Scope of Practice With Nurse Practitioners

I have been receiving an increasing number of questions about the scope of practice for medical assistants when they are working under the supervision of nurse practitioners (NPs) or physician assistants (PAs), and not under the direct supervision of a physician. This scenario will become more frequent because of the Affordable Care Act and the anticipated increase in demand for primary care, which is often provided by NPs and PAs.

Because physician assistants always work under physician authority and supervision—although, in some states, very general physician supervision—the scope of practice for medical assistants working under PAs is usually very similar to their scope of practice when working under physician supervision. However, there are some state laws that do not permit medical assistants to administer medication unless a physician (MD) or osteopath (DO) is on the premises.

Medical assistants’ scope of practice when working under nurse practitioners (or other advanced practice nurses) is usually more difficult to ascertain from state law. The controlling law is the state nurse practice act and the regulations and policies of the state board of nursing. Often, the legal analysis is complicated.

If you work under the direct supervision of a nurse practitioner or a physician assistant and have questions about scope of practice, please feel free to direct your questions to me.

About Donald A. Balasa

Donald A. Balasa, JD, MBA, chief executive officer and legal counsel for the American Association of Medical Assistants, keeps his eye on what is happening in the profession.
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229 Responses to Scope of Practice With Nurse Practitioners

  1. George LaBarca says:

    Nice article about this in Legal Eye…so my question is…how does this apply to the State of Florida or where do I find out?? I frequently work very close with PA’s and Nurse Practioners…thanks in advance…George CMA (AAMA).

    • Thank you very much! Here is the provision of the Florida nursing law that delineates what tasks nurses are NOT permitted to delegate:
      64B9-14.003 Delegation of Tasks Prohibited.
      The registered nurse or licensed practical nurse, under direction of the appropriate licensed professional as defined in Section 464.003(3)(b), F.S., shall not delegate:
      (1) Those activities not within the delegating or supervising nurse’s scope of practice.
      (2) Nursing activities that include the use of the nursing process and require the special knowledge, nursing judgment or skills of a registered or practical nurse, including:
      (a) The initial nursing assessment or any subsequent assessments;
      (b) The determination of the nursing diagnosis or interpretations of nursing assessments;
      (c) Establishment of the nursing care goals and development of the plan of care; and
      (d) Evaluation of progress in relationship to the plan of care.
      (3) Those activities for which the UAP has not demonstrated competence.
      Specific Authority 464.006 FS. Law Implemented 464.003(17),(18), (19), (20), 464.018(1)(h) FS. History–New 1-1-96, Amended 4-29-96, Formerly 59S-14.003.

      Here is the language of the Florida nursing law that states what nurses ARE permitted to delegate:
      64B9-14.002 Delegation of Tasks or Activities.
      In the delegation process, the delegator must use nursing judgment to consider the suitability of the task or activity to be delegated.
      (1) Factors to weigh in selecting the task or activity include:
      (a) Potential for patient harm.
      (b) complexity of the task.
      (c) Predictability or unpredictability of outcome including the reasonable potential for a rapid change in the medical status of the patient.
      (d) Level of interaction required or communication available with the patient.
      (e) Resources both in equipment and personnel available in the patient setting.
      (2) Factors to weigh in selecting and delegating to a specific delegate include:
      (a) Normal assignments of the UAP.
      (b) Validation or verification of the education and training of the delegate.
      (3) The delegation process shall include communication to the UAP which identifies the task or activity, the expected or desired outcome, the limits of authority, the time frame for the delegation, the nature of the supervision required, verification of delegate’s understanding of assignment, verification of monitoring and supervision.
      (4) Initial allocation of the task or activity to the delegate, periodic inspection of the accomplishment of such task or activity, and total nursing care responsibility remains with the qualified nurse delegating the tasks or assuming responsibility for supervision.
      Specific Authority 464.006 FS. Law Implemented 464.003(17),(18), (19), (20), 464.018(1)(h) FS. History–New 1-1-96, Formerly 59S-14.002.

      As you see, there is no explicit prohibition in Florida law of any nurse (including nurse practitioners) from delegating to competent and knowledgeable medical assistants working under their direct supervision the administration of medication.

      The following is the Florida law that specifies what physicians are permitted to delegate to medical assistants:
      The 2012 Florida Statutes
      Title XXXII
      REGULATION OF PROFESSIONS AND OCCUPATIONS Chapter 458
      MEDICAL PRACTICE View Entire Chapter

      458.3485 Medical assistant.—
      (1) DEFINITION.—As used in this section, “medical assistant” means a professional multiskilled person dedicated to assisting in all aspects of medical practice under the direct supervision and responsibility of a physician. This practitioner assists with patient care management, executes administrative and clinical procedures, and often performs managerial and supervisory functions. Competence in the field also requires that a medical assistant adhere to ethical and legal standards of professional practice, recognize and respond to emergencies, and demonstrate professional characteristics.
      (2) DUTIES.—Under the direct supervision and responsibility of a licensed physician, a medical assistant may undertake the following duties:
      (a) Performing clinical procedures, to include:
      1. Performing aseptic procedures.
      2. Taking vital signs.
      3. Preparing patients for the physician’s care.
      4. Performing venipunctures and nonintravenous injections.
      5. Observing and reporting patients’ signs or symptoms.
      (b) Administering basic first aid.
      (c) Assisting with patient examinations or treatments.
      (d) Operating office medical equipment.
      (e) Collecting routine laboratory specimens as directed by the physician.
      (f) Administering medication as directed by the physician.
      (g) Performing basic laboratory procedures.
      (h) Performing office procedures including all general administrative duties required by the physician.
      (i) Performing dialysis procedures, including home dialysis.
      (3) CERTIFICATION.—Medical assistants may be certified by the American Association of Medical Assistants or as a Registered Medical Assistant by the American Medical Technologists.
      History.—s. 7, ch. 84-543; s. 7, ch. 84-553; ss. 21, 26, ch. 86-245; s. 4, ch. 91-429; s. 28, ch. 97-264; s. 113, ch. 2007-5.

      This law requires medical assistants to work under direct physician supervision in order to be delegated the administration of medication. To my knowledge, there is no provision in Florida law that permits medical assistants to administer medication under the supervision of a physician assistant when a physician is not exercising direct supervision.

      Here is the Florida definition of direct supervision by a physician over a medical assistant:
      64B8-2.001 Definitions.
      (1) Levels of Supervision:
      (a) “Direct supervision” shall require the physical presence of the supervising licensee [physician] on the premises so that the supervising licensee is reasonably available as needed.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • mslindawill says:

        What does the law say about this in Alabama?

      • This is what the rules of the Alabama Board of Nursing say:

        610-X-6-.11 Assignment, Delegation and Supervision
        (1) The registered nurse shall be accountable and responsible for the assignment of nursing activities and tasks to other health care workers based on but not limited to:
        (a) Knowledge, skills and experience.
        (b) Complexity of assigned tasks.
        (c) Health status of the patient.
        (2) Assignments may not exceed the scope of an individual registered nurse or licensed practical nurse’s scope of practice including, but not limited to:
        (a) Educational preparation, initial and continued.
        (b) License status.
        (c) State and federal statutes, and regulations.
        (d) State and national standards appropriate to the type of practice.
        (e) Nursing experience.
        (f) Demonstrated competence.
        (g) Consideration for patient safety.
        (h) Knowledge, skills, and ability to manage risks and potential complications.
        (3) The registered nurse or licensed practical nurse shall delegate only after considering various factors including but not limited to:
        (a) Knowledge, skills and experience of the person receiving the delegation.
        (b) Complexity of the delegated tasks.
        (c) Health status of the patient.
        (4) Tasks delegated to unlicensed assistive personnel may not include tasks that require:
        (a) The exercise of independent nursing judgment or intervention.
        (b) Invasive or sterile procedures.
        (i) Finger sticks are not an invasive or sterile procedure within the meaning of these rules.
        (ii) Peripheral venous phlebotomy for laboratory analysis is not an invasive or sterile procedure within the meaning of these rules.
        (c) The assistance with medications except as provided in Chapter 610-X-7.
        (5) Supervision shall be provided to individuals to whom nursing functions or responsibilities are delegated or assigned.
        (6) The practice of licensed practical nursing shall be directed by a registered nurse or physician or dentist.
        (7) A licensed practical nurse or unlicensed individual may not supervise, direct, or evaluate the nursing care provided by the registered nurse.
        Author: Alabama Board of Nursing
        Statutory Authority: Code of Alabama, 1975, §§ 34-21-1(3)(b), 34-21-2(a)(21), 34-21-2(c)(6).
        History: Filed November 23, 2009. Effective December 28, 2009.

        This applies to all nurses, including nurse practitioners.

        I hope this is helpful.

        Donald A. Balasa, JD, MBA
        Executive Director, Legal Counsel

        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

        Visit us on Facebook! http://www.aama-ntl.org/facebook

        The CMA (AAMA): Health Care’s Most Versatile Professional

      • Lori Yakubek says:

        I would like the Ohio decision making model emailed to me, RE: scope of practice with NP. Thank you.

      • Thank you. I will send it directly to your e-mail.

        Donald A. Balasa, JD, MBA
        Executive Director, Legal Counsel

        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

        Visit us on Facebook! http://www.aama-ntl.org/facebook

        The CMA (AAMA): Health Care’s Most Versatile Professional

      • Dorian Kerr says:

        I can”t find anything on medical assistants being able to give injections under the supervision of a physician or NP on the SCLLR. Can you help and give references?

      • Thank you for your question. Are you referring to the South Carolina law?

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

  2. Leah Zart says:

    I work under two physicians and three NP’s in a private pediatric practice in Nebraska. How does this apply to me and the other medical assistants in our practice?

    • Thank you for your question. I am happy to respond.

      First, let me define direct supervision. Direct supervision in the context of physicians delegating to medical assistants is defined as the delegating/overseeing/supervising physician(s) being on the premises and reasonably available.

      If the physicians are exercising direct supervision over the medical assistants, then the fact that the nurse practitioners are exercising intermediary supervision over the medical assistants as directed by the physicians does not have a direct impact on the scope of practice of the medical assistants. Note the following from my article in the May-June 2013 CMA Today:
      Is it legal for physicians to assign to
      other health professionals supervisory
      responsibilities over medical
      assistants?
      Yes. Under the laws of most states, physicians
      are permitted (explicitly or implicitly)
      to ask health professionals, such as
      advanced practice nurses (APNs)—most
      often nurse practitioners—physician assistants,
      and registered nurses to supervise
      medical assistants in the performance of
      duties delegated to the medical assistants
      by the physician. This type of supervision
      is sometimes referred to as “intermediary
      supervision.”

