Question on delegation and the law

mammac5 · Dec 2, 2011

I was a CMA for many years prior to going to nursing school and then becoming an ANP. I taught medical assisting at a local community college as well, so I feel somewhat qualified to speak to this issue.

Unless you are in a state that specifically limits what CMAs can do, you are technically allowed to perform noninvasive skills as delegated to you by a physician/NP/PA superior. Obviously this is something that must be communicated between you and the physician you work with/for - and any skills must be agreed to by each of you and (if your employer is smart) there will be documentation on file for the training you've had to perform said skills.

With a few state-specific exceptions, which you can determine by contacting the AAMA in Chicago, you can do nursing-type outpatient skills that do NOT require assessment. Assessment is a nursing function. Confused yet? There are a lot of gray areas in the outpatient world!

Generally you can give oral meds and injections; you can place PPD tests, but not read them; you can draw blood from a vein but you cannot do arterial draws unless trained as a phlebotomist; you CANNOT start or give medications via intravenous route. You can take a patient history, HPI, review meds & allergies, take & record vital signs, and prepare the patient for examination. You can assist with the exam and function as a chaperone. You can hook a patient up and run an EKG, but you cannot interpret it or advise the physician on what the EKG looks like.

You CANNOT administer any medication (oral or parenteral) without the physician ON THE PREMISES because you are not authorized to treat any allergic reaction that may result.

Obviously, there must be good communication between you and your employer. If you're smart, you'll get it all in writing as to what he/she authorizes you to do so that (if something goes wrong) you have proof that you were allowed to perform a given skill. If your employer is smart, they will make sure you are well educated and trained, with proof of that on-site. And common sense should NEVER go out the window; if you're doing something you're not comfortable with STOP, go speak to the physician and let them know you feel out of your depth.

Kaligirl02, ADN, BSN, MSN, LVN, RN, APRN, NP · Dec 2, 2011

Thank you so much. I live in the state of Alaska and there are a few things that NP's can't delegate to us (CMA). So Ma's can't read a ppd? Hmm, all the CMA's at my work do. We only inform the NP if we notice any type of swelling and/or hardness to the site. It is a sticky situation.... I will talk with the NP on Monday about my concerns. Once again, thank you for your response.

nomadcrna, DNP, CRNA, NP · Dec 3, 2011

I happen to be in Alaska. :)

Here is the law. NP CAN delegate to a CMA.

The administration of injectable medication is a specialized nursing task that may be delegated under the standards

set out in 12 AAC 44.950(a), ©, and (d) and this section.

(b) The administration of injectable medication may be delegated only by an advanced nurse practitioner to a

certified medical assistant. The certified medical assistant may only perform the delegated duty in a private or

public ambulatory care setting, and the advanced nurse practitioner must be immediately available on site when the

certified medical assistant is administering injectable medication.

must successfully complete a training course in administration of medication approved by the board.

(d) To delegate to a certified medical assistant the administration of an injectable medication to a patient the

written instructions provided to the certified medical assistant under 12 AAC 44.950(a)(7) must also include the

information required in 12 AAC 44.965(d)(1) – (3).