While most laws on how medical assistants can be utilized remain vague, the laws on medical assistant direct supervision are very clear. The ultimate authority in charge of the medical assistant is the employer, usually a doctor or licensed health care practitioner who hired them, and in turn, the doctor is the one who answers to the state Medical Board/Board of Medical Examiners of the state in which they practice the art of medicine. Nursesanswer to their State Board of Nursing.
Too many medical assistants and their supervisors falsely believe that as long as they work under the umbrella of the doctor they are allowed to do anything, however, little do they know that they might be taking massive risks. Without access to information on prevailing rules and regulations and support from some sort of organization permissible tasks and activities are hard to pinpoint. It is ALWAYS good practice to check with your State Board of Medical Examiners, Board of Medicine, Board of Licensure in Medicine, Department of nursing, or State Board of Nursing to research whether any standards and legal parameters have been established on how medical assistants may be utilized in a particular setting, e.g. in the Nurse Practice Act or scope of practice in medicine. Verify which acts and duties are permitted so that procedures that can potentially lead to medical negligence and scope of practice violations can be avoided.
Only in certain US states can medical assistants be supervised by a registered nurse (RN) and if so, only certain patient care tasks can be delegated to them. 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. Again, doctors and nurses should check with their state Medical Board and Board of Nursing regarding limitations, proper procedure and standards.
Nurses delegating tasks to medical assistants must assure proper supervision of such. 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, which means the RN, by delegating a task, transfers the responsibility for the performance of the task to the medical assistant, but retains professional accountability for the overall outcome and care. In those states where specific regulations for medical assistants don’t exist it is highly recommended they utilize their medical assistants conservatively and with proper supervision and evaluation.
Part of proper supervision is the 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 health care 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 highly 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.