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.

delegation, On the Job, Scope of Practice

Relaying Providers’ Orders by Telephone

Part of the AAMA’s mission is to protect medical assistants’ scope of practice. Sometimes that means gathering evidence to prove that what other health professionals think is a limitation of medical assistants’ scope of practice is unsubstantiated by state law. Consider the following from a medical assistant in Wisconsin:

I work in a small physician-owned clinic. Our primary care providers visit two local skilled nursing facilities each month. … [Does] our state permit nurses to take a provider’s order by telephone that is conveyed by a medical assistant? These telephone orders are always followed up by a written electronic order from the provider. [But] we are being told that nursing home staff will only take telephone orders directly from licensed health professionals.

Why would this be any different from a provider directing one of our medical assistants to convey a normal lab value? Our providers would spend all day calling the nursing homes if medical assistants cannot relay information at the request of the provider. If the nursing home staff members do not understand the order, they can always ask for clarification from one of our providers.

I reviewed the nurse practice act and the regulations and policies of Wisconsin’s state board of nursing. I found nothing stating that registered nurses (RNs) and licensed practical nurses (LPNs) are prohibited from receiving and executing orders from a licensed provider (e.g., physicians, nurse practitioners, physician assistants) that are transmitted verbatim by telephone by an unlicensed allied health professional, such as a medical assistant.

Unless state law specifically indicates otherwise, my legal opinion is that knowledgeable and competent medical assistants are permitted to convey verbatim information (including orders) on behalf of the delegating provider and receive verbatim information for the overseeing provider. Information conveyed by telephone should be followed up by a written order (electronic or hard copy).

delegation, On the Job, Scope of Practice

Standing Orders and Supervision Requirements

I welcome further questions about my blog posts because addressing those questions allows me to dive deeper into a pertinent topic for medical assistants who wish to better understand their scope of practice.

For instance, in response to my blog post “Standing Orders from an Overseeing Provider,” I received the following question:

Does a standing order change the supervision requirements for medical assistants? For example, if our state law requires the delegating licensed provider to be on the premises when a medical assistant is performing venipuncture, is this supervision requirement changed by a standing order from the provider?

A standing order does not change the supervision requirement established by state law. The supervision requirements apply regardless of whether the licensed provider issues a standing order, verbal order, or written order. If this were not the case, a provider could circumvent supervision requirements by issuing standing orders instead of verbal orders.

The purpose of supervision requirements is patient protection.