I always thought that I had a decent understanding of the current evolution of certain parts of the healthcare delivery process: specifically the trend toward MD offices no longer hiring licensed nursing personnel and instead choosing to hire and train MA's to carry parts of the role of the licensed nurse. I have somewhat resigned myself to the trend, considering that (a) I have no choice in the matter, and (b) I deal with the fall-out day in and day out in my position as a pre-op RN in an ASC (i.e., dealing with patients who are totally unsuitable for an ambulatory surgery center, but no one who "assessed" them understood that). At the same time, I thought that the assistive personnel who were filling positions previously occupied by nurses understood the scope of their positions.
However, several recent posts have me wondering if I really do understand what's going on. There are MA's that sincerely believe that they are "doing the job" of a licensed nurse. They apparently believe that their MA courses are on a par with accredited nursing program courses. They do not seem to understand the concept or value of a professional license. And then there's the apparent turf war between MA's and CNA's...MA's rank higher than CNA's?
Am I seeing this trend accurately? I am seriously starting to question where healthcare delivery is headed.
I was shocked as a nursing student. They had me follow the MAs around. The clinic that I was a student nurse in had the MAs room the pts and do other procedures w/in their scope of practice. The LPNs and RNs would do the injections, whatever the MAs couldn't do, and return the phone calls. Well I now attend that clinic.
2 things of note have happened in that time. I went in to see a PA and we were talking about what I'd come in for...she said OH my nurse charted it was ANTERIOR thigh...I said NO it is the POSTERIOR part of my leg. And I believe she is your MA and NOT your nurse. The PA laughed and said oh I know this, it's just easier to call her my nurse. I did clinicals there and the MA was one I'd followed around.
The other thing happened at my job. I called this same clinic (from the nursing home I work at). When you call this clinic you can press a # for the nurses line (which goes straight to voice mail). I called and the MA called me back. When I spoke with her I instantly recognized her voice and name as another MA I'd shadowed! She said this is Dr. B's nurse and I spoke with her and at the end of the phone call I said aren't you so and so the MA I followed. Shd said oh yeah hi B. I said you told me your were his nurse, but you aren't. She then laughed and said well I am his nurse! I said NO, if you didn't go to nursing school and sit for your state boards then you aren't his nurse! She made some other snotty comment. I then told her she should be proud of her title and announce when she is a MA.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
MAs are trained to be "doers" for physicians. CNAs are trained to be nurse extenders. They are completely different roles and jobs.
Clearly the for-profit model of health care delivery has been moving more expensive RNs out of the primary care office "mix" for some time now. It is not at all uncommon to visit a physician office today that has only MA staff to assist the physician and care for the patient. The less financially lucrative the practice the less likely it is to pay an RN. I suspect this may well be more common in some of the primary physcian practices in our poorer communities. Of course, these are some of the very communities where health behaviors and outcomes are worst.
We are the health professional discipline whose primary role is that of patient advocate...in all health arenas, we are sort of trained to be "case managers" for the individual patient's health and care across the spectrum of age. A large part of our discipline is centered upon assessing our patients for ANY deviation from the "norm". Based upon that assessment and diagnosis, we determine what the patient needs to return to the baseline and create a plan.
Our plan allows us to educate the patient and interact with them to improve their health outcome. The loss of this consistent nursing oversight and planned one on one education based interactions in the physician office setting will, ultimately, adversely affect the health outcomes of the patients of those practices. I believe we may already be seeing the affects of that.
Many people have very little experience with RNs outside of the urgent care or acute care setting. Too many IMHO.
I have said it before, and I will say it again- the PTB are trying their best to figure out ways to eliminate nurses. Our low levels of education only encourages this practice.
PTs, OTs, SLPs, Pharmacists, etc. They have ALL INCREASED THEIR ENTRY INTO PRACTICE!!
Why did they do this? To differentiate themselves from lesser skilled/educated personnel. And make more money.
When a Doctorate degree separates RPTs from PTA's, it is a little harder to sell to the public that these lower educated PTAs can replace them, and to the same work, as a doctoral prepared, Physical Therapist.
Now lets look at nurses. An RN can enter the profession with a Diploma, an Associates Degree, or a BSN. LPN/LVNs can enter the profession with only one year of post HS education.
And Nurses Aides?assisitants (CNSs), their training can consist of a few weeks of OJT!
How does that make nursing look? How do me measure up to the other members of the Health Care Profesisons who we intermingle with on a daily basis?
Is there any reason that hospitals, physicians offices, etc, find it easy to replace RNs with Medical Assistants, and Nurses Aides? We are making it easy for them to replace us. Hospitals and nursing homes, will soon follow suit, if they haven't already started.
How hard it is to sell to the public, "well, these medical assistants have almost the same amount of education as LPNs/LVNs". And they are right.
RNs aren't a lot harder to explain, with only two years of post HS education. Many nurses complete their AAS degree in two years by concurrently taking pre-requisites with nursing classes.
The fact is, the PTB are trying to replace us by deskilling our professional practice, and most of us have no power/control to stop it from happening.
I had a major health issue and called my PCP's nurse line. Apparently the RN was off that day. The person who called me back identified herself as Dr. H's nurse. She listened to my concerns and then stated "I'll call you something in," which is EXACTLY WHAT SHE DID, without even notifying my doctor that I had called. Called in an antibiotic she apparently chose at random on her own!! My problem was an arrhythmia!! To make a very long story short I ended up in ICU because I needed immediate help and a medical assistant made the choice to deny me access to medical care. This one bypassed practicing nursing without a license and went right on to practicing medicine!! Note: she doesn't work in the "medical field" anymore....
