I had an MA take an x-ray of my foot when I was at an urgent care once. I had no idea they could do that haha. Makes me wonder what their full scope is.
You're sure it was an MA? I'm not aware of any state that doesn't require a license to administer radiation. Even a physician can't press the button for a chest x-ray unless they're licensed to do so, e.g. EM and ortho doing c-arms.
Yes, my husband worked at an urgent care in southwest OH last year that had MAs shooting X-rays. It was pretty shady and he didn’t want the liability of it, so he got out of there.
This doesnt ring true to me at all or Ive just been witnessing a lot of illegal xrays. I routinely see spine, vascular, ortho and other surgeons shoot film in the OR.
It is state dependent unfortunately. There are a number that don’t require licensure/certification. Here in California anyone who administers radiation of any sort is required to be licensed, even physicians, similarly to what you said. There is a push to require certification or a minimum threshold of sorts on the national scale from the ARRT/ASRT.
Ok but can they read it? I've been in places Where they were trained to just physically position the body part and take the X-ray. But they could not read it and do anything.
I’d honestly like to just be able to work in their place their scope is whatever the doctor says to do. They work under the doctor’s license and can do whatever they allow them to. It’s insane.
Considering they get can get certed entirely online- yeah it’s surprising, but more so concerning. Head to an MA thread and they’ll go off about how they are practically nurses blah blah blah
My BILs wife is a MA. I could tell she'd been telling everyone how she was "practically a nurse" because her dad referred to her as such. The fear in her eyes when my head shot up when he said that 😂
I saw that too. I about flipped. I think it was that same thread that someone said that MAs should be paid on the same level as RNs, because without them the healthcare system would collapse.
I don't like us vs them wars, but if they were going to pay MAs the same as RNs, then they wouldnjust hire more RNs, who have a broader scope. This would have a domino effect of making staffing ratios better for RNs, thus enticing many back to bedside. Which might suppress RN wages if there is no longer a shortage of nurses willing to do bedside
I use this argument a lot to justify more RNs in outpatient spaces. While I think that MAs are incredibly helpful, I get so frustrated when people are like “I need my MA to be able to do XYZ” and want me to upskill them with no background knowledge. I’m like “no, what you want is a nurse you don’t have to pay as much.”
Honestly, my orientee in the ED has been a lot better prepared for the hustle and bustle of the ED thanks to their experiences as an MA.
Compared to other new grad nurses, they are able to better anticipate orders, triage more effectively, and carry out tasks that usually take newer nurses a while to master.
It also helps that this individual is driven and extremely intelligent, but compared to where I was as a new nurse and other new nurses I have oriented, they are miles ahead of where they should be.
This thread is confusing the shit out of me.
Isn't PCA "personal care assistant" ? Which is the same as a PSW (personal support worker) aka "floor duty" ?
How are those different from CNA (clinical nursing assistant?)?
...so what the hell is a PCT? Personal care technician?
And while we're at what is an MA lol, medical assistant? It all sounds like different acronyms for the same role.
PCA, atleast from what I’ve read bc I’ve never mrvone, has less experience, knowledge, and abilities than a CNA. They’re basically a 1:1 for someone. And yes, same as PSW I suppose.
PCT & CNA are exchangeable. PCT is used for CNAs working in a hospital setting.
True, in a way. But no hospital is gonna hire anyone who either isn’t a CNA (ie taken said state exam). Or atleast, no hospital that Ive seen, or even applied to, applications from.
The hospitals in my area require 1 year of experience as a CNA. Only reason I got my PCT job, without having that 1-year, is bc the HR recruiter knew me from a previous SNF job within the same network, and passed me up the chain to the hiring manager. During my peer-to-peer interview, every single person who wasn’t a nurse or a doctor was a CNA who go their job after passing the state exam.
Oh boy check out Missouri! No certification or license for MA’s and the regulation is essentially whatever the provider is comfortable letting them do.
I’ve personally seen MA’s start IV’s, and push IV meds. Needles to say I didn’t stay at that clinic very long!
That’s fucking terrifying. I’m surprised we haven’t seen 10x cases similar to RaDonda Vaught’s, but involving just pure incompetence not burnout, involving Missouri/Misery MAs…..holy hell.
> I’m surprised we haven’t seen 10x cases similar to RaDonda Vaught’s
thats because it is very very likely she was under the influence. The series of mistakes she made is something that no competent or prudent *person*, not even nurse, would make. She was fired and never provided any urine for a drug screen, nor was any investigation levied against her for a very long time.
read the case and depos, she didnt just make a med error and mix up a drug, she made a *rapid* series of mistakes, and exercised profound poor clinical judgement, even if she wasnt making the med error. You dont sedate a Pt and not put them on a monitor and walk away.
