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Why are Unlicensed Staff Allowed to Call Themselves Nurses and Perform Illegal Clinical Duties?

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by Nurse Beth Nurse Beth, MSN (Columnist) Educator Columnist Innovator Expert Nurse

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

Dear Nurse Beth,

Why aren't State Nursing Boards protecting nursing positions in healthcare? More and more businesses are utilizing unlicensed/uncertified staff to perform a multitude of clinical duties, illegally. Furthermore, the same unlicensed/uncertified staff often refer to themselves as nurses to an unsuspecting public. It seems to be most prevalent in the southern states, and rural areas. Why is this being allowed to continue? 

Dear Why is This Allowed,

Not only is an individual who is not a nurse calling themself a nurse disrespectful and unethical, but it's also a crime in all states. This is because it can be viewed as practicing nursing without a license.

Here's an example from the California legislature:

"In the interest of public safety and consumer awareness, it shall be unlawful for any person to use the title "nurse" by any individual except for an individual who is a registered nurse or licensed vocational nurse."

It's also disrespectful because those of us with an RN license worked hard to earn it. It has meaning. It is not OK for us to not protect our professional title. Speak up when you are witness to this behavior. 

Medical assistants in doctors' offices sometimes misrepresent themselves as nurses, and it's grossly misleading to the public. Patients will assign more weight to information given by a registered nurse than to information given by a medical assistant.    

Without specifics on the duties you say are being performed illegally, it's hard to comment. Regulations vary according to setting and oversight. Unlicensed assistive personnel (UAP) working under the license and general supervision of a provider in an office setting, for example, can administer injections and give some medications, but the same individual could not do so in a hospital.

There are no standard educational criteria for medical assistants, so the scope of practice varies from state to state and from provider to provider. One problem is that there is no governing body, such as the BON, or the Department of Consumer Affairs (DCA), because they are not licensed or certified. The DCA is a licensing entity that issues and oversees licenses, certificates and permits.

Typically they cannot diagnose, treat, or perform invasive procedures (such as start IVs).

They can perform EKGs, take vital signs, draw blood, administer immunizations, even remove sutures and change dressings.

When RNs delegate to unlicensed assistive personnel (UAP), the responsibility remains with the RN. The ANA and our state associations provide guidelines for delegating. These include that the assigned task falls within the scope of the UAP, and that the UAP has had the required training. The RN must ensure appropriate supervision.

I would love to hear more specifics and examples you've encountered. Thanks for sharing,

Nurse Beth

Ruthie Nurse

Specializes in ER. Has 36 years experience.

As a past clinical coordinator in an orthopedic surgery office this would happen all the time The medical assistants where working with wound vacs x fixes etc even doing triage When  I would  try to tell management they were out of their scope of practice I was told they work under the doctor’s umbrella and his license and if he was OK he takes on the responsibility I left that job after they demoted the nurses and promoted the medical assistants to their clinical team led positions 

Hoosier_RN, MSN

Specializes in dialysis. Has 28 years experience.

39 minutes ago, Ruthie Nurse said:

As a past clinical coordinator in an orthopedic surgery office this would happen all the time The medical assistants where working with wound vacs x fixes etc even doing triage When  I would  try to tell management they were out of their scope of practice I was told they work under the doctor’s umbrella and his license and if he was OK he takes on the responsibility I left that job after they demoted the nurses and promoted the medical assistants to their clinical team led positions 

And those poor MAs never realize if something goes south, the Dr will throw them under the bus and hit the gas.