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  3. Christie Buxton says:

    Can you send a link or post about Washington state? I work in a large multi physician clinic with many physicians, PAs, & NPs with many years experience. My clinic has 100’s of providers and will definitely want to know as well.

    Christie B., CMA

  4. Pam Christianson says:

    What does the state of Montana say about working under NPs or PAs?

    Thank you

    • Thank you for your question. Please note the following from the Montana law:
      (b) the level of physician or podiatrist supervision required for a medical assistant when performing specified administrative and clinical tasks delegated by a physician or podiatrist. However, the board shall adopt a rule requiring onsite supervision of a medical assistant by a physician or podiatrist for invasive procedures, administration of medication, or allergy testing.

      (3) Physician or podiatrist supervision shall be active and continuous but does not require the physical presence of the supervising physician or podiatrist at the time and place that services are rendered so long as the physician or podiatrist is available for consultation, except that physician or podiatrist supervision shall be onsite when a medical assistant performs:

      (a) invasive procedures;

      (b) administers medicine; or

      (c) performs allergy testing.

      Therefore, it is my legal opinion that Montana law requires the delegating/supervising/overseeing physician to be on the premises and reasonably available when a medical assistant is administering medication or doing phlebotomy/venipuncture. For other duties, however, the physician does not need to be on the premises, and the physician is permitted to have a nurse practitioner or physician assistant exercise intermediary supervision over the medical assistant.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  5. Paula Cooke says:

    What about North Carolina? Thank you for all that you do and for keeping us informed.

    • Thank you for your question. Under North Carolina law, it does appear that the overseeing/delegating/supervising physician(s) must be on the premises and reasonably available when the medical assistant is administering medication or doing venipuncture/phlebotomy. Having a physician assistant or a nurse practitioner on the premises is not permissible when the medical assistant is administering medication or doing venipuncture.

      If a nurse practitioner is working semi-autonomously (that is, under a physician collaboration agreement), the North Carolina Board of Medical Examiners has posted a decision tree to be used by all nurses (LPN, RNs, advanced practice nurses such as nurse practitioners) when determining what to delegate to unlicensed allied health professionals such as medical assistants. I will send that directly to your e-mail address.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • JMP says:

        Mr. Balasa,
        Thank you for putting this very useful article together. Do you happen to have the citation to the NC law or regulation that leads you to believe that an overseeing/delegatin/supervising physican must be on the premises and reasonably available when a medical assistant is adminstering medication?
        Thank you.

      • You are welcome! Yes, I will be happy to send by legal opinion letter for North Carolina, and other documents, to your e-mail address.

        Donald A. Balasa, JD, MBA
        Executive Director, Legal Counsel

        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

        Visit us on Facebook! http://www.aama-ntl.org/facebook

        The CMA (AAMA): Health Care’s Most Versatile Professional

  6. Jodie Olson says:

    I am wondering what Minnesota law states about it. The clinic I worked at was a nurse practitioner owned clinic.

    • Elizabeth Sprinkle says:

      I would like to know what the law is on this subject for the state of NC as well. I teach medical assisting for a local community college and therefore would like to know how to let students and the community know in my area how they are affected. Thank you!

      • Thank you for your question. I will send to your e-mail the North Carolina Board of Nursing’s decision tree for determining what North Carolina nurses are and are not permitted to delegate to unlicensed allied health professionals such as medical assistant.

        Donald A. Balasa, JD, MBA
        Executive Director, Legal Counsel

        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

        Visit us on Facebook! http://www.aama-ntl.org/facebook

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    • Thank you for your question. I am happy to respond.

      Minnesota law requires nurse practitioners to work under a collaboration agreement with a physician. Here is an excerpt from MN law:
      Subd. 5.Clinical nurse specialist practice.”Clinical nurse specialist practice” means the provision of patient care in a particular specialty or subspecialty of advanced practice registered nursing within the context of collaborative management, and includes: (1) diagnosing illness and disease; (2) providing nonpharmacologic treatment, including psychotherapy; (3) promoting wellness; and (4) preventing illness and disease. The certified clinical nurse specialist is certified for advanced practice registered nursing in a specific field of clinical nurse specialist practice.

      Subd. 6.Collaborative management.”Collaborative management” is a mutually agreed upon plan between an advanced practice registered nurse and one or more physicians or surgeons licensed under chapter 147 that designates the scope of collaboration necessary to manage the care of patients. The advanced practice registered nurse and the one or more physicians must have experience in providing care to patients with the same or similar medical problems, except that certified registered nurse anesthetists may continue to provide anesthesia in collaboration with physicians, including surgeons, podiatrists licensed under chapter 153, and dentists licensed under chapter 150A. Certified registered nurse anesthetists must provide anesthesia services at the same hospital, clinic, or health care setting as the physician, surgeon, podiatrist, or dentist

      I find nothing in MN law that forbids nurse practitioners from delegating to competent and knowledgeable unlicensed allied health professionals such as medical assistants working under their direct supervision the administration of medication (including by intramuscular, intradermal, and subcutaneous injections) as specifically directed by the NP.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  7. Missy says:

    How does this apply to Illinois, I work in a rural health clinic with PA’s and NP, sometimes on weekends there is not a physician on the premises.

    • Thank you for your question. I find nothing in Illinois law that forbids medical assistants from working under a physician assistant and performing the full range of medical assisting duties (as long as the physician overseeing the PA and the medical assistant so authorizes).

      However, here is the language regarding what nurses (including NPs) are permitted to delegate:
      (225 ILCS 65/50-75)
      (Section scheduled to be repealed on January 1, 2018)
      Sec. 50-75. Nursing delegation.
      (a) For the purposes of this Section:
      “Delegation” means transferring to an individual the authority to perform a selected nursing activity or task, in a selected situation.
      “Nursing activity” means any work requiring the use of knowledge acquired by completion of an approved program for licensure, including advanced education, continuing education, and experience as a licensed practical nurse or professional nurse, as defined by the Department by rule.
      “Task” means work not requiring nursing knowledge, judgment, or decision-making, as defined by the Department by rule.
      (b) Nursing shall be practiced by licensed practical nurses, registered professional nurses, and advanced practice nurses. In the delivery of nursing care, nurses work with many other licensed professionals and other persons. An advanced practice nurse may delegate to registered professional nurses, licensed practical nurses, and others persons.
      (c) A registered professional nurse shall not delegate any nursing activity requiring the specialized knowledge, judgment, and skill of a licensed nurse to an unlicensed person, including medication administration. A registered professional nurse may delegate nursing activities to other registered professional nurses or licensed practical nurses.
      A registered nurse may delegate tasks to other licensed and unlicensed persons. A licensed practical nurse who has been delegated a nursing activity shall not re-delegate the nursing activity. A registered professional nurse or advanced practice nurse retains the right to refuse to delegate or to stop or rescind a previously authorized delegation.
      (Source: P.A. 95-639, eff. 10-5-07.)

      I take this to mean that nurse practitioners (and RNs and LPNs) are not permitted to delegate to medical assistants the administration of medication. However, it is my opinion that NPs are permitted to delegate to medical assistants other tasks, such as taking vital signs and venipuncture/phlebotomy.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • Fada says:

        We have protocols written out for prescription refills and calling back patients with their lab/imaging results..etc by the physician. Is it ok to continue following this even if there’s no physician in the building for the state of Illinois?

      • Thank you for your question. It is my legal opinion that Illinois law permits physicians to delegate to competent and knowledgeable medical assistants working under their direct supervision in outpatient settings the verbatim conveying of laboratory and imaging results as long as the medical assistant does not answer any questions from the patient that requires the medical assistant to exercise independent professional judgment or to make clinical assessment/evaluations/interpretations. In essence, the medical assistant should not convey anything over the phone other than what the physician authorized/directed the medical assistant to say.

        With prescription refills, however, it is my opinion that medical assistants are permitted to pend the medication order in the CPOE system. However, the delegating provider must review, approve, and attest to/electronically sign the order before the order becomes actionable and is transmitted to the pharmacy.

        I hope this is helpful.

        Donald A. Balasa, JD, MBA
        Executive Director, Legal Counsel

        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

        Visit us on Facebook! http://www.aama-ntl.org/facebook

        The CMA (AAMA): Health Care’s Most Versatile Professional

      • allison says:

        What about in the state of Ohio?
        Thank You
        allison

      • Thank you for your question. I will send to your e-mail the address the pertinent excerpts from the Ohio nursing law.

        Donald A. Balasa, JD, MBA
        Executive Director, Legal Counsel

        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

        Visit us on Facebook! http://www.aama-ntl.org/facebook

        The CMA (AAMA): Health Care’s Most Versatile Professional

  8. Kathy says:

    I am also wondering about the State of New Jersey? I work in a group practice with Physicians Assistants usually the MD or DO is in close proximity however, sometimes as stated above I work on week-ends only with PA’s…??

    • Thank you for your question. Please see the following from the New Jersey law:
      4. The physician shall remain on the premises at all
      times that treatment orders for injections are being
      carried out by the assistant and shall be within
      reasonable proximity to the treatment room and
      available to observe, assess and take any necessary
      action regarding effectiveness, adverse reaction or
      any emergency.

      Therefore, it would appear that you could work under a physician assistant if a medical assistant is not on the premises, but you could not administer any injections if the physician is not on the premises.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  9. Jill says:

    Colorado?
    I work for a nurse practitioner. We do not file insurance nor do we take medicare , does this make a difference?

    • Thank you for your question. Whether the health care provider accepts third-party insurance, or participates in Medicare, has no bearing on scope of practice. Scope of practice is usually determined by state law, although federal law occasionally has an impact on scope of practice.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  10. Mandy says:

    I am having trouble on where to find out Michigan laws pertaining to what you mentioned above and also, what an MA is and is not aloud to do when a physician is not on premise. Any help is greatly appreciated!

  11. Robin CMA(AAMA) says:

    I work at a can you please post a link for Georgia laws with both APRN and PA-C

  12. Angie says:

    I work under 3 NP’s and 1 RN in California. Could you please tell me if this affect my scope of practice as an MA?

