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]

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.

Couldn't agree more. And I strongly disagree that anyone has disparaged the position of medical assistant.

[roser13, ASN, RN]

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.

If you actually were taught that, then shame on your instructors and shame on your school.

And if you actually believe that to be a true statement, then shame on you. You have no business working anywhere near the practice of medicine if you believe that to be an accurate depiction of medical professionals.

[nurseprnRN, BSN, RN]

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.

There's a difference between "guidelines," which word has a particular meaning in med/legal and clinical settings, and common practices. You apparently seek to have some authoritative (another very specific word) source for the back-of-the-hand practice. You will not find one, and if you have a bone to pick about it, I refer you to the authoritative bumper stickah: "Don't like (a controversial procedure)? Don't have one." If you have a better way to move a breast that meets the patient's right to be treated respectfully, that's the one you use and teach if the occasion arises. Otherwise, stand down. That's why it doesn't matter, and I stand by that.

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.

You are entitled to your opinion, although I question your interpersonal skills if you think this is a good place and way to express it. If you truly believe that someone's actual rights are being "violated," per the ethical guidelines that govern all clinical practice, then your obligation is not to go on a crusade to identify the origins of a policy but to report to your charge, the ethics committee in your facility, or, failing that, the state ombudsman.

As to potential, this is why there are ethics committees or consults. I don't go around using nebulous thinking along the lines of, "Gee, we see and touch people's private areas, and some people are pervs, so therefore there is potential for patient abuse by pervy nurses and techs, and so I have to find out who made the rule about moving a breast to place leads to prevent ...." and the brain is off and running. Back up and take a deep breath. Steady on.

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.

You may also be surprised to learn that you are not unique in your ability to perceive opportunities for improving practices, routines, regimens, and policies, and influence change. However, this particular windmill isn't deserving of your tilt. I wonder why you are so fixated on it, and why a simple question (that has been clearly answered by people with a lot more experience) has caused this flight into realms fantastic (in the original sense of "fantasy").

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.

:: drily :: No, you may have noticed nowadays that women who want to be physicians go to medical school. Women (and men) who want to be nurses go to nursing school. Even though the years of education until entry into practice are different, if you think that being a nurse is easier than being a physician, well, that's an attitude that will probably change when you have some actual experience over time. Your assumptions are misleading you again.

As to RNs being "above" MAs, we are licensed and have legal and ethical obligations in patient care that far exceed those of MAs, this is quite true. The ANA definition of nursing is:

"Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of the human response, and advocacy in the care of individuals, families, groups, communities and populations.” (ANA, 2015) You can see the difference between this and being a medical assistant.

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.

There's a term in law that says something like, "Everything you say is true; so what?" That applies to the above. I did bedside patient care for a long time in many settings. Then I practiced as a nurse in non-bedside settings in the community in the insurance/legal realm. Now I practice as a nurse in non-bedside settings and do have occasion to do personal assessments of clients, but most of my work does not involve personal contact with patients in a care setting.

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.

Again, you're entitled to your opinion, and to spend your time getting whatever education you want in whatever sequence you like. However, MA is not a step towards nursing, and will not put you at any advantage over naive-to-patient-care students from more than a few weeks of Nursing I. Everybody learns to take vital signs and do other small tasks related to patient care pretty fast. The vast majority of nurses won't have occasion to do EKGs or phlebotomy that often ... MAs and techs do those tasks. So they won't even look helpful on your new-grad resume. If you decide to be a nurse.

And with that, I think I've wasted entirely too much time on this hash of misapprehensions, confusion, and delusion. Good luck to you, whatever you do.

[psu_213, BSN, RN]

I'm not sure where the rant about nursing and medicine came from, but, all I will say it that is was filled with far too many half truths and far too much misinformation for me to address.

As for the back of the hand "rule"-- there isn't one. If there is any rule, it is a rule of common sense--i.e., it was not created by any one person or individual; it was created by the standards of a civil society. The rule is "don't violate someone's sense of dignity," or, in a more selfish sense "don't get accused of sexual harassment/assault." To say that the "back of the hand" is the only way to accomplish it is just not true. I know one male tech that has every female lift there own breast if they are able. If not, he brings a female chaperone. I announce what I'm going to do ("I'm going to gently lift your breast so that I can attach the EKG leads to get an accurate picture") then use a cupped hand to lift the breast while I apply electrodes. This seems to be a more stable way to lift a breast, especially if it is particularly large, than using the back of one's hand. Perform the EKG, remove leads, cover the patient.

And, just because people know who created a rule, it does not necessarily make individuals more likely to follow it.

[Red Kryptonite]

I just lift the breast by the nipple. The most minimal touching I can think of!

I really, really hope you're kidding.

[BuckyBadgerRN, ASN, RN]

Oh boy, the op came back, I got excited! And then, I read her post. I'm on my phone and all I could think was "I'll never get to respond point by point!" Alas, i don't have to, the many eloquent posters here on an have it covered!

and ftr, it was me who asked "what does it matter"?, not grntea :). My point was, if you don't like this rule (as you call it) are you going to track down whomever said it and verbally duke it out with them? I don't like the rule that says it have to wear shoes in a building--who do I take thT up with? The point is, it's a rule, easy to comply with, just do it