Its all about money. They can pay the MA's much much less than nurses to do the same job.
I understand the motive. But are "they" teaching the assistive personnel that they are the equivalent of licensed nursing staff? That's what's taking me by surprise and, by the same token, frightening me with the risk potential.
I'm not sure increasing nurses education and therefore their salaries is going to allow them to compete when the driving force for their being replaced by unlicensed personnel is primarily financial. If RNs worked at MA wages the RN's versatility would eventually squeeze the MAs out.
Specializes in Emergency Dept. Trauma. Pediatrics.
I have said it before, and I will say it again- the PTB are trying their best to figure out ways to eliminate nurses. Our low levels of education only encourages this practice.
PTs, OTs, SLPs, Pharmacists, etc. They have ALL INCREASED THEIR ENTRY INTO PRACTICE!!
Why did they do this? To differentiate themselves from lesser skilled/educated personnel. And make more money.
When a Doctorate degree separates RPTs from PTA's, it is a little harder to sell to the public that these lower educated PTAs can replace them, and to the same work, as a doctoral prepared, Physical Therapist.
Now lets look at nurses. An RN can enter the profession with a Diploma, an Associates Degree, or a BSN. LPN/LVNs can enter the profession with only one year of post HS education.
And Nurses Aides?assisitants (CNSs), their training can consist of a few weeks of OJT!
How does that make nursing look? How do me measure up to the other members of the Health Care Profesisons who we intermingle with on a daily basis?
Is there any reason that hospitals, physicians offices, etc, find it easy to replace RNs with Medical Assistants, and Nurses Aides? We are making it easy for them to replace us. Hospitals and nursing homes, will soon follow suit, if they haven't already started.
How hard it is to sell to the public, "well, these medical assistants have almost the same amount of education as LPNs/LVNs". And they are right.
RNs aren't a lot harder to explain, with only two years of post HS education. Many nurses complete their AAS degree in two years by concurrently taking pre-requisites with nursing classes.
The fact is, the PTB are trying to replace us by deskilling our professional practice, and most of us have no power/control to stop it from happening.
JMHO and my NY $0.02.
Lindarn, RN, BSN, CCRN
Somewhere in the PACNW
I am not sure how it is at all schools, but at my school (both CC I went to) the pre reqs for the Associates degree for the RN required a minimum of 1.5 years of Pre Reqs that could not be taken with the program. The Pre Reqs were taken before you could even apply for the program and it was full time courses. I did most of my Pre Reqs in WA which was on quarters and not semesters and I got majority of my Pre Reqs done in 1.5 years, I was doing 17 credits a quarter average.
Here in CO they are on Semesters so you can't knock out as many as fast but I got my Co Reqs done here before entering my 2 year program. So after all is said and done I spent 4 years and it's always assumed it's just 2 years. The actual nursing program with strictly nursing classes may be 2 years, but all the education required before entering it is more than 2 years. Even if my school allowed Pre Reqs to be taken during the program it wouldn't be doable. The nursing program is a full time program credit wise and than we have clinicals on top of that.
Anyway, again I am not sure if it's like this at all other schools but it's frustrating to always hear people talk as if it is only 2 total years of college from start to finish when it's not. My school has an option after you pass the first year of the RN program you can take a 2 week transition course in the summer and do x amount of clinical hours and be eligible to sit for the LPN boards but even doing that you still have to have the same pre reqs so it's still about 2.5 years of college classes full time to get your LPN.
In many states, a physician may oversee anyone doing anything. For years many docs trained their unlicensed help to give all manner of injections, from vaccines to allergy shots, draw blood, get vitals, etc. This was on the doc's own license.
But PLEASE don't call them nurses. They are office help.
Wowzer. Now I understand why all the docs at my clinic are
worried about the MAs not doing their jobs correctly. It's under
their license. All the stuff I see.....scary indeed.
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Butterfliesnroses
348 Posts
I was shocked as a nursing student. They had me follow the MAs around. The clinic that I was a student nurse in had the MAs room the pts and do other procedures w/in their scope of practice. The LPNs and RNs would do the injections, whatever the MAs couldn't do, and return the phone calls. Well I now attend that clinic.
2 things of note have happened in that time. I went in to see a PA and we were talking about what I'd come in for...she said OH my nurse charted it was ANTERIOR thigh...I said NO it is the POSTERIOR part of my leg. And I believe she is your MA and NOT your nurse. The PA laughed and said oh I know this, it's just easier to call her my nurse. I did clinicals there and the MA was one I'd followed around.
The other thing happened at my job. I called this same clinic (from the nursing home I work at). When you call this clinic you can press a # for the nurses line (which goes straight to voice mail). I called and the MA called me back. When I spoke with her I instantly recognized her voice and name as another MA I'd shadowed! She said this is Dr. B's nurse and I spoke with her and at the end of the phone call I said aren't you so and so the MA I followed. Shd said oh yeah hi B. I said you told me your were his nurse, but you aren't. She then laughed and said well I am his nurse! I said NO, if you didn't go to nursing school and sit for your state boards then you aren't his nurse! She made some other snotty comment. I then told her she should be proud of her title and announce when she is a MA.