Scope of Practice

North Carolina Medical Assistants in Inpatient Settings

I recently received the following question from a manager at a health care system in North Carolina: 

We are looking at ways to assist nurses in the hospital setting due to the nursing shortage. Can medical assistants practice in a hospital setting without a nursing assistant certification? 

Medical assistants are permitted to meet the requirements and register with the state as certified nursing assistants (CNAs) and medication aides. Short of this, medical assistants are considered unlicensed assistive personnel (UAP) when working under nurse supervision in inpatient settings. 

The North Carolina Board of Nursing has issued some detailed and helpful position statements on what nurses are permitted to delegate to UAP. See the following documents for additional details: 

delegation, Scope of Practice

Permissible Delegation to Montana Medical Assistants

I recently received the following appeal from a licensed practical nurse working in Montana:

I’m requesting something in writing that states that CMAs (AAMA) can still administer immunizations. The verbiage that my bosses are reading has [caused them to change] what our medical assistants can and can’t do. I depend on [medical assistants] being able to give shots (i.e., immunizations) when working with me.

For documentation related to this issue, go to the State Scope of Practice Laws webpage on the AAMA website to find the medical assisting laws of all states, including Montana.

Note the following from the Montana Code Annotated (MCA):

37-3-104. Medical assistants — guidelines. (1) The board shall adopt guidelines by administrative rule for:

(a) the performance of administrative and clinical tasks by a medical assistant that are allowed to be delegated by a physician, physician assistant, or podiatrist, including the administration of medications; and

(b) the level of physician, physician assistant, or podiatrist supervision required for a medical assistant when performing specified administrative and clinical tasks delegated by a physician, physician assistant, or podiatrist. However, the board shall adopt a rule requiring onsite supervision of a medical assistant by a physician, physician assistant, or podiatrist for invasive procedures, administration of medication, or allergy testing. [Italics added.]

Further, note the following from the Administrative Rules of Montana (ARM):

24.156.401    MEDICAL ASSISTANT – DELEGATION AND SUPERVISION

(1) A health care provider authorized by 37-3-104, MCA, may delegate administrative and clinical tasks which are within the delegating health care provider’s scope of practice to medical assistants who:

(a) work in the delegating health care provider’s office under the general supervision of the delegating health care provider; and

(3) A health care provider delegating administrative and/or clinical tasks to a medical assistant shall:

(c) personally provide onsite direct supervision as defined by ARM 24.156.501 to a medical assistant to whom the health care provider has delegated:

(i) injections other than immunizations;

(ii) invasive procedures;

(iii) conscious sedation monitoring;

(iv) allergy testing;

(v) intravenous administration of blood products; or

(vi) intravenous administration of medication [Italics added.]

The definition for direct supervision is in ARM “Definitions”:

(7) “Direct supervision” means the supervising physician is:

(a) physically present in the same building as the person under supervision; or

(b) in sufficiently close proximity to the person under supervision to be quickly available to the person under supervision. [Italics added.]

Given this language from the Montana statutes and regulations, my legal opinion is that Montana law permits physicians to delegate to medical assistants—who have the knowledge and competence outlined in the Montana rules—the administration of immunizations under the physician’s general supervision. My opinion is also that Montana law requires the delegating physician to be exercising direct supervision when medical assistants are performing the following tasks outlined in ARM:

(ii) invasive procedures;

(iii) conscious sedation monitoring;

(iv) allergy testing;

(v) intravenous administration of blood products; or

(vi) intravenous administration of medication

On the Job, Scope of Practice

Legal Requirements for Venipuncture in Washington

I recently received the following question regarding the legality of medical assistants performing venipuncture in Washington:

I am licensed as a medical assistant-certified (MA-C) under Washington law. Do I need to obtain the Washington state medical assistant-phlebotomist credential in order to perform venipuncture?

To answer this question, note the following excerpt from the Washington State Department of Health’s Frequently Asked Questions webpage:

The scope of practice of a medical assistant-phlebotomist includes capillary, venous, and arterial invasive procedures for blood withdrawal, CLIA [Clinical Laboratory Improvement Amendments] waived, moderate and high complexity tests, and [(electrocardiogram (ECG)]. A medical assistant-certified may perform capillary and venous blood withdrawals, CLIA waived and moderated complexity tests, and [ECG] but may not perform arterial invasive procedures for blood withdrawal or high complexity designated CLIA tests. If you hold a medical assistant-certified credential, you need only to retain your medical assistant-phlebotomist credential if you’re required to perform arterial invasive procedures for blood withdrawal or high complexity tests.

covid-19, Scope of Practice

Federal Policy and the Pandemic: How the Pandemic and Changes in Federal Policy Have Expanded Medical Assistants’ Scope of Practice

Medical assistants’ role and duties have been significantly impacted by the COVID-19 pandemic. During this time, federal agencies and state governors have made necessary changes to expand medical assistants’ legal scope of practice to meet new health care needs.

In the March/April 2021 Public Affairs article in CMA Today, I discuss how these government actions have changed the knowledge, skills, and professional attributes and behaviors medical assistants are now expected to have and to demonstrate, particularly in these areas:

  • Telehealth
  • Nasopharyngeal swabbing
  • COVID-19 vaccination administration

Learn more about how recent federal policy has affected medical assistants’ scope of practice by reading “Federal Policy and the Pandemic: How the Pandemic and Changes in Federal Policy Have Expanded Medical Assistants’ Scope of Practice” on the AAMA website.

delegation, Scope of Practice

Nebraska Amendment Clarifies Medical Assisting Scope of Practice

Beginning in 2018, a particular interpretation of Nebraska law has cast doubt on the legal authority of physicians to delegate to medical assistants the performing of certain tasks under direct/on-site physician supervision in outpatient settings.

In response, the Nebraska Medical Association drafted an amendment to the Medicine and Surgery Practice Act to eliminate any ambiguity about medical assistants’ scope of practice. The American Association of Medical Assistants® and the Nebraska Society of Medical Assistants submitted written testimony supporting this legislation, and the amendment was enacted into law.

The new language clarifies the authority of physicians to delegate—and the right of medical assistants to perform—tasks within the standard scope of practice for medical assistants throughout the United States. I have incorporated this new language into my legal opinion letter for Nebraska, which is available on the AAMA State Scope of Practice webpage.