When did physician’s offices start using medical assistants instead of RNs and what can nurses do about it?

By | 2022-02-21T17:47:05-05:00 August 6th, 2014|19 Comments

Dear Nancy,

I have noticed many physician’s offices are using medical assistants instead of RNs or LPNs. It concerns me that these assistants are able to give injections and medications that in other settings would be done by a nurse. When did this change and what can licensed nurses do about this?

Marvin

Dear Nancy replies:

Dear Marvin,

The use of medical assistants in physicians’ offices in the place of RNs and/or LPNs is most likely due to the lowered cost of the salary of a medical assistant in contrast to that of an RN or LPN. Keep in mind, however, that a medical assistant is not an RN and therefore cannot perform nursing responsibilities that are only to be done by a licensed RN. Such responsibilities would include a nursing assessment, patient and family teaching, making a nursing diagnosis and utilizing the nursing process.

Likewise, the assistant is not an LPN so the nursing responsibilities the LPN is able to perform within his or her scope of practice cannot be performed by the medical assistant either.

Using a medical assistant in lieu of a licensed nurse is short-sighted. Since the assistant cannot, or should not, be performing the nursing responsibilities listed above along with others not listed, the physician’s patients are not being evaluated from a nursing perspective.

The physician is delegating medication administration to the assistant without the benefit of an RN or LPN’s observations of the patient and the identification of health issues the patient may bring up to
the nurse.

Physicians are often able to delegate the administration of medications to assistants because of a state Medical Practice Act that allows them to delegate patient care to others.

As a licensed nurse, you can help educate the public about the difference between a medical assistant and a licensed RN or LPN. If possible, see a physician who only uses RNs or LPNs in his office. Better still, talk to your physician if he does not use RNs or LPNs in the office, and help change the physician’s mind to use licensed health care providers for the patients’ care and treatment.

Cordially,
Nancy

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19 Comments

  1. Avatar
    Karen April 7, 2020 at 2:54 pm - Reply

    Most Medical Assistants can do more in a Drs office than an RN could ever do. For instance, most RNs cannot draw blood or do a manual cbc w diff with a slide and microscope like they do when no lab is available. Nurses are better trained for a hospital setting whereas MA’s are trained to work in Drs offices.

  2. Avatar
    Patricia August 26, 2020 at 11:05 am - Reply

    This is incorrect. An RN can do anything a medical assistant does. It is only for cost control that preference is often given to medical assistants in an office setting.

  3. Avatar
    Shelley September 14, 2020 at 7:38 pm - Reply

    Karen, that is one of the dumbest things I have heard. An an ER nurse, I do everything for my patients that’s included within my scope of practice. And yes, I can certainly, and usually do draw blood. Often, CMA’s step outside of their own scope and should be corrected, especially when a patient will call them “the nurse.” That’s misrepresentation and is in fact illegal. See following article. http://www.aama-ntl.org/docs/default-source/other/mj19-pa.pdf

  4. Avatar
    Nancy February 2, 2021 at 1:14 pm - Reply

    Wow! Karen that is so untrue!
    You are so very uninformed about RN roles and responsibilities, and law. Study up!

  5. Avatar
    Craig Cabral, RN March 21, 2021 at 6:31 pm - Reply

    In most states use of the nurse title by an MA or other non-nurse is either a class A or class B misdemeanor punishable by up to $10,000 fine and up to one year in jail. If a medical assistant attempts to practice nursing skills the same law applies. Nurses can and often do perform the same “tasks” medical assistants perform. Medical assistants often mistakenly believe they “do the same thing nurses do because when they work together they see nurses perform certain TASKS. Medical assistants are trained to be TASK oriented while nurses both LPN (LVN) are duty oriented. So Karen, get yourself educated or you risk legal trouble. To say MAs do more than RNs in any setting is categorically untrue. I am a nurse (RN) and I have trained both MAs and nurses as I am also a nurse educator. I have worked in acute care, long-term care, emergent care (ER), urgent care and yes even family care. It sounds like you may be feeling a little insecure about your training. Go to nursing school!