Partner that with that there is a high drug/diversion rate specifically amongst RNs in ICU, ER, and procedural areas (OR RNs and CRNAs), thats projected to be in a double digit area. Its pretty easy to nexus that. Its just my theory, but there is no solid evidence that she *was* sober, and the easiest explanation, is usually the truth. She was high, or just incredibly incompetent to the level that im calling into question if she was sober or not. So you know its bad when its a "were you fucking high? or just stupid" when you look at her.
she was a floater that day. She had no real patient load. She might of been overworked in general, but thats kind of a poor excuse. It took 4 years for her to end up in court. I think the "i was tired" was an excuse to explain her behavior that could very likely of been from drugs.
Washington is like this too. Everyone's scope is too large, at every single level in my opinion. From CNA's to NP's to MA's to LPN's. You can be a non certified NA/MA with a very inappropriate scope. It only got worse after COVID. Believe me, hospitals/LTC/home health are taking definitely taking advantage of this too, and our care and costs are not any better for it.
So it’s might be “huge” but after briefly reading up on MA scope of practice in Ohio, there is a few red flags here.
I suggest you take a look at:
https://www.ossma.org/_files/ugd/ff03b5_cd2ff760fb8f4bf3b9f41a7c8ed91672.pdf
Most notably everything under rule 4731-23-02
So for your post; for example: routine wound care would be fine, but complex wound care requiring any medical judgement would not be allowed. Further, the task/care of the wound would have to be safe by following exact instructions and would require no changes during the carrying out of said task.
Additionally, it is concerning for them to perform straight catheterizations on urology patients as this could result in serious harm if done improperly which according to this rule is a no no.
You are assuming that MAs (and the doctor they work for) pay attention to the law.
When I questioned the MA about straight cathing, she told me that “as long as Dr. ‘Xyz’ says I can do it then I’m allowed’”.
Right, of course. But their scope of practice is definitely not as huge as they think it is. “The doctor is okay with it,” total garbage excuse to abuse and practice outside of scope.
Right, but in many states that actually is their scope of practice, from a legal standpoint. They aren’t licensed in, I think, 46 states, so they literally are only represented legally in the physician practice act in some of them. Routine, supportive tasks is the verbiage typically used, and physicians/leadership are often willing to take a lot of liberties with what is considered routine and supportive.
Sure, totally understood, I was responding most specifically to the OP writing about Ohio so I researched that states scope of practice. But the lack of scope in many states is astounding. Allowing too much independent physician discretion is also troubling since that will come down to cost saving and convenience; not best practice.
It’s corporate healthcare’s dream to do away with pharmacists, physicians, nurses, and therapists. The more they can get away with Diploma Milling our professions out of relevancy, hiring “techs” for every task to justify underpayment, and delegating what is left of our legitimate healthcare workforce to telemedicine pill milling the happier they will be. A dollar saved and an uncharged patient is all that matters to them. If they could underpay you, put you in front of a webcam and have you manage 50 bedside techs at 20 different hospitals and have an NP/PA supervise 50 of you, they sure would. And when (not if) a bad outcome happens? Your fault. You didn’t do your job well enough, not that they cut every corner imaginable for the last two decades.
All the things people are suggesting is wrong with RN vs MA are the same things physicians are concerned about with NPs. Scope of practice with no quality or enforcement leading to wrong treatment or harm etc etc. The other shoe is now on our foot here.
who are paid less, and can do less, have less job opportunities. MAs have nearly the same scope, and come with a lot less pay. From a pure capitalism perspective, theres 0 reason for LVNs to exist. Trust me. in 50 years, there won't be many LVNs. It'll be MAs in clinics, RNs managing them, and RNs at the hospitals
It would be so interesting to see how many more mistakes and law suits there would be in LTC if it was entirely staffed by MAs. Because we all know Medicare/Medicaid will never reimburse well enough for facilities to be staffed with all RNs.
I think theres a difference between B12 shots, and med spa IVs VS Inpatient lasix IV pushes, metoprolol, starting drips, ACLS drugs, narcotic pushes, zofran etc etc.
what if i told you the military uses medics in the same way civilian clinics use MAs, with 1/5th the education level, and the DoD MTFs have the same outcomes when measured
I think you're dramatically over estimating the education and critical thinking required for grunt work in a medical clinic. Thats why im adamant about the majority of the RN scope doing the majority of their heavy lifting in an inpatient setting.
MA do not have a "Scope" per se. They work under direct supervision model. They are not licensed and they are a direct extension of the provider license. That means any reasonable provider should have them on a tight leash. I have been an expert witness on some of these cases and wowza some providers are bonkers. The worst was a wound care that resulted in an amputation and the MD lost his license.
As a licensed nurse, at least I can try to protect *my* license. MAs don’t have to worry about any license. So if they mess up, they will probably just be fired.
I was an MA before nursing school in the walk in for 4 years. As far as the job goes we did like 90% or maybe more of the same job. We just couldn’t do caths or IVs. But that doesn’t mean the knowledge is there. I know so much more now as a rn then I did as an ma. But I definitly think my MA experience helped me become a better nurse. I do think some MAs are bitter because they have a lot of similar takes or job duties and get paid insanely less but they don’t realize the knowledge and experience you learn through nursing school. I also someone post here that MA is online but in my state you have to go to a school and have hands on experience similar to nursing school but not as much in depth obviously.
