Sally Now

I agree, adhering to the policy is ideal. However, issues with patients running out of critical meds (BP, heart, benzos, anything that could be life-threatening) is an issue. It's a legal issue as well.

Which electronic system do you use? I am in agreement, the demands placed by 'meaningful use' and CQM have gotten out of hand. If you are rooming patients, there is not enough time for all of the refills, results questions, etc. I'm trying to sort this out in my practice now. Add to that all of the med reviews/risk assessments involved with rooming a patient, and that can take 15-20 minutes. We have 3 physicians who are there 4 1/2 days per week; each has an MA. When fully staffed, we will have an extra MA, and my plan is that she will handle all Rx refills, coordinate results/problem questions (scheduling next step labs, referrals, tests), handle routine questions, and back up for in-house orders (immunizations, MAR, EKG, etc). As the RN, I will continue triage and continue to work on CQM/Medical Home/BPA implementation. However, I often must serve as back-up for the 'extra MA' duties.

Yes, we are now using Epic, transitioned from Centricity. Some things better, some not as good. Overall, really wondering about the cost/benefit ratio. I understand the certified meaningful use necessity. However, in comparison, I find Epic clunky, the screens far too busy, and perhaps this is in the build, but some major pieces missing right now. The implementation here was rushed (one year to roll out electronic practices, 14 months for the paper sites). Epic Ambulatory seems to be a red-headed stepchild. The 'InBasket' thing is a mess. There are more steps and clicks than previously. I like anti-coag better, and it's easier to find results. All in all, though, I think Epic is overpriced and sold via a huge dog and pony show that does not live up to expectations. I don't see any care coordination episode linking, for example, for DM or CVD. BPA will be great but it'll take another year until all the patients have been seen/uploaded for this to be effective. I'll post later on my thougts about CMS and 'Meaningful Use'

I would dearly love to hear about new EMR systems launches/go live. This is one of the most challenging and frustrating things out there right now. It is sucking the life and resources out of my organization right now. Which EMR system do you use? What are the pros and cons?

Until there's a lawsuit it probably won't get the top of mind awareness it needs. Continue to address/introduce RN/LVN as nurse and MA as Medical Assistant. My ID goes into a red-bordered plastic cover that says RN. Maybe LVNs could be green, and MAs another color. In any event, it's a continual education process, so unless a formal policy comes out...and yes, it irritates me!

I hear you! I'm an RN working with 3 MAs (we're short one), 3 receptionists (we're short one), and 3 physicians (primary care, and...we're short one!). I was hired to do Triage, CQM, chronic disease management, and care coordination. If we were fully staffed, I'd hopefully be doing just that. However, with EMR and meaningful use, the MAs rooming patients really need an extra MA to help with injections, EKGs, etc. As it is, this falls to me. Now, I'm not saying I'm opposed to doing those things, however, if that's what's needed, why not hire an additional MA? As for spending time doing receptionist work -- not exactly a good use of RN skills and money. Until/unless this resource allocation thing gets worked out, we need to pitch in, but there's a line in the sand somewhere. And no, I'd say it's not normal to do receptionist work, unless there's an unusual situation

Yes, this is a major issue in a lot of places. Until relatively recently, experience (whether as MA or receptionist) was enough. Not anymore. Unfortunately, the formal policies, scripts, ancillary/UAP training on the issue and appropriate triage staffing are not usually in place. This is a management issue, they must provide the written policy and procedures, the education on those two things, the scripts, and ensure there is enough triage (RN) staffing. Having said that, many are now dealing with crisis management - EMR implementation and meaningful use attestation prep (money) and until there are lawsuits (money) this will not get the priority attention it deserves. I'm struggling with this as a triage RN. We don't even have electronic protocols, I'm using the Briggs' book. And every day, I hear receptionists and MAs continuing to triage. It's a management issue, and we must find a way to make them take notice.

Paramedics and MAs are not the same thing

I agree. For too long now, MAs in the ambulatory setting have probably been exceeding scope of practice. An RN can legally do anything an MA can do, but the reverse is not true. If your clinic just needs another MA, then they should just hire one. However, they've clearly hired an RN for a reason, and maybe you need to explore that reason. Do they just need to say they have an RN on board? I've been experiencing some of what you describe as well. Two of the MAs understand that they are Unlicensed Assistive Personnel, the other two believe that they are "doing RN work" for less pay. Clinic Directors and Practice Managers are likely in the position of sorting this out. Check out the MA 'scope of practice' for your state (some states like mine are not as specific). I would also recommend checking out Kaiser Permanente's Scope of Practice Resource Guide: (http://www.ambulatorypractice.org/clinical_practice/docs/Scope%20of%20Practice%20Resource%20Guide.pdf Although this is state-specific it give a LOT of good information to work with. With all of the new CQM, care coordination, and regulatory issues coming down the pike, RNs will have a much expanded role in the ambulatory setting. Best of luck to you!

"I do a ton of RN work for half the pay." If you are not an RN you should not be doing any RN work. The difference is that RNs can (legally) do anything an MA can do, but the reverse is not true. Often, this seems to be the crux of the matter: MAs, some of them, truly believe they are doing "RN work" for less pay. MAs may gather data, but not assess, and need direct orders for anything whatsoever that they do, be those standing orders or otherwise. MAs may communicate information, but not idependently formulate a plan of care or teach. There are individual exceptions in ability, such as the Combat Medic. However, MAs are classed as Unlicensed Assistive Personnel and need to remember this regardless of what is directly or indirectly conveyed in MA school. Unfortunately, in the ambulatory setting MAs in general have been exceeding scope of practice. I work with some terrific MAs who could probably pass NCLEX tomorrow, however the reality is that's not possible. I work with some MAs who understand that the RNs scope of practice far exceeds theirs, and some who do not or will not get this. If you want to practice as an RN, go back to school