RNs Told They are Equal to MAs

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Specializes in Tele, ICU, Staff Development.

Dear Nurse Beth,

I am a seasoned nurse working in Ambulatory in a major teaching institution. We are told repeatedly by management we are equal with MA's. They are given peer review forms to evaluate us. I do not consider them peers. Is this type of brainwashing common in other institutions? They sit back while we run around doing their job of rooming patients.

Dear Seasoned Nurse,

Could this be management's way of messaging that every coworker is important to the team? Equal may mean equal in human respect. It certainly doesn't mean you are paid equally or have equal responsibilities, and I wouldn't take offense at the message. You know your own worth.

Being peer reviewed in a 360 manner means that coworkers at all levels are solicited to provide feedback, usually around interpersonal skills. An MA would not be called upon to evaluate your nursing care plans, for example, but could evaluate your soft skills.

It does sound like the MAs and the RNs do not work well together at your facility, which is a shame and ultimately affects patient care. In my opinion management should work on mutual respect and team building because what they are doing is divisive and not effective.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

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Specializes in Urgent Care, Oncology.

Where I work, MAs and Nurses work side by side and thus we do peer review each other. However, it is exactly how Nurse Beth said - it is about interpersonal skills, or how you interact with your peers. When we were doing our reviews I saw management cut snippets from reviews, so if they didn't agree with something it didn't go on the review. However, 95% of what peers had to say was valid so sometimes it is best to reflect within.

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In an ideal world peer reviews would be useful.

As it is, it's curious how they were conceived in a positive light. If the review comments are fair, then they represent things already known. And things that are already known (both compliments and critiques) should be being addressed on a continual basis through the official employer-employee relationship channel and through professional day-to-day interactions with coworkers.

I wouldn't feel comfortable critiquing coworkers; I don't think it's appropriate. Objectivity is a disciplined endeavor and a skill that some people practice and some people just don't; their version of objectivity is how they feel about things. And I guess it seems like life's too short and the workplace has too many other stressors to make room for this one.

I'm against this sort of thing as a means of workforce control, which I believe is its main purpose and benefit.

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In an ideal world peer reviews would be useful.

I wouldn't feel comfortable critiquing coworkers; I don't think it's appropriate. Objectivity is a disciplined endeavor and a skill that some people practice and some people just don't; their version of objectivity is how they feel about things.

I'm against this sort of thing as a means of workforce control, which I believe is its main purpose and benefit.

I agree with you. The drawback with peer reviews is that there are people in the workforce that will take advantage of the anonymity of the review to lash out at a peer with hurtful criticisms that they would never say if they had to do it face to face. And oftentimes the criticism is focused on an isolated event rather than a pattern of behaviors. Years ago when I worked in ICU I personally witnessed a peer go up to the manager while she was handing out the co-worker evaluations and ask for a specific person, saying that she wanted to "nail them" for something.

You are absolutely right that objectivity is a skill set that doesn't come natural to everyone. Oftentimes there is no training on how to give feedback before the peer reviews are assigned. Even legitimate criticism that is intended to be constructive can come across hurtful and/or insulting if it isn't worded carefully.

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If an RN is equal to an aide, I'd ask the MA's to do nursing tasks & when they go to the manager to report that they're being told to perform nursing tasks & the manager comes stomping over to you to ask why you are telling an aide to do a nursing task, I'd say "Well, didn't you say that RN's and MA's are the same? If we are the same, then we can do the same stuff. So, that's why I am asking the aide to flush this patient's PICC line."

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Specializes in Reproductive & Public Health.

I actively seek out feedback from my MAs, and wish we had a formal process for 360 reviews here. Constructive advice from my team has helped me become a more effective leader AND team player. We are 100% equal in terms of the value we add to the team.

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Specializes in Reproductive & Public Health.
If an RN is equal to an aide, I'd ask the MA's to do nursing tasks & when they go to the manager to report that they're being told to perform nursing tasks & the manager comes stomping over to you to ask why you are telling an aide to do a nursing task, I'd say "Well, didn't you say that RN's and MA's are the same? If we are the same, then we can do the same stuff. So, that's why I am asking the aide to flush this patient's PICC line."

