*rant* "Nurse" at office answering questions.

Specialties Ob/Gyn

Published

Hi all.

So I called my FP's office to schedule an appointment for a lump I found in my breast. No big deal, probably a milk duct since I'm a lactating mom, but I wanted it checked out all the same. So I call the office for an appointment. The woman I spoke to was nice enough, and offered an appointment a week from the time I was calling. I questioned if I should be seen sooner or if it was ok to go a week out. So she starts asking questions, kind of assessing the situation. Well, I'm dumb but not stupid, so I ask, "Are you a nurse?" And she says, "Yes, I am, I'm Dr. S's nurse." And then I say, "Are you an RN or an LVN?" And she says,

"I'm neither. I'm a Medical Assistant."

AAAGGGHHH. I replied, "Then you are not a nurse and you shouldn't be trying to assess over the phone." I wasn't trying to be a rude b*tch, but when a MA, who has very limited medical training, is trying to assess a breast lump over the phone, she should not pass herself off as a nurse. I spoke to one of the docs in the clinic, who is a friend, and I told her she needed to speak to this "nurse", because that MA was opening the clinic up to major medical liability if she screwed up and assessed something or someone she wasn't supposed to.

Am I off here? Or am I just being a cranky new mom? I guess I'm just protective of the title "nurse", since that implies a certain skill and knowledge set.

Alison

I don't think thats fair to say about all MA's. I am sure it is true for some but as for myself, I never allow a patient to assume I am an RN or LPN. I originally went to nursing school and I did not finish the program. So after some time I went back to school and recieved my Associate Degree in Medical Assisting. I learned alot of the same things in MA school as I did in nurisng school and many RN's only have a two year degree also. Therefore, I wouldn't call MA school a "misnomer." MA's can actually do the same thing as LPN's in our state. We can get IV therapy certified through CE courses and even pass out meds. We also must take a certification exam that is very similar to the N-CLEX. Don't get me wrong, nursing school is difficult and very time consuming but becoming a good MA isn't just a walk in the park either. Unfortunatly, there are MA's out there that give the rest of us a bad name but I have also met my fair share of RN"s that really give the title "nurse" a bad taste. We have all had to work our way up so don't forget that. I still think that if we all work together, no matter what our title may be, then we can provide better patient care. Besides, isn't that why we are all here anyway?

Actually Dhill, it's not that ALL nurses believe that ALL MAs are guilty of misleading/misrepresenting themselves as "nurses". Personally I believe that MAs have their role in health care. Also, I didn't see any posts where nurses have assumed that being an MA is a walk in the park.

Specializes in Nursing assistant.

Wow! When I was working private duty years ago for a demetia patient, her daughter told me that she was paying me less than the other girl because "she was a nurse". Found out she was a MA. One morning (about 11 am)I called the house while she was working and she said that the pt. was still in bed because she "couldn't get her to wake" but that she was alright. I rushed over to the house, the pt was clearly febrile and soaked in sweat, along with her unchanged diaper, so her bed was wet and she was chilling. She ended up in the hospital for a few days with dehydration and a kidney infection! Ugh! I am just a cna. This is no reflection on all MA's, I would love to get at least that much training! but clearly, MA's are not nurses.

Wow! When I was working private duty years ago for a demetia patient, her daughter told me that she was paying me less than the other girl because "she was a nurse". Found out she was a MA. One morning (about 11 am)I called the house while she was working and she said that the pt. was still in bed because she "couldn't get her to wake" but that she was alright. I rushed over to the house, the pt was clearly febrile and soaked in sweat, along with her unchanged diaper, so her bed was wet and she was chilling. She ended up in the hospital for a few days with dehydration and a kidney infection! Ugh! I am just a cna. This is no reflection on all MA's, I would love to get at least that much training! but clearly, MA's are not nurses.

Chadash, did this person actually represent herself as a "nurse" or was this patient's daughter aware that it was actually an MA taking care of her mother? The "we do almost everything a nurse does," or "we're just like nurses" is misleading to the public.

Pity this poor woman suffered because her "nurse" was cluelessly unaware that she needed medical attention. Glad you checked into the situation. Clearly not the actions of "just" a CNA, but a diligent CNA.

