Certification and the CMA (AAMA) Credential, On the Job, Professional Identity

Medical Assistants as “School Nurses”

Today I received a question about whether a medical assistant is allowed to work as a “school nurse.”

Just as medical assistants cannot use the title “nurse,” “office nurse,” or “doctor’s nurse” (see my Public Affairs article from the January/February 2011 CMA Today), under the laws of all American jurisdictions medical assistants—even CMAs (AAMA)—are not permitted to be employed as “school nurses.”  In some states medical assistants are permitted to assist registered nurses who are functioning as school nurses.  To reiterate, however, medical assistants are not allowed to work as “school nurses.”

16 thoughts on “Medical Assistants as “School Nurses””

  1. Is it permissible for medical assistants to work under the title of Health Aide in a school? I’ve seen this a few times, and I assume it is so the school can avoid having to pay for the services of an RN.

    1. I work as a Health Clerk. Only qualifications is GED or High School Diploma and CPR/First Aid. We still have to have an RN.

  2. Why are medical assistants categorized as not being a nurse and CNA s are nursing assistants when we do the same things in a clinic and much much much more

    1. Because everyone must use the credentials they are trained and certified for. It doesn’t diminish their value or the hard work they do, but it does reflect their training.

    2. Danette, It is difficult to know exactly what you are asking as your question is worded in a confusing and awkward way. Still, I would like to try to help you better understand why medical assistants are not nurses, as this seems this is your core concern. Simply put, nurses are trained differently than medical assistants in that nursing is a profession unto itself. While most nurses posses the same skills as medical assistants, medical assistants do not posses the same skills as nurses. For example, medical assistants and nurses are trained to collect and process laboratory specimens but nurses are further trained to perform assessments, develop and implement nursing interventions for abnormal assessment findings as well as perform evaluations to determine the success of those interventions. Nurses monitor the results of laboratory specimens, identify normal vs. abnormal reports and often develop nursing interventions and evaluations around those results. This requires that nurses think critically allowing them to adjust care delivery to fit the changing dynamic… and in many cases, to anticipate a problem before it happens as well as develop an intervention to help prevent it. Medical assistants, while important to the overall patient outcome, are neither trained nor burdened with the skills of assessment, intervention and evaluation. In response to your comment; “…we do the same things…”, it is difficult to know what you mean by that. Perhaps you are referring to the obvious “technical” skills being performed in the clinical setting like, obtaining vital signs, venipuncture, etc. Typically one would conclude that these skills would appear to be performed similarly as there is little room for variation in the technical sense. Regarding your claim “…we do…” “much, much, much more”, I am not sure what you mean by that either. You may not always be able to tell when a nurse is using his/her skills of assessment and/or evaluation without checking the documentation. But then, I am assuming you are a medical assistant though it is hard to tell, again, by the way your question or concern is worded. If I have missed the point here, please forgive me as your point was not made clear. If you care to elaborate on your statements here, please respond-and I will endeavor to assist you further in your quest for understanding. I sincerely hope this helps. Be well.

      1. Exactly. The difference between an MA and an RN is in the scope of training, the amount of personal liability/responsibility, and the accrediting body. The OP’s question centered around STNA’s and MA’s, though the skill sets are different, STNA’s and CNA’s are governed by the Board of Nursing, MAs are not. Hence the reason the term “nurse” in in their title, and not ours. STNA’s are trained by nurses to be nurse’s assistants. MA’s are educated and accredited by entirely different bodies, and not with intention of necessarily being a “nurse’s assistant”. Two different roles to fill two different needs to in the grand scheme of the healthcare world. Too much time and effort is spent comparing apples to oranges between nursing and medical assisting.

  3. Yes and there are a lot of things R.M.A.’s are trained to do that nurses are not. Particularly to work with insurance, billing and administrative work. A M.A.’s training would probably make her more suited to work as a “school nurse,” but she can not because M.A. aren’t independently licensed.

    1. Actually an MA is not better equipped to function as a school nurse because you are missing the point of assessment and intervention. In a school setting, the RN works independently and needs to know what interventions are necessary and when to refer to an MD or hospital. While the MA has many technical and office skills, they are not prepared to make medical/nursing decisions. The title MA comes from originally being able to assist the Medical Doctor in his/her office. It originated because …bottom line, the MD didn’t want to pay for a nurse, nor need his/her expertise to perform routine, repetitive tasks. Dr. Mandl, one of the founding fathers of the MA position felt that his medical secretary could be trained to carry out routine tasks. The CNA was specifically designed to assist the nurse, working directly under their supervision to perform routine and personal care functions. Sadly, most CNA programs only teach geriatrics because that it where the certification is necessary for nursing home employment (in NY anyway), and no longer include other specialties. I hope this clears it up for you. As a long time health career faculty member, I know the value of all of the ancillary personnel. However, it is usually the CNA, MA, and LPN that do not see the full picture of what is a Registered Nurse, but only focus on the repetitive technical skills and think “I do that too”