    • Thank you for your question. Here is the answer from the website of the Medical Board of California:

      Can medical assistants be supervised by a nurse practitioner, nurse midwife, or physician assistant in the absence of a physician and surgeon?
      Per Business and Professions Code section 2069 (a)(1), a supervising physician and surgeon at a “community clinic” licensed under Health and Safety Code section 1204(a) may, at his or her discretion, in consultation with the nurse practitioner, nurse midwife, or physician assistant provide written instructions to be followed by a medical assistant in the performance of tasks or supportive services. The written instructions may provide that the supervisory function for the medical assistant in performing these tasks or supportive services may be delegated to the nurse practitioner, nurse midwife, or physician assistant and that those tasks may be performed when the supervising physician and surgeon is not on site.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  13. Michele Miller says:

    Thank you for this information Don, can you comment on the state of Ohio? I have shared this with my practice administrators and we are not clear on what it means for NP to supervise MA’s in Ohio.
    Thank you,
    Michele

    • You are welcome, Michelle. The situation in Ohio regarding what nurse practitioners are permitted to delegate to medical assistants is a bit tricky. Here is my analysis.

      First of all, based on the following language, all Ohio nurses (including nurse practitioners) are not permitted to delegate to unlicensed allied health professionals such as medical assistants the administration of medication, with the minor exceptions set forth in the following:

      4723-13-05 Criteria and standards for a licensed nurse delegating to an unlicensed person.

      ……

      (C) Except as otherwise authorized by law or this chapter, a licensed nurse may delegate to an unlicensed person the administration of only the following medications:

      (1) Over-the-counter topical medications to be applied to intact skin for the purpose of improving a skin condition or providing a barrier; and

      (2) Over-the-counter eye drop, ear drop, and suppository medications, foot soak treatments, and enemas.

      For all tasks other than administration of medication, the decision-making model from the Ohio Board of Nursing would determine what can be delegated by all nurses (including NPs) to unlicensed allied health professionals such as medical assistants. I will forward the decision making model directly to your e-mail.

      I hope this will be helpful, Michelle.

      Don

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • Melanie Rittenour says:

        Dear Don:

        Could I also get the rules for NPs delegating to Medical Assistants – for the state of Ohio?

        Thank you.

        – Melanie

      • I will be happy to forward to you.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

  14. Rhonda says:

    How does this affect Indiana? Thank you for your assistance. Rhonda

    • Thank you for our question. Please note the following from the website of the Indiana Board of Nursing:

      Q. What is the scope of practice for nurses in Indiana?
      The Indiana State Board of Nursing does not issue advisory opinions, and the only guidance it formally offers regarding scope of practice questions is to refer questions to Indiana’s statutes and administrative rules regarding the practice of nursing. These rules and statutes are available in compilation form on the Indiana Professional Licensing Agency website at: http://www.in.gov/pla/2497.htm
      Indiana’s Nurse Practice Act was written to be intentionally broad and general so that as new skills and procedures become part of standard nursing practice, the laws maintain their relevance and applicability. Basically, each nurse licensed in Indiana is responsible for ensuring that he or she is adequately prepared, competent, and qualified to perform any particular skill or procedure that is utilized. In a sense, the nursing profession itself actually determines the scope of practice. For a particular skill or procedure, some relevant points to consider would be what other nurses and other facilities are doing with regards to that skill or procedure. Another point to consider is whether there is a well-developed system for ensuring that those performing a given skill or procedure have the adequate training and support to ensure consistent, safe and competent delivery of that skill or procedure.
      For additional information, you may want to discuss particular procedures with peers in the nursing profession as represented by the Indiana State Nurses Association or other professional nursing organizations specific to your practice specialty.

      It appears that nurse practitioners have broad discretion in determining what duties to delegate to unlicensed allied health professionals such as medical assistants.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  15. Sherry says:

    Can you please provide information on Michigan? Thank you.

    • Thank you for your question. Here are the delegation rules of the Michigan Board of Nursing:

      DEPARTMENT OF CONSUMER & INDUSTRY SERVICES
      DIRECTOR’S OFFICE
      BOARD OF NURSING – GENERAL RULES
      (By authority conferred on the director of the department of consumer and industry services by section 17201 of 1978 PA 368, MCL 333.17201 et seq. and Executive Reorganization Order Nos. 1996-1 and 1996-2, MCL 330.3101 and 445.2001)
      PART 1. GENERAL PROVISIONS
      R 338.10101 Definitions.
      Rule 101. (1) As used in this part:
      (a) “Act” means 1978 PA 368, MCL 333.1101 et seq.
      (b) “Authorized representative” means the chairperson, vice chairperson, or such other member of the board or staff as the board may formally designate.
      (c) “Board” means the Michigan board of nursing.
      (2) Terms defined in the act have the same meanings when used in these rules.
      History: 1989 AACS; 2003 AACS.
      R 338.10102 Request for board action.
      Rule 102. (1) A person who desires to submit a request for declaratory ruling under 1969 PA 306, MCL 24.201 et seq. shall make that request in writing. The request shall be filed with the Michigan Board of Nursing, Department of Consumer and Industry Services, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909.
      (2) The board or its authorized representative may require the person to submit additional information necessary to make an appropriate resolution of the matter.
      History: 1989 AACS; 2001 AACS; 2003 AACS.
      R 338.10103 Assessment of fines.
      Rule 103. (1) The board shall make a determination as to the amount of a fine based on the following factors:
      (a) The extent to which the licensee obtained financial benefit from any conduct comprising part of the violation found by the board.
      (b) The willfulness of the conduct found to be part of the violation determined by the board.
      (c) The cost incurred in investigating and proceeding against the licensee.
      (2) A fine shall not exceed the sum of $2,500.00 for each violation found to have been committed by the licensee.
      History: 1989 AACS.
      R 338.10104 Delegation.
      Rule 104. (1) Only a registered nurse may delegate nursing acts, functions, or tasks. A registered nurse who delegates nursing acts, functions, or tasks shall do all of the following:
      (a) Determine whether the act, function, or task delegated is within the registered nurse’s scope of practice.
      (b) Determine the qualifications of the delegatee before such delegation.
      (c) Determine whether the delegatee has the necessary knowledge and skills for the acts, functions, or tasks to be carried out safely and competently.
      (d) Supervise and evaluate the performance of the delegatee.
      (e) Provide or recommend remediation of the performance when indicated.
      (2) The registered nurse shall bear ultimate responsibility for the performance of nursing acts, functions, or tasks performed by the delegatee within the scope of the delegation.
      History: 1989 AACS; 2003 AACS.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • Cindy Gordon says:

        Thank you for your response regarding nursing delegation but can you address working under a Physician’s Assistant in the state of MI?

      • Thank you for your question. I will send more detailed information directly to your e-mail address.

        Generally, I will state that–in all states–physician assistants must work under physician supervision/oversight, although the supervision can be very general, under the laws of all states.

        I will send you information about the Michigan law.

        Donald A. Balasa, JD, MBA
        Executive Director, Legal Counsel

        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

        Visit us on Facebook! http://www.aama-ntl.org/facebook

        The CMA (AAMA): Health Care’s Most Versatile Professional

  16. What does Oregon regulations say about CMAs working for Nurse Practioners and PAs

    • Thank you for your question. I was unable to find specific language in the Oregon statutes or regulations about nurse practitioner or physician assistant delegation to medical assistants of duties that include administration of medication.

      Because nurse practitioners have full practice authority under OR law, it is my tentative legal opinion that NPs most likely do have the authority to delegate to competent and knowledgeable medical assistants working under their direct supervision in outpatient settings clinical duties such as venipuncture/phlebotomy and administration of medication (including by intramuscular, intradermal, and subcutaneous injections). It is also my tentative legal opinion that OR law permits PAs to delegate to knowledgeable and competent medical assistants working under their direct supervision (regardless of whether the overseeing physician is on the premises) the duties set forth in the previous sentence.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  17. Valerie Curry says:

    we have several new convenient/acute care clinics opening in Iowa that are owned and operated by Nurse Practitioners. Can you expand on Iowa laws regarding CMAs working for ARNPs and / or send me a link to review?

    • Thank you for your question. The Iowa Board of Nursing does not have specific delegation rules for APRNs. The Iowa BON does have the following language in this rules for RNs. Because nurse practitioners are required to be RNs, the following also applies to NPs:
      6.2(5) The registered nurse shall recognize and understand the legal implications of accountability.
      Accountability includes but need not be limited to the following:
      a. Performing or supervising those activities and functions which require the knowledge and skill
      level currently ascribed to the registered nurse and seeking assistance when activities and functions are beyond the licensee’s scope of preparation.
      b. Assigning and supervising persons performing those activities and functions which do not
      require the knowledge and skill level currently ascribed to the registered nurse.
      c. Using professional judgment in assigning and delegating activities and functions to unlicensed
      assistive personnel. Activities and functions which are beyond the scope of practice of the licensed practical nurse may not be delegated to unlicensed assistive personnel. For the purposes of this paragraph, “unlicensed assistive personnel” does not include certified emergency medical services personnel authorized under Iowa Code chapter 147A performing nonlifesaving procedures for which those individuals have been certified and which are designated in a written job description, after the patient is observed by a registered nurse.

      The Iowa Board of Nursing website references the position paper on delegation of the National Council of State Boards of Nursing. I will send that paper directly to your e-mail address.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  18. Julie Fogt says:

    What does Ohio regulations say about CMAs working for Nurse Practioners and PAs. You may post on here but could you also email it to me. 2nd question is if you work under a NP and have a medical director with 10 minutes how does that stand for a practice.

  19. Melanie says:

    Could you please address the laws of the state of South Carolina concerning CMAs working with Nurse Practitioners? Also, is there a resource that you can provide where I can find the SC state laws on CMAs and their roles and repsonsibilities? I have been unable to locate this. Thank you!

  20. Torey says:

    Massachusetts law?

  21. Shawn Severson says:

    Can you post the link for Wisconsin law?

    • Thank you for your question. I will send to your e-mail address two documents from the Wisconsin Board of Nursing that address this issue.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • Robin Isely says:

        Could I also have the address links from the Wisconsin Board of Nursing discussing delegation of medical assistants by a Nurse Practitioner. Where do I find the laws pertaining to physicians as well as for Medicare/Medicaid? I appreciate your response. My email is: iselyrob@yahoo.com

      • Thank you. I will be happy to send you my Wisconsin documentation for delegation by physicians, and delegation by nurse practitioners, to medical assistants.

        I will also send to your e-mail address my CMS article.

        Donald A. Balasa, JD, MBA
        Executive Director, Legal Counsel

        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

        Visit us on Facebook! http://www.aama-ntl.org/facebook

        The CMA (AAMA): Health Care’s Most Versatile Professional

  22. Lori Hardgrave says:

    Hello,

    Do you know of or can you address any upcoming Federal changes to the Medical Assistants scope of prectice as it pertains to injections or administration of medications for those CMAs that work under Nurse Practitioners.
    Thank you,

    • Thank you for your question. The legality of nurse practitioners delegating to medical assistants injections is determined at the state level, not the federal level. I am not aware of any direct impact that President Obama’s Affordable Care Act will have on the laws of medical assistants working under nurse practitioners.

