Supervision in an Office Setting

I recently received the following question:

I work in a medical specialty office. We have four CMAs (AAMA) and six nurses. Is it legal for a medical assistant to supervise a nurse in an office setting?

Here is my response:

Thank you for your question. It is my legal opinion that a medical assistant is permitted to supervise a registered nurse and a licensed practical/vocational nurse in regard to non-clinical matters–such as work schedule, office attire, compliance with government regulations, and administrative protocol. A medical assistant is not permitted to supervise an RN or an LP/VN in regard to clinical matters. This is due to the fact that clinical supervision of a nurse may require the medical assistant to exercise independent professional judgment, or to make clinical assessments, evaluations, or interpretations.

About Donald 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.
This entry was posted in Clinical Assessment, On the Job, Professional Identity, Scope of Practice and tagged , , , . Bookmark the permalink.

8 Responses to Supervision in an Office Setting

  1. Karen Dinsmore, RN, MN says:

    What is your opinion in the physician office practice where a Medical Assistant might be the lead or the Practice Administrator responsible for the management of the office. Is the physician the supervisor of the clinical staff? Thank you

  2. C.A. Cabral, RN says:

    I am not a legal professional so I would not presume to challenge Mr. Balasa’s legal opinion on this matter (Or any legal matter) except to add, there may be a caveat or two…that is…it depends. If we are referring to a medical assistant with no further training or education and a registered nurse I’m afraid I would have to take issue with this as most RNs do receive some leadership education in their curriculum. What I hear Mr. Balasa saying here is that medical assistants are trained specifically for that environment while nurses are trained to perform in a much wider range of environments… but then doesn’t that mean that nurses have a broader and more rounded knowledge and understanding of the healthcare system (food for thought)? While I admit I do not know the extent to which medical assistants are trained in leadership roles, I have worked with many medical assistants and I have held roles as clinical supervisor and medical office manager. Based solely on my observations and experiences, it is my opinion that medical assistants don’t seem very well prepared for supervisory roles. (Or maybe I just haven’t been exposed to the appropriate representative sample). However, if the medical assistant has formal training in business management or administration (BBA, MBA, etc.), it would be foolhardy for the nurse (LVN or RN) not to recognize and perhaps yield to the medical assistant in the office setting in matters non clinical. That is assuming that the medical assistant possesses the authority of the office (Upper level management). In that case, the medical assistant would not likely be functioning in a clinical capacity. Clinical supervisors are responsible for a lot more than just enforcing “office attire”, “work schedules”, compliance issues and “administrative protocol”. They are also responsible for supervising skill levels and the appropriateness and safety of patient care delivery, and of course, training and the list goes on from there. There would have to be a clinical component at the supervisory level as that usually means DIRECT supervision, especially when you figure in the responsibility of prioritization. How can a medical assistant prioritize patient care without using “independent professional judgement”, or without “making clinical assessments” or “evaluations” and “interpretations”? If Mr. Balasa says it is LEGAL for medical assistants to supervise nurses, who am I to challenge that? But the position of Supervisor of “work schedules”, “office attire” and “administrative protocol” doesn’t exist in a clinical setting-so it’s a hypothetical. (The position of compliance officer or coordinator does exist but it usually requires a degree beyond the training of a medical assistant). Since you can’t “supervise” in a vacuum, the question I would now ask myself if I had to appoint a supervisor in my clinic is; Is it appropriate and SAFE to promote a medical assistant to a supervisory position above a nurse in ANY clinical environment?

    • Susie says:

      It is my observation that medical assistants are required to exercise independent professional judgment,and make clinical assessments, evaluations, or interpretations on a daily basis. The fact that the medical assistant is in charge of the day to day flow of the patients and the office, rooming patients for their appointment, scheduling, assisting in procedures, emergencies, phone calls, records, EMR, complaints, medication requests, patient compliance to care, rooming patients, taking vitals, vaccinations, immunizations… I don’t think “supervised” is the right vocabulary here. Staff supports staff initially, working in a team effort. If a medical assistant is showing a nurse how to utilize the system and instructing the nurse how to input data in the EMR, this is teaching somehow to do something necessary as a team member. Showing the nurse how the Provider prefers a procedure set up, is teaching someone- as a team member.
      Showing a nurse how the Provider they are working for prefers the room set up for a procedure concluded, teaching. Showing a nurse how a particular patient prefers to be handled,this is team work. What ever you call it, know this:

      A MA student just graduating and on their practicum, this is supervision. A nurse instructed to supervise is supervising. A nurse has had more accredited academics than a MA and are equally important to the provider. It takes two to do the job one person use to do. A nurse and a MA – equally valuable, bringing both skills to the practice. Both would be inefficient without the other. This is working as a Team.
      Words make or break a statement, Asking for assistance should not have a tutelage attached.

  3. Charlotte says:

    I think what they may be referring to is in most Dr’s offices there is an office manager who is in charge of the administrative side of the office., normally this person is a medical assistant or medical office administrative professional. The office I work in is the same way, we have an office manager who is in charge of the office functions but is not in charge of the NP or Drs, there is a difference in the back office and front office.

    • C.A. Cabral, RN says:

      Thank you Charlotte! The question that was asked was; “Is it legal for a medical assistant to SUPERVISE a nurse in an office setting?”. I made the distinctions hoping it would lead to clarification. You and I agree that the role of “front office” leadership differs from that of “back office” leadership. Role assignment and job description may also depend on the size of the office as well as other variables. But the distinction between supervisor and manager still exists and therefore must be made, just as the distinction between medical assistant and nurse must be made. I hope this helps to clarify further. Be well.

  4. Mary says:

    Hello Donald, Thank you for your work. I am a new APRN in Oklahoma and would very much appreciate your information on medical assistants in the State of Oklahoma. Thank you

  5. Mrs. S. says:

    Most states acknowledge that a Medical Assistant is under the direct supervision of the physician, or other licensed staff.

  6. Nikki Moore says:

    I am a currently a Certified Clinical Medical Assistant. I am inquiring in regards to a CCMA administering injections and injectable medications ordered by a Nurse Practitioner in the state of Mississippi. Can we/I give injections under the direct supervision of a Nurse Practitioner?

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