*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

Thanks for the info. I may print that out and post it in our clinic. Forgive my ignorance but does it include catherization? We insert and remove urinary caths all the time.

Regarding the PA, she wanted me to decide whether or not the pt needed an x-ray. Of course, I thought YES but again, I'm an MA you're a PA. I don't get paid to make that decision. BTW, I'm older, in my 40's, so a lot of people assume I'm an LVN or RN. Trust me, I always set them straight.

Regarding the doc I work with, he's older and thinks all "the girls" are the same. He doesn't care what letters follow our names. He just wants done what he says done. The nurse (LVN) he had before me used to pick up his drycleaning! I laughed the first time he mentioned it to me and told him sure for time and a half!! No, I don't pick up his laundry.

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

Specific tasks, you must check w/the State BON or similar body in your State. I am unsure of what tasks are covered for an MA in the State of Penn. NrsKarenRN one of our administrators, is from PA and a very savvy politically-educated gal. I would ask her this. You could PM her, or actually I can, if you would like.

You may very well, be covered/allowed to catheterize patients in your scope in PA.

I know where I work, UAP (including MA) do not insert catheters in patients. But that is where I work----only.

deb

Specializes in Vents, Telemetry, Home Care, Home infusion.

pa does not regulate medical assistants at this time, language only found in physician licensure laws.

[color=#660099]lawful scope of practice pdf

published in amt events march 2003

....the medical practice laws of a number of states expressly allow a physician to delegate basic clinical tasks to an unlicensed assistant provided that the task is generally one that can be delegated, the task is within the scope of the assistant's training, the delegation is not prohibited by other law or regulation, and the assistant is under the supervision of a physician who assumes responsibility for the assistant's actions.

among that states that have such laws or regulations are: colorado, georgia, illinois, indiana, kansas,massachusetts,maine,michigan,montana, north carolina, north dakota, nebraska, new mexico, ohio, oklahoma, pennsylvania, south carolina,tennessee,texas,utah,virginia,and wisconsin.

as far as we can ascertain, only seven states (arizona, california, florida,new jersey,maryland, south dakota and washington) have adopted laws or regulations directly addressing the practice of medical assisting. each of those laws expressly recognizes that medical assistants with adequate training are qualified to perform certain administrative and basic clinical tasks under a physician's supervision. none of the states requires that medical assistants be licensed,but the south dakota law requires any person who practices as a medical assistant to register with the state board of medical and osteopathic examiners.

from the same site smiling posted:

medical assistants cannot...

http://www.medicalassistant.net/

certain tasks that medical assistants are not allowed to do. medical assistants:

1x1.gif

37511090.pngcannot independently perform telephone triage (medical assistants are not legally authorized to interpret data or diagnose symptoms!)

36f11090.pngcannot independently diagnose or treat patients

37011090.pngcannot independently prescribe medications

37511090.pngcannot independently give out medication samples

37111090.pngcannot independently refill prescription requests

37211090.pngcannot independetly do triage

37111090.pngcannot perform arterial punctures

37111090.pngcannot inject medications into a vein (most states) unless permitted by state law

37511090.pngcannot start, flush, or discontinue iv's (most states) unless permitted by state law

37511090.pngcannot insert urinary catheters

(* considered "invasive procedure into body/human tissues" requiring nursing level knowedge.* karen)

37111090.pngcannot provide medical treatment, analyze, or read test results

37111090.pngcannot advise patients about their condition, or treatment regimen

37111090.pngcannot assessments or perform any kind of medical care decision making.

37111090.pngcannot administer any anesthetic agent (except topical numbing agents such as emla cream)

37111090.pngcannot perform tests that involve the penetration of human tissues except for skin tests and drawing blood as provided by law

37b11090.pngcannot interpret the results of blood or skin tests

37111090.pngcannot operate laser equipment

37d11090.pngcannot administer chemotherapy or make an assessment of the patient receiving chemo

37e11090.pngcannot practice physical therapy

37f11090.pngcannot place splints to injured digits or limbs

medical assistants career outlook from us gov -- minimal states with license or certification requirements.

:o WOW! What MA's cannot do is actually more enlightening than what they can do. Does this mean I shouldn't be reading TB tests? How about UA's? I also administer mini-mental exams to the elderly, or anyone, suspected of early stages of dementia. I do think the MD should do this because often the pt's answers and/or their behavior during the test is much more telling than the score at the end. But, alas, my doc doesn't like to take the time.....
Specializes in Ante-Intra-Postpartum, Post Gyne.
:o WOW! What MA's cannot do is actually more enlightening than what they can do. Does this mean I shouldn't be reading TB tests? How about UA's? I also administer mini-mental exams to the elderly, or anyone, suspected of early stages of dementia. I do think the MD should do this because often the pt's answers and/or their behavior during the test is much more telling than the score at the end. But, alas, my doc doesn't like to take the time.....