Okay, this is my first post on this site but I've "visited" for quite a while. I am a Certified Medical Asst. and have been working for the same clinic for the past 10 years. Everyone at the clinic, including my direct supervisor who is an RN, calls us nurses. I know "real" nurses take offense to this but I think it's more of a generalized term and not exactly a title. I know you've worked hard for your title and have gone to school for many years for your title and I respect that. As an MA I do telephone triage under the direction of the MD I work with. As a matter of fact, ya'll would come unglued if I told you half the things he expects me to do. But he and I have worked together a long time and he trusts me. Actually, I've told him about the discussions I've read on this site regarding the nurse v. ma controversy and his response is "you're a nurse". Well, I know I'm not a nurse and I don't pass myself off as a nurse but I can't help that the clinic does or that the MD does. My understanding is that an MA works under the MD's license and we can do anything he shows us to do. My doc called one time when he was away from the office and wanted me to sign his name to a triplicate prescription for a pt who was coming by to pick it up and I had to finally draw the line and say um, NO. I guess what I really want to say is that as an MA, I'm don't secretly covet your RN license. Well, actually I do, but I don't pass myself off as one and I don't feel we're in competition as I think you all do. I'm back in school working on my ADN and I'm having serious doubts regarding the nursing profession because of this very reason. Come on, we're all in this for the same cause, right? There is just so much nastiness and elitetism it's really depressing.

I hope ya'll don't bash me and keep me from ever posting again!!! Open minds....

SmilingBluEyes

Clearly, it violates ethics and in some states/provinces, LAW, to refer to an MA as a "nurse" , or to allow MA's to triage and/or dispense advice to patients at all.

Further, it behooves us all to know the laws pertaining to this situation in our own state/province and take correct actions when violations occur. Reporting violators is appropriate and is in the best interest of the public safety.

Crisscross, it does behoove us all to know the laws and how they pertain to us in whatever setting we work in, especially in regards to what falls into our realm of practice whether it you are an MA, LPN, RN, etc. Knowing the laws is the first step in CYA.

crisscross

As an MA I do telephone triage under the direction of the MD I work with. As a matter of fact, ya'll would come unglued if I told you half the things he expects me to do. Actually, I've told him about the discussions I've read on this site regarding the nurse v. ma controversy and his response is "you're a nurse". Well, I know I'm not a nurse and I don't pass myself off as a nurse but I can't help that the clinic does or that the MD does. My understanding is that an MA works under the MD's license and we can do anything he shows us to do. My doc called one time when he was away from the office and wanted me to sign his name to a triplicate prescription for a pt who was coming by to pick it up and I had to finally draw the line and say um, NO.

That does not mean he is following things in a legal fashion. Ignorance of the law does not excuse one from breaking it nor does it relieve them of accountablility. Because your MD expects you to do things that would probably cause us to become unglued if we even knew half of them, would not be an acceptable excuse in a court of law if you are violating the law. The fact that this MD ASKED YOU to sign his name on a prescription isn't a clue that maybe, just maybe he is already having you doing things that perhaps you shouldn't? I wouldn't be assuming that I'm working under his license so therefore I'm covered.

There are laws in regards to using the title "nurse" (yes, it is a title, just like doctor is a title). There actually are legal ramifications in regards to those using that title who do not hold a license as an LPN or RN. Those referring to you as "nurse" are actually subject to those ramifications. Actually you can help the fact that the clinic or the MD refers to you as a nurse, provide them with your states legislature concerning the use of the title "nurse".

The only controversy is the fact that there are doctors, MAs, and even nurses who disregard the laws concerning the use of the title nurse. This can set up a dangerous situation. When you have an MA that believes that they are the same as a nurse it can often lead to them stepping outside of the MA role and start "functioning" as a nurse, this can lead to very dangerous consequences for patients. I've seen this happen with CNAs and RPNs/LPNs who have stepped outside the scope of their practice.

It's not nastiness or elitism I'm seeing here, but nurses who are angry about misrepresentation in regards to the use of the title nurse. "Open minds" has to flow both ways. What concerns me about this issue is that misrepresentation can be the first step that places a patient in danger.

BTW I'm not the least bit concerned whether an MA covets my license, nor do I feel that MAs are competition, they have every right to obtain their own nursing license should they choose to do so. Although I've noticed alot of MAs comparing themselves to nurses, I see that more as competition on their part.

If you view this post as a flame that is unfortunate, I'm actually concerned about the situation your working in and the possible consequences that could happen to you.

DusktilDawn, I've read your reply and I completely agree and understand. Thank you for replying in a calm and sensical manner which I think will help other MA's reading this to understand. Maybe I SHOULD bring it up with the hierachy in the clinic I work that they should refer to the nurses as nurses and the ma's as ma's. I KNOW the reason the docs hire MA's is because we're cheaper and also because we're willing to learn anything. At least I've always been. I work along side an LVN (performing the exact same duties) and she's more likely to balk at something because she doesn't want to risk losing her license. Whereas, I figure, I don't have a license, it's HIS (the MD's) license. Ultimately he's responsible for anything I do working under his supervision. But, I guess what you're saying is that really I am responsible for anything I do, period. Good point.

So, what are the boundaries for MA's? Because I'm here to tell you that I do everything. I mean EVERYTHING. I know I would lose my job if I were to start questioning orders at this point.

