I read with great interest the article in Nursing Spectrum: Your top Legal Questions Answered. Although you somewhat touched on my question, I hope you can help me find some answers.
I have been an RN for 30 years and always reported to another RN. Recently, management made some major changes in our medium-size clinic, and the RNs now report to a certified medical assistant. She is a nice person, but I think this should not be happening for all the obvious reasons (legally, she can’t even start an IV). In the past, an RN was in charge in any medical setting in the hospital. This clinic has been slowly getting rid of the RNs when possible. The model for outpatient is a certified medical assistant or medical office assistant takes the job of the RN, to save money of course, but it seems unsafe for a CMA or MOA to be passing himself or herself off as an RN, faxing prescriptions, giving injections and giving advice to the unknowing public. Can you tell me legally where the RN stands in the outpatient setting?
This health system also did not include our titles after our names when we went paperless. Some other RNs and I brought this to managements attention, and with time and help from the board of nursing legal department our titles now appear (RN, MD, RpH, CMA, etc.).
Nancy Brent replies:
An RN should not be reporting to a medical assistant, unless your state nurse practice act allows this to occur (which is highly unlikely). RNs are supervised by other RNs or advanced practice nurses (APNs). RNs work with medical assistants, and they can be very valuable team members. They are not RNs, however, and should not be performing those professional responsibilities that are within the scope of the RN. Nor should they be masquerading as RNs.
If you have not done so already, you may want to raise these issues with the risk manager and chief nursing officer (if there is one) at the clinic. If neither of these individuals exist, you will need to share your concerns with the highest administrative officer to whom you have access. If it will carry more weight, seeking an opinion from a nurse attorney or attorney in your state and sharing the information obtained during that consultation would be helpful when discussing the issue with your head administrative officer.
Thank you for your feedback about the article that appeared in Nursing Spectrum.