  6. Avatar
    Sharon May 2, 2021 at 9:27 am - Reply

    While obviously nurses have more education on patient care and emergent situations a MA still has enough education to know what they are doing in a clinic setting. For example, where I work we draw blood, give injections, explain test results and procedure results to the pt., do urinalysis testing, perform EKGs. We also schedule patients, do medicine PAs and procedure PAs. As well as call in medication when needed.That’s just a few of the many things. Not all MAs are just MAs. I am registered in phlebotomy, medical billing and coding, EKG and I’m also a CNA. I am NOT a nurse and do not claim to be but I most certainly know what I am doing in the setting I work in.

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    Amanda May 14, 2021 at 12:19 am - Reply

    Being a CMA myself, I think this depends largely on if you work inpatient or ambulatory. The OP references his physicians office, and unfortunately is then told basically that the MA knows nothing, when in the clinic setting we are the ones doing 90% of all hands on patient care. If I asked a nurse to go give a vaccine or assist with a procedure they would have no idea what to do,because it’s above their scope. They’re taking emergent calls and working 200 telephone encounters that the CMA’s would be lost in. Basic patient education that this lady majorly failed on, would have went a long way. Side note- CMA’s are mistaken “assumed” to be nurses constantly. Just something to ponder. Imagine being a patient knowing very little of the health care world.

  8. Avatar
    Amanda May 14, 2021 at 12:21 am - Reply

    Being a CMA myself, I think this depends largely on if you work inpatient or ambulatory. The OP references his physicians office, and unfortunately is then told basically that the MA knows nothing, when in the clinic setting we are the ones doing 90% of all hands on patient care. If I asked a nurse to go give a vaccine or assist with a procedure they would have no idea what to do,because it’s above their scope. They’re taking emergent calls and working 200 telephone encounters that the CMA’s would be lost in. Basic patient education that this lady majorly failed on, would have went a long way. Side note- CMA’s are mistaken “assumed” to be nurses constantly. Just something to ponder. Imagine being a patient knowing very little of the health care world, would you know the difference?

  9. Avatar
    Mona Lisa June 25, 2021 at 9:33 am - Reply

    As a Medical Assistant for 19 years I have to say that it is a pleasure to be able to walk with those who are in a different season of life. Some are terminally ill and some are there for acute reasons and taking presentative measures at all cost. Instead of comparing one another and dogging us, we too have a heart and care for those who can no longer care for themselves. If you stop and think for a second maybe this will help. When you took your maternity leave to have your baby, a doctor didn’t fill that out, I did, the medical assistant. When you needed a work note because you had to miss a day from work who typed that up? I did, the medical assistant. When you needed your TB test done so that you could get into nursing school, who did that? I the medical assistant. When you needed to have your babies vaccinated to be able to enter into school including their Tdap to enter into college, who did that? I did the medical assistant. When your baby was sick and needed their labs done to have their CBC checked to see if their was an infection, who did that? I did, the medical assistant. When you were with your loved ones and they were getting their chemotherapy treatments, I the medical assistant walked in and got vitals, did the blood draws and scheduled your next appointment for you. I have met so many nurses who have horrible bedside manners and to sit their and be tough behind the keyboard and say what you say, I bet you wouldn’t have the guts to say that to a Medical Assistants face. As trashy as your attitude is on here, I begin to wonder.. who gave you your license because with a nasty attitude like that, I wouldn’t want you treating any of my family members because you think that having a RN behind your name makes you better. Where is your integrity and why did you want to become a nurse or CMA? It was because you chose to die to self to help other who are sick. We all have different titles but it doesn’t make you a better person than me. And with an attitude like that you should look in the mirror and ask yourself if this career is really for you. If you have an issue with Medical Assistants go draw your own blood, go do your own spirometry tests, go fill out your own FMLA’s and affidavits for your Disability papers, and check yourself in and verify your own policy and insurance at your next primary visit being that CMA’s are not good enough to do this. You say we are not qualified but my License that is Registered through the U.S. says I am, and mostly I see that I am qualified, educated and I have integrity. To say we are cheaper because of money can be true, but God knows my heart. Your mind frame is Disrespectful, Distasteful, Disgusting and Despicable, and you as Registered High and all mighty nurses with no class or self respect should be ashamed. I love my job as a CMA, with a Bachelors Degree in Science and Healthcare Administration. Who knows, one day this CMA will be your next Executive Director at a nurse facility, or medical corporation.

