On the Job, Scope of Practice

Scope of Practice near State Borders

I received the following interesting question:

I’m struggling with a difficult question! I am the clinical operations director for a medical group located in Oregon near the Oregon-Washington border. We provide care to Oregon and Washington residents and employ several medical assistants. As you know, Washington law requires certain medical assistants to meet educational and credentialing requirements and to register with the Washington State Department of Health. There are no such requirements for medical assistants under Oregon law.

Do my medical assistants who assist providers treating Washington residents need to meet the medical assisting requirements of the Washington law? All our providers (e.g., physicians, nurse practitioners, physician assistants) are licensed in Oregon.

The following is my response:

Because you are located in Oregon and the providers are licensed under Oregon law, the governing law is that of Oregon. Therefore, your medical assistants are not required to meet the requirements and register with the Washington State Department of Health. It does not matter that some patients are residents of Washington.

However, if your medical group had another location in Washington, the medical assistants would have to meet the requirements of Washington law to work as medical assistants.

medication aide, medication assistant, Scope of Practice

CMAs (AAMA), CNAs, and Medication Aides

I recently received the following question:

Does the law permit a CMA (AAMA) to work as a certified nursing assistant (CNA) in a nursing home without meeting the state requirements for registering as a CNA?

The answer is no. A medical assistant—even a CMA (AAMA) who has graduated from a programmatically accredited medical assisting program—must meet the state requirements for CNAs and register with the state as a CNA in order to perform clinical tasks in a skilled nursing facility or other inpatient settings.

Some states have a category of “medication aides (or assistants).” Medication aides are permitted to distribute medications to patients in an inpatient setting, usually under registered nurse authority and supervision. CMAs (AAMA) must also meet state requirements in order to work as a medication aide.

For more discussion on this topic, read my previous blog post “Medical Assistants and Medication Aides/Assistants/Technicians: Differences and Clarifications.”

delegation, Scope of Practice

The Relationship between Scope and Competence

Medical assistants are under a legal duty to not exceed the legal scope of practice in their state.  Medical assistants are also under a legal duty to perform all tasks competently.  It is important to understand the relationship between these two legal duties.

Even if a medical assistant performs a task competently, and meets or exceeds the standard of care that is required of a medical assistant, the medical assistant could face legal sanctions if the task is beyond the legal scope of practice for medical assistants in the state.

Similarly, if a medical assistant performs a task that is permitted under state law, the medical assistant (and, most likely, the medical assistant’s delegating provider) could be sued for negligence if the task is not performed competently.

Medical assistants must make sure they perform all tasks competently.  They must also make sure that the tasks they perform do not exceed the legal scope of practice in the state (or other American jurisdiction) in which they are working. Of course, the best way to do so is by remaining informed about the laws in your own state. To help health care professionals navigate this issue, the AAMA website has a large collection of documents relating to different states’ scope of practice laws. Any medical assisting scope of practice questions that are not covered by these materials can be emailed to me at dbalasa@aama-ntl.org.

medication aide, medication assistant, medication technician, Uncategorized

Medical Assistants and Medication Aides/Assistants/Technicians: Differences and Clarifications

Although I have written about the difference between medical assistants and medication aides/assistants/technicians in Public Affairs articles in CMA Today, I continue to receive questions about the topic. Here are the basics:

Medical assistants work in outpatient settings under direct provider supervision, and may be delegated clinical and administrative tasks. Medication aides/assistants/technicians work in inpatient settings, usually under registered nurse supervision. A primary task of medication aides is to pass medications as directed by the RN supervisor.

Medication aides do not exist under the laws of some states. The laws of other states refer to these health workers by a designation other than medication aide. In some states an individual must first meet the requirements and register with the state as a certified nursing assistant (CNA) in order to be eligible to receive additional training and become a medication aide.

Medical assistants do not work in a clinical capacity in inpatient settings as medical assistants per se. Medical assistants must meet the requirements and register with the state as a CNA and/or a medication aide in order to work in a clinical capacity in inpatient settings.

Some state laws refer to medication aides as “certified medication aides.” The initialism associated with this phrase can cause confusion between medical assistants and medication aides. To help minimize such confusion, the National Council of State Boards of Nursing refers to medication aides as “MA-Cs” and encourages states to use this initialism. This change was made at the request of the American Association of Medical Assistants.

delegation, On the Job, Professional Identity, Scope of Practice

Medical Assistants and Limited Scope Radiography

I receive fewer questions than I did seven or 10 years ago about the legalities of medical assistants performing limited scope radiography. However, in some states medical assistants are called upon to expose patients to ionizing radiation, as specifically directed by the overseeing/delegating provider.

The legality of this task is governed by state law. In some states unlicensed professionals such as medical assistants are forbidden from doing any limited scope radiography. Only licensed radiologic technologists are permitted to perform radiography. In other states medical assistants are required to complete a short course and pass a test in order to be delegated limited scope radiography. In other states limited scope radiography under direct/on-site provider supervision is not regulated. Physicians are permitted to delegate limited scope radiography to knowledgeable and competent employees.