      However, there is some pending or forthcoming state legislation that could impact the authority of nurse practitioners to delegate to medical assistants. I have established contact with the American Association of Nurse Practitioners and will make sure I and our national and state leaders are aware.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  23. Jannie Washington says:

    I was informed that student medical assistants are required to have volunteer hours. Is this true?

  24. Sarah Deskins says:

    New CMA working at a new urgent care located within a hospital. Would love to discuss what can be delegated by an NP to an MA in this setting.

  25. Kim Houghton says:

    What are the laws in Texas governing delgation of medication adminstration to MA’s by NP’s or PA’s in a walk-in clinic, physcian is not on-site.

    • Thank you for your question. I will send documents to your e-mail.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

    • Jennifer castaneda says:

      I have the same question can an np in Texas Delegate medication administration and injections in an independently owned clinic to a medical assistant with no physician onsite.

      • Thank you for your question. According to Texas law, nurse practitioners are permitted to delegate to medical assistants a wide variety of tasks, but cannot delegate to medical assistants the administration of medication. However, as authorized by the overseeing physician, NPs and RNs are permitted to supervise medical assistants who are administering medication as specifically delegated to the medical assistant by the physician.

        I have sent the excerpts from Texas law to your e-mail address.

        I hope this is helpful.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

  26. Donna Hudson says:

    Do you have information on Massachusetts regarding Medical Assistants working with PA and NP?
    I would appreciate any infor on the subject.

  27. Chris Degenhardt says:

    After reading the laws in different states presented here, I am wondering if MA’s should be licensed. I do not know what changes by MAERP,CAAHEP would need to take place but it sure would help in this matter. What are your thoughts on this?
    Thank you.

    • Thank you for your question.

      State legislatures generally license professions only if it can be demonstrated by tangible evidence that the lack of licensure has caused harm to the public. Because medical assistants work under direct physician supervision, it is difficult to demonstrate harm to patients resulting from negligent medical assisting services.

      I will send to your e-mail address a few of the articles I have written on this topic.

      Thank you again for your question.

  28. sphillips746 says:

    I work in the state of Wyoming, I do understand that they don’t really recognize CMA’s and now my job is telling me that we can not work under an NP but we can work under a PA, can you please clarify this.
    Thank you

    • Thank you for your question.

      In all American jurisdictions, physician assistants work under physician supervision. In the laws of some states, the physician supervision of PAs is very general. However, in no states are physician assistants permitted to work totally independently of a physician.

      Because, in all states–either explicitly or implicitly–physicians are authorized by law to delegate to medical assistants a reasonable scope of duties, there is little controversy over the authority of physicians to assign to PAs the oversight/supervision of medical assistants.

      Nurse practitioners are governed by the nurse practice act of each state, and the regulations and policies of the state board of nursing. Whether NPs are permitted to delegate to unlicensed allied health professionals such as medical assistants, and–if so–what tasks they can and cannot delegate, is a difficult legal question in many states.

      I hope this is helpful as an initial response.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262  |  Fax: 312/899-1259  |  http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook  

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • Smiers says:

        I am a Nurse Practitioner in Texas, can I delegate to a CMA prescription orders, injection orders?

  29. Nicole says:

    Hello I was wondering if you could send me the information that you have on medical assistants practicing under an NP and a PA in the state of Wisconsin. Thank you much appreciated.

  30. Laura says:

    Don, I was wondering if you could also send me the same information as Nicole requested for WI. We are having difficulty differentiating whether or not a PA can delegate acts to an MA where a physician isn’t physically located (but supervising)

    • I will be happy to do so, Laura. Here is the language from the Wisconsin law:

      Section 448.03(2)(e) of the Wisconsin statutes indicates that the law shall not impinge upon the right to practice of:
      Any person other than a physician assistant providing patient services as directed, supervised, and inspected by a physician who has the power to direct, decide, and oversee the implementation of the patient services rendered.

      My legal opinion is that the delegating/overseeing/supervising physician must be on the premises and reasonably available when a medical assistant is administering medication by any route. However, it is also my opinion that a medical assistants is permitted to do venipuncture/phlebotomy and other clinical duties (e.g., taking vital signs, EKGs) when a PA is on the premises and reasonably available, even if the physician is not on the premises.

      I hope this is helpful, Laura.

      Don

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262  |  Fax: 312/899-1259  |  http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook  

      The CMA (AAMA): Health Care’s Most Versatile Professional

  31. Katheena Shannon says:

    I currently work under an ARNP in the state of Iowa. I see that you have already addressed this. Please send me any information that may be applicable.

  32. Faith says:

    I am wondering what the MN law is for delegating task to a MA. Can a RN supervisor in the buliding delegate task such as injections, checking doctors orders, transcribing doctor oders received in a fax?

    • Thank you for your question. The following excerpts from my May-June 2013 Public Affairs article in CMA Today applies to Minnesota law:
      Is it legal for physicians to assign to
      other health professionals supervisory
      responsibilities over medical
      assistants?
      Yes. Under the laws of most states, physicians
      are permitted (explicitly or implicitly)
      to ask health professionals, such as
      advanced practice nurses (APNs)—most
      often nurse practitioners—physician assistants,
      and registered nurses to supervise
      medical assistants in the performance of
      duties delegated to the medical assistants
      by the physician. This type of supervision
      is sometimes referred to as “intermediary
      supervision.”

      Is it legal for a nurse to exercise such
      intermediary supervision assigned
      by a physician if the physician’s
      delegation to medical assistants is
      not based on the state nurse practice
      act and the rules and policies of the
      state board of nursing?
      Yes. Note the following from Working with
      Others: A Position Paper, a publication of
      the National Council of State Boards of
      Nursing1:
      Accepting an assignment to supervise—
      There are situations when a nurse may
      be assigned to supervise a staff member
      who has been delegated tasks by another
      licensed provider (e.g., in a physician’s
      office). There are other situations where
      the authority to provide tasks or procedures
      … has been granted by a statute or
      rule/regulation separate from the Nurse
      Practice Act or rules/regulations.

      So, the answer to your question is that Minnesota law permits physicians to delegate the competent and knowledgeable medical assistants working under their supervision in outpatient settings the administration of intramuscular, intradermal, and subcutaneous injections, the verbatim transcribing of physicians’ orders, and the checking of physicians’ orders for editorial and formatting purposes (but not for substantive review). MN law also permits physicians to delegate to registered nurses the immediate supervision of medical assistants performing these tasks, although the overseeing/delegating/supervising physician(s) must be on the premises and reasonably available when the medical assistants are administering medication.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262  |  Fax: 312/899-1259  |  http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook  

      The CMA (AAMA): Health Care’s Most Versatile Professional

  33. Steph says:

    I work for a clinic in the state of Alaska that utilizes MD’s,PA-C’s all the way down to us CMA’s. Our doctors and PA’s would like us to do more. However, we are being told by the director of nursing we are not allowed to do certain things even if requested by our providers; “because if one holds a license to do a medical procedure (let’s say), that one can not delegate the task to one who does not have that same license”. I do understand the difference between a license and a certification. Any clarification would be greatly appreciated. If it would be more convenient to respond to my email that would be fine also. Thank you~

  34. hiral1081@hotmail.com says:

    Would you be able to email me laws for OHIO nurse practitioners delegation to medical assistants? I am a new practitioner and will be independent in couple of months. Is there any difference in delegation (for NP to MA) with physician in the building versus out of the building?

  35. Shelly says:

    Can I please get the decision making algorithm for Ohio? I am a recently graduated NP and want to be sure I know the appropriate actions to take. There may or may not be a physician on site.
    Thank you,
    Shelly

    • Thank you. I will e-mail the Ohio information to you.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

    • Allison Citriglia says:

      Would you please send this information to me as well? I would also like to know what the scope of practice for MA is and if they can perform telephone triage duties. Thanks

      • Thank you for your question. Please note the following excerpt from one of my Public Affairs articles:
        Are medical assistants
        permitted to triage patients?
        In order to answer this question correctly,
        it is essential that terms be precisely
        defined and thoroughly understood. In
        interacting with patients or their representatives—
        by telephone or in person—
        medical assistants are allowed to convey
        verbatim physician-approved information
        and directions without exercising independent
        professional judgment or making
        clinical assessments or evaluations.
        This communication process is frequently
        called screening. Communication that does
        require the health professional to exercise
        independent judgment or to make clinical
        assessments or evaluations is frequently
        called triage. The general legal principle
        is that physicians are allowed to delegate
        screening, but not triage, to competent
        and knowledgeable medical assistants
        working under their direct supervision
        in outpatient settings.

        I hope this is helpful. I will send the article to your e-mail address.

        Donald A. Balasa, JD, MBA
        Executive Director, Legal Counsel

        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

        Visit us on Facebook! http://www.aama-ntl.org/facebook

        The CMA (AAMA): Health Care’s Most Versatile Professional

  36. Haley Thomas says:

    I’m an RMA and I work directly under an FNP at a community health clinic in South Carolina. When I first started I was administering medications of all kinds and giving injections under the FNP. Recently one of the head RN’s over all the nurses informed us that in SC RMA’s and CMA’s are only to administer medication under an MD and not an FNP. She said that the nursing board states that no MA can administer any kind of medication whether it be tylenol or something injectable to a patient if it was ordered by the FNP. My question to you is from my understanding in your article above that an MA CAN administer medications under an FNP as long as there is an MD on the premises, is that correct?

    • Thank you for your question. Please note the following from the South Carolina law:
      Section 40-47-30(5) of the Medical Practice Laws of South Carolina states that the statute does not:
      Prohibit a licensed physician from delegating tasks to unlicensed personnel in his employ and on his premises if: (a) the task is delegated directly to unlicensed personnel by the physician and not through another licensed practitioner; (b) the task is of a routine nature involving neither the special skill of a licensed person nor significant risk to the patient if improperly done; (c) the task is performed while the physician is present on the premises and in such close proximity as to be readily available to the unlicensed person if needed;

      South Carolina law permits physicians to delegate to competent and knowledgeable medical assistants working under their direct supervision in outpatient settings the administration of medications orally, and by IM, ID, and sub-Q injections (including vaccinations/immunizations). I also take the position that SC law permits physicians to assign to nurse practitioners (and other intermediary health care professionals) the supervising of medical assistants who are carrying out tasks delegated to them by the overseeing physician.

      Thus, as long as the administration of medication is ordered by the delegating physician (who is on the premises when the medication is being administered), I am not aware of anything in SC law that would forbid a nurse practitioner from overseeing a medical assistant who is administering medication as ordered by the delegating physician.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  37. Kacey Sexton says:

    Can you please email me the guidelines regarding medical assistants working under ARNPs in the state of Oklahoma?
    Thank You!

