Legal Requirements for Venipuncture in Washington

I recently received the following question regarding the legality of medical assistants performing venipuncture in Washington:

I am licensed as a medical assistant-certified (MA-C) under Washington law. Do I need to obtain the Washington state medical assistant-phlebotomist credential in order to perform venipuncture?

To answer this question, note the following excerpt from the Washington State Department of Health’s Frequently Asked Questions webpage:

The scope of practice of a medical assistant-phlebotomist includes capillary, venous, and arterial invasive procedures for blood withdrawal, CLIA [Clinical Laboratory Improvement Amendments] waived, moderate and high complexity tests, and [(electrocardiogram (ECG)]. A medical assistant-certified may perform capillary and venous blood withdrawals, CLIA waived and moderated complexity tests, and [ECG] but may not perform arterial invasive procedures for blood withdrawal or high complexity designated CLIA tests. If you hold a medical assistant-certified credential, you need only to retain your medical assistant-phlebotomist credential if you’re required to perform arterial invasive procedures for blood withdrawal or high complexity tests.

Federal Policy and the Pandemic: How the Pandemic and Changes in Federal Policy Have Expanded Medical Assistants’ Scope of Practice

Medical assistants’ role and duties have been significantly impacted by the COVID-19 pandemic. During this time, federal agencies and state governors have made necessary changes to expand medical assistants’ legal scope of practice to meet new health care needs.

In the March/April 2021 Public Affairs article in CMA Today, I discuss how these government actions have changed the knowledge, skills, and professional attributes and behaviors medical assistants are now expected to have and to demonstrate, particularly in these areas:

• Telehealth
• Nasopharyngeal swabbing
• COVID-19 vaccination administration

Learn more about how recent federal policy has affected medical assistants’ scope of practice by reading “Federal Policy and the Pandemic: How the Pandemic and Changes in Federal Policy Have Expanded Medical Assistants’ Scope of Practice” on the AAMA website.

Delegation of COVID-19 Vaccinations in Oregon: Part II

In part I of this topic, I responded to a registered nurse (RN) who questioned whether language in the regulations of the Oregon Board of Nursing might prevent RNs from delegating to medical assistants the administration of COVID-19 vaccinations. The RN followed up with an additional question:

What language in the Oregon nursing law permits RNs to delegate to medical assistants the administration of intramuscular injections—including COVID-19 vaccinations?

Medical assistants are classified as unregulated assistive personnel (UAP) under the Oregon nursing law. Division 45 of the regulations of the Oregon Board of Nursing, “Standards and Scope of Practice for the Licensed Practical Nurse and the Registered Nurse,” contains the key information on medical assistants’ scope of practice:

(11) Standards related to the RN who delegates the performance of a nursing procedure to a UAP.

…

(e) The RN’s authorization of a UAP to perform a nursing procedure shall only occur when the following delegation process steps are met:

(A) Based on nursing judgment, the RN determines that:

(i) The procedure does not require interpretation or independent decision making during its performance on the client;

(ii) The results of performing the procedure are reasonably predictable;

…

(B) The RN teaches the nursing procedure to the UAP and competency validates the UAP in the safe and accurate performance of the procedure on the client.

…

(f) The RN shall provide clinical supervision of the UAP to whom the procedure has been delegated.  The clinical supervision shall include:

(A) Monitoring of the UAP’s performance of the procedure to verify the UAP’s adherence to written directions; and

(B) Engaging in ongoing evaluation of the client and associated data to determine the degree to which client outcomes related to performance of the procedure are being met.

My legal opinion is that Division 45—not Division 47, which was discussed in Part I—is the applicable Oregon nursing law for determining what tasks may be delegated by RNs to UAP such as medical assistants in outpatient settings, including vaccination clinics. Division 45 states that RNs are permitted to delegate to UAP nursing procedures as long as all of the conditions delineated in Division 45 are satisfied.

An intramuscular injection such as a COVID-19 vaccination is a nursing procedure. Therefore, my legal conclusion is that Oregon nursing law allows RNs to delegate to knowledgeable and competent medical assistants working under direct or on-site RN supervision the administration of COVID-19 vaccinations in outpatient vaccination clinics as long as all the requirements of nurse delegation in Division 45 are met.

Delegation of COVID-19 Vaccinations in Oregon: Part I

I recently received the following question regarding the delegation of COVID-19 vaccinations in Oregon:

I am a public health registered nurse [RN]. I represent the Oregon Health Authority COVID-19 Recovery and Response Unit. Under Oregon law, may an RN delegate to medical assistants the administration of COVID-19 vaccinations? I found the following in Oregon nursing law which would seem to indicate that the answer is no:

Authorized Duties and Standards for Certified Medication Aide (CMA)

…

(4) A CMA may not administer medications by the following routes:

…

(c) Intramuscular;

[Another division of Oregon nursing law says something similar:]

Division 47

Standards for Community-Based Care Registered Nurse Delegation Process

…

(11) The Registered Nurse may not delegate the administration of medications by the intramuscular route

Certified medication aides are very different from medical assistants. The RN who contacted me is correct in stating that Division 47 of the Oregon Board of Nursing regulations does not permit RNs to delegate to certified medication aides the administration of intramuscular injections. Whether RNs are permitted by Oregon law to delegate to medical assistants the administration of intramuscular injections, however, is a different legal question.

Furthermore, Division 47 addresses community-based care settings. Note the following language from the Division 47 “Rule Summary, Statement of Purpose and Intent”:

(1) These rules apply only in settings where a Registered Nurse is not regularly scheduled and not available to provide direct supervision [italics added]. These are home and community-based settings as described in OAR 851-047-0010(6) and local corrections, lockups, juvenile detention, youth corrections, detoxification facilities, adult foster care and residential care, training and treatment facilities as described in ORS 678.150(9).

(2) These rules have no application in acute care or long-term care facilities or any setting where the regularly scheduled presence of a registered nurse is required by statute or administrative rule.

Therefore, my legal position is that Division 47 does not answer the question of whether RNs are permitted to delegate to medical assistants the administration of COVID-19 vaccinations in a vaccination clinic when the RNs are on the premises and immediately available.

Stay tuned for part II of this discussion, in which I will examine language in Oregon nursing law that allows RNs to delegate to medical assistants the administration of intramuscular injections.

Medical Assistants Deserve COVID-19 Vaccinations as Health Care Workers

I recently received notice of difficulties scheduling COVID-19 vaccinations appointments for health care professionals:

I had an appointment [to receive] a COVID-19 vaccine [in February] and was just notified today by Publix Pharmacy per their corporate office that frontline health care workers needed to have a Florida license number.

I tried to explain that [medical assistants] in the state of Florida are not required to have a medical license and that [medical assistants] work under the supervision of the physician.

Still, my appointment was canceled due to the fact that I do not have a state license. I have already sent an email to Publix’s customer care department and included a link that explains what a medical assistant is and does.

I am not certain if any other medical assistants (credentialed or not) have encountered this same issue with trying to obtain COVID-19 vaccination appointments as frontline health care workers at Publix or other pharmacies. I am simply passing this information on in the event that others have encountered the same issues.

This was the first medical assistant to report this issue to me, and they did all the right things. Medical assistants may use this as a model for what to do if denied the COVID-19 vaccination for not having a license number.

In this situation, medical assistants may also want to suggest to the pharmacy staff that they go to the AAMA website and navigate to the State Scope of Practice Laws webpage, where they will find the medical assisting law for all states.