    • Avatar
      Glenda Bitter February 3, 2022 at 10:35 am - Reply

      Thank you, God love you !!! You hit the nail on the head. Dead on!! I graduated from Medical Assistant school as a Registered Ma. I have worked for MANY years honing my craft to peak performance. MD’s sought me out to work with them in their practices. I am good at what I do. I loved my patients. I can start an IV, because my employers saw something in me. I ate up their teaching, mentoring, because I LOVE the profession I chose. We work just as hard, are just as devoted and just as smart as many RN’s. And the Dr’s who recognize our ability, our gifts, know what they have before them. Don’t count us out, don’t belittle us, because we know you couldn’t you look as good without us. We are brothers and sisters caring for those who are in need……of us.

  10. Avatar
    Micha Smith August 26, 2021 at 11:17 pm - Reply

    I think people fail to realize that whether one is a medical assistant or nurse the credentials were not given we all had to be taught, study and pass an examination before we could work under this title. At the end of the day patients don’t really care what those letters are you choose to place after your name. They just want someone to give them the best care without error or attitude. Why do people always have to divide to feel superior “punishable by law” for calling someone a nurse who isn’t but is practicing as a healthcare worker? smh. It’s not that deep.

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    AdenosinePush October 11, 2021 at 7:01 pm - Reply

    I’m a resident physician and I’m sorry there is just no contest between any MA and an RN. The MAs at my office can’t even take a coherent chief complaint/history, and in my state they can’t even give vaccines, I literally need to both give the shot and document it myself because they can’t even be trusted to record it correctly at my office. I would honestly be faster most times if I could room patients myself (and was during deep COVID when we had to furlough them). About the only thing they’re helpful for is running some diagnostic tests like EKGs and scanning/copying/doing paperwork. We just lost our nurse to another practice and things are so much worse. I know it’s a residency clinic but honestly I’d take RNs or LPNs any day, I hope you guys have better MAs at your offices but based on what I’m seeing they are just not at all qualified to do what we ask them to do.

    • Avatar
      Veronica Theesfeld October 20, 2021 at 4:37 pm - Reply

      You’re not very nice with your words towards CMA, we are taught and took state test to be a healthcare worker , and to assist the doctors, nurses in all healthcare work assigned to us, from the EMR to giving injections, calling in prescription’s, ordering supplies, rooming patients, assisting in surgery, to giving pre and post instruction’s, and calling in to check on patients, to sterilizing instruments, and setting up patient rooms, drawing blood filling out all paper work, briefing the doctors and nursed on CC, taking vitals, to faxing patient orders/referrals etc, etc Now what do you call the work we do??? At a very low cost to you!!!

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      Kathleen February 21, 2022 at 10:08 pm - Reply

      Makes me wonder why your practice lost the RN to another practice. I have been a CMA for 38 years. When I chose this profession, we had to earn an Associates degree, pass our boards. One bit of advice I would send your way is to examine how you treat your MA’s mutual respect goes a long way. Just because a person has letters after their name doesn’t automatically make them better than anyone else including you, Doctor.

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    Brandon October 27, 2021 at 12:41 pm - Reply

    Washington state is actually one of the only states in the United States that licensed medical assistants. To qualify for a license in Washington state you have to meet certain educational requirements. Washington state medical assistants meet all of those educational requirements and therefore hold a license. A lot of us in Washington state holding associates degrees in medical assisting and we are thought dosage calculation, IV placement, sterile technique, critical thinking, nursing judgment, etc. As long as we are in the same building as a practicing MD that we can consult if needed, we are able to perform a lot of nursing tasks beyond our scope. That’s the beauty of an MA!