    • I will be happy to do so.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • I own a private practice NP clinic in Oklahoma. I’d like those guidelines too!!!

      • I will be happy to send the Oklahoma law for medical assistants working under nurse practitioner direction. I will send it to your e-mail.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

        [cid:image003.jpg@01CFF8F0.5DE79010] [cid:image007.jpg@01CFF8F0.5DE79010] [wordpress] [mail]

      • Lawrence Muiruri says:

        Hi. Could you please email me the law in Oklahoma regarding Medical assistants working under a Nurse Practitioner? Thank you so much

  38. Kendra Proctor says:

    Could you please send me the information for Texas?

  39. Stephanie says:

    Are there any changes or updates in regards to medical assistants working with nurse practioners in the state of ohio? My office has recently hired nurse practioners and I wanted to know if she can delegate duties to me and if not do you think there will be any changes to that in the future?

    • Thank you for your question. I have excerpts from the Ohio law that establish the fact that nurse practitioners are permitted to delegate to medical assistants working under their direct supervision. I will send these excerpts to your e-mail address.

      Also, there is a bill moving through the Ohio legislature that would permit nurse practitioners to delegate to medical assistants the administration of medication. This is currently not permitted under Ohio law. I understand from the leaders of the Ohio State Society of Medical Assistants that this legislation is receiving very little opposition, and is very likely to be enacted into law. As soon as that happens, we will publicize it via our website, CMA Today, and this blog.

      I will send the current law to you now.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • Shelly Turski says:

        Mr. Balasa,
        Did his effectively go into law? I am working in a facility without a collaborating physician on site. The administration was to hire a LPN for me, working under the belief that I could not delegate injections to a MA. They hired a LPN though gave her the job title MA. I cannot find specifics dealing with delegating to a licensed person if they are working under a different title. So the questions are 1) can I delegate injections to a MA 2)can I delegate injections to a LPN working as MA. Could you also direct me were to look to find these answers in the law. It is so difficult to find answers to these questions and I appreciate your willingness to help.
        Thank you!

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  41. Anna Contreras says:

    Can you tell me what delegation of duties can be given to a RMA or CMA by an NP or APRN in a clincal setting in Texas. I am being told they cannot delegate or supervise CMA/RMAs to administer injections, assist with procedures, etc….

    • Thank you for your question. There is some specific language in Texas law that addresses your questions. The language is lengthy, so I will send it to your e-mail address.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

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      • Susan Thomas says:

        Will you also send me the information on delegating to MA. Also in Texas does the MD have to be onsite to delegate injections/immunizations to the MA?

      • Anna says:

        Could you send me the information regarding Texas law and delegation to a MA by an APRN/NP?

      • I have sent the information to your e-mail address.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

    • Smiers says:

      Would you post the answer or send it to me as well?
      I work in a clinic and need to know if I have to have LPN/LVN as my nurse or can I use a CMA.

  42. Eliza Morales says:

    Can you please tell me if it is legal in Texas for a Nurse practitioner or PA that works in a Physical Medicine practice (FYI the supervising physician is not on site) to recommend therapy (ie. exercises, stretches..electrical therapy) to a patient and then supervise an MA who will actually be the one doing the therapy? Moreover, if it is legal, can the therapy be billed to major medical insurances (NOT Medicare) under the NP or PA’s NPI number (even though they are not the one’s actually rendering the therapy?) I am getting mixed information on this subject and would like to get a clear answer. Thank you for your input on this matter.

    • Thank you for your question.

      It is legal under Texas law for nurse practitioners and physician assistants to delegate certain duties to unlicensed allied health professionals such as medical assistants. However, it is no legally permissible for medical assistants to do the full range of physical therapy. This is reserved to physical therapists under the laws of all states.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • Sharon says:

        What about in Colorado?

      • Thank you for your question. Here is language from the Colorado Nurse Practice Act regarding delegating of tasks by nurses:

        12-38-132. Delegation of nursing tasks. (1) Any registered nurse, as defined in section 12-38-103 (11), may delegate any task included in the practice of professional nursing, as defined in section 12-38-103 (10), subject to the requirements of this section. In no event may a registered nurse delegate to another person the authority to select medications if such person is not, independent of such delegation, authorized by law to select medications.

        (2) Delegated tasks shall be within the area of responsibility of the delegating nurse and shall not require any delegatee to exercise the judgment required of a nurse.

        (3) No delegation shall be made without the delegating nurse making a determination that, in his or her professional judgment, the delegated task can be properly and safely performed by the delegatee and that such delegation is commensurate with the patient’s safety and welfare.

        (4) The delegating nurse shall be solely responsible for determining the required degree of supervision the delegatee will need, after an evaluation of the appropriate factors which shall include but not be limited to the following:

        (a) The stability of the condition of the patient;

        (b) The training and ability of the delegatee;

        (c) The nature of the nursing task being delegated; and

        (d) Whether the delegated task has a predictable outcome.

        (5) An employer of a nurse may establish policies, procedures, protocols, or standards of care which limit or prohibit delegations by nurses in specified circumstances.

        (6) The board may promulgate rules pursuant to this section, including but not limited to standards on the assessment of the proficiency of the delegatee to perform delegated tasks, and standards for accountability of any nurse who delegates nursing tasks. Such rules shall be consistent with the provisions of part 3 of article 1.5 of title 25 and section 27-10.5-103 (2) (k), C.R.S.
        Editor’s note: This version of subsection (6) is effective until March 1, 2014.

        Here is language from the regulations of the Colorado Board of Nursing:
        4. CRITERIA FOR DELEGATION
        4.1 Any nursing task delegated by the professional nurse shall be:
        4.1.1 Within the area of responsibility of the nurse delegating the task;
        4.1.2 Within the knowledge, skills and ability of the nurse delegating the task;
        4.1.3 Of a routine, repetitive nature and shall not require the Delegatee to exercise nursing judgment or intervention;
        4.1.4 A task that a reasonable and prudent nurse would find to be within generally accepted nursing practice;
        4.1.5 An act consistent with the health and safety of the Client; and
        4.1.6 Limited to a specific Delegatee, for a specific Client, and within a specific time frame, except for Delegation in Schools or Delegation in a Licensed Child Care Facility as described in section 7 of these Chapter 13 rules.
        4.2 The Delegatee shall not further delegate to another individual the tasks delegated by the professional nurse.
        4.3 The delegated task may not be expanded without the express permission of the
        Delegator.
        4.4 The Delegator shall assure that the Delegatee can and will perform the task with the degree of care and skill that would be expected of the professional nurse.
        5.1

        The decision to delegate shall be based on the Delegator’s assessments of the following:

        5.1.1

        The Client’s nursing care needs, including, but not limited to, complexity and frequency of the nursing care, stability of the Client, and degree of immediate risk
        to the Client if the task is not carried out;

        5.1.2

        The Delegatee’s knowledge, skills and abilities after training has been provided;

        5.1.3

        The nature of the task being delegated including, but not limited to, degree of invasiveness, irreversibility, predictability of outcome, and potential for harm;

        5.1.4

        The availability and accessibility of resources, including but not limited to, appropriate equipment, adequate supplies and appropriate other health care personnel to meet the Client’s nursing care needs; and

        5.1.5

        The availability of adequate Supervision of the Delegatee.

        I hope this is helpful.

        Donald A. Balasa, JD, MBA
        Executive Director, Legal Counsel

        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

        Visit us on Facebook! http://www.aama-ntl.org/facebook

        The CMA (AAMA): Health Care’s Most Versatile Professional

  43. David H. Kaye, DO, MPH says:

    Interesting – MD = physician, DO = osteopath. When I finished medical school, residency and fellowship, I was a physician. I am still a physician 20 years later.

  44. dentistry says:

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  45. Jennifer Alexander PA-c says:

    I work in a hospital based clinic in Illinois. My husband is a family doctor and I am his PA. We also have a nurse practitioner that works with us. My husband was in solo practice for over twenty years prior to selling the practice two years ago to a local hospital. Since he began practicing he has employed a Respiratory Therapist who has functioned as a MA and it has worked seamlessly…until the hospital purchased our practice. Administration is concerned that she is not certified. From my research I have found that only 15% of all MAs are in the US. I am getting her registered to take the RMA test next month. My question is will that be enough? As far as I can tell there is no law in IL that requires certification but the hospital demands it. Another questions can she work under a mid level provider or only under a doctor?

    • Thank you for your question. Increasing numbers of employers in Illinois and other states are preferring to hire, or insisting on hiring, CMAs (AAMA). There are legal advantages in doing so. I will send one of my articles to your e-mail address that discusses this. However, you are correct in stating the Illinois law does not require medical assistants to have formal medical assisting education, or to have a medical assisting certification such as the CMA (AAMA).

      Could you provide me anything in writing from the hospital about their requirement for certification of medical assistants?

      Also, CMS ruled that only “credentialed medical assistants” (as well as licensed health care professionals) are permitted to enter medication, laboratory, and radiology orders into the CPOE system and have such entry county toward meeting the meaningful use thresholds under the Medicare and Medicaid Incentive Programs. I will send some of my articles about this to your e-mail address.

      Illinois law does permit physicians to assign physician assistants and nurse practitioners the supervision of medical assistants. However, the Illinois law requires the delegating/overseeing/supervising physician to be on the premises and reasonably available when a medical assistant is administering medication. I will also send you my legal opinion letter for Illinois and some other pertinent documents.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  46. Brad Goshorn says:

    Can you define physician supervision in regard to CMA working under a nurse practitioner or nurse midwife in the state of Ohio? Also can the CMA work under the supervision of a nurse practitioner if the NPs collaborating physician is on the premises?

    • Thank you for your question. I answered an almost identical question from Ohio yesterday afternoon. I will send it to your e-mail address, along with supporting attachments.

      To answer one of your questions, Ohio law permits physicians to assign to advance practice nurses and physician assistants the delegation to medical assistants of a reasonable scope of tasks. This will be spelled out in the e-mail I will be sending you.

      I hope you find this helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  47. Bobbie says:

    Could you give my any information you have regarding Tennessee law regarding MA working under the supervision of a NP only. There is not a physician on site.