I think some of the responsibilites that medical assistants "have" that they are not suposed to have are many times the doctors fault. I worked for a FNP once that started handing me lab sheets and saying "His diagnosis is on there you know what to draw, I don't have to time to fill that whole thing out"

I agree. I don't mean to keep picking on the doctor I work with because it's not just him, but he likes to stand there as he's going through lab results and messages "telling" me what to do with them. I just tell him "write it down". The other day he said so and so is coming for this inj blah blah, I said write it on her chart, doc left for lunch, pt showed up, guess what, nothing written down... I refused to give the inj. until he showed back up at the clinic. He wasn't happy but I didn't care.

BTW, the inj was Toradol and Phenergan. Not something I want to be guessing at and giving without the doc available.

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

Karen always comes through, with information you can BANK ON.

TY SO MUCH KAREN!

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

I guess I stopped short of the "Cannot do's" at that site. Shame on me....

but you all have the link so now you know where to go for the reliable information. Remember, you may not have a license to lose, but it does not mean you can't lose a LOT practicing outside your scope or allowing yourself to be referred to as a nurse, when you are not.

Specializes in Case Mgmt; Mat/Child, Critical Care.

This is what I've seen and believe to be true, from my experiences over the last oh-so-many years.... MA's are typically trained for office work...what they call "back office", w/some of the "front office" duties thrown in. Nursing assistants, nurse "techs", aides, nursing aides, etc are typically working for hospitals, nursing home, some home health "sitter"/aide type jobs. Having worked extensively w/both "sets" of individuals, there really is a difference. The docs in primary care offices typically do not employ licensed personnel, they "train" MA's fresh from these 3 mo courses (although I have seen MA's who have rcvd OJT) and inform them that they are his/her "nurse" and are working under the MD's license. That is true to an extent, however, the MA can be held legally liable for working outside of their practice. And I can assure you, the MD is not gonna take the fall when/if something comes down. They figure...this person doesn't have a license, they have nothing to "lose"(their mentality, not mine), I'm not taking responsibility (in a court of law) for their "illegal" actions. Believe me, I have seen it.

Furthermore, it is obvious why MD's do this....money, the $$$$$$$, cashola. I have had this discussion w/the medical director of a primary care/urgent care center I was working at....we constantly were having problems w/the MA's wanting to start IV's, draw up and give IV drugs, etc, etc. Of course, it is not going to cost as much to hire an MA vs an LPN or RN. So you have lots of MA's in primary care and very little RN's or LPN's. This is the kicker...the MA's, technically were working under our license, we were supervising them, making their assignments, etc, and we constantly got this "I work under the MD's license" line. That is one reason I got out of primary care, much as I enjoyed Urgent Care, and went back to the hospital....roles seem so much more defined....

I can assure you, the MD is not gonna take the fall when/if something comes down. They figure...this person doesn't have a license, they have nothing to "lose"(their mentality, not mine), I'm not taking responsibility (in a court of law) for their "illegal" actions. Believe me, I have seen it.

...

Amen.

I have experienced it as an RN. I worked for an MD, who put the pt., on our surgery schedule for a procedure that did not require the type of surgical intervention, that was done on him.

The MD tried to blame it on me and told the practice manager that I had put the pt. on the MD's schedule without his authorization. This was a totally false accusation and I was lucky that one of my coworkers had confirmed with the MD that this pt. was to be placed on the schedule.

The MD then tried to put the blame on me by stating that I should have known by the diagnosis the pt. did not have to be scheduled for this type of intervention. I told the MD that since I am not a surgeon, It wouldn't be up to be to decide what type of procedure the pt. needed to have. In addition, The MD, picked up the knife and cut on the pt., even after looking at the pt.'s chart prior to the start of surgery.

I was very fortunate that the Practice Manager believed me and not the MD.

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

Therefore, I do not think most MA's intentionally represent hemselves as nurses.

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.

.

1. Unfortunately, the MA's I have contact with daily do intentionally misrepresent themselves. When I talk with them, I always have to clarify what type of "nurse" they are, so that my actions are appropriate. ie- I can't take any type of orders from them.

2., dr.s do know ,for the most part ,what the legal ramifications of using the term "nurse", when referering to their MA's. The reason they do it for strictly financial reasons, such as paying a MA $10 per hour vs. a Nurse at $20 per hour. The doctors know that the public doesn't know the difference in responsibilities.

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