Just because people have different skill sets and levels of responsibility does NOT mean they aren't equal. My clinic cannot run without skilled medical assistants, a well oiled front desk, and effective management. I would be *lost* without my nurse. I have no clue what the right tube is to run an A1C, I don't know how to work the autoclave, I don't want to be in charge of managing our inventory or taking BPs or turning over exam rooms or managing a full waiting room or triaging the gazillion phone calls we get each day. I just want to do my work, and do it well.

My MAs have critical insight regarding our work flow, and their feedback is invaluable.

It's all about working together; we are more than the sum of our parts. It takes a culture shift in the office.

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Working as a team is much different than comparing the practices of various healthcare workers. Just like a nurse can't perform surgery, an MA can't manage a patient on a ventilator or flush a PICC line. To say that everyone's practice is equal is not realistic. Everybody's actual job is essential to keep the place functioning as a whole. I believe human beings are equal, but job responsibilities are not.

Since you have a master's in nursing & are a certified nurse midwife, I am surprised you don't know how to take someone's blood pressure or turn over an exam room. In order to function as a team & keep the flow moving, sometimes people have to do tasks that they don't ordinarily do, that may be "beneath them", no matter their skill set. As a midwife, you can provide pre-natal care & deliver a baby (I think), but you can't perform a c-section. Professional practice is governed by state licensing authorities.

I totally appreciate a team working together to keep the process moving, but to imply that front desk employees are equal to clinical providers is not accurate, I don't think. You actually make a great statement when you say that "people have different skill sets"---if you do not know the skill set of your peer, how can you possibly write a "peer review" for them? As a CRNA, how could I possibly write a peer review for you as a CNM? I don't know what you do (well, I do, kind of--but don't know if you are doing it well or poorly) nor do I know what the goals are. And you couldn't write a peer review for me---you know I give pregnant women spinal & epidural anesthesia, but you have no idea what I do in the O.R. because you aren't there. So, even as 2 post-graduate prepared nurses, we wouldn't be able to peer review each other.

Working together is important. When a cog is absent from the wheel, it greatly impairs function.

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Specializes in Reproductive & Public Health.

Since you have a master's in nursing & are a certified nurse midwife, I am surprised you don't know how to take someone's blood pressure or turn over an exam room. In order to function as a team & keep the flow moving, sometimes people have to do tasks that they don't ordinarily do, that may be "beneath them", no matter their skill set. As a midwife, you can provide pre-natal care & deliver a baby (I think), but you can't perform a c-section. Professional practice is governed by state licensing authorities.

Of *course* I can do these things. And I often do, if they are busy and I am not. You know that is true, so I am not sure why you made the comment. :bored: I said that I don't *want* to do these things. I want to provide consistently excellent care, and I want to spend as much face time with my patients as possible. That is my job, you know that.

I think were are using a different definition of "equal" here. I lead my care team and I make the decisions. Their job is to help me do my job. No way are we equal in terms of responsibility and expertise. But we ARE equal within the team. I could not provide the same quality of care, or see as many patients as I do, without them.

Thats what I mean by equal.

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I would think that asking MAs to provide feedback on RNs is the same as asking RNs and STs to provide feedback. My manager doesn't ask the STs I work with the critique my assessment skills, she asks them for feedback on me as a whole, as a team member - things expected of EVERYONE - communication, being willing to teach and help, etc. I can function in their role, and am assigned to scrub sometimes. They can't function as a circulator. In our facility either RN or ST can be a laser operator. The same is true - I'm asked for feedback on working with them, things everyone is expected to be good at. Not about nuances in practice or who can/can't do what.

For those of you with snarky comments about skills and delegation - seems to me that can backfire on you as you are supposed to be the responsible party with delegation. The legal burden is on you, not the MA or CNA.

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Hi Everyone,

Would you all explain to me what an MA is?

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I'm curious about a scrub tech being permitted to be a "laser operator". You don't mean that a scrub tech can actually "use" the laser, do you? I am curious because I know in some states, only MD's can use lasers for dermatology/cosmetic purposes, and in other states nurses and even "technicians" can do dermal laser procedures. There are lots of "spas" that perform laser hair removal & the person operating the laser does not have any professional license--they just took a course for a couple of days to learn how to turn on & push the laser around so the spa can charge a couple hundred dollars per procedure. I have to assume in a general O.R., you must mean nurses & ST's can turn the laser on, input settings, etc. for the surgeon to actually use. Usually---and I say usually because sometimes facilities will skate on thin ice for financial purposes---the state sets forth who can do what when it comes to clinical practice.

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