    • Thank you for your question. I have research the Tennessee law and cannot find any language that addresses what nurse practitioners are permitted to delegate to unlicensed allied health such as medical assistants. I do have a document issued by the TN Board of Nursing that addresses steps in the decision-making process that nurses should take to determine what is and is not within their scope of practice. I will forward this document to your e-mail address.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • jcmamy says:

        I am a NP in TN, could you also forward to me this information? Thanks, Amy

      • I will be happy when I return to the office Monday November 17. Don

        Sent from my iPhone

      • jcmamy says:

        I was hoping to have that information emailed to me this morning if possible. Thanks

        Amy Naylor Sent from my iPhone

        >

      • Could you please forward me the above requested information regarding the scope of practice and state laws regarding MA’s working under MD’s in a medical office setting?
        I have researched various sites and there are states listed but not TN. Help.

      • christie says:

        Hi, Would you let me know TN scope of practice please for RMA and also in the setting of wound care and ostomy care? I cannot find anything. Also there are 2 NP, 1 RN, 1 LPN and numerous MD on site however not every day, so never sure who will give orders. Please email this information to me. Thanks!

      • Thank you for your question. Tennessee law does not specifically address the medical assisting scope in regard to wound care. I will send to your e-mail address my legal opinion letter for TN and some other pertinent articles and documents.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

  48. henry lee, aas-ncma,cma,gna,cna says:

    What’s maryland law ~ are we working under a rn,bsn and np.

    • Thank you for your question. Under the Maryland nursing law, medical assistants—even CMAs (AAMA)—are considered unlicensed individuals. Note the following summary of Maryland law. You can click on the links on the far left to access the full section of the law:

      10.27.11.03.htm

      10.27.11.03. 03 Criteria for Delegation.. A. The nurse may delegate the responsibility to perform a nursing task to an unlicensed individual, a certified nursing assistant, or a medication technician. The delegating nurse retains the accountability for the nursing task.B. A nursing task delegated by the nurse shall be:. 1) Within the area of responsibility of the nurse delegating the act;. 2) Such that, in the judgment of the nurse, it can be properly and safely performed by the unlicense

      10.27.11.04.htm

      10.27.11.04. 04 Supervision.. A. The nurse shall determine the required degree of supervision after an evaluation of appropriate factors including, but not limited to the:1) Stability of the condition of the client;. 2) Training of the individual to whom the nursing task is being delegated;. 3) Nature of the nursing task being delegated;. 4) Orientation of the unlicensed individual, certified nursing assistant, or medication technician to the specific patient en5) Ability of the unlicen

      10.27.11.05.htm

      10.27.11.05. 05 Nursing Functions.. A. The following nursing functions require nursing knowledge, judgment, and skill and may not be delegated:1) The nursing assessment including, but not limited to, the admission, shift, transfer, or discharge assessment;2) Development of the nursing diagnosis;. 3) The establishment of the nursing care goal;. 4) Development of the nursing care plan;. 5) Evaluation of the client’s progress, or lack of progress, toward goal achievement; and.

      Note also the following from Maryland law:
      HEALTH OCCUPATIONS
      TITLE 8. NURSES
      SUBTITLE 1. DEFINITIONS; GENERAL PROVISIONS

      Md. HEALTH OCCUPATIONS Code Ann. § 8-102 (2014)

      § 8-102. Scope of title

      (b) Conduct not prohibited. — Except as specifically provided in this title, this title does not limit the right of:

      (3) An unlicensed individual to perform acts of registered nursing or acts of licensed practical nursing:

      (i) While supervised by an individual who is authorized by this State to practice registered nursing or licensed practical nursing; and

      (ii) If the unlicensed individual performs only acts that are in the area of responsibility of the supervisor and under the instruction of the supervisor.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  49. Terry Laburay says:

    Thank you for the article. I’ve searched Missouri Statutes to no avail. Do you have any information regarding scope of practice in Missouri for CNA’s. My particular group is supervised by both MDs and PAs.

    • Thank you for your question. I have just sent my response, with relevant documents and articles, to your e-mail address.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

      • Shawn says:

        Can you please provide information on Missouri? We are a rural health clinic with four (4) physicians, four (4) nurse practitioners and three (3) locations. A nurse practitioner has challenged me that a medical assistant can’t administer injections and/or medications without a physician present in the building (the N.P. works 1.5 days solo at one of the locations. She collaborates with one of the physicians. I read something about an “intermediary,” but not sure if this covers the issue. Thank you.

  50. Mariza says:

    What about the state of New Mexico? I do not see many laws regarding the scope of practice in the State of New Mexico.

  51. Jennifer Alexander, PA-C says:

    Can a RMA escribe medication refills in an EMR system?
    Our medical assistant that has worked with our office just passed her RMA test and I know she can telephone in prescriptions….but can she refill medications by escribe?
    Thank you

    • Thank you for your question. Could you please tell me in what state you are located? The medical assisting laws vary somewhat from state to state. I will then be happy to answer your question.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  52. Liz says:

    Would you please comment on the practice of Nurse Practitioners delegating to MAs in Oklahoma?

  53. Barbara Zalokar says:

    Would a medical assistant’s salary be increased if he or she administers medication (delegated by an APRN)?
    Would he or she require additional training in order to administer the medication?

    Barb
    Columbus, Ohio

    • Thank you for your question. I will send my analysis of the medical assistant’s scope of practice under Ohio law to your e-mail address.

      Ohio law permits physicians to delegate to competent and knowledgeable medical assistants working under their direct supervision in outpatient settings the administration of medication orally, and by sub-Q, ID, and IM injections—including immunizations/vaccinations. Employers sometimes increase the salary of their medical assistants depending on the types of tasks they are delegated.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

      [cid:image003.jpg@01CFF8F0.5DE79010] [cid:image007.jpg@01CFF8F0.5DE79010] [wordpress] [mail]

  54. Elizabeth D. says:

    What does the law say about Montana? Or where can I find out?

    Thanks,

    Elizabeth

    • Thank you for your question. I will send the Montana law to your e-mail address.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

      [cid:image003.jpg@01CFF8F0.5DE79010] [cid:image007.jpg@01CFF8F0.5DE79010] [wordpress] [mail]

  55. Beata says:

    Can a Certified Medical Assistant administer injections under a Nurse Practitioner if MD/DO is not at premises, and is available only via telefon in State NJ?
    Thank you

    • Thank you for your question. The regulation of the New Jersey Board of Medical Examiners states that the delegating physician must be on the premises when a medical assistant who meets the requirements of the regulation is administering the injections that are permitted in the regulation. It does not permit the physician to be off the premises.

      I will send the NJ regulation to your e-mail address.

      I hope you find this helpful.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

      [cid:image003.jpg@01CFF8F0.5DE79010] [cid:image007.jpg@01CFF8F0.5DE79010] [wordpress] [mail]

      • Leah Zart says:

        I have two questions. What does Nebraska law say about medical assistants working under nurse practitioners and PA’s without a physician present? I was thinking it was not an issue due to in my particular city, there are a few offices who are owned/operated by APRN’s. Also, if a medical assistant is not certified/registered in Nebraska, are they allowed to enter in medication orders into EMR?

      • Thank you for your questions. I am happy to respond.

        Nebraska law does not require medical assistants to be credentialed to enter orders into the CPOE system as specifically directed by the overseeing/delegating/supervising physician. However, under federal law, CMS has issued a rule stating that only “credentialed medical assistants” (as well as licensed health care professionals) are permitted to enter orders into the CPOE system for meaningful use calculation purposes under the Medicare and Medicaid Incentive Programs.

        I have found the following from Nebraska law:
        EFFECTIVE NEBRASKA HEALTH AND HUMAN SERVICES
        11/17/04 REGULATION AND LICENSURE 172 NAC 99
        10
        99-004 STANDARDS FOR DELEGATION
        99-004.01 Delegation of Nursing Interventions. Full utilization of licensed nurses may require
        auxiliary patient care services provided by persons carrying out interventions for the support
        of nursing services as delegated by RNs, The scope of delegation may vary depending on the
        level of nursing judgment required for the interventions, the knowledge and skills of the
        unlicensed person, the method and frequency of supervision, and the client/patient’s condition,
        ability, and willingness to be involved in the management of his/her own care.

        The following are tasks which cannot be delegated by a nurse, including a nurse practitioner:
        (2) Interventions which must not be delegated include, but are not limited
        to:
        (a) activities including data collection, problem identification, and
        outcome evaluation which require independent nursing
        judgment;
        (b) teaching except for that related to promoting independence in
        personal care and activities of daily living;
        (c) counseling, except that unlicensed persons may be instructed
        to recognize and report basic deviations from healthy behavior
        and communication patterns, and may provide listening,
        empathy, and support.
        (d) coordination and management of care including collaborating,
        consulting, and referring;
        (e) triage and/or the giving of advice; and
        (f) treatments which are complex interventions as defined in 172
        NAC 99-002.

        Based on the above excerpts and my additional review of the law, I find nothing in Nebraska law that forbids nurse practitioners from delegating to competent and knowledgeable medical assistants working under their direct supervision in outpatient settings venipuncture and the administration of medication orally, and by IM, sub-Q, and ID injections—including immunizations/vaccinations.

        Physicians always work under the authority of a physician. It is my opinion that, if the delegating physician is not on the premises, medical assistants can nevertheless execute tasks such as venipuncture and the administration of medication orally, and by IM, sub-Q, and ID injections—including immunizations/vaccinations—delegated to the medical assistant by the physician when a physician assistant is execising direct supervision over the medical assistant. The direct supervision over medical assistants by a physician assistant must be authorized by the overseeing physician.

        I hope this is helpful.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

        [cid:image003.jpg@01CFF8F0.5DE79010] [cid:image007.jpg@01CFF8F0.5DE79010] [wordpress] [mail]

  56. Erika says:

    Would you mind clarifying the scope of practice for a medical assistant, in the state of Florida, under the direct supervision of an ARNP with no physician physically on-site? Specifically, can they administer medications and vaccines?

