Two State Nursing Boards Recognize Educated and Credentialed Medical Assistants

Earlier this year, Connecticut and South Carolina enacted legislation that empowered medical assistants in these states to perform tasks for which they are educated, credentialed, and competent. Recently, nursing boards in Delaware and South Dakota have similarly revised existing legislation to differentiate duties delegable to educated and credentialed medical assistants from tasks delegable to all other medical assistants.

Specifically, the Delaware Board of Nursing and the South Dakota Board of Nursing issued proposed regulations that allow licensed nurses to delegate to formally educated and credentialed medical assistants the administration of medications by speci­fied routes. Like the Connecticut and South Carolina legislation, these newer revisions speak to the ongoing demand for knowledgeable and competent medical assistants to perform a greater number of advanced functions.

Learn more about this trend and read supporting documentation in the November/December 2022 Public Affairs article, “Two State Nursing Boards Recognize Educated and Credentialed Medical Assistants,” on the “Public Affairs Articles” webpage.

How to Receive Guidance on Scope of Practice from State Medical Boards

I recently received the following question:

My physician employer contacted the state medical board and asked whether she could delegate a particular task to a medical assistant. The staffer at the medical board replied that the board does not regulate medical assistants and therefore he was not able to answer the question. My physician employer wants to know how she can obtain an answer from the medical board.

Your physician employer should ask the state medical board whether the medical practice act and the regulations and policies of the medical board permit her to delegate a certain task to an unlicensed employee. The question should not contain the term “medical assistant” unless this term is found in the medical practice act and/or the regulations of the medical board. By using “unlicensed employee” instead of “medical assistant,” it is more likely that your physician employer will receive an answer to her question.

Delegation to Medical Assistants under Florida Law

The Florida Medical Practice Act defines medical assistant as “a professional multiskilled person dedicated to assisting in all aspects of medical practice under the direct supervision and responsibility of a physician.” While some medical practice consultants argue that the act’s definition means medical assistants are permitted to work under only physicians, such an argument is flawed.

In the May/June 2022 Public Affairs article, “Delegation to Medical Assistants under Florida Law,” I provide evidence—from the Florida Board of Nursing—that demonstrates that Florida law permits medical assistants to work under advanced registered nurse practitioners as well as physicians. Then, I offer insight into medical assistants’ scope of service under Florida law.

Read the article on the “Public Affairs Articles” webpage.

Proposed Delaware Regulation Expands APRN Delegation to Medical Assistants

On June 9, 2022, I sent a letter to the executive director of the Delaware Board of Nursing regarding proposed regulations that would allow advanced practice registered nurses (APRNs), including nurse practitioners, to delegate to educated and credentialed medical assistants the administration of medication.

Read the full letter here:

I am writing on behalf of the American Association of Medical Assistants® (AAMA), the national professional society for medical assistants, in regard to the following proposed addition to the regulations of the Delaware Board of Nursing (BON):

8.7.15.1 APRNs are authorized to assign and supervise medication administration to a medical assistant if the medical assistant has successfully completed a medical assistant training program and possesses current national medical assistant certification.

8.7.15.1.1 If a practice is solely operated by APRNs, the APRN must be present in the building when the medical assistant is administering medications and assumes liability for the actions of the medical assistant.

8.7.15.2 When a physician delegates to a medical assistant, and an organizational policy exists to allow the APRN to assign and supervise the medical assistant, the physician retains responsibility and accountability for the actions of the medical assistant and will be notified of unsafe or improper practices.

It is the position of the AAMA that medical assistants who have completed a medical assistant training program that includes medication administration theory and technique, and who have a current national medical assistant certification such as the CMA (AAMA)® that tests knowledge needed to safely administer medication, should be permitted to administer medication under the authority of APRNs—including nurse practitioners—and other licensed independent practitioners such as physicians.

The AAMA commends the Delaware BON for increasing the availability of safe and accessible health care for the residents of Delaware by proposing this revision to the BON regulations.

Permissible Delegation of Catheterization Tasks in Iowa

I recently received the following question from a medical assisting educator regarding scope of service for Iowa medical assistants:

Regarding urinary catheterization, we have been told that a Certified Medical Assistant^® cannot insert a straight catheter, but they can remove the catheter. Our [medical assisting] course does not include performing this task, but I have had a few students who would be doing their externship in urology, and the question is always presented because the urinary [practices] allow medical assistants to insert catheters. But, we have been informed that it is out of our scope.

Are you able to provide some insight on this subject and possibly some documentation so we can correctly advise our externship sites as well as provide accurate information for our students?

Iowa law neither specifically authorizes nor forbids medical assistants being delegated and performing catheterization tasks.

The Commission on Accreditation of Allied Health Education Programs and the Medical Assisting Education Review Board recently issued new Standards and Guidelines for the Accreditation of Educational Programs in Medical Assisting, which includes a revised “Core Curriculum for Medical Assistants.” The Medical Assisting Education Review Board has also updated Educational Competencies for Medical Assistants. Note the following from this document:

Catheterization: Catheterization may not be a common day-to-day task of a medical assistant; however, some communities of interest may see a need for training in this area due to local physician office needs. Laws for catheterization performed by medical assistants will vary by state. It is important to know and follow the specific state regulations for medical assistants performing catheterization procedures.

Note the following from my handout on federal and state updates to medical assisting scope of practice:

30. … It may be prudent to ask the malpractice insurance carrier for the practice/clinic/health system whether it would cover any negligence by a medical assistant in performing [certain tasks.] The insurance carrier should be asked to put its opinion in writing.

31. To formulate a legal opinion on whether a particular task is delegable to medical assistants when state law does not address the legality or when state law is ambiguous, … I often begin my analysis by evaluating whether the task is usually and customarily delegated to medical assistants in the state and in other states. I also determine whether the task is contained in the “Core Curriculum” of the current CAAHEP [Standards]. [The “Core Curriculum” of the CAAHEP Standards takes into account the results of the most recent occupational analysis of the medical assisting profession.]

Thus, in such cases, I suggest that educators or practitioners contact the malpractice insurance carrier for their school and program or medical practice and ask whether it would cover any negligence by a medical assistant in performing these catheterization tasks.