BTW, as an interesting anecdote, I once had a Phys Asst. ask me to look at this womans foot and tell her if I thought it was broken or not. I showed her my badge and said "are you kidding me?". Needless to say, she didn't last very long.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Here is a good start for us all to understand Medical Assistant Scope of Practice....

From this site:

http://www.medicalassistant.net/can_ma_do.htm

MA Scope of Practice

It must be understood that allied health and health care professionals MUST stay within their scope of practice and practice only methods and procedures that are commonly accepted in their profession, and they were sufficiently trained to do. Professionals who disregard established professional standards and attempt to perform procedures beyond their capabilities are exposing themselves to serious consequences and a possible malpractice lawsuit

Can MAs Do That?

Medical Assistants Can...

Can do clinical and administrative tasks to keep the work flowing in a medical office

Can determine the acuity of a visit, and the visit-length for scheduling purposes using an office protocol provided by the supervising physician

Can record patient data including height, weight, temperature, pulse, respiration rate and blood pressure

Can escort patients to the exam room, and prepare them for an exam

Can use scientific methods to solve problems and choose a mathematical method or formula to solve problems

Can collect patient demographics, data, and histories

Can convey clinical information on behalf of the physician

Can arrange examining-room instruments, and equipment

Can change wound dressings, and obtain wound cultures

Can remove orthopedic splints

Can remove sutures or staples from superficial incisions or lacerations

Can operate diagnostic equipment to record ECG's, electroencephalograms, spirometry, or plethysmography tests, except full body plethysmography; but NOT interpret them!

Can record basic information about the presenting and previous conditions

Can use medical terminology, and accepted charting abbreviations

Can provide patient information, and instructions (patient education)

Can provide a single dose of oral medication to a patient for immediate self-administration under observation

Can administer medications topically, sublingually, lady partslly, rectally, and by injection

Can assist patients in ambulation, postitioning, and with transfers

Can perform CPR, and render First Aid in an emergency

Can prepare patients for examination, including draping, shaving, and disinfecting treatment sites

Can prepare a patient for gait analysis testing, or muscle strength assessment

Can collect blood specimens via capillary- and venipuncuture technique

Can obtain specimens by non-invasive techniques, such as lady partsl and throat cultures, and nasal smears limited to the opening of the nasal cavity

Can preserve specimens for testing, including urine, sputum, semen, vomitus, and stool

Can perform simple laboratory and screening tests customarily performed STAT in a medical office

Can cut the nails of otherwise healthy patients

Can perform ear lavage to remove impacted cerumen

Can perform visual acuity and hearing tests under the direct supervision of a licensed physician

Can administer different types of cryotherapy to reduce pain or swelling

Can proper filing and bookkeeping

Can process insurance claims

Can transcribe medical dictation

Can call in prescription and refill orders (as ordered by a physician!) to the pharmacy

*there is also a link provided that further discusses Medical Assistant Legal issues.*

Hope this helps. You still need to check w/your specific state or province for further details/information regarding Medical Assistant Scope/use. Note, nowhere does it say that an MA may be referred to as a "nurse" by anyone, including his/her employer. I would urge all MA's and Nurses to be familiar with the laws/scope in their particular province/state, if this is an issue where you practice. It's not about "oneupmanship", just being legally and ethically prudent.

Specializes in Nursing assistant.
Chadash, did this person actually represent herself as a "nurse" or was this patient's daughter aware that it was actually an MA taking care of her mother? The "we do almost everything a nurse does," or "we're just like nurses" is misleading to the public.

Pity this poor woman suffered because her "nurse" was cluelessly unaware that she needed medical attention. Glad you checked into the situation. Clearly not the actions of "just" a CNA, but a diligent CNA.

Yeah, she had told our employer that she was a nurse. And actually her certification was not current as a MA....I am sure she was not representative of MAs.......but what concerned me was when I asked her about it, she considered herself a nurse. This does not discount the importance and value of MAs, but I just see there role and education as clearly different than that of a nurse. I do not think it would be appropriate for a MA to do triage, for instance. Just out of their scope of practice. In NC it is illegal to represent yourself as a nurse if you are not licensed.

DusktilDawn, I've read your reply and I completely agree and understand. Thank you for replying in a calm and sensical manner which I think will help other MA's reading this to understand. Maybe I SHOULD bring it up with the hierachy in the clinic I work that they should refer to the nurses as nurses and the ma's as ma's. I KNOW the reason the docs hire MA's is because we're cheaper and also because we're willing to learn anything. At least I've always been. I work along side an LVN (performing the exact same duties) and she's more likely to balk at something because she doesn't want to risk losing her license. Whereas, I figure, I don't have a license, it's HIS (the MD's) license. Ultimately he's responsible for anything I do working under his supervision. But, I guess what you're saying is that really I am responsible for anything I do, period. Good point.