    “RN” does not mean competent. I’ve been doing this Work for 10 years and I’ve never seen so many “Nurses” degrade Medical Assistants.

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    Kevin Bradley December 10, 2021 at 12:11 am - Reply

    I currently work as a Charge Nurse for a FQHC here in Virginia. As a LPN of many years I have taken great care to respect the limitations of my license and the scope of practice that is offered. In my facility MAs are the backbone of the medical staff. They indeed handle many challenging things everyday. Our practice handles life from the womb to the very end. Our providers are a mixture of MD and FNP. The use of MA vs LPN is strictly for lowered overhead. My MAs come from literally every part of the globe and are delightful to work with. The concern over license only exists with having to dispense a medication. The MA staff handle every procedure…we train them for Pediatric/OB/GYN/Geriatric. The MAs do most of the intake, vaccinations, and procedures requested by the Providers during a office visit. A lot of training and proctoring is involved in developing the talents of the MA in this setting. Those MAs that have moved on have benefited greatly from the time and energy spent to help them grow. Just like any profession there is a starting point(school, license) and from there you grow with application of your knowledge. Anyhow, just 2 cents, from a LPN that enjoys the opportunity to work with some really great folks.

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    Sheryl February 9, 2022 at 2:41 am - Reply

    Thank you so much Kevin for just showing your support of all of the Medical Assistants you work with.. Health care is a team effort. All parts of the team are specifically trained for their job/roles and for that to work efficiently there should be mutual respect of everyone’s role. Do you disrespect your waitress when you are eating out? She may not be cooking the food or managing the restaurant but she is the person you are dealing directly. She doesn’t claim to be the cook but she should be respected as part of that team effort.

    It’s unfortunate that Medical Assistants have a great many roles from working in the administrative side of scheduling, billing, referrals, refill requests, insurance approvals, work notes and medical forms for schools, immunization records. Clinically the medical assistant does more than room patients, recording vital signs, medication reconciliation, medical history, chief complaint into the patients medical record. Perform any in office lab tests, vaccinations, assist in office surgical procedures as well as serve as a chaperone in certain examinations. Sterilize instruments, clean and prepare the exam rooms as well as stocking the rooms, ordering medical supplies, inventory, recording the vaccine storage temperature and maintaining an inventory of expirations on everything in the clinic or office. I can keep going but the point is by the medical assistant performing these roles, the RN has time to do her responsibilities and the doctor, PA or nurse practitioner is able to concentrate on the patients care. All of these roles need to work smoothly together in order for the patients to get the best care. To the patient it is the team work that is what makes the visit comfortable as well as their health and wellbeing the priority. Dismissing ones importance in this team, is not only disrespectful but can be dangerous. Praise for ALL Healthcare workers no matter of title or license should be applauded. It’s hard work.

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    Nancy February 26, 2022 at 10:45 pm - Reply

    Thank you Mona Lisa! I’ve been an MA for 16 years for family doctors. I take vital signs, call PTs with lab results, perform EKGs, do (All) vaccination and injections. I prepare PTs to do Zoom for virtual visits, PAs for medications and the list can go on. Most of the LPNs that worked with me had no clue and don’t do what I Do, so needless to say MAs are very important in the doctor’s office setting. So If anyone thinks that MAs know nothing, you are totally wrong.

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    Lynn March 1, 2022 at 10:05 pm - Reply

    My distrust of our healthcare system is growing leaps and bounds now that those with no medication training are being allowed to do many things related to meds, which puts patients at risk. Patients and families are very unaware that unqualified people are filling out and calling in meds. They have none of the nursing training and education that a nurse has to assess while talking to or filling out a form to recognize there’s something wrong with this.

    Dumbing down of our medical field is real and nurses are being replaced left and right. Life and death are truly the difference. Enough has been taken from nurses. Get rid of all the time waster insurance interference and let doctors and nurses give quality care instead of continuing to dilute their work more and more! I’m greatful for our medical assistants, but they need to stay well defined and away from meds. Employers are making grave errors going for the cheapest route rather than safety. We’ll see what happens in courts this next decade.

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