Washington state to make Medical Assistants work under RN license?

[Psychtrish39, BSN, RN]

Hi all. This is for Washington state RNs in particular and I am sure in coming years other states are going to attempt this in state BONs. The DOH ( which is our BON here in Washington ) has proposed draft rules about credentialing medical assistants in my state. I am all for this credentialing mandate so there will be a high quality work force. However, it has been my experience that MAs work in an office under a physician license and he or she is responsible for delegation and overseeing their work.

I get a newsletter (link.serv) from my state and they sent us a copy of these proposed changes which of course lie in an RN's scope of practice and the DOH credentialing person said in the body of the email that they sent us these proposed rule changes because we oversee them.

My questions to you fellow nurses in Washington and elsewhere because I don't work in a physician office environment is this correct?, or are RNs once again being dumped on by 1. Having a person who will have a credential but does not have a quarter of the clinical hours being trained even a new graduate RN does but I will be responsible to oversee her care of patients. There are items in the proposed rules that talk about allowing MAs to do IV pushes, start and stop IVs etc all under a RNs supervision. I am enclosed a doc file of the proposed rules including where Washington RNs may email the DOH and state what they think. I hope that RNs here dont once again let the powers that be take away even more of the RN scope of practice to less educated professionals. I realize there is a "nursing shortage" haha but this to me is just another example of replacing highly skilled and educated medical professionals with less educated ones and also making us responsible for delegating our own scope of practice to them. Any thoughts everyone?

Medical Assistants DRAFT Rules.docx

[xoemmylouox, ASN, RN]

Pretty soon nurses will be nothing more than paper pushers.

[DSkelton711]

I am shocked that a medical assistant would be allowed to give IV push medications. I hope I never have to go to the hospital. This is scary IMHO.

[Psychtrish39, BSN, RN]

Xoemmyloux,

I am afraid of that too. Its time for me to move to another state as soon as I can if these proposed rules become rules of law under the RCW and WACs in this state. I just voted in the election and did not see any legislation put to a vote about this . Perhaps it was attached to the home care aide program in this state . This is where people must be certified home care workers with background checks and pass a testing exam both written and skills test for a certification that cost $ 125 to test for and for workers who will not make much over minimum wage here. I think this MA certification is along the same lines its a money maker for this state. I think certification and background checks are good however the testing fees and how the DOH is running over home care aides and RNs is a little crazy.

[wish_me_luck, BSN, RN]

No way! They are trying to make money off this and cheapen the labor market. The problem is, if nurses have to oversee the MA, then why would they want to do that? Nurses are capable of starting and stopping IVs and giving IV push meds. This would mean that the ultimate responsibility would lie on the nurse. I would not want to be responsible for what someone else does as far as IV push and such. That could be a huge problem. If I do it, I want to do it myself. Even if the MA was responsible, they aren't trained for that and that's a big responsibility to add to a job that makes $9-$10 an hour. Fast food jobs pay only a little less than that and they don't have that responsibility. If they want people to run away from health care, then I guess this is the way to go. Although, I am not big on the argument of "nurses make a lot of money, so I want to be a nurse."

So, what happens with the CNAs and medication aides with this development?

[jadelpn, LPN, EMT-B]

LPN's work under their own license, and in many states can't push IV meds! But a MA can do in an MD's office a great deal more, and usually under the direction of the MD. This guideline would now take responsibility off of a doctor, and put it onto the RN. Which has delegation as part of their scope. (but appropriate delegation--and this is by no means appropriate). This is crazy. I am curious about this--Who clinically teaches MA's to push meds? (and why would one push IV meds in an MD office???) Never the less, I don't think I would want to work in an MD's office that allows this. It is too much responsibility on an RN to delegate (and be responsible for) what she could do herself safely for a patient. As an LPN, if I am responsible for asssessing, giving med, and re-assessing, then I want to be sure it is all correct. And it is not within my scope to push meds. Sounds like the MD's can have a little less malpractice insurance, however, the RN's are going to need a great deal more. And the RN would need the support of the MD to say to the MA's "when I am on, the ONLY thing I want the MA's to do it xyz. There will be no pushing of meds. Although you may have the credentials, I am responsible."

As an aside, it is also within an LPN's scope to delegate. Interesting if the LPN's scope in Washington State does not include pushing meds, but the MA's scope is in an MD's office. An LPN can be IV certified, but still scopes are such that IV pushes are not part of it in many states (and I KNOW that in other states, LPN's can and do push meds, but not in a number of them).

All in all sounds like they are putting this on the RN's and leaving the LPN's out of it, as part of scopes and licenses--delegate to the UAP....fingers crossed they get it correct. Not.

[Esme12, ASN, BSN, RN]

Just another way to cheapen the workforce and remove the nurse from the bedside.......shame on your DON. Personally, I think those that push these type of things have a secret hatred of nursing and nurses.

I have said for a long time nurses will educate themselves away from the bedside....and so it begins. I pray this doesn't pass.

ps....there is no nursing shortage....

[BrandonLPN, LPN]

Why on earth would a MA need to push IV meds anyway?? Why would any pt need meds via IV push in a doctors office? I've never seen a MA working on a hospital floor, unless it was as a phlebotomist. Are MAs going to start passing meds in acute care?

[BrandonLPN, LPN]

Yes the future of hospital floors being run by one or two RNs with an army of various $10 an hour "techs" is fast approaching. And we all will pine for the days of good old fashioned RN/LPN team nursing. The model of having one RN per 5 pts on a med surg floor is a nice thought, but it was never economically viable in the long run. Now, with the economy tanking, we can all look forward to "tech land". At least with team nursing you had licensed, qualified nurses.

[cienurse]

ps....there is no nursing shortage...

Agreed! If there was a nursing shortage I wouldn't have 12 applicants for 2 open positions and the hospitals would be hiring new grads instead of turning them away to the SNF's and doctor's offices!

[netglow, ASN, RN]

This isn't just an error or a confusion, this was planned to get rid of nursing from acute care, and replace it with techs, as well as lessen the medmal burden on MDs. Seems clear. We know hospitals hate nursing, we ruin everything don't we.

BTW, I've seen a lot of posting of late for a network south of me for office RNs with extensive acute care experience. They say 3 to 5 years minimum, mentioning needing people who can take charge. Acute care nursing has nothing to do with office nursing. This thread makes me wonder if they have a similar motive.

[netglow, ASN, RN]

You know this is such an important thread that it should be in the general forum as it has such a monumental potential affect on everybody.