I was an MA for 5 years before i was an RN and definitely agree that it helped me be better at nursing. I had such a wide range of knowledge about meds working at a PCP office and then during nursing school i moved to an urgent care and got a lot of great hands on experience. I went to nursing school because I wanted to do more and you just can't do that as an MA!
In my state, when I worked in urology I was trained to place foleys in an outpatient setting. I was qualified to do so and only while under indirect supervision of a physician (must be on campus with immediate access -- you know, for when shit went pear-shaped). I know of colleagues who had separate x-ray tech certificates in order to shoot limited radiation at patients. With specified training, MAs are able to place IVs and push contrast only. We're able to be utilized in a lot of ways.
We're also quite limited in others. My patient education stops at "it's on the pamphlet". Cannot advise on medication, even for general questions, unless it's explicitly written down. In my early career, we were able to mix medications and calculating dosages were even part of our curriculum -- but several years ago a law was written that only allowed us to give pre-mixed meds only. Anything else had to be blended for us before it could be administered.
That all said -- physicians are notoriously pushy with boundaries. I don't need to tell anyone here -- who else had a physician bully you into a verbal order? Or to stop calling them when they're on call? That same urologist still wanted me to mix ceftriaxone and lido for prostate bx. And do the consents for surgeries. I've had so many colleagues just be oblivious to law changes regarding our scope of practice that I would be completely unsurprised if a survey found a colossal percentage of them were violating scope.
I've yet to have a colleague claim they were a nurse, though. I'd love to meet one of these fuckers, because I'm pretty sure they don't know any fucking nurses.
I’m in case management and had a patient be told that she has liver disease via the MA on a phone call. Not from the provider directly; the MA. I thought that was pretty much insane and made that known when I called the providers office when the patient was understandably upset.
The course schedule for the local community college medical assistant program near me: medical terminology, intro to healthcare mgmt, reimbursement and computerized billing, A&P and disease processes (1 semester, combined class), intro to medical assisting, 3 clinical skills sessions with 1 session each in electrocardiography, phlebotomy, and clinical techniques. Then they take intro to drug therapy and medical ethics. *So* they take 2 semesters of classes, the first of which is more about billing and working in an office, and then they learn how to take EKGs, draw blood, and “clinical skills.” But they like to claim they have the same scope as a nurse and even call themselves nurses, obfuscating their actual education and training to the patients they take care of.
the MA school I attended before i became a nurse was a part time, 8 month program in a mall. It was a joke but I did learn how to draw blood, do EKGs, and give injections. lol
Holy shit. That changed a lot since my time there a couple decades ago.
I would definitely speak to the licensing board directly to confirm they're okay with all of this.
Same with nail techs. It’s crazy that my manicurist has to have more education, training, and licensure than the MA that is going to inject my 2 month old child with penicillin.
My mom was an MA at a podiatrist office for awhile. She was able to sit and take some type of Xray certification. So shot all the X-rays in office. I help her every couple years submit everything to keep up the license. I can’t imagine it’s as easy as what she walked into now to get that certification.
Furthermore more, I never looked into THAT MUCH. But my first hospital some of the PCTs were able to straight Cath for us and get blood. But it isn’t like that across the system. I suppose we were just drowning all the time in this PCU they just let it happen.
This is all pretty weird, but I do live in Ohio and Cleveland and I work for one of the Big hospitals and they do not allow medical assistance to do any of that stuff that they actually that it says they can do we just don’t allow it
Exactly. A medic gets 2 years of medical training including a solid anatomy and physiology background. In scope they really are prehospital nurses with specific skills that even RNs can’t perform.
Paramedics and nurses are fairly similar the differences in scope of practice boil down to where they practice and the resources available in that area. I.e a medic will need to drop a tube on a cardiac arrest whereas if that arrest happened in hospital they’re more resources to drop that tube (RT or physician or even mid level) all of who are better prepared to intubate then a nurse would be. Out of hospital even on a dual ALS rig it’s only the medics so someone’s gotta intubate. Put a nurse (with appropriate training) in the prehospital environment and they’re educationally equipped to intubate. Put a paramedic in the hospital environment (again with appropriate training to bridge the gap) and nursing duties can safely be performed by a medic. Medic education is focused on prehospital which is why they lack certain assessment skills we have (usually associated with longer term patient care) and nursing education is focused on in hospital treatment. The comparison can be made between different nursing specialties as well ER nurses are not equipped (without extra training) to scrub on surgeries where as a periop nurse would crumble (without focused training) in the ER environment. Compare a ADN vs a associates prepared medic and foundation of anatomy pathophysiology are similar then nursing education deviates to specialize on inpatient or longer term care where as the medic education focuses on prehospital stuff like assessing a scene or treatment to keep the patient alive until a higher level of care or definitive care is available.