    • Thank you for your question. Here are some excerpts from the rules of the Florida Board of Nursing. Medical assistants are considered “unlicensed assistive personnel” for the purpose this analysis:
      64B9-14.001 Definitions.
      As used in this chapter, the following mean:
      (1) “Unlicensed assistive personnel” (UAP) are persons who do not hold licensure from the Division of Health Quality Assurance of the Department of Health but who have been assigned to function in an assistive role to registered nurses or licensed practical nurses in the provision of patient care services through regular assignments or delegated tasks or activities and under the supervision of a nurse.
      (2) “Assignments” are the normal daily functions of the UAP’s based on institutional or agency job duties which do not involve delegation of nursing functions or nursing judgment.
      (3) “Competency” is the demonstrated ability to carry out specified tasks or activities with reasonable skill and safety that adheres to the prevailing standard of practice in the nursing community.
      (4) “Validation” is ascertaining the competency including psychomotor skills of the UAP, verification of education or training of the UAP by the qualified individual delegating or supervising the task based on preestablished standards. Validation may be by direct verification of the delegator or assurance that the institution or agency has established and periodically reviews performance protocols, education or training for UAP’s.
      (5) “Delegation” is the transference to a competent individual the authority to perform a selected task or activity in a selected situation by a nurse qualified by licensure and experience to perform the task or activity.
      (6) “Delegator” is the registered nurse or licensed practical nurse delegating authority to the UAP.
      (7) “Delegate” is the UAP receiving the authority from the delegator.
      (8) “Supervision” is the provision of guidance by a qualified nurse and periodic inspection by the nurse for the accomplishment of a nursing task or activity, provided the nurse is qualified and legally entitled to perform such task or activity. The supervisor may be the delegator or a person of equal or greater licensure to the delegator.
      (9) “Direct supervision” means the supervisor is on the premises but not necessarily immediately physically present where the tasks and activities are being performed.
      (10) “Immediate supervision” means the supervisor is on the premises and is physically present where the task or activity is being performed.
      (11) “Indirect supervision” means the supervisor is not on the premises but is accessible by two way communication, is able to respond to an inquiry when made, and is readily available for consultation.
      (12) “Nursing judgment” is the intellectual process that a nurse exercises in forming an opinion and reaching a conclusion by analyzing data.
      (13) “Education” means a degree or certification of the UAP in a specific practice area or activity providing background and experience in theoretical or clinical aspects of that practice or activity.
      (14) “Training” is the learning of tasks by the UAP through on the job experience or instruction by a nurse who has the education or experience to perform the task or activity to be delegated.
      Specific Authority 464.006 FS. Law Implemented 464.003(17),(18), (19), (20), 464.018(1)(h) FS. History–New 1-1-96, Amended 4-29-96, Formerly 59S-14.001.
      64B9-14.003 Delegation of Tasks Prohibited.
      The registered nurse or licensed practical nurse, under direction of the appropriate licensed professional as defined in Section 464.003(3)(b), F.S., shall not delegate:
      (1) Those activities not within the delegating or supervising nurse’s scope of practice.
      (2) Nursing activities that include the use of the nursing process and require the special knowledge, nursing judgment or skills of a registered or practical nurse, including:
      (a) The initial nursing assessment or any subsequent assessments;
      (b) The determination of the nursing diagnosis or interpretations of nursing assessments;
      (c) Establishment of the nursing care goals and development of the plan of care; and
      (d) Evaluation of progress in relationship to the plan of care.
      (3) Those activities for which the UAP has not demonstrated competence.
      Specific Authority 464.006 FS. Law Implemented 464.003(17),(18), (19), (20), 464.018(1)(h) FS. History–New 1-1-96, Amended 4-29-96, Formerly 59S-14.003.
      64B9-14.002 Delegation of Tasks or Activities.
      In the delegation process, the delegator must use nursing judgment to consider the suitability of the task or activity to be delegated.
      (1) Factors to weigh in selecting the task or activity include:
      (a) Potential for patient harm.
      (b) complexity of the task.
      (c) Predictability or unpredictability of outcome including the reasonable potential for a rapid change in the medical status of the patient.
      (d) Level of interaction required or communication available with the patient.
      (e) Resources both in equipment and personnel available in the patient setting.
      (2) Factors to weigh in selecting and delegating to a specific delegate include:
      (a) Normal assignments of the UAP.
      (b) Validation or verification of the education and training of the delegate.
      (3) The delegation process shall include communication to the UAP which identifies the task or activity, the expected or desired outcome, the limits of authority, the time frame for the delegation, the nature of the supervision required, verification of delegate’s understanding of assignment, verification of monitoring and supervision.
      (4) Initial allocation of the task or activity to the delegate, periodic inspection of the accomplishment of such task or activity, and total nursing care responsibility remains with the qualified nurse delegating the tasks or assuming responsibility for supervision.
      Specific Authority 464.006 FS. Law Implemented 464.003(17),(18), (19), (20), 464.018(1)(h) FS. History–New 1-1-96, Formerly 59S-14.002.
      I find nothing in the Florida law that forbids nurse practitioners from delegating to competent and knowledgeable medical assistants working under their direct supervision in outpatient settings the administration of medication orally, and by IM, sub-Q, and ID injections—including immunizations/vaccinations.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

      [cid:image003.jpg@01CFF8F0.5DE79010] [cid:image007.jpg@01CFF8F0.5DE79010] [wordpress] [mail]

  57. Kim Lowry says:

    Can you please provide any information clarifying the scope of practice for a medical assistant, in Mississippi, under the direct supervision of an ARNP with no physician physically on-site?

  58. Sheila Howard says:

    I work in the state of MS as a registered medical assistant. My question is can an MA work under an NP and give injections? What is the legal scope of practice for an MA in MS?

  59. Paula says:

    In the state of Arkansas, what is the law for a CMA to work in a rural health clinic with a PA? The physician is in clinic 3-4 times a month.

    Thank you.

  60. Brenda says:

    Can you please give me information about the scope of practice for a CMA or a LPN in the state of South Carolina. Currently have a PA-C. NP. And a DO. Does the physician have to be in office or can they practice under the NP?

  61. Belinda says:

    If working in the state of Mississippi, can a medical assistant work with a nurse practitioner in a clinic with doctors on premises?

  62. Jacki Buck says:

    Does a Family Nure Practitioner have the right to delegate to a RN and a Medical Assistant in Texas if the physician has the day off?

  63. Rose Koneski says:

    I was wondering if MA’s can call in medications for a nurse practitioner in the State of Texas?

  64. Angela says:

    Hello! I was wondering about medical assistants and if they can have a role in telemedicine? Does a nurse have to sit in with the patient, or can a MA do that? I was thinking if they have to have direct supervision, then a nurse may have to be handling the patients? Thank you for your time.

    Angela Dixon, RN-BC

  65. Susan NP-C says:

    Thank you for your information. I would like the info on Texas please. I’m going to work for a clinic and will not have direct supervision by a physician (I’ll be the evening staff) and they said I would have an “ma”. I have read the nurse prCtice act and still unclear if I can delegate I’m injections to the ma. Can you clarify please

  66. Staci says:

    Thank you for your information. I am an NP in Ohio. I am familiar with how the law reads concerning delegation to unlicensed professionals. In the past I have worked in a clinic that had a LPN available for certain delegation, however I am currently working in a smaller office with MA’s. Could you please email me any information about Ohio and delegation. I would like to utilize the MA’s experience as much as possible?

  67. Corina Zackowski says:

    Can I Nurse practitioner oversee a medical assistance or laser tech to do lazer procedures in a medical spa, such as Laser Hair removal?? I live in Montana

  68. Chelsea Millis says:

    I am a certified clinical medical assistant that works under a nurse practitioner in a primary care clinic in mississippi I have recently been told by management that I can no longer give medications whether be by injection or oral medications. I’ve also been told that I can no longer Co sign prescriptions that are not controlled but can call them in to pharmacies. My management team has yet to provide me with were they have found the information and wanted to find out for myself if this stands to be true.

  69. Tracey Mertens says:

    Hello, I just received a question relating to this today regarding whether a Nurse Practitioner can supervise an MA in the physician office giving injections. Can you please send Missouri’s requirements regarding this? Thanks so much!

  70. Susan reynolds says:

    Can a MA work under ARNP supervision in the state of montana

  71. MISTY DAWN MILLER says:

    Can a MA work under ARNP supervision in the state of OKLAHOMA and administer medications. i have done this for years and now for this new company they use APRN-CNP and I was advised I can not give injections now. please help me

  72. Niccii Jones says:

    Can a aama work under direct supervision of a np in sc. Please help. Such as iv and injections I am also a paramedic

  73. Kelsey says:

    Can a non certified medical assistant take order from a CNP?

    • Thank you for your question. In what state are you located? The medical assisting laws vary somewhat from state to state.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  74. Jennifer Moore says:

    Hi, I am a Certified Clinical Medical Assistant in the state of Mississippi. I recently started a new job and told I can not administer injection under an NP unless the physician is in the building. Is this true?

  75. Angela says:

    Can a nurse practitioner in ohio delegate a task to a medical assistant such as diluting an IM drug for injection and drawing up the drug into syringes to be injected intermuscularly? This is coming into question because harm was done to the patient. Thank you.

    • Thank you for your question. The law on this in Ohio is in a state of flux. The Ohio legislature enacted legislation last year that changed the provisions of the Nurse Practice Act in regard to advanced practice registered nurse delegation of medication administration to unlicensed allied health professionals such as medical assistants. The Ohio Board of Nursing is currently holding hearings to determine what language should be included in its regulations. I would suggest that you pose this question to the Ohio Board of Nursing.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

      • Carol says:

        Can you tell me if this law in Ohio is still in a state of flux?

      • Thank you for your question. The Ohio legislature enacted a law that authorizes nurse practitioners and physician assistants to delegate certain types of medication administration of unlicensed allied health professionals such as medical assistants. The Ohio Board of Nursing and the State Medical Board of Ohio, respectively, are drafting regulations for NP and PA delegation. The AAMA and the Ohio State Society of Medical Assistants submitted comments to the OH BON. You will find the comments in the March-April issue of CMA Today. As soon as these two sets of regulations are finalized by the respective boards, there should be no more uncertainty about mid-level provider delegation to qualified medical assistants of certain types of medication administration.

        I hope this is helpful.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

  76. Leah Zart says:

    I have multiple questions.

    I work in a clinic that is staffed only with a Nurse practitioner here in Nebraska. What are the guidelines for that in my state?

    I am certified, but is it ok for a non-certified medical assistant to enter in orders into EMR/EHR if given oral instructions by the nurse practitioner? Is it legal for the non-certified medical assistant to enter in orders without verbal ok? I thought that if orders were to be entered by a medical assistant, they must be done by a certified medical assistant. There is conflicting information in my clinic.

    • Thank you for your questions. I will answer some of them here. Some are too complicated to answer her, so I will send my answers to your e-mail.

      It is my legal opinion that Nebraska law permits providers to direct competent and knowledgeable medical assistants to enter orders into the CPOE system. However, orders that are entered by non-credentialed medical assistants cannot be counted for meaningful use calculation purposes under the Medicare and Medicaid Incentive Programs. Only orders entered by credentialed medical assistants can be counted toward meeting the meaningful use thresholds.

      I will send documentation to your e-mail address, and answer your question about working under NP supervision in Nebraska.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  77. Christie Mitchell says:

    I am currently working for a NP in ohio, and have been for 4.5 years, I would like to know the legal aspects. Thank you!

