Open Forum

Great comments Jennifer. 

You are correct in highlighting that state boards of nursing do not have enforcement or guidance over medical assisting staff. The medical assistant role was developed and defined under states boards of medicine as a way to have help in the office without having to pay a nurses salary.

 APRNs (such as myself) have oversight over cma staff as a delegated authority from the physician. I personally, treat the cma as an unlicensed personnel (according to my state board of nursing). I do not allow them to do many of things that physicians want and allow them to do, such as renewing prescription medications in the EMR and drawing up medications for certain procedures.

Scope of practice remains a struggle because there seems to be minmal direct  communication at the executive level between physician and nusring leadership. When health systems take over physician practices, the nursing department typically absorbs the cma staff; Not sure if this is a voluntary decison or just an accepted norm. No medical director would want to actually be responsible and accountable for the teaching, training and evaluating competencies for the cma staff (as indicated in most state board of medicine regulations).  

We would all like to see more ambulatory care training as part of core nuring training. You will be happy to know that AAACN is diligently working towards updating our position statement, collbaorating with nursing faculty, and beginning research aimed to provide the evidence to 'potentially' develop and enforce policy changes that benefit entry into ambulatory care and further ambulatory RN professional development.  Unfortunately, for now, the current state of nursing education remains focused on entry level  preparation into an acute care health setting; a setting which is becoming the smaller arena for healthcare delivery as ambulatory care continues to expand. 

Scope of practice is such a struggle outpatient, also with the variability with the scope of unlicensed professionals working under physicians and APRNs don’t allow for boards to enforce a great deal because it fall on the responsibility of the supervisor practitioner. 

another comment is I would love to see more ambulatory practice training in nursing core program. Med surg is important for a base but many new grad nurses take an ambulatory role post graduation and often struggle and return to inpatient