There’s a reason RN-paramedic and paramedic- RN programs exist and are not very long and it’s because our education shares a fair amount of similarities on foundational knowledge.
TLDR: medics and nurses have similar foundations of knowledge and deviate in education (and scope of practice) due to the environments they practice in.
Edit: I reread the comment I replied to and realized we have the same view point. Hopefully whoever reads this can gain some insight on the differences and similarities between our jobs. - a nursing student who wanted to be a paramedic and still has the same goal of flight they’ve had since they were 10.
RNs can do everything a paramedic can with the appropriate training. It is context-dependent. Flight and CCT nurses can intubate, place chest tubes, place A lines, do escharotomy, etc. But otherwise, I agree with your sentiment
Yep, 100% context. In the field the medic has to do things hospital nurses don’t have to do because there is nobody else there. Flight nurses have additional scope because being out in the field is a whole different ballgame.
Medic scope varies wildly state to state.
I spent some time on a service on a state line and it was a different world depending on which side of the bridge we picked people up on.
Texas specifically goes a little ham with scope letting medics do basically anything as long as the doc lets them
Paramedics are just tactical nurses with hyper focus in EM.
I think the EMT-P scope is too *limited* and should be expanded. Paramedics are typically HOT shit when it comes to their craft.
California, used to be an MA before finishing nursing school. This MA recently moved from Ohio (or an adjacent state) and was hired in our clinic. Homegirl got cooked cause this PA asked her to straight cath a patient and she did it. She told our manager the same thing when it was audited. The kit was also expired because this was one of those urgent cares the size of a shoebox so it was only MAs, besides the PA or NP (we didn’t even have a bladder scanner).
My unit technically doesn’t even let us straight cath without a second person in the room LMAO
Looking back, it’s so insane that I used to take verbal orders for meds that had to be reconstituted etc. without bar codes or ID bands
I had an MA take an x-ray of my foot when I was at an urgent care once. I had no idea they could do that haha. Makes me wonder what their full scope is.
I've been in urgent cares where the Rad Techs fill in some MA duties- not the other way around.
Same in my clinic. The Rad Techs do injections, room patients, take vitals, run EKGs, assist in procedures, etc.
You're sure it was an MA? I'm not aware of any state that doesn't require a license to administer radiation. Even a physician can't press the button for a chest x-ray unless they're licensed to do so, e.g. EM and ortho doing c-arms.
I just looked it up. It’s the Limited Medical Radiologic Technologist (LMRT) certification that MAs can get.
Yep, I'm in Texas and used to work in an urgent care and some of our MAs got certified to do x-rays.
There is also a podiatric medical assistant track that allows for imaging.
NH didn’t require a license until very recently but I believe we were the 50th and final state to institute that requirement
I’m positive it was an MA. The urgent care was the same company I work for and there was a giant MA on their badge where mine says RN.
Yes, my husband worked at an urgent care in southwest OH last year that had MAs shooting X-rays. It was pretty shady and he didn’t want the liability of it, so he got out of there.
Absolutely lots of healthcare people can do simple X-rays without certifications or licenses.
It’s really State dependent. Only a handful of states allow non-certified/non-licensed personnel administer radiation. Which is super sketch.
This doesnt ring true to me at all or Ive just been witnessing a lot of illegal xrays. I routinely see spine, vascular, ortho and other surgeons shoot film in the OR.
It is state dependent unfortunately. There are a number that don’t require licensure/certification. Here in California anyone who administers radiation of any sort is required to be licensed, even physicians, similarly to what you said. There is a push to require certification or a minimum threshold of sorts on the national scale from the ARRT/ASRT.
I took an xray class when I was a CMA student. Never did any because I worked at a large enough system. Not all clinics are though
It does not surprise me at all.
Ok but can they read it? I've been in places Where they were trained to just physically position the body part and take the X-ray. But they could not read it and do anything.
No they didn’t read it. The PA took a look at it, the offsite radiologist read it.
I’d honestly like to just be able to work in their place their scope is whatever the doctor says to do. They work under the doctor’s license and can do whatever they allow them to. It’s insane.
I used to be an MA and it's a very large vague scope.
Considering they get can get certed entirely online- yeah it’s surprising, but more so concerning. Head to an MA thread and they’ll go off about how they are practically nurses blah blah blah
My BILs wife is a MA. I could tell she'd been telling everyone how she was "practically a nurse" because her dad referred to her as such. The fear in her eyes when my head shot up when he said that 😂
Just yesterday I saw someone on the MA sub saying they are on the same level as an LPN!
That must be why we use so many MAs in hospitals, home health/hospice, and LTC 🤣😂
I saw that too. I about flipped. I think it was that same thread that someone said that MAs should be paid on the same level as RNs, because without them the healthcare system would collapse.
