Who establishes the rules

[quizzical]

I am completely new to this forum. Maybe a lot of you would think I don't belong here. I actually am currently studying to be a Medical Assistant but might eventually go on to become an RN.

However in the Medical Assisting program I am in, there were several nurses who needed to learn phlebotamy , and there was even one doctor from Russia who's Russian MD was somehow insufficient for the US and was studying to be an MA or phlebotamist.

I would have some stories to tell about my Medical Assistant training but I

just want to begin by saying that I was taught quite a bit about medical ethics and it left me with a lot more questions than I ever had. Of course my experience as a patient (whenever I had to go to a doctor or the hospital) already had left me with a lot of questions that my enrolling in Medical Assisting training hardly answered.

There is a "closed" forum on this site about how nurses ought to deal with female patients when applying EKG leads on them. At MA training I was taught that it is appropriate to touch the female's breast using the back of the hand because this is considered less intrusive and if you use your palm it can be considered "groping" thus sexual harassment or assault.

(By the way, I was also told that the same technique would apply when you are dealing with a man who has gynecomastia ; and this is not mentioned much).

What I wonder about is who established such a rule and had it become a "universal" technique to be taught to all nurses, or medical assistants or EKG technicians, ( etc)?

Anyone know?

This will be my first question on this forum. I will probably have more of different kinds.

[roser13, ASN, RN]

Trying to move breast tissue with the back of the hand will usually make it take longer and make it more awkward than if you say, "I need to place some EKG leads under your breast to get an accurate reading, is it okay if I lift your breast for a second?" and then do it in whatever manner is quickest.

We never place leads under the breast. On top of breast tissue is our cardiology group's recommendation.

[nurseprnRN, BSN, RN]

Trying to move breast tissue with the back of the hand will usually make it take longer and make it more awkward than if you say, "I need to place some EKG leads under your breast to get an accurate reading, is it okay if I lift your breast for a second?" and then do it in whatever manner is quickest.

We never place leads under the breast. On top of breast tissue is our cardiology group's recommendation.

You know what? I just had my annual this afternoon, and they did an EKG, and that's exactly what they did. Surprised me.

[blondy2061h, MSN, RN]

Mmhm, I've always gone under. To the literature I go!

[quizzical]

I am not being a troll. If the question seems to be that of a troll, that is coincidental. Sometimes there are difficult albeit strange questions that need to be addressed at least for certain people.

I disagree with your "What does it matter" stance, "GrnTea."

If more of us knew who established certain guidelines that are largely followed, then we would have a better chance at directing our questions, and suggestions for changes to the right party.

I actually think that a much of things that medical personnel do is a violation of patient rights or there is great potential for it .

In the MA class I am in I had learned that doctors prefer to tell the patient as little as possible so that the patient cannot know about alternatives to certain procedures, and about his or her rights.

I could tell quite a few stories about how I found out who was in charge and who was responsible for running things and I complained to the right person and got my concerns addressed and got the right person to do his or her job right, and got things done . I had learned long ago that you just have to know who made the decisions and who has the authority to make them.

I guess that a lot of you can guess that I don't completely agree with those of you who are saying that my medical assisting training is useless and everything negative.

I have read lots of stuff on the internet about how medical assisting is very low-level and disrespected and insignificant type of work for people who have no other choices , or have little ambition, or who are too stupid etc etc..

Of course it can be true . A lot of people who become janitors, or doormen, or taxi drivers, or cashiers, or elevator operators, or who do any low-skill type of work could be just trying to avoid doing anything more daring such as going to school for at least 7 years to become a doctor, or trying to become a lawyer or rocket scientist etc etc.

This is actually a whole other discussion, but the harsh reality is that there are a lot of people for whom it is just not practical or realistic to try and do what only the brightest people will ever successfully do. There is a lot said about "going for it" and "never giving up" etc etc, but though some people succeeded by trying hard there are others who only came to realize that they are beating a dead rickshaw driver. Some people cannot hope to go into the best schools to pass all tough courses and be several degrees above the average person. A lot of people would like to go to medical school to become a doctor. I never got a chance to be one when I was of a younger age. I probably won't have a chance in my 50s even though I had heard a very unusual story of one woman who went to medical school in her 60s.

I actually never wanted to be a nurse. It is something that a lot of women become because it is easier than becoming a doctor or physician assistant. However I doubt I can spend 7 years and thousands of dollars to become a doctor now or anytime in the future, and a RN is above a medical assistant. A friend of mine who encouraged me to go back to school even if to first become an MA before becoming an RN, told me that there are thousands of jobs for RNs that don't involve dealing with patients and being by sick people's bedsides. She has known other people who had become RNs and got jobs that did not involve being among or dealing with patients at all.