    • Thank you for your question. I will attach the information and e-mail it to you.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  78. Chantel says:

    In the state of Wisconsin can a medical assistant refill medications per a refill medication protocol? Physician does have to co-sign the scripts but the patient script is sent to the pharmacy before a co-sign is needed.

    • Thank you for your question. Under Wisconsin law a medication order can be entered into the CPOE system based on a refill prescription refill protocol approved by the overseeing/delegating provider. However, it is my legal opinion that the order should not be actionable and transmitted until the provider has reviewed, approved, and indicated approval in some tangible way—such as by initialing or signing.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  79. What is the scope of practice and state laws for medical assistants in the state of Tennessee? The medical assistant is supervised under a M.D.
    I have researched various sites and there is no information for Tennessee. I’ve tried the State Board of TN, Tenn.CodeAnn, and the TN Board of Nursing. I could really use your help.

    Thank you in advance.

  80. Monica says:

    Can I administer an inject when working under the supervision of a Nurse Practitioner whom cola berated with an MD under the Oklahoma state law?

  81. Caitlin Copes says:

    Are medical assistants allowed to give injections in Louisiana with an NP on site or a DDS? or their scope of practice in general

    • Thank you for your question. I will e-mail my legal opinion letter to you and other pertinent documents and articles.

      It is my legal opinion that Louisiana law permits physicians in outpatient settings to assign to nurse practitioners the oversight of medical assistants who are administering IM, sub-Q, and ID injections as ordered by the overseeing/delegating physician. Whether a dentist is permitted to do this is a bit of a difficult question. I will respond in my e-mail to you.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  82. Tara says:

    I work for 2 NP’s in a clinic that has an MD as a Collaborator.
    Can you tell me if a medical assistant / Phlebotomist can legally give injections with the order of the FNP?

    • Thank you for your question. Could you please tell me in what state you are located? The laws vary from state to state.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

      • Tara says:

        Louisina

      • Thank you. Louisiana law permits registered nurses and nurse practitioners to delegate to unlicensed allied health professionals such as medical assistants certain tasks. I will forward to your e-mail the pertinent excerpts from the Louisiana law.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

  83. Emily says:

    Hello,

    I currently work as an office manager for a FNP in SouthCarolina. I will be graduating this August and will become a Certified Medical Assistant. If my role changes, I would be responsible for giving injections, phlebotomy, and many other clinical duties.

    Would it be possible to work under her license?

    • Thank you for your question. It is my legal opinion that South Carolina permits nurse practitioners to delegate the usual and customary tasks that physicians are permitted to delegate under SC law, with the exception of administration of medication. I will send specific information to your e-mail address.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  84. LaMonica Hodges says:

    Can medical assistants work under the direct supervision of a Nurse Practitioner and take orders in the state of Mississippi

    • Yes, Mississippi law permits medical assistants to work under the authority of a nurse practitioner. I will send specific attachments supporting my opinion to your e-mail address.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  85. Katie says:

    In Oklahoma can a medical assistant take vitals for a nurse practitioner?

    • Thank you for your question. It is my legal opinion that Oklahoma law permits nurse practitioners to delegate to competent and knowledgeable unlicensed allied health professionals working under their supervision in outpatient settings the taking of vital signs. I will send documentation to your e-mail address.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  86. tenisha murray says:

    How does it apply to the state of Louisiana .where can I find that information. Thanks

    • Thank you for your question. I will send you my legal opinion letter for Louisiana and other documents to your e-mail address.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

      • Heather Surcouf DNP says:

        I would also love that information for Louisiana. Great article.

        Thanks

      • Thank you! I will e-mail you information from Louisiana law regarding medical assistants and APRNs.

        Donald A. Balasa, JD, MBA
        Chief Executive Officer, Legal Counsel
        American Association of Medical Assistants
        Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
        The CMA (AAMA): Health Care’s Most Versatile Professional®

  87. A Christine says:

    Hello,

    Thank you for providing a wealth of knowledge for all who have visited the site. I am an APRN working in Nevada and currently cannot delegate the MA to give a vaccine, state law maintains that the delegation of such task must only be under the direction of the MD/DO/PA. I am conflicted when reading further into the clause regarding rural practice delegation. I will be practicing telemedicine a few days a week to a very rural community in southern NV, does NAC630.820, remote supervision of medical assistant, cover the delegation of such tasks in such circumstances?

    Any advice is welcomed.

    • Thank you for your question. Without having the opportunity to study the Nevada law you mention, it is my preliminary opinion that medical assistants cannot be delegated the administration of immunizations/vaccinations when a provider is not on the premises and readily available.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  88. Mario says:

    Can you tell me about Oklahoma ???

    • I will e-mail you the information regarding medical assistants working under nurse practitioner authority under Oklahoma law.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  89. Misty Cobb says:

    I am a medical assistant for a mental health facility in Corinth, MS I was recently informed that my PHMNP- BC could not give me an order for injections?? Because this was illegal in MS?? That I could only take orders for injections from the MD. I have been a medical assistant for over 7 yrs and have given many injections under the supervision of a FNP…I am so confused as to why..Misty, CMA (AAMA)

    • Thank you for your question. I will send information directly to your e-mail address.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  90. Laura says:

    Hello,
    Can you please tell me if nurse practitioners can delegate to medical assisants without a physician on premises in the state of Pennsylvania?
    Thank you
    Laura

    • Thank you for your question. Pennsylvania law permits nurse practitioners to delegate to unlicensed allied health professionals such as medical assistants. I will send the information to your e-mail address.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  91. Dan says:

    Thank you for all of the your help and information. I am a Pediatric NP and considering taking a job in private practice in Chicago. The office staffs both MAs and RNs, both of which administer medication and vaccines. What is your opinion on NPs delegating administration of immunizations to MAs? I read in a previous response that in your opinion, NPs are not able to delegate administration of medication to MAs, however that was in 2013. Do you believe anything has changed since then?

    Thank you very much,

    Dan

    • You are very welcome, and thank you for your question. The following language is still in the regulations of the Illinois Board of Nursing:
      Section 1300.20 Nursing Delegation
      ……
      b) Nursing shall be practiced by licensed practical nurses, registered professional nurses, and advanced practice nurses. In the delivery of nursing care, nurses work with many other licensed professionals and other persons. An advanced practice nurse may delegate to registered professional nurses, licensed practical nurses, and others persons.
      c) A registered professional nurse shall not delegate any nursing activity requiring the specialized knowledge, judgment, and skill of a licensed nurse to an unlicensed person, including medication administration. A registered professional nurse may delegate nursing activities to other registered professional nurses or licensed practical nurses.

      However, if a nurse practitioner is working under physician authority, and the physician is on the premises and readily/immediately available, it is my legal opinion that the physician is permitted to delegate to the medical assistants certain types of medication administration. The physician is also permitted to assign to an RN or physician assistant or nurse practitioner the responsibility of supervising the medical assistant when the medical assistant is administering medications as delegated by the physician to the medical assistant.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  92. sphillips746 says:

    I am also a Certified Medical Assistant in Texas can you email me the law also.
    Thank you Sherrie Phillips
    Email is sphillips746@gmail.com

  93. Kate says:

    I am a CCMA in Illinois who works for a hospital employed clinic. I have been employed there as a CMA for the last 3 years. My question is that now they are saying that Medical Assistants can’t call or refill medications or call patients with test results. They are saying that we can strictly room patients, perform point of care testing, medication reconciliation, medication administration, and only call patients with normal lab results. Can you please give me information on Illinois Medical Assistant’s Scope of Practice? What I have found is that I should be able to do anything under the Physicians delegation if I have had the training to do so.

    • Thank you for your questions. I will send my legal opinion letter for Illinois to your e-mail address.

      The policy of the clinic is stricter than what the Illinois law permits.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  94. Elliott says:

    Would you please send me the legal documentation regarding Medical Assistants in the state of Oklahoma and their practice under a NP? Thank you!

    • I will be happy to attach the relevant Oklahoma documents and forward them to your e-mail address.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  95. Dana Hulstine says:

    Live in TX and as a Medical Assistant,have in the passed work under a NP. But the new office I am now at said as a MA we are no longer able to? Is this true?

    • Thank you for your question. I recently received a very helpful answer to this question from the Texas Board of Nursing. I will forward it to your e-mail address.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  96. nursepierson@gmail.com says:

    Can medical assistants administer local anesthetics like lidocaine with epi in FL? Is there a list somewhere of meds that nurses and medical assistants can give?

  97. Thank you for your question. Here is the Florida Law:

    The 2016 Florida Statutes
    Title XXXII: Regulation of Professions and Occupations
    Chapter 458: Medical Practice

    458.3485 Medical assistant.—

    (1) DEFINITION.—As used in this section, “medical assistant” means a professional multiskilled person dedicated to assisting in all aspects of medical practice under the direct supervision and responsibility of a physician. This practitioner assists with patient care management, executes administrative and clinical procedures, and often performs managerial and supervisory functions. Competence in the field also requires that a medical assistant adhere to ethical and legal standards of professional practice, recognize and respond to emergencies, and demonstrate professional characteristics.
    (2) DUTIES.—Under the direct supervision and responsibility of a licensed physician, a medical assistant may undertake the following duties:
    (a) Performing clinical procedures, to include:
    1. Performing aseptic procedures.
    2. Taking vital signs.
    3. Preparing patients for the physician’s care.
    4. Performing venipunctures and nonintravenous injections.
    5. Observing and reporting patients’ signs or symptoms.
    (b) Administering basic first aid.
    (c) Assisting with patient examinations or treatments.
    (d) Operating office medical equipment.
    (e) Collecting routine laboratory specimens as directed by the physician.
    (f) Administering medication as directed by the physician.
    (g) Performing basic laboratory procedures.
    (h) Performing office procedures including all general administrative duties required by the physician.
    (i) Performing dialysis procedures, including home dialysis.

    ***

    Florida law does not put limitations on the injectable substances the administration of which by IM, sub-Q, and ID injections physicians are permitted to delegate to knowledgeable and competent medical assistants working under their direct/onsite supervision in outpatient settings.

  98. Could you please email me the Laws for Certified Medical Assistants in Oklahoma?

    • I will be happy to forward this information to your e-mail address.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

  99. Kim Tyler says:

    Can a NP supervise a medical assistant independently onsite in Nevada

    • Thank you for your question. Nebraska nursing law permits licensed nurses (including nurse practitioners) to delegate to knowledgeable and competent unlicensed professionals such as medical assistants certain tasks. I will send you an e-mail and will attached the applicable Nebraska law.

      Donald A. Balasa, JD, MBA
      Chief Executive Officer, Legal Counsel
      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org
      The CMA (AAMA): Health Care’s Most Versatile Professional®

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