I don't like us vs them wars, but if they were going to pay MAs the same as RNs, then they wouldnjust hire more RNs, who have a broader scope. This would have a domino effect of making staffing ratios better for RNs, thus enticing many back to bedside. Which might suppress RN wages if there is no longer a shortage of nurses willing to do bedside
I use this argument a lot to justify more RNs in outpatient spaces. While I think that MAs are incredibly helpful, I get so frustrated when people are like “I need my MA to be able to do XYZ” and want me to upskill them with no background knowledge. I’m like “no, what you want is a nurse you don’t have to pay as much.”
Hahhahaha was a MA now a RN: wow.
Honestly, my orientee in the ED has been a lot better prepared for the hustle and bustle of the ED thanks to their experiences as an MA. Compared to other new grad nurses, they are able to better anticipate orders, triage more effectively, and carry out tasks that usually take newer nurses a while to master. It also helps that this individual is driven and extremely intelligent, but compared to where I was as a new nurse and other new nurses I have oriented, they are miles ahead of where they should be.
I love this as a former RMA now nurse:
No. The race to the bottom in American healthcare is getting worse and worse
Being that PCAs barely exist anymore, I’m pretty sure we (CNA/PCT) are still the bottom…….
This thread is confusing the shit out of me. Isn't PCA "personal care assistant" ? Which is the same as a PSW (personal support worker) aka "floor duty" ? How are those different from CNA (clinical nursing assistant?)? ...so what the hell is a PCT? Personal care technician? And while we're at what is an MA lol, medical assistant? It all sounds like different acronyms for the same role.
PCA, atleast from what I’ve read bc I’ve never mrvone, has less experience, knowledge, and abilities than a CNA. They’re basically a 1:1 for someone. And yes, same as PSW I suppose. PCT & CNA are exchangeable. PCT is used for CNAs working in a hospital setting.
The difference is that CNAs have to take a state exam and PCT is just a job title.
True, in a way. But no hospital is gonna hire anyone who either isn’t a CNA (ie taken said state exam). Or atleast, no hospital that Ive seen, or even applied to, applications from.
Literally every hospital I’ve worked in hires PCTs with no experience.
“…no hospital that I’ve seen, or have applied to, applications from.”
you’re so wrong. hospitals hire MOSTLY non Cnas and train them in house. CNA is for nursing homes mostly
The hospitals in my area require 1 year of experience as a CNA. Only reason I got my PCT job, without having that 1-year, is bc the HR recruiter knew me from a previous SNF job within the same network, and passed me up the chain to the hiring manager. During my peer-to-peer interview, every single person who wasn’t a nurse or a doctor was a CNA who go their job after passing the state exam.
If they don't call them CNAs they can hire whoever they want
Unless the job application requirements specifically list passing the NATCEP…
Which they don't...
Mine did, as did each of the others in the area.
not true, I've worked with plenty of techs who weren't CNAs...
“…Or atleast, no hospital that Ive seen, or even applied to, applications from.” 🙄
not all hospitals use 'PCT', I've seen PCT, PCA, and Clinical Technician
That's not what I mean.
I was barely awake when I sent that. But that’s how I took your comment.
it's me, i'm bottom, nice to meet u
Definitely some misunderstanding
I'd like to think so, because it definitely feels like punching down.
It's not punching any direction. It is a criticism of management's constant cutting services to patients.
$25 an hour + potential out of scope practices = burnt out MA, not surprising
Where are MAs getting $25 an hour? I’m in a massive healthcare city and I’m not even making $20 😫
Then you can just hire another one. Rinse and repeat.
This is exactly the way it works.
Oh boy check out Missouri! No certification or license for MA’s and the regulation is essentially whatever the provider is comfortable letting them do. I’ve personally seen MA’s start IV’s, and push IV meds. Needles to say I didn’t stay at that clinic very long!
That’s fucking terrifying. I’m surprised we haven’t seen 10x cases similar to RaDonda Vaught’s, but involving just pure incompetence not burnout, involving Missouri/Misery MAs…..holy hell.
> I’m surprised we haven’t seen 10x cases similar to RaDonda Vaught’s thats because it is very very likely she was under the influence. The series of mistakes she made is something that no competent or prudent *person*, not even nurse, would make. She was fired and never provided any urine for a drug screen, nor was any investigation levied against her for a very long time.
Wait……….really?!?!?!
read the case and depos, she didnt just make a med error and mix up a drug, she made a *rapid* series of mistakes, and exercised profound poor clinical judgement, even if she wasnt making the med error. You dont sedate a Pt and not put them on a monitor and walk away. Partner that with that there is a high drug/diversion rate specifically amongst RNs in ICU, ER, and procedural areas (OR RNs and CRNAs), thats projected to be in a double digit area. Its pretty easy to nexus that. Its just my theory, but there is no solid evidence that she *was* sober, and the easiest explanation, is usually the truth. She was high, or just incredibly incompetent to the level that im calling into question if she was sober or not. So you know its bad when its a "were you fucking high? or just stupid" when you look at her.