I disagree that studying to be an Medical Assistant is completely useless if one decides to then go on to become an RN or perhaps other medical profession. I think that it helps. It does not hurt. It has a lot to do with public image and prejudiced ideas of other people.

I don't see how it is useless for nurses to know anatomy and physiology and using an EKG machine and medical ethics and some medical billing and coding.

I guess I won't change anyone's mind whose mind does not want to be changed, but though it is not the best occupation, it is decent . Some people just expect too much out of life. I read one post on an internet site saying that Medical Assistants "only" make some $30,000 measly dollars a year.

I think that the average person who gets up in the morning to live hand-to-mouth cannot ever hope to make that much in his/her life.

Of course I have seen a different side of life than other people have, too.

[klone, MSN, RN]

There is a lot I take issue with in your post that I wish I could go through with a fine-tooth comb, but I have dinner cooking on the stove. If one of my esteemed colleagues does not rebut, I will do so later tonight.

[JBudd, MSN]

First: I did not become a nurse because I am a woman and medical school was too hard. I became a nurse because I like nursing.

Second: Doctors do not routinely keep information from patients just to force them into doing what the doctor wants.

Third: It is only your opinion that medical personnel violate rights routinely, you have no idea what we put up with in order not to violate rights even when we know that people are making really bad decisions, we still respect their wishes.

Fourth: Nurses take a minimum of 6 college credit hours, usually more with lab, in anatomy and physiology, and we are the ones who put people of monitors and watch their EKG rhythms closely, not the tech who might run around running an EKG, which requires nothing more than knowing where to attach leads.

Fifth: the objection to MAs has to do with people being trained to do tasks, without any of the assessment or understanding of the principles of those tasks, being a nurse is far more than tasks.

Sixth: you sound very much like a poster who has started several inflammatory threads that disintegrated into name calling and insults about American medicine, and has been banned several times. If you don't want to sound like a "troll", then come here with an open mind, and actually read the responses you get with their rationales.

[OCNRN63, RN]

Why does it matter? My DH is a police officer, it is standard procedure to use the back of the hand when "frisking" a female detainee. THAT was most certainly brought about by the litigatious nature of America. Maybe its the same thing in this instance.

I agree. No one person or entity established this, and it isn't even a universal rule. Even if "someone" did establish this rule, how would knowing that change your way of doing an EKG?

This reminds me of when I was a nursing student. In post-conference, the instructor asked what the NPH in NPH insulin stood for. Blank stares all around the table. And once learning it, it didn't change how I gave insulin.

[OCNRN63, RN]

I am not being a troll. If the question seems to be that of a troll, that is coincidental. Sometimes there are difficult albeit strange questions that need to be addressed at least for certain people.

I disagree with your "What does it matter" stance, "GrnTea."

If more of us knew who established certain guidelines that are largely followed, then we would have a better chance at directing our questions, and suggestions for changes to the right party.

I actually think that a much of things that medical personnel do is a violation of patient rights or there is great potential for it .

In the MA class I am in I had learned that doctors prefer to tell the patient as little as possible so that the patient cannot know about alternatives to certain procedures, and about his or her rights.

I could tell quite a few stories about how I found out who was in charge and who was responsible for running things and I complained to the right person and got my concerns addressed and got the right person to do his or her job right, and got things done . I had learned long ago that you just have to know who made the decisions and who has the authority to make them.

I guess that a lot of you can guess that I don't completely agree with those of you who are saying that my medical assisting training is useless and everything negative.

I have read lots of stuff on the internet about how medical assisting is very low-level and disrespected and insignificant type of work for people who have no other choices , or have little ambition, or who are too stupid etc etc..

Of course it can be true . A lot of people who become janitors, or doormen, or taxi drivers, or cashiers, or elevator operators, or who do any low-skill type of work could be just trying to avoid doing anything more daring such as going to school for at least 7 years to become a doctor, or trying to become a lawyer or rocket scientist etc etc.

This is actually a whole other discussion, but the harsh reality is that there are a lot of people for whom it is just not practical or realistic to try and do what only the brightest people will ever successfully do. There is a lot said about "going for it" and "never giving up" etc etc, but though some people succeeded by trying hard there are others who only came to realize that they are beating a dead rickshaw driver. Some people cannot hope to go into the best schools to pass all tough courses and be several degrees above the average person. A lot of people would like to go to medical school to become a doctor. I never got a chance to be one when I was of a younger age. I probably won't have a chance in my 50s even though I had heard a very unusual story of one woman who went to medical school in her 60s.

