delegation, On the Job, Scope of Practice

Suicide Safety Plan Delegation

Is it appropriate for a nurse practitioner to delegate patient follow-up that will establish a suicide safety plan to a medical assistant?

My legal opinion is that nursing law of some states allows nurse practitioners to assign to knowledgeable and competent unlicensed professionals such as medical assistants the interacting by telephone with chronically suicidal patients to establish a suicide safety plan as long as both of the following conditions are met:

  1. The medical assistant adheres strictly to the information guidelines provided by the licensed therapist and approved by the nurse practitioner
  2. The medical assistant’s interaction with the patient does not require the exercise of any degree of independent clinical judgment or the making of clinical assessments or evaluations 

These principles are especially important in interacting with psychiatric patients—even more so for those who are chronically suicidal.

I would also suggest that delegating nurse practitioners check with their malpractice insurance carrier to make sure that the insurance would cover any negligence by a medical assistant in assisting a patient in establishing a suicide safety plan. The opinion from the malpractice carrier should be in writing and kept on file.

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

Delegation Authority of Nurse Practitioners vs. Physician Assistants

If you have been told that different health care professionals share identical authority to delegate to medical assistants, consider the following situation:

A practice management consultant is telling us that medical assistants working under the authority of a nurse practitioner (NP) have the identical scope of practice as medical assistants working under a physician assistant (PA). Is that legally accurate? The consultant is saying that this is the case because the educational and licensing requirements for NPs and PAs are the same.

The medical assisting scope of practice under nurse practitioner authority is not necessarily the same as the scope of practice under physician assistant authority. Nurse practitioners are governed by the state nurse practice act and the regulations of the state board of nursing, whereas physician assistants are governed by the physician assistant practice act (which is sometimes part of the medical practice act) and the regulations of the state board of medical examiners. Consequently, the NP legal delegation authority in a state often differs significantly from the PA legal delegation authority in the same state.

And although the educational and testing requirements for NPs and PAs are similar, they are not identical. I have read articles asserting that the “nursing model” under which NPs are trained is very different from the “medical model” under which PAs are trained. This is a debatable point. However, it is indisputable that the tasks delegable to unlicensed allied health professionals such as medical assistants by NPs and PAs practicing in the same state are sometimes very different.

delegation, Scope of Practice

Duties and Delegation Abroad

I field many scope-of-practice questions in my work, some of which are highly specific to the individuals posing them. Others can be applied more broadly, however. These serve as interesting material to share with readers of this blog. The following is one such question I received recently.

I practice as a medical assistant in North Carolina. I routinely travel outside the country for medical missions. As a CMA (AAMA), when working under a physician licensed in another country, am I permitted to perform the same tasks that I am allowed to perform under North Carolina law?

I responded as follows:

Thank you for your most interesting question.  Your legal scope of practice would depend on the laws of the country in which you are working.  You would not necessarily be able to perform the same tasks you are delegated in North Carolina.

However, to take your question a step further, it is my legal opinion that—if a physician licensed in North Carolina also went on such a mission trip—the physician would be permitted to delegate to you the same tasks that he/she delegates to you under North Carolina law.  This same legal principle would apply to nurse practitioners and physician assistants licensed in North Carolina.

Note that the state in question here is largely interchangeable. Were the medical assistant and physician from Oklahoma, for example, the same legal principle would apply, only specific to Oklahoma law instead of North Carolina.

Computerized Provider Order Entry (CPOE), EHR Incentive Programs, Eligible Professionals, Medicaid, On the Job

Order Entry Requirements for Non-Physician Practitioners

I was recently asked whether non-physician practitioners (e.g., nurse practitioners and physician assistants) must meet the meaningful use order entry requirements under the Medicaid Electronic Health Record (EHR) Incentive Program.  The answer is yes.

The following are considered “eligible professionals” (EPs) who can participate in the  Medicaid EHR Incentive Program:

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioners
  • Certified nurse-midwives
  • Dentists
  • Physician assistants who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant

All participating EPs must meet the computerized provider order entry (CPOE) requirements of the Incentive Program in order to receive incentive payments.