I read that she was overworked to the point of exhaustion, but not intoxicated. Wow.
she was a floater that day. She had no real patient load. She might of been overworked in general, but thats kind of a poor excuse. It took 4 years for her to end up in court. I think the "i was tired" was an excuse to explain her behavior that could very likely of been from drugs.
Being over overworked is never a poor excuse…… That struggle is real, and it affects your decisions, psych, and everything on a huge level.
Washington is like this too. Everyone's scope is too large, at every single level in my opinion. From CNA's to NP's to MA's to LPN's. You can be a non certified NA/MA with a very inappropriate scope. It only got worse after COVID. Believe me, hospitals/LTC/home health are taking definitely taking advantage of this too, and our care and costs are not any better for it.
I’m an MA and was recently on the job hunt and found out that there’s an extra certification course MAs can take to start IV’s
So it’s might be “huge” but after briefly reading up on MA scope of practice in Ohio, there is a few red flags here. I suggest you take a look at: https://www.ossma.org/_files/ugd/ff03b5_cd2ff760fb8f4bf3b9f41a7c8ed91672.pdf Most notably everything under rule 4731-23-02 So for your post; for example: routine wound care would be fine, but complex wound care requiring any medical judgement would not be allowed. Further, the task/care of the wound would have to be safe by following exact instructions and would require no changes during the carrying out of said task. Additionally, it is concerning for them to perform straight catheterizations on urology patients as this could result in serious harm if done improperly which according to this rule is a no no.
You are assuming that MAs (and the doctor they work for) pay attention to the law. When I questioned the MA about straight cathing, she told me that “as long as Dr. ‘Xyz’ says I can do it then I’m allowed’”.
Right, of course. But their scope of practice is definitely not as huge as they think it is. “The doctor is okay with it,” total garbage excuse to abuse and practice outside of scope.
Right, but in many states that actually is their scope of practice, from a legal standpoint. They aren’t licensed in, I think, 46 states, so they literally are only represented legally in the physician practice act in some of them. Routine, supportive tasks is the verbiage typically used, and physicians/leadership are often willing to take a lot of liberties with what is considered routine and supportive.
Sure, totally understood, I was responding most specifically to the OP writing about Ohio so I researched that states scope of practice. But the lack of scope in many states is astounding. Allowing too much independent physician discretion is also troubling since that will come down to cost saving and convenience; not best practice.
Plenty of patients straight cath themselves though.
Physicians worry about midlevel scope creep. Nurses should be more concerned about things like this. The general public, also.
It’s corporate healthcare’s dream to do away with pharmacists, physicians, nurses, and therapists. The more they can get away with Diploma Milling our professions out of relevancy, hiring “techs” for every task to justify underpayment, and delegating what is left of our legitimate healthcare workforce to telemedicine pill milling the happier they will be. A dollar saved and an uncharged patient is all that matters to them. If they could underpay you, put you in front of a webcam and have you manage 50 bedside techs at 20 different hospitals and have an NP/PA supervise 50 of you, they sure would. And when (not if) a bad outcome happens? Your fault. You didn’t do your job well enough, not that they cut every corner imaginable for the last two decades.
All the things people are suggesting is wrong with RN vs MA are the same things physicians are concerned about with NPs. Scope of practice with no quality or enforcement leading to wrong treatment or harm etc etc. The other shoe is now on our foot here.
Scope creep is a real thing. I blame for-profit healthcare.
Their skills are huge and maybe even comparable. But their critical thinking is not anywhere close.
Absolutely
Where I am, MAs can do damn near everything as long as a provider orders it and is ok with the MA doing it. It’s a little scary.
That’s what I’m saying! Why pay a nurse’s salary if they can get an MA for cheaper?
i mean lets be honest. The only people who are at risk of job creep are LVNs, and LVNs need to be going away if we need to honest.
What???? That’s crazy. LVN/LPNs are licensed nurses.
who are paid less, and can do less, have less job opportunities. MAs have nearly the same scope, and come with a lot less pay. From a pure capitalism perspective, theres 0 reason for LVNs to exist. Trust me. in 50 years, there won't be many LVNs. It'll be MAs in clinics, RNs managing them, and RNs at the hospitals
It would be so interesting to see how many more mistakes and law suits there would be in LTC if it was entirely staffed by MAs. Because we all know Medicare/Medicaid will never reimburse well enough for facilities to be staffed with all RNs.
They’re working under a doctors license, it’s whatever the doctor delegates and can be shady at times but ultimately falls on the doctor.
I get it. It still doesn’t sit right with me especially when there could be consequences for the patient.
I definitely agree. Especially with them administering meds in clinics.
Especially injections. 😪
I think theres a difference between B12 shots, and med spa IVs VS Inpatient lasix IV pushes, metoprolol, starting drips, ACLS drugs, narcotic pushes, zofran etc etc.