So, what are the boundaries for MA's? Because I'm here to tell you that I do everything. I mean EVERYTHING. I know I would lose my job if I were to start questioning orders at this point.

BTW, as an interesting anecdote, I once had a Phys Asst. ask me to look at this womans foot and tell her if I thought it was broken or not. I showed her my badge and said "are you kidding me?". Needless to say, she didn't last very long.

It looks like SmilinBlueEyes has provided alot of useful info Crisscross.

Bear in mind that the MD you work for may not be aware of the legalities that govern your practice. Heck, alot of doctors and nurses are not aware of all laws regarding their own practice much less that of another discipline. Fear of losing ones job has prevented many nurses from exercising their legal rights in regards to many situations. The laws that govern practice are not just there to protect patients, they are also there to protect us.

You mentioned you were in the ADN program. Your instructors can also be a valuable source of info. I had an ethics instructor who was on the disciplinary committee of the licensing board for nursing in the province I was educated in.

Providing legal information regarding your practice does not necessarily mean job loss, like I said the MD may not be aware of possible legal ramifications in regards to MAs. If it is a situation where he just doesn't care about the laws, you may need to ask yourself whether you want to continue working for him.

BTW in regards to PA anecdote, ya think maybe an X-ray was order? No wonder she didn't last long. :D

Specializes in Nursing assistant.
Okay, this is my first post on this site but I've "visited" for quite a while. I am a Certified Medical Asst. and have been working for the same clinic for the past 10 years. Everyone at the clinic, including my direct supervisor who is an RN, calls us nurses. I know "real" nurses take offense to this but I think it's more of a generalized term and not exactly a title. I know you've worked hard for your title and have gone to school for many years for your title and I respect that. As an MA I do telephone triage under the direction of the MD I work with. As a matter of fact, ya'll would come unglued if I told you half the things he expects me to do. But he and I have worked together a long time and he trusts me. Actually, I've told him about the discussions I've read on this site regarding the nurse v. ma controversy and his response is "you're a nurse". Well, I know I'm not a nurse and I don't pass myself off as a nurse but I can't help that the clinic does or that the MD does. My understanding is that an MA works under the MD's license and we can do anything he shows us to do. My doc called one time when he was away from the office and wanted me to sign his name to a triplicate prescription for a pt who was coming by to pick it up and I had to finally draw the line and say um, NO. I guess what I really want to say is that as an MA, I'm don't secretly covet your RN license. Well, actually I do, but I don't pass myself off as one and I don't feel we're in competition as I think you all do. I'm back in school working on my ADN and I'm having serious doubts regarding the nursing profession because of this very reason. Come on, we're all in this for the same cause, right? There is just so much nastiness and elitetism it's really depressing.

I hope ya'll don't bash me and keep me from ever posting again!!! Open minds....

I did not read your post before I wrote my earlier one, so I just wanted to say that I do not think in any way you are attempting to misrepresent yourself....you are apparently in a tough situation.

Yeah, she had told our employer that she was a nurse. And actually her certification was not current as a MA....I am sure she was not representative of MAs.......but what concerned me was when I asked her about it, she considered herself a nurse. This does not discount the importance and value of MAs, but I just see there role and education as clearly different than that of a nurse. I do not think it would be appropriate for a MA to do triage, for instance. Just out of their scope of practice. In NC it is illegal to represent yourself as a nurse if you are not licensed.

God, I hope legal action was brough against this person. As I stated in another post misrepresentation can be the first step that places a patient in danger.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I think most MA's (and doctors/nurses) are basically honest people.

Therefore, I do not think most MA's intentionally misrepresent themselves. I do not think most nurses believe they do. I don't have a problem w/MA's as a nurse, myself. Please understand.

I do think there is a problem, clearly, that involves a lack of understanding of scope of practice of MAs and nurses. On all of our parts. I have learned a thing or two myself, here. In doing so, I have attempted to provide information from an MA site, that helps to clear up some confusion on our parts.

Now, personally, I have a hard time believing most doctors are completely unaware of the laws regarding scope/and misusing the title of "nurse". I still would wager, most know this----but are doing it anyhow, for a variety of reasons.

What does that mean for the MA in his/her employ? Well, were it me, I would be very careful working w/a physician or health care professional that mis-uses the term "nurse" w/his or her MA's. (I would actually avoid this, if I could; trust is a huge issue with me).

This person, whether he/she knows it or not, is breaking the law in most cases. Anyone willing to continue to do so, especially after becoming aware it is wrong----well----How honest is this person, all around? If they persist, despite knowing it is wrong, you may be risking a LOT working for this person.

Sure, as an MA, you may not have a license to lose, but you can still wind up in legal hot water. Ignorance is not bliss for any of us.

Just something to consider.

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