I actually never wanted to be a nurse. It is something that a lot of women become because it is easier than becoming a doctor or physician assistant. However I doubt I can spend 7 years and thousands of dollars to become a doctor now or anytime in the future, and a RN is above a medical assistant. A friend of mine who encouraged me to go back to school even if to first become an MA before becoming an RN, told me that there are thousands of jobs for RNs that don't involve dealing with patients and being by sick people's bedsides. She has known other people who had become RNs and got jobs that did not involve being among or dealing with patients at all.

I disagree that studying to be an Medical Assistant is completely useless if one decides to then go on to become an RN or perhaps other medical profession. I think that it helps. It does not hurt. It has a lot to do with public image and prejudiced ideas of other people.

I don't see how it is useless for nurses to know anatomy and physiology and using an EKG machine and medical ethics and some medical billing and coding.

I guess I won't change anyone's mind whose mind does not want to be changed, but though it is not the best occupation, it is decent . Some people just expect too much out of life. I read one post on an internet site saying that Medical Assistants "only" make some $30,000 measly dollars a year.

I think that the average person who gets up in the morning to live hand-to-mouth cannot ever hope to make that much in his/her life.

Of course I have seen a different side of life than other people have, too.

It's a bad move to come on a website for nurses and then proceed to insult us. And FTR, we learn A&P in depth in nursing school. We don't need to learn medical coding/billing; that's the role of office staff. Most nurses know how to use an EKG machine.

I have to stop, because what I wish to say in response to this post will get me in deep trouble. Why don't you go to a website for MAs where you can discuss your role with your peers.

[OCNRN63, RN]

There is a lot I take issue with in your post that I wish I could go through with a fine-tooth comb, but I have dinner cooking on the stove. If one of my esteemed colleagues does not rebut, I will do so later tonight.

Please do. :)

[Altra, BSN, RN]

Common strategies to maintain the boundaries of both patient and caregiver when placing EKG leads include

1. using the back of the hand to move breast tissue, as you have noted

2. wearing gloves to prevent skin-to-skin contact with an intimate body area

3. placing a towel or other covering over the EKG leads as soon as they are placed - so long as doing so does not interfere with the tracing

I'm not arguing for or against any one of these specifically -- just pointing out that there is more than one approach derived from the same goal -- that of minimizing discomfort/embarrassment for the patient. None of these are "rules", though any instructor in any educational program certainly may teach one technique or another, for this task or any other task, and expect students to be able to perform a correct return demonstration of what has been taught.

If you object to the technique you've been taught, the mature thing would be to discuss it privately with your instructor, being prepared to elaborate on what you find objectionable and why. Instructors are human beings, so the response you get to voicing your concerns may range from permission to perform the task using an alternative method ... to good discussion about why your instructor prefers the method s/he is teaching ... to clear instruction that the expectation for the class is to perform the task as taught. Such is life.

Your posts drift from some concern with performing EKGs on female patients ... to more vague statements of dissatisfaction with the practice of healthcare. To that, I offer the following observation, based on my own personal life and career experience:

Those who enter a healthcare profession with a proverbial "chip on their shoulder" regarding past treatment or other perceived injustice do not tend to find satisfaction in "making everything right" with their own entry into practice. Along the way they either learn some underlying rationale for the practice that they, as a layperson, found objectionable and are forced to conclude that their uninformed opinion was not entirely correct ... or to learn that healthcare by definition involves humans of every stripe, every possible life circumstance, and not all are looking to be "saved" by a righteous healthcare practitioner. In my experience, those who enter healthcare professions believing their practice will be radically different from all those who have gone before are setting themselves up for the disappointment of being unable to attain unrealistic goals.

Wishing you well.

[nursel56]

Hi all.

I am the one who created this post. I have yet to fully learn how to utilize this forum.

I appreciate the replies but none really answers the question, who made the "back of the hand" rule?

It seems to be taught to every medical worker who will have to deal with the matter. Therefore, some "medical authority" must have thought it up and made it a standard to teach to all students of EKG or Medical Assisting ( etc). Was it the American Medical Association? ( It seems that they are very politically powerful and can make rules for a lot of medical personnel to follow).

Thanks to anyone who can provide info. Maybe some of you can ask a teacher or professor whom had taught it to you.

Having worked in lots of ambulatory care settings I've done lots of EKGs with lots of machines on lots of people and have to agree with the others regarding no "authority" making a back of the hand rule, which I wasn't aware of either, though it makes sense. I always communicate with a patient throughout what I'm doing and what I need/plan to do so can't recall a time when my hand position would be an issue either way. I'm always open to new developments on best practice though!

[blondy2061h, MSN, RN]

Honestly we didn't learn how to do EKG's in nursing school. Technical programs will focus on skills like that. Nursing programs are more likely to focus on indications for EKG's, the different parts of the heart each lead looks at, interpretation of EKG's, and causes and treatments of different dysrhythmias. Actually doing an EKG is a 10 min on the job crash course.