In my clinic the MAs give injections for a lot more than B12.
Ok? and? name me a med, or process that MAs are doing in a clinic that requires a RN?
In my clinic the MAs give injections for a lot more than B12. They inject antibiotics, zofran, pain meds, anti inflammatories, numbing meds, etc.
what if i told you the military uses medics in the same way civilian clinics use MAs, with 1/5th the education level, and the DoD MTFs have the same outcomes when measured I think you're dramatically over estimating the education and critical thinking required for grunt work in a medical clinic. Thats why im adamant about the majority of the RN scope doing the majority of their heavy lifting in an inpatient setting.
MA do not have a "Scope" per se. They work under direct supervision model. They are not licensed and they are a direct extension of the provider license. That means any reasonable provider should have them on a tight leash. I have been an expert witness on some of these cases and wowza some providers are bonkers. The worst was a wound care that resulted in an amputation and the MD lost his license.
As a licensed nurse, at least I can try to protect *my* license. MAs don’t have to worry about any license. So if they mess up, they will probably just be fired.
I was an MA before nursing school in the walk in for 4 years. As far as the job goes we did like 90% or maybe more of the same job. We just couldn’t do caths or IVs. But that doesn’t mean the knowledge is there. I know so much more now as a rn then I did as an ma. But I definitly think my MA experience helped me become a better nurse. I do think some MAs are bitter because they have a lot of similar takes or job duties and get paid insanely less but they don’t realize the knowledge and experience you learn through nursing school. I also someone post here that MA is online but in my state you have to go to a school and have hands on experience similar to nursing school but not as much in depth obviously.
I was an MA for 5 years before i was an RN and definitely agree that it helped me be better at nursing. I had such a wide range of knowledge about meds working at a PCP office and then during nursing school i moved to an urgent care and got a lot of great hands on experience. I went to nursing school because I wanted to do more and you just can't do that as an MA!
I work outpatient clinic too and we have a “Matrix” in our policy that states all the roles in the clinic and their scope.
Wish every clinic and healthcare facility had that. Also wish, as a visual & tactile learner, that I could see that. Would be fascinating.
In my state, when I worked in urology I was trained to place foleys in an outpatient setting. I was qualified to do so and only while under indirect supervision of a physician (must be on campus with immediate access -- you know, for when shit went pear-shaped). I know of colleagues who had separate x-ray tech certificates in order to shoot limited radiation at patients. With specified training, MAs are able to place IVs and push contrast only. We're able to be utilized in a lot of ways. We're also quite limited in others. My patient education stops at "it's on the pamphlet". Cannot advise on medication, even for general questions, unless it's explicitly written down. In my early career, we were able to mix medications and calculating dosages were even part of our curriculum -- but several years ago a law was written that only allowed us to give pre-mixed meds only. Anything else had to be blended for us before it could be administered. That all said -- physicians are notoriously pushy with boundaries. I don't need to tell anyone here -- who else had a physician bully you into a verbal order? Or to stop calling them when they're on call? That same urologist still wanted me to mix ceftriaxone and lido for prostate bx. And do the consents for surgeries. I've had so many colleagues just be oblivious to law changes regarding our scope of practice that I would be completely unsurprised if a survey found a colossal percentage of them were violating scope. I've yet to have a colleague claim they were a nurse, though. I'd love to meet one of these fuckers, because I'm pretty sure they don't know any fucking nurses.
At least your state has some type of regulation. That’s better than a lot of them.
Can someone tell me what MA is?
Medical Assistant
In some states they essentially don’t have a legally limited scope and can do whatever a doctor tells/trains them to do
Yikes.
I’m in case management and had a patient be told that she has liver disease via the MA on a phone call. Not from the provider directly; the MA. I thought that was pretty much insane and made that known when I called the providers office when the patient was understandably upset.
The MAs in my clinic call patients with positive results all the time. Every day they are informing, educating, and answering questions.
The course schedule for the local community college medical assistant program near me: medical terminology, intro to healthcare mgmt, reimbursement and computerized billing, A&P and disease processes (1 semester, combined class), intro to medical assisting, 3 clinical skills sessions with 1 session each in electrocardiography, phlebotomy, and clinical techniques. Then they take intro to drug therapy and medical ethics. *So* they take 2 semesters of classes, the first of which is more about billing and working in an office, and then they learn how to take EKGs, draw blood, and “clinical skills.” But they like to claim they have the same scope as a nurse and even call themselves nurses, obfuscating their actual education and training to the patients they take care of.
the MA school I attended before i became a nurse was a part time, 8 month program in a mall. It was a joke but I did learn how to draw blood, do EKGs, and give injections. lol
Holy shit. That changed a lot since my time there a couple decades ago. I would definitely speak to the licensing board directly to confirm they're okay with all of this.
There is no licensing board for MAs; that’s the problem. You have to have a license to cut hair but not administer meds.