    2. Jacqui, I believe You may be confused not only about the differences between nursing and medical assisting, but also between that which constitutes a task and that which constitutes a skill. A task can be anything performed that does not require formal training, while a skill does in fact require training as well as discipline and experience to master. You said; “…there are a lot of things RMAs are TRAINED to do that nurses are not.” You then listed tasks that frankly anyone in the office can be called upon to perform after some orientation. I am afraid “Anthony, RN is correct- MAs whether registered or not, do not possess SKILLS that nurses do not possess-while nurses DO possess skills that MAs do not possess. Nurses practice a profession and can therefore function independently under their own license while MAs cannot since they are not licensed to practice a profession. It is the reason state boards of nursing have developed “scope of practice” laws for nurses. I am afraid too many people misunderstand-and therefore-misuse words like “professional”, “profession” and even “nurse”. I hope this clarifies your understanding. Be well.

  4. Maybe providers need to stop referring us C.M.A’s to patients as their “nurse” example: ” my nurse will be right back” this is confusing to me and obviously illegal. “Nurse” is a general term of what I do, C.M.A. is my title. My passion is “taking care of the ill and infirm”, that is what I do and that is the definition of a Nurse.

    1. Theresa, your message, though perhaps well intentioned, requires clarification. You are spot on correct about providers referring to you as a “nurse” but as a CNA , that should not confuse you- though is does often confuse patients, family and even ancillary staff. As a nurse educator I am acutely aware of the nurse’s role as well as the roles of those we work with. (I am often distressed that some providers don’t seem to know the difference). I do sometimes substitute teach in the MA and CNA programs at the college where I teach. You said “nurse” is what you do. I find that we disagree. Our training, educational requirements and therefore our roles and responsibilities are very different though some similarities may seem apparent to some. The role of a CNA is that of assistant, hence the title Certified Nurse Assistant. The practice of nursing requires licensure while certification is the goal for nursing assistants. Could it be then that you are adding to your own confusion by not clearly defining your own role? Part of the problem, as I see it, is too many people use the terms “nurse” and “nursing” as “generalities”…you admitted that in your message. It turns out “Nurse” is not a ” general ” term at all. Additionally, I feel compelled to correct your “definition” of a nurse. While I agree nursing is a profession of caring and compassion, I’m afraid even I could not sum it up in such limited and simplified terms. I can hear your passion however and I invite you and hope you will deeply consider joining the nursing profession. You’re the kind of student I love having in my classroom. Be well.

    2. I guess it depends on where you get your accreditation through. Because with my scope of practice through AAMA as a CMA we do alot of things an RN does, except narcotics. We educate, can start an IV, infuse , insert catheters, etc.. There is a HUGE difference between an RMA and a CMA and where your certification is through also makes a difference in what you are allowed to do, within your scope of practice. The hospital system I was working for laid of about 3000 RN’s because an AAMA certified CMA has such a vast knowledge, training to do so much. There’s 1 RN on per shift now instead of 6 or 8. A lot of CMA’s who have an Associates degree did that because of the potential to manage an office or practice, be a lead CMA and further down the road go into nursing or healthcare administration. BUT we still do have an associates degree as do alot of RN’s. That’s why it i so very important to make sure you get your certification through AAMA. The pay is remarkably different also.

      1. I am also a CMA (AAMA) and agree that we are qualified to many things in the clinical setting as the RN. I work in public school under the RN, BSN and am delegated to provide daily meds, etc. School health requirements are different than clinics, etc. And I find that some RN’s are clueless in the administrative areas though very skilled in patent care. Lots of the school needs are also administrative. I’ve met other RN’s who are without compassion of any kind so a title is recognized and paid for but the poor attitude speaks volumes and isn’t even considered in the work vs. pay arena. I’d rather have a knowledgible CMA with compassion dealing with my kids than an over worked RN who just runs from school to school complaining about her workload. School districts often can not afford RN’s for every school and thus hire “health assistants or technicians” whom may have no training outside CPR/1st aid. This allows the districts to bump liability off on the supervisory RN’s license as oversee-er. RN’s often need the trained staff to assist with diabetics, asthma issues, mental health, first aid issues, proper documentation, screenings, etc. seen daily in the school setting.But we are not nurses, we are first responders, facilitators, mentors, advocates to students, notify paramedics, RN’s, parents and staff and carry out needed supports. I make known in my title that I am a CMA and post the CMA credential in my office for parents and staff since many use the term “nurse” even for the high school/GED and CNA staff. I also have CPR/1st aid and mental health first aid certificates and worked in family practice clinics prior. I am not trying to compare credentials, however I find that many RN’s often try to discredit the CMA by comparing us to the MA (high school/GED) hired and trained on the job type staff used by many medical offices. There is a HUGE distinction, but sadly, doctors have contributed to the underpaying of the CMA by dumping the MA, RMA, and CMA into all one boat. And RN’s don’t always know what a CMA education compared to CNA education consists of. Yes. The CMA has an Associates degree and so does the RN; just different skill sets.Even the 2 year degree RN’s get better pay due to licensing. The only one with a bachelor’s degree is the RN, BSN. Schools pay their health staff much better than doctor’s offices who often pay the 2 yr degree CMA half of the 2 year RN and less than the 1 year LPN! That’s why pay for the CMA needs to seriously reviewed. Many look for work outside the doctor’s office or hospital settings due to the poor pay. My area pays the walmart employee 12.00 to start and the CMA 11.00 and that pathetic! I think CMA’s can work in schools and they bring more than states require as a “health assistant” with no education. Parents need to ask school districts for CMA’s when an RN is not in ever school all day. The Dept of Education only requires that districts have supervisory RN’s; Schools cant pay for RN’s in every school full time. CNA’s and CMA’s can work in school clinics and health settings under the delegation of the district’s authorized physician and RN’s. CMA’s are versatile- the better link to better school health care! It’s a great place for the CMA with better pay and benefits.

