On the Job, Scope of Practice

NP Delegation in South Carolina: State Law Permits Nurse Practitioner Delegation to Medical Assistants

Conflicting information has been circulating about whether South Carolina nursing law permits licensed nurses—including advanced practice registered nurses (APRNs), such as nurse practitioners (NPs)—to delegate tasks to medical assistants.

Nevertheless, South Carolina law specifically authorizes licensed nurses, including NPs, to delegate certain nursing tasks to knowledgeable and competent unlicensed assistive personnel (UAP), such as medical assistants, who are working under appropriate nurse supervision.

Administration of medication, however, is a task licensed nurses cannot legally delegate to UAP (such as medical assistants) under South Carolina nursing law.

Review the supporting evidence in the January/February 2020 Public Affairs article, “NP Delegation in South Carolina,” on the AAMA website.

delegation, On the Job, Scope of Practice

New Alaska Standards for Delegation of Certain Duties

The Alaska State Medical Board has added a new section to its regulations that establishes standards and conditions under which a licensed physician (doctor of medicine or osteopathic medicine), podiatrist, or physician assistant may delegate certain medical duties to unlicensed professionals such as medical assistants.

These regulations remove any ambiguity from the assertion that knowledgeable and competent unlicensed allied health professionals such as medical assistants can legally perform intramuscular (IM), subcutaneous (subq), and intradermal (ID) injections delegated by a licensed provider under the provider’s direct/on-site supervision.

The regulations of the Alaska State Medical Board were finalized November 25, 2019, and went into effect December 25, 2019.

You can read the regulations by either accessing the December 2019 medical statues and regulations document (Page 37) via the Alaska State Medical Board webpage or the Alaska section of the AAMA State Scope of Practice Laws webpage on the AAMA website.

This is a significant scope of practice victory in Alaska, and I congratulate the Alaska Medical Assistant Society for its excellent and diligent work on strengthening and clarifying medical assistants’ right to practice!

delegation, On the Job, Scope of Practice

Medical Assistants and Vaccination Administration under Pharmacists

Improving vaccination rates and lessening vaccination hesitancy is a top priority for all health care professionals. Medical assistants are in a prime position to help, but the exact nature of their role requires some legal considerations.

Consider the following situation:

I own a pharmacy in which pharmacists administer influenza vaccinations. Could I hire a medical assistant to help us administer these influenza shots, or is it required that medical assistants work only under the supervision of a physician?

Most often, medical assistants work under the authority and supervision of licensed providers such as physicians (doctors of medicine or osteopathic medicine), nurse practitioners, and physician assistants in outpatient settings. However, state laws generally do not prohibit other licensed health care professionals (such as podiatrists, dentists, optometrists, and pharmacists) from employing medical assistants and delegating legally permitted tasks to them.

In response to your specific question, it is necessary to check the pharmacy practice act of your state—and the regulations and policies of the state board of pharmacy—to ascertain which allied health professionals (if any) may be delegated the administration of influenza vaccinations by a pharmacist. It is also necessary to determine the degree of supervision pharmacists must exercise over allied health professionals who are administering influenza vaccinations. I suspect the pharmacy law of your state requires delegating pharmacists to exercise on-site supervision over professionals who are administering influenza vaccinations.

If you’d like to know more about your specific state laws, visit the State Scope of Practice Laws webpage on the AAMA website.

dental assistant, On the Job, Scope of Practice

Medical Assistants Working with Dually Licensed Providers

The following question is not asked frequently. However, it raises important legal considerations:

I work for an oral surgeon who is both a licensed physician and a licensed dentist. Is my scope of practice determined by the state medical practice act or the state dental practice act?

Many oral surgeons have both an MD/DO degree (doctor of medicine or osteopathy) and a DDS/DMD degree (doctor of dental surgery or dental medicine) and are licensed as both physicians and dentists.

When medical assistants perform a dental task, they function as dental assistants. Thus, the state dental practice act and the regulations and policies of the state board of dental examiners determine the legal scope of practice—including supervision requirements by the delegating oral surgeon. If state law allows delegation of certain dental tasks only to individuals who meet dental assisting education and credentialing requirements, medical assistants must meet these requirements or obtain a waiver from the board of dental examiners to perform such tasks.

When medical assistants perform a medical task, the scope of practice is established by the state medical practice act and the regulations and policies of the state board of medical examiners. Go to the State Scope of Practice Laws webpage on the AAMA website to find the medical assisting law of all states.

delegation, On the Job, Scope of Practice

Medical Assistants and Fetal Nonstress Test Monitors

State laws are the best place to look for guidance on medical assisting scope of practice, but they are sometimes less thorough than desired. For cases such as those, consider the following:

We have some CMAs (AAMA) and RMAs(AMT) assisting physicians who are providing obstetrical services. The physicians delegate to the medical assistants the hooking up of patients to fetal nonstress test monitors. The medical assistants do not interpret the results of the fetal nonstress test. Is this delegation permitted by Minnesota law?

Based on my research, hooking up a patient to a fetal nonstress test monitor is a straightforward, repeatable process that does not require (1) the knowledge or skill or a licensed health care professional, (2) the exercise of independent clinical judgment, or (3) the making of clinical assessments. Therefore, my legal opinion is that this task is likely delegable to knowledgeable and competent unlicensed allied health professionals such as medical assistants working under direct/onsite physician supervision.

The delegating physicians should reverify periodically (perhaps every 12 months) the knowledge and skill of the medical assistants performing this task and should document in writing each medical assistant’s current competence in this task.

It may also be advisable to request a written opinion from the practice’s malpractice insurance carrier stating that it would cover any negligence by a medical assistant in hooking up a patient to a fetal nonstress test monitor.