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In our current health care system, ambulatory care nursing must focus work efforts on delivering safe, effective, and efficient patient care while utilizing cost effective measures within staffing models. This drives ambulatory care to place the right person, with the right skill set in the right position. Adding medical assistants to the staffing mix assists with cost containment but opens many questions as to what the medical assistant can legally perform in the ambulatory care setting. This column will review how to research scope of practice, appropriate delegation, state legislation, rules and regulation that are needed to guide our decisions related to the utilization of medical assistants.
Before determining what tasks the medical assistant can perform, one must first understand what encompasses a scope of practice. The American Academy of Ambulatory Care Nursing (AAACN) defines Scope of Practice as the "procedures, actions and processes permitted for a licensed individual and is limited to that which the law allows for specific education and experience, and specific demonstrated competency" (Paschke, 2013, p. 38). The definition refers to the "licensed individual." Currently medical assistants are not licensed in the United States and there is not a uniform, standard, or national definition of a medical assistant's scope of practice. Medical assistants work under the direct supervision of a licensed physician who has the authority within their state to delegate certain medical tasks and procedures. Maryland's definition of physician to medical assistant delegation is typical of most states, whereby the delegating individual is a "physician possessing an active license to practice medicine in the State who directs an assistant to perform technical acts" (Code of Maryland Regulations, 2013). This leaves each state to determine scope of practice laws along with any educational requirements they deem necessary for the medical assistant. These laws and scopes vary greatly across the country from state to state.
In California, medical assistants are not licensed, certified or registered by the State (Medical Board of California, 2010). However, the physicians' malpractice insurance carriers may require medical assistants to be certified by a private or national organization. The legislature recognizes a core scope of practice for medical assistants and the Medical Board has set forth minimal training requirements for procedures that include: intradermal, intramuscular, and subcutaneous...