  5. Just to clarify- A CMA in school health is not a “school nurse” but can be a “health assistant” or “health technician” under school job descriptions. The Dept of Educ. only requires schools have supervisory RN’s as individual school over-site. Health assistants/Techs who are at the schools throughout the day are able to work under this directive. Health assistants do not need an associates degree and therefore a CMA brings added benefits to the field of school health. Some are in school health clinics and others can manage minor school health offices. School districts often require delegation and training from RN’s to the health assistants/tech’s to carry out daily health care needs while they run from school to school and are in touch by email, phone etc. which is also under the directive of a District Supervisory RN, BSN and designated district physician. This is an area where a health assistant/tech ( with no secondary education required, though desired) often gets better pay than a doctor’s office CNA or CMA! Here’s a short comparison from Colorado. The CNA (3 month education) and CMA’s (2 yr. Associates/AS degree) start out with the same pay range in most doctor’s offices at $10.00-13.00 per hour. Whereas, an RN (basic 2 year ASN degree) will get $19.00 to 23.00 to start. NEARLY DOUBLE! Do you see a problem with how the CMA is paid/ viewe; compared to those with zero to 3 months training)? I worked in a medical clinic for years before school health and I was given the same starting pay as a MA with no education, only on the job training. The term “MA” to many doctor’s offices can be a person they train on the job. That’s what is often the comparison due to ignorance. It’s the “school nurse” who is the RN, BSN whom we are not to be compared to because she/he has a 4 year degree and license. As for the comment above from E. Roko, the need for the CMA is vital to bringing in the required skill sets and many RN’s might fear this because we are paid half the RN salary?? This is not fair to either CMA or RN. We are not apples and oranges, we peaches, apricots and peachcots! We need to value the differences we bring and doctor’s offices should pay better for a CMA. A CMA working in the school setting can be paid much closer to the RN with a 2 year degree and that is fair for AS (CMA) or ASN (RN) educational level of 2 years college for each; both requiring ongoing ceu’s. Again, this is not the RN, BSN. The salary of a CMA with a 2 year degree being half that of another based on licensing to certification is a big problem that needs to addressed. If I knew of this pay discrepancy in the past, I would have rethought it for my future. Anyone who says otherwise doesn’t truly value the credential as they should and it shows in the poor salaries offered and that continue. There is no reason a CMA should get such low pay. School districts may not even know what a CMA actually is, but their pay offered for the “Health Assistant/tech” ( with no secondary education) is better than a doctor’s office. I, as a CMA get paid much better in a school health setting than any doctor’s office with decades of experience…and I get every holiday and weekend off! School health is a great place for better pay and continued skill. One more concern: Our area doctor’s have stressed the need for school health to have better collaborations with area doctors due to the rise in health issues at an earlier age ( including mental health) and the need to address the rising issues and referrals in schools because students are not seeking medical attention as needed when parents are working. Because of the rise in student health needs, doctors are needing school staff to be better educated. What better way to make improvements for everyone, than have a CMA (with better pay and versatile skills) in a school health care setting! Maybe the AAMA could get more information on school health needs and get the word out for all of us. It really is a win- win, so don’t let lack of understanding by use of “school nurse” be a stick in the wheel. The school nurses association should be wanting more than a warm body in the schools when it comes to their oversight and knowing that schools cant afford more RN’s, we are a benefit to each other. It’s just that people need to be educated on the topic; School nurse’s and CMA’s as health assistant/tech’s, can be of great benefit to each other and community health! (Yes, we also work under a physician since every district has to have a designated physician, and supervisory RN).

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