairs.
to administer medications by intramuscular, subcutaneous and intradermal injections, to perform skin tests, or to perform venipuncture or skin puncture for the purposes of withdrawing blood, a medical assistant shall complete the minimum training prescribed in the regulations. training shall be for the duration required by the medical assistant to demonstrate to the supervising physician, podiatrist, or instructor, as referenced in 16 ccr section 1366.3 (a)(2), proficiency in the procedures to be performed as authorized by section 2069 or 2070 of the code, where applicable, but shall include no less than:
10 clock hours of training in administering injections and performing skin tests, and/or
10 clock hours of training in venipuncture and skin puncture for the purpose of withdrawing blood, and
satisfactory performance by the trainee of at least 10 each of intramuscular, subcutaneous, and intradermal injections and 10 skin tests, and/or at least 10 venipuncture and 10 skin punctures.
for those only administering medicine by inhalation, 10 clock hours of training in administering medical by inhalation.
training in (a) through (d) above, shall include instruction and demonstration in:
pertinent anatomy and physiology appropriate to the procedures;
choice of equipment;
proper technique including sterile technique;
hazards and complications;
patient care following treatment or tests;
emergency procedures; and
california law and regulations for medical assistants
in every instance, prior to administration of medicine by a medical assistant, a licensed physician or podiatrist, or another appropriate licensed person shall verify the correct medication and dosage. the supervising physician or podiatrist must authorize any technical supportive services performed by the medical assistant and that supervising physician or podiatrist must be physically present in the treatment facility when procedures are performed, except as provided in section 2069(a) of the code.
are medical assistants required to be licensed or certified by the state of california to perform procedures within their "scope of practice"?
no. medical assistants are not licensed, certified, or registered by the state of california. however, the medical assistant's employer and/or supervising physician's or podiatrist's malpractice insurance carrier may require that the medical assistant be certified by a national or private association. a medical assistant must be certified by one of the approved certifying organizations in order to train other medical assistants. (title 16 ccr 1366.3)
how may medical assistants legally "administer medications"?
the phrase intends to mean the direct application of medication in several ways including simple injections, ingestion and inhalation or pre-measured medications. for our purposes, the phrase "administer medications" when used regarding medical assistants, means to inject, handle, or provide medications to a patient after verification by a physician, podiatrist or another appropriate licensed person.
are medical assistants allowed to administer injections of scheduled drugs?
if after receiving the appropriate training as indicated in item 1, medical assistants are allowed to administer injections of scheduled drugs only if the dosage is verified and the injection is intramuscular, intradermal or subcutaneous. the supervising physician or podiatrist must be on the premises as required in section 2069 of the business and professions code, except as provided in subdivision (a) of that section. however, this does not include the administration of any anesthetic agent.
are medical assistants allowed to start or disconnect iv's or administer injections or medication into iv's?
no. medical assistants may not place the needle or start and disconnect the infusion tube of an iv. these procedures are considered invasive, and therefore, not within the medical assistant's scope of practice. medical assistants are not allowed to administer medications or injections into the iv line. (title 16 ccr 1366(b)(1))
are medical assistants permitted to perform "finger sticks"?
yes. medical assistants are trained and allowed to draw blood as long as they have received the proper training. the procedure of finger stick is the pricking of the finger in order to collect a sample of blood. this procedure is within the "scope of practice" of a medical assistant.
are medical assistants allowed to swab the throat in order to preserve the specimen in a throat culture?
yes. medical assistants are allowed to swab throats as long as the medical assistant has received the proper training and a physician or podiatrist is on the premises.
are medical assistants allowed to take a patient's blood pressure?
yes. medical assistants are allowed to take the necessary information to prepare a patient for the physician's or podiatrist's visit. this information may include taking the patient's height, weight, temperature, blood pressure and noting the information on the patient's chart.
are medical assistants allowed to give narcotic injections?
yes. at this time there are no restrictions as to what type of medications a medical assistant may inject, except anesthetic agents, as long as the medication has been pre-verified and the injection is either intradermal, intramuscular, or subcutaneous. (16 ccr 1366 (b)(1)). both 1366 and business and professions code section 2069 provide that they shall not be construed as authorizing the administration of any anesthetic agent by a medical assistant."
are medical assistants allowed to have access to the keys of the narcotic medication cabinet?
this question should be directed to the supervising physician or podiatrist as it is an "in-house" procedure and the decision must be made by the supervising physician or podiatrist.
are medical assistants allowed to chart pupillary responses?
no. the charting of pupillary responses is considered an assessment, which is a form of interpretation. medical assistants are not allowed to read, interpret or diagnose symptoms or test results.
are medical assistants allowed to perform telephone triage?
no. medical assistants are not allowed to independently perform telephone triage as they are not legally authorized to interpret data or diagnose symptoms.
are medical assistants allowed to inject collagen?
no. the injection of collagen does not fall within the medical assistant's scope of practice. 16 ccr section 1366.4 states that medical assistants may inject "medications".
are medical assistants allowed to administer chemotherapy and/or monitor patients?
