Open Forum

Hi everyone, 

We are moving to shut down our current COVID-19 testing area and integrating the testing back onto the floors. As such, we are working to expand the level of people deemed competent on the sample collection. All MAs have now been deemed competent. Occupational health has been asked to perform sample collection for employees. The current plan is for our occupational health nurses to be deemed competent by Medical Assistants. This is something that feels a little off, to me. It feels a little concerning that a supervisory role is able to sign off a supervisor and a non-licensed individual is able to sign off a licensed individual. 

I have reached out to the BON in Massachusetts as well as reviewed the scope of practice. Unfortunately, the scope of practice is not clear. As you all are likely aware, it will take a bit for the BON to reply. Given the time crunch, I wanted to see what everyone else's thoughts were. 

Best, 
Chris

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Christopher Mangels ACRN, MSN, OCN, RN
Nursing Professional Development Manager and Infection Preventionist
Fenway Health
Hyde Park MA
(443)690-2805
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Christopher,

I just responded to a similar post about Medical Assistants and competency validation. You've completed the first step, which was reviewing what your state board of nursing has said. Is there any sort of governing body for Medical Assistants in your state, or does the Medical Board have any sort of position statement on it? 

In my state (North Carolina), a RN is the role that can validate competency, although the position statement does note that is for nursing activities. This could be interpreted in different ways in this situation. It could mean that the RN has to be the person performing the competency validation for all of it (which could also include a NP, PA, or MD). 

I did find this on the Mass BON page: https://www.mass.gov/lists/advisory-rulings-for-the-board-of-registration-in-nursing Click on the advisory for delegation to the UAP. Is someone within the chain trying to delegate the competency validation to the UAP? If so, this shouldn't happen because the situations will vary. While some certainly would have the knowledge, we cannot consistently guarantee that the UAP performing competency validation is able to assess and determine the needs of the learner and modify to meet the learner's individual need. In particular, this second to last bullet on that document sticks out to me, stating "•The nurse must determine the appropriate degree of supervision required, and provide it based on the stability of the patient's condition, the training and capabilities of the UAP, the nature of the delegated task and the proximity and availability of the nurse while the UAP is carrying out the activity." 

Is it a possibility to send one or two Occ Heath nurses to your testing site to train, or to the ED to train (we are having an early flu season and the specimen collection should be similar enough to get competency validation)? You can then use the "train the trainer" model and allow them to return to their unit to competency validate the other nurses and OH staff. We borrowed a NG intubation model from our academic hospital, which was a hard model that was cut in half so the learner could visualize the swab insertion and depth (we still perform NP swabs).

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Andrea Kelly MSN, RN, NPD-BC
Director, Population Health
ECU Health Physicians (formerly Vidant Medical Group)
Greenville NC
(252)847-3930
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