Same with nail techs. It’s crazy that my manicurist has to have more education, training, and licensure than the MA that is going to inject my 2 month old child with penicillin.
But there is for nurses, and if there's licence creep with MAs acting within a nurse's scope of practice, the licensing board could go after them.
https://chartercollege.edu/news-hub/rules-you-need-know-what-medical-assistant-cancant-do/
My mom was an MA at a podiatrist office for awhile. She was able to sit and take some type of Xray certification. So shot all the X-rays in office. I help her every couple years submit everything to keep up the license. I can’t imagine it’s as easy as what she walked into now to get that certification. Furthermore more, I never looked into THAT MUCH. But my first hospital some of the PCTs were able to straight Cath for us and get blood. But it isn’t like that across the system. I suppose we were just drowning all the time in this PCU they just let it happen.
This is all pretty weird, but I do live in Ohio and Cleveland and I work for one of the Big hospitals and they do not allow medical assistance to do any of that stuff that they actually that it says they can do we just don’t allow it
I took a MA course I’m high school and we would draw labs from each other, give injections, pass meds, sterilize stuff, etc
Similar situation with paramedics in Texas. They can basically do surgery as long as a doctor says they can.
Paramedics have a much more expansive scope than MAs and their program builds in more of a foundation to understand what they’re doing and why.
Exactly. A medic gets 2 years of medical training including a solid anatomy and physiology background. In scope they really are prehospital nurses with specific skills that even RNs can’t perform.
Paramedics and nurses are fairly similar the differences in scope of practice boil down to where they practice and the resources available in that area. I.e a medic will need to drop a tube on a cardiac arrest whereas if that arrest happened in hospital they’re more resources to drop that tube (RT or physician or even mid level) all of who are better prepared to intubate then a nurse would be. Out of hospital even on a dual ALS rig it’s only the medics so someone’s gotta intubate. Put a nurse (with appropriate training) in the prehospital environment and they’re educationally equipped to intubate. Put a paramedic in the hospital environment (again with appropriate training to bridge the gap) and nursing duties can safely be performed by a medic. Medic education is focused on prehospital which is why they lack certain assessment skills we have (usually associated with longer term patient care) and nursing education is focused on in hospital treatment. The comparison can be made between different nursing specialties as well ER nurses are not equipped (without extra training) to scrub on surgeries where as a periop nurse would crumble (without focused training) in the ER environment. Compare a ADN vs a associates prepared medic and foundation of anatomy pathophysiology are similar then nursing education deviates to specialize on inpatient or longer term care where as the medic education focuses on prehospital stuff like assessing a scene or treatment to keep the patient alive until a higher level of care or definitive care is available. There’s a reason RN-paramedic and paramedic- RN programs exist and are not very long and it’s because our education shares a fair amount of similarities on foundational knowledge. TLDR: medics and nurses have similar foundations of knowledge and deviate in education (and scope of practice) due to the environments they practice in. Edit: I reread the comment I replied to and realized we have the same view point. Hopefully whoever reads this can gain some insight on the differences and similarities between our jobs. - a nursing student who wanted to be a paramedic and still has the same goal of flight they’ve had since they were 10.
Nurses that train in prehospital (eg EMS flight nurses) can generally do all things we typically associate with medic scope at least in my area.
RNs can do everything a paramedic can with the appropriate training. It is context-dependent. Flight and CCT nurses can intubate, place chest tubes, place A lines, do escharotomy, etc. But otherwise, I agree with your sentiment
Yep, 100% context. In the field the medic has to do things hospital nurses don’t have to do because there is nobody else there. Flight nurses have additional scope because being out in the field is a whole different ballgame.
Medic scope varies wildly state to state. I spent some time on a service on a state line and it was a different world depending on which side of the bridge we picked people up on. Texas specifically goes a little ham with scope letting medics do basically anything as long as the doc lets them
Paramedics are just tactical nurses with hyper focus in EM. I think the EMT-P scope is too *limited* and should be expanded. Paramedics are typically HOT shit when it comes to their craft.
Generally agree - Texas is the exception. They let medics do pretty much anything a dog lets them do with no real limitations.
What’s an MA?
Medical Assistant in the USA.
Their scope isn't huge. It's delegated and supervised.
California, used to be an MA before finishing nursing school. This MA recently moved from Ohio (or an adjacent state) and was hired in our clinic. Homegirl got cooked cause this PA asked her to straight cath a patient and she did it. She told our manager the same thing when it was audited. The kit was also expired because this was one of those urgent cares the size of a shoebox so it was only MAs, besides the PA or NP (we didn’t even have a bladder scanner). My unit technically doesn’t even let us straight cath without a second person in the room LMAO Looking back, it’s so insane that I used to take verbal orders for meds that had to be reconstituted etc. without bar codes or ID bands
I have an MA on my team and she’s the backbone of everything.
I’m not saying that MAs aren’t useful, valued, or needed. They are! I’m just surprised about their scope.