no. medical assistants are not legally authorized to administer chemotherapy or make an assessment of the patient as the procedure does not fall within the medical assistant's scope of practice.
are medical assistants allowed to apply orthopedic splints in emergency situations, such as splints in a physician's office?
no. medical assistants are legally authorized only to remove casts, splints and other external devices. placement of these devices does not fall within the medical assistant's scope of practice. please reference ccr section 1366(b)(3).
are medical assistants allowed to interpret the results of skin tests?
no. medical assistants may measure and describe the test reaction and make a record in the patient's chart. for every questionable test result, the result should be immediately brought to the physician's attention. in addition, all results need to be reported to the appropriate provider. please reference 16 ccr 1366(b)(2).
can medical assistants be supervised by a nurse practitioner, nurse midwife, or physicians assistant in the absence of a physician and surgeon?
per business and professions code section 2069 (a)(1), a supervising physician and surgeon at a "community clinic" licensed under health and safety code section 1204(a) may, at his or her discretion, in consultation with the nurse practitioner, nurse midwife, or physician assistant provide written instructions to be followed by a medical assistant in the performance of tasks or supportive services. the written instructions may provide that the supervisory function for the medical assistant in performing these tasks or supportive services may be delegated to the nurse practitioner, nurse midwife, or physician assistant and that those tasks may be performed when the supervising physician and surgeon is not on site.
can medical assistants call in refills to a pharmacy?
yes. under the direct supervision of the physician or podiatrist, a medical assistant may call in routine refills that are exact and have no changes in the dosage levels. the refill must be documented in the patient's chart as a standing order, patient specific. medical assistants may not call in new prescriptions or any prescriptions that have changes. the physician should view carefully his or her decision to allow medical assistants to perform this task, as the authority to prescribe or refill prescriptions is only granted to licensed physicians and surgeons, podiatrists, or those individuals authorized by law to do so.
yes. medical assistants may perform hearing tests under the direct supervision of a licensed physician and surgeon or podiatrist. this procedure is within the scope of practice of a medical assistant. per business and professions code section 2530.5(a), "nothing in this chapter shall be construed as restricting hearing testing conducted by licensed physicians and surgeons or by persons conducting hearing tests under the direct supervision of a physician and surgeon."
are medical assistants allowed to administer flu shots?
yes. after receiving the appropriate training as indicated in the first question, medical assistants are allowed to administer influenza vaccinations in a clinic or physician's office settings. the dosage must be verified and the supervising practitioner must be on the premises as required in section 2069 of the business and professions code, except as provided in subdivision (a) of that section.
however, if the shot is being provided at a local governmental or private, nonprofit agency the vaccine shall be administered only by a physician, a registered nurse, or a licensed vocational nurse acting within the scope of their professional practice acts. the physician under whose direction the registered nurse or a licensed vocational nurse is acting shall require the nurse to satisfactorily demonstrate familiarity with (1) contraindication for the administration of such immunizing agents, (2) treatment of possible anaphylactic reactions, and (3) the administration of treatment, and reactions to such immunizing agents. (health & safety section 104900(e))
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i hope this answers some of the questions regarding medical assitants. this from the ca brn website, and i don't know what is going on in other states.
After reading this, I have to say this is very scary. I've witnessed some of the above procedures not within the scope of practice of a MA being done by a MA. I never really thought about it up until now.
Specializes in Ambulatory (Urgent care) & Home Health.
Doctors dont care about those "rules". They want cheap labor, medical assistants dont have a license to protect so they dont care either. I would never go to an office without at least 1 nurse on staff.
I don't think it's that the Medical Assistants don't care. A lot has to do with lack of education. Meaning that they're not educated on what they can and can't do. They just do what they're told to do.
Specializes in Community Health, Med-Surg, Home Health.
I was thinking also...if it is not mandatory for medical assistants to become registered or certified, then, how can one assure that they are following their scope of practice? The fact that it is not necessarily required that they are certified by a governing body, then, this means that they are not regulated. Maybe some states demand that they are certified, but many are not.
. I see now how he was just being cheap:twocents:, he would have had to pay a nurse:nurse: double what i was making, for the life of me i cant figure out why the doc's put their pts in harms way to save a buck.
skpklpn
4 Posts
Just flu, not tetorifice.
I don't want everyone to be down on MAs. :yeah:The girls in my office are great at their jobs. They draw blood well, they give injections well, and they are pleasent to the pts. If you've ever been to an office with a miserable staff you will appreciate how hard it is to find decent MAs. Its appropriate for them to do those things.
I guess after 12 years (the last 2 have been at the office) of literally running my behind off on various floors, timing med passes, glucometer checks, meal tray passes with insulin injections, hanging IVs, answering call bells, wiping behinds, getting puked on, taking flak from doctors, pts., families, whoever, and working weekends, holidays, and mandatory overtime, and don't forget charting, maybe the word :nurse:"Nurse" would mean something. And maybe that when I was hired for this job (because its been noted not many offices bother with nurses anymore because of the cost) it was because of all that hard work and experience, and because not just anyone should be doing it. Again, this is my first office job. I'm still adjusting!
I guess if you're not a nurse you really just don't get it!