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.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
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.
That's about it in my state, too. There is no minimum amount of formal education needed to be an MA if a doctor hires you and trains you. My own feeling is that a good part of it can be explained by increased amounts of red tape and more stringent reimbursement procedures that affect the doctor's bottom line -- so they are making up the difference by hiring MAs instead of LVNs, LPNs, and RNs. I worked in the ambulatory care arena for 8 years. Even at that time, it was rare for an RN to be working in a private practice.
I don't think you can use length of time to ability to perform in a particular healthcare setting, because if you spend your year in an MA class you will learn things not taught in LPN school such as taking of simple X-Rays, billing, EKGs, simple PT functions and things like that. The only two things in my state that are strict no go for an MA are the offering of advice via telephone and patient assessments. It sounds like from what I am reading that MAs routinely function as a telephone triage nurse and assess if giving someone the go ahead to have surgery. Anyone who thinks that a doctor in his own office with his own employees is going to stick with the letter of the law as far as those two things is probably not being realistic.
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....
If I really valued my PCP I would need to tell him about that one! That is truly scary.
I'm confused OP. Are MA's & CNA's doing pre-op assessments, teaching, getting pre-op signatures from patients, & starting I.V.s, ect?!
elprup
"At my place they do everything! As the only RN (new grad, new job)
it scares me to death! "
I don't know about your state, but in CA the RNs are responsible for delegation. If ancillary staff is doing things that RNs cannot legally delegate, I would expect some clarity about accountability. If the MDs are willing to be accountable for ancillary staff practicing nursing without a license, that is their business. However, I would notify the State Board of Nursing if it's not clearly written and understood that I am not supervising. I don't care how great the MA or CNA is. I am not risking my nursing license for anyone. CYA sister.
I'm confused OP. Are MA's & CNA's doing pre-op assessments, teaching, getting pre-op signatures from patients, & starting I.V.s, ect?!
Yes, they are, in the surgeon's office (not starting IV's, but all the rest). And so the ASC receives a patient one hour pre-op and sees:
*An H&P filled out by the surgeon's MA that has no detail, only a check in the box: "All systems negative." MD"s stamped signature.
*A list of meds a mile long that includes: Digoxin, nitro, lisinopril, warfarin, prednisone, Metformin, etc., etc. The MA (calling herself Dr. H's nurse) who filled out the "assessment" didn't have enough basic understanding of anything to connect the dots and realize that some relevant physical conditions must be present.
*A patient that is elderly, frail, incoherent and confused. Accompanying elderly spouse cannot contribute much to the assessment either. It appears to be a miracle of some sort that they made it to the ASC at all.
*A patient who has been instructed to "hold all meds" and has not taken their digoxin, metformin or advair for 5 days.
*No after-care arranged.
I could go on and on and it happens every single day. The nurses and anesthesiologists are constantly scrambling to accurately assess the patient in the one hour that we have pre-op. Poor Anesthesia bears the brunt of providing safe care to an inadequately prepared patient.
Do I blame the surgeon? Of course I do, but I'm never going to change the "cut and run" mindset. I'm just finding the whole situation scary. Back in the day () when an RN was assessing the patients in the surgeon's office, these types of patients were vetted and cleared (cardiac, pulmonary,etc.) before setting foot in the ASC.
As a CNA (in RI. that is 120 hrs schooling, 2 wks clinicals and a license required) I would not WANT to put myself in the position of doing anything out of my SOP. I have refused to hand a pt. her meds per request of my nurse, hook up mr. !@#@ oxygen, per request of my nurse and a few other things. I have a license that would be in jeopardy too. If I expect to continue on in the medical field, I had better keep my license in good standing. Really, I think it is the MDs offices that encourage this over stepping of the SOP to save money.
On a personal note, several years ago I had to call my sons ped. office. He had some unusal symptoms. I am thankful for the RN who said "call 911 immediately, DO NOT drive him to the hospital" I followed her instructions and we were at the ED when my son had a major trauma occur that hospitalized him for 3 months and left him disabled. His original symptoms were so unusual, but not serious, I had no idea he was in a life threatening situation. Had it not been for an experienced RN who recognized those symptoms as early onset to his problem, he may not be here today. I will take the nurse over the MA everytime when I need medical advice. And I would never give med. advice. I need to keep the safety of others in mind too.
Specializes in Management, Emergency, Psych, Med Surg.
When unlicensed/ or minimally qualified staff work under the supervision of the MD in an office or clinic setting, they essentially work under his license and he/ she is responsible for the supervision/ actions of that person. If something goes wrong, the doctor is held accountable. When an RN works in that setting, he/ she is bound by the nurse practice act but he/ she usually works for the physician group. This can be a double edged sword depending on the quality of the physician.
I'm confused OP. Are MA's & CNA's doing pre-op assessments, teaching, getting pre-op signatures from patients, & starting I.V.s, ect?!
elprup
"At my place they do everything! As the only RN (new grad, new job)
it scares me to death! "
I don't know about your state, but in CA the RNs are responsible for delegation. If ancillary staff is doing things that RNs cannot legally delegate, I would expect some clarity about accountability. If the MDs are willing to be accountable for ancillary staff practicing nursing without a license, that is their business. However, I would notify the State Board of Nursing if it's not clearly written and understood that I am not supervising. I don't care how great the MA or CNA is. I am not risking my nursing license for anyone. CYA sister.
I am in CA too. This is the reason I am so not going to be the supervisor! Thank you for your guidance. I am going to call the Board as well to make sure I am not considered the supervisor either, which I am not, nor do I want to, nor am I even getting a decent wage. I am so going to talk the doctors as well. Thanks again.
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.
Thank you for pointing that out. It took me 2 yrs to complete my pre-req's then 10 months to complete the LPN Diploma Program. We were then told that we could sign up for the Bridge Program and obtain our RN in 1 year instead of two. It is very frustrating to have the first 2 yrs of my education discounted.
Specializes in Oncology; medical specialty website.
MA or PA?
No, she was an MA. She said she's taught residents how to suture, give injections, calculate medication dosages, etc. It's on the thread about "Are nurses smarter than doctors?" or something like that.
) when an RN was assessing the patients in the surgeon's office, these types of patients were vetted and cleared (cardiac, pulmonary,etc.) before setting foot in the ASC.
nursel56
7,122 Posts
That's about it in my state, too. There is no minimum amount of formal education needed to be an MA if a doctor hires you and trains you. My own feeling is that a good part of it can be explained by increased amounts of red tape and more stringent reimbursement procedures that affect the doctor's bottom line -- so they are making up the difference by hiring MAs instead of LVNs, LPNs, and RNs. I worked in the ambulatory care arena for 8 years. Even at that time, it was rare for an RN to be working in a private practice.
I don't think you can use length of time to ability to perform in a particular healthcare setting, because if you spend your year in an MA class you will learn things not taught in LPN school such as taking of simple X-Rays, billing, EKGs, simple PT functions and things like that. The only two things in my state that are strict no go for an MA are the offering of advice via telephone and patient assessments. It sounds like from what I am reading that MAs routinely function as a telephone triage nurse and assess if giving someone the go ahead to have surgery. Anyone who thinks that a doctor in his own office with his own employees is going to stick with the letter of the law as far as those two things is probably not being realistic.