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.

Utilizing Medical Assistants to the Top of Their Training

Medical assistants’ scope of service has greatly expanded during the last 18 months due to changes in federal and state law. To help clinicians and managers utilize medical assistants to the top of their education or training and credentialing, I presented on some of these major changes during the Medical Group Management Association (MGMA) Medical Practice Excellence: Leaders Conference on October 25, 2021.

The March/April 2022 Public Affairs article, “Utilizing Medical Assistants to the Top of Their Training,” summarizes this presentation, covering important facets of health care such as telehealth, remote physiologic monitoring, and post-discharge medication reconciliation.

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

Vaccine Administration under Utah Medical Assisting Law

On March 10, 2022, the Utah legislature amended Section 58-67-102 of the Utah statutes to permit medical assistants to administer vaccines under general physician supervision rather than indirect supervision. Note the following definitions from the Utah Administrative Code:

(b) “Indirect supervision” means the supervising licensee:

 (i) has given either written or verbal instructions to the person being supervised;

 (ii) is present within the facility in which the person being supervised is providing services; and

 (iii) is available to provide immediate face-to-face communication with the person being supervised as necessary.

(c) “General supervision” means that the supervising licensee:

(i) has authorized the work to be performed by the person being supervised;

(ii) is available for consultation with the person being supervised by personal face-to-face contact, or direct voice contact by telephone, radio or some other means, without regard to whether the supervising licensee is located on the same premises as the person being supervised; and

(iii) can provide any necessary consultation within a reasonable period of time and personal contact is routine.

New Mexico Supervision Requirements for Medical Assistants

I recently received a question from a health officer in New Mexico who wanted to know whether a nurse practitioner can supervise a medical assistant without a physician on-site.

The “State Scope of Practice Laws” webpage on the AAMA website provides information on medical assisting–related laws of 49 states, including New Mexico. The second document in the “New Mexico” section, an excerpt from New Mexico Board of Nursing regulations, classifies medical assistants as unlicensed professionals under the New Mexico nursing law.

My legal opinion is that New Mexico nursing law permits advanced practice registered nurses, including nurse practitioners, to delegate to unlicensed professionals—such as medical assistants working under their supervision—tasks that do not require the exercise of independent clinical judgment or the making of clinical assessments or evaluations. Note the following language from the regulations of the New Mexico Board of Nursing: 

B. The nurse shall assign/delegate to licensed and unlicensed persons only those nursing actions which that person is prepared, qualified or licensed or certified to perform.

(1) The nurse is accountable for assessing the situation and is responsible for the decision to delegate or make the assignment.

(2) The delegating nurse is accountable for each activity delegated, for supervising the delegated function or activity, and for assessing the outcome of the delegated function or activity.