Still Angry at MAs playing nurse or PA

[CaLLaCoDe]

My wife called her Doctor's clinic today in order to discuss her Provera prescription. She was told that the Physician was out of the office and would not be back by friday, so "we'll have our MA return your call." And so the MA calls back and says that its ok for my wife to reduce her dose from 10mg to 5mg daily and she can check back with the physician on Friday. I thought MAs were supposed to work under direct supervision of a doctor. Sure this MA may have heard the doctor say the give the same advice to another patient, but it doesn't make this practice right (not conferring directly with the MD). Even I as a nurse would never consider prescribing a dose without consulting a physician...because we're trained to do so. So how can we stop this common practice from happening?

My wife loves her clinic and wouldn't think of complaining. Since her physician had stated that the Provera could be stopped by her at any time without side effects, she thought of it as no big deal. So, it's not my place to complain. Or is it? She's not my doctor and I did not speak directly to the MA. My wife specifically asked if she were a Physician's Assistant and was told MA. (So no confusion there!) Should I as a nurse write a heads up letter or speak directly to the physician that this is putting her practice in jeopardy? How would you handle this?

[MinnieMomRN]

Reminds me of the girl with her mother on Boston med in the ED. In the thickest new englander accent "I'm a teachor eand I'm also in meadicine. I'm a meadicol asseestent eand I knoa dat my mudda needs" blah blah. Actually sounds more like from jersey when I hear it in my head. Just gotta hit 'em with the hard truth.

That scene was classic!! ROFL. My thoughts when I saw it: Hey! I think I've seen these people in MY hospital! Seriously... you can't make this stuff up.

As to the original comment, I have finally (after much coaching) got my elderly parents to ask "what type of nurse are you? LPN, RN??" Everyone needs to operate within their scope of practice. This goes back to the many threads posted about using the title 'Nurse'.

[thinkertdm]

The doctor at the office I worked in had a system that even if he was "out" it was still possible that someone in the office could contact him. That's why I asked- it is theoretically possible that the doctor was asked or saw the chart, and wrote the instructions in it.

Now, that's not likely- it's way more likely that the MA thinks that because they've worked there so long that they could just do what they want.

[sweetER]

Until today when I started my new job, I worked in a family practice office for 5 years while in nursing school. We had only 2 LPNs, and the rest were MAs. Any time a doctor is out, an MA will take a patient's message, relay it to another doctor in the practice, and that doctor tells the MA what to do (whether it is give a refill, write a script, or tell them they have to wait until their doctor comes back).

[LuxCalidaNP]

Under almost ALL states Board of Nursing laws, making ANY change to medication orders without the physician's order, it is prosecutable as PRACTICING MEDICINE WITHOUT A LICENSE, a felony. The problem is that in a lot of states, neither the board of medicine nor the board of nursing regulate MAs. So the only person's butt on the line is the one delegating to the MA. If they do something of their own accord, can ANYONE hold them accountable?

[AZO49008]

Ugh. I'd bring it to the attention of the office manager of your wife's practice. MAs have a habit of referring to themselves as nurses, mostly because the doctors themselves refer to their MAs as their "nurses."

Before deciding to make the jump and undertake a huge career change into nursing I thought I'd make sure I was compatible with the medical field in general and while waiting to get into nursing school enrolled in an MA program. I worked as an MA in a medical office for about a year prior to nursing school.

Nearly all the doctors referred to their MAs as their nurses. When they referred to me as a nurse I was the first to pipe up and clarify that I was an MA. I brought it up to the office manager that I thought it was perhaps a legal liability to have MAs being represented as nurses, but it fell on deaf ears.

I agree that the public doesn't often understand the difference, but its up to the doctors to change that misperception.

[CaLLaCoDe, BSN, RN]

Are you sure it was an MA and not a PA? I hate how those two titles are so close together when the licensing and scope of practice are totally different.

My wife had asked are you a physician assistant and the person responded with "No I'm an MA." I requested her ask this when she was given the change of dosage. I agree there's a vast difference!

[melmarie23, MSN, RN]

Reminds me of the girl with her mother on Boston med in the ED. In the thickest new englander accent "I'm a teachor eand I'm also in meadicine. I'm a meadicol asseestent eand I knoa dat my mudda needs" blah blah. Actually sounds more like from jersey when I hear it in my head. Just gotta hit 'em with the hard truth.

ahhhhhhh hahaha, I saw that one last week. Total jack of all trades right there! :-P

[melmarie23, MSN, RN]

Can you write an anonymous letter so that your wife's relationship with those in the practice isnt compromised? I am sure she isnt the first that this has happened to.....

[kwest210]

Instead of jumping to conclusions about what the MA screwed up on just call and ask to speak with the MA regarding who made the decision to decrease the dosage. She may have spoken with the MD over the phone or with another MD who advised her to do so; ask if the decrease was documented and then follow up with the physician at his/her next available appointment to make sure he is aware of the actions that were taken. There is no need to tattle on the MA if the MD authorized this action.

If your wife has any future issues with medications maybe you would be more comfortable with her making an appointment instead of calling at her convenience so these "prescribing MAs" can be avoided.

[pers]

Nearly all the doctors referred to their MAs as their nurses. When they referred to me as a nurse I was the first to pipe up and clarify that I was an MA. I brought it up to the office manager that I thought it was perhaps a legal liability to have MAs being represented as nurses, but it fell on deaf ears.

I agree that the public doesn't often understand the difference, but its up to the doctors to change that misperception.

Funny story. A close friend of mine took her mother to the doctor's office and as they were heading back to the exam room they pass him and he says hello, that nurse Jane will get them settled in and he'll be back in a few. So making conversation in the exam room they start talking to nurse Jane about how long she's been a nurse and does she like it there, etc.. She's polite and answers their questions and as the conversation progresses it turns out Jane isn't really a nurse but a MA. She of course explains that she does everything a nurse does and had pretty much the same training. My friend smiles and nods politely and Jane leaves. Not a nurse herself but my friend spent years working in the hospital and her mother has a doctorate in nursing so they were very familiar with the different levels of training and practice.

After the doctor comes in and does his thing they're wrapping things up and Jane is back. Dr. tells Jane to schedule a FU in a couple of weeks. My friend's mom asks if that will be with him or the other doctor. Doctor gives her a funny look and says there isn't another doctor in his practice and my friend mentions the name of his NP (who has a DNP). The doctor chuckles a bit and says, "oh, she's not a doctor she's my NP." Her mom looks right at him and says, "well she's got a doctorate doesn't she? Jane doesn't have a nursing degree or a license but you call her a nurse."

Sorry for the sidetrack but made me chuckle since doctors really protect their title but don't always have respect for ours.

[BSN75]

I believe you said the Dr already told your wife she could stop the med at any time? So why does it matter if she decreases to 5mg before stopping? I'm not seeing the big deal here. If the wife is not upset, I wouldn't worry about it.

[blondy2061h, MSN, RN]

My wife had asked are you a physician assistant and the person responded with "No I'm an MA." I requested her ask this when she was given the change of dosage. I agree there's a vast difference!

Ugh, that's terrible. One can only hope this MA did that under the direction of the physician.