Proper Supervision and Utilization of Medical Assistants in a Medical Office

While laws on the utilization of medical assistants on the work place remain vague, the laws on medical assistant supervision are very clear. Unless explicitly prohibited by state law, supervising licensed nursing staff such as registered nurses (RNs) placed in charge of medical office staff under the direction of the doctor are authorized to delegate certain clinical and healthcare duties to medical assistants, except those that constitute the practice of medicine and lie outside of the medical assistant's scope of practice.

Such permissible tasks and activities are identified according to legal parameters defined by each state in its nurse practice act and by the scope of practice and standards established by professional nursing organizations and the Board of Medicine/State Board of Medical Examiner.

It is ALWAYS good practice to check with your State Board of Medical Examiners, Board of Medicine, also called Board of Licensure in Medicine, to verify how a medical assistant may be utilized in a medical practice setting and what exactly they are allowed to do. Procedures that may lead to medical acts of negligence and scope of practice violations must be identified and recognized so that errors and malpractice accidents can be prevented. Legal consequences can be costly. 

Nurses Delegating Tasks to Medical Assistants

In certain states certain patient care tasks can be delegated to the medical assistant and supervised by a registered nurse (RN). The State Board of Nursing in New Hampshire realizes that nurses may need to delegate certain activities to medical assistants and have published specific guidelines, which explain how nurses in New Hampshire can delegate and what medical assistants are allowed to do. From what we have heard NH is headed towards the state ruling that if you want to give injections as a medical assistant you will have to be certified, some states have already gone this way.

Delegation is defined as the transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome. For example, the RN, in delegating a task to an assistive individual, transfers the responsibility for the performance of the task but retains professional accountability for the overall outcome and care.

Nurses delegating tasks to medical assistants must assure proper supervision of medical assistant staff. In those states where specific regulations for medical assistants don't exist it is highly recommended that doctors and nurses check with their state Medical Board and Board of Nursing regarding limitations, proper procedure and standards of practice. It is highly recommended they utilize their medical assistants conservatively and with proper supervision and evaluation.

Part of proper supervision is proper evaluation of skills

Supervision is the active process of directing, guiding and influencing the outcome of an individual’s performance of a task. Supervision is generally categorized as on-site, where the doctor, or the RN is physically present or immediately available while the task is being performed or off-site, where the doctor, or RN directs certain activities and tasks through various means of written and verbal communications, but is not present at the site. Certain patient care procedures, such as injections, venipunctures, radiographic imaging, cast removal and other procedures carry a higher risk of injury, therefore adherence to proper standards of care, protocol and execution must be carefully monitored and supervised. The steps are as follows:

The medical assistant must first have been properly trained, instructed and taught before any specific technical or clinical activities can be delegated. It is very important that the evaluation of these particular skills are properly documented by the person in charge, usually the doctor, or licensed medical practitioner, under whom the medical assistant works. It is always a good idea to check malpractice and professional liability insurance policies for specific riders to see if the medical assistant is covered during all stages of the training phase. And remember, just because something was taught in medical assistant school doesn't automatically mean the medical assistant is also allowed to do it on the job.

As before mentioned the rule of thumb is that a medical assistant may only do tasks that a medical doctor, or other licensed healthcare provider has ordered and in which the medical assistant has been properly trained and is supervised—but even there are exceptions, such as, for example the hotly debated topic of medical assistants starting IV lines. While some medical assistant vocational programs have decided to include IV therapy into their teaching curriculum, it is an area that, although discussed in class, remains outside the medical assistant's scope of practice since it is an invasive procedure.

Medical Assistant Scope of Practice Differ from State to State...

Regulations and patient care limitations differ from state to state, for example:

• in Alaska, patient care tasks CANNOT be delegated to medical assistants by a registered nurse (RN). Only a medical doctor can delegate any sort of direct hands-on patient care tasks to a medical assistant in Alaska
  
• in the state of New York medical assistants may not legally administer medications to patients, by any route (New York State Board of Nursing)
  
• many states require medical assistants to have a limited x-ray license if their duties include taking and processing radiographic images, including Florida 

AGAIN, if you are unsure about certain procedures medical assistants can do contact your state's Board of Medical Examiners, Board of Licensure in Medicine, State Nursing Board and one of the medical assistant certification bodies in the USA. 

Procedures Requiring Special Training

Certain states require medical assistants to have special training if their job requires them to expose patients to X-rays, or venipuncture procedures. Those with blood drawing responsibilities in California and those who perform point of care testing in Georgia are also required to be certified in medical assisting. Some states won't allow medical assistants to administer medications or injections. Any cases of non-compliance with established laws and rules and contrary to facility policies will put the medical assistant, supervisors and the facility in a precarious situation, where existing malpractice insurance doesn't have to cover anyone should something happen and a lawsuit ensue.

• Medical Assistant Supervised | Respondeat Superior Doctrine
  
  When a master acts through the servant to accomplish the master's task, such as the medical assistant carrying out direct patient care under the physician.