NursingLink

I'm a LVN, and an instructor for a Nationally Registered Certified Medical Assistant program. It is getting kind of old hearing RN's and others

Slamming CMA's and LVN's. I have been one for 25 years, and done everything from being an Administrator of an Assisted Living Home, (and winning the Administrator of the year award over every other administrator in the United States), to being a Critical Care nurse, worked in ICU

and CCU for well over a decade, and also was a critical Care instructor, as well as an ADON, TILE/MDS nurse, and also a director of education in long term care. I took every kind of patient from fresh open hears, to trauma, and everything in between. Many times I had to take

an RN's patient, because they didn't know what to do as far as cardiac outputs and the like. CMA's are the wave of the future. Not only can they

take care of patients, they can do many things licensed people cannot, like coding and billing, and also do a variety of lab tests like hematocrits, sed rates, and many others. They are the true meaning of "cross-trainied.

People should respect them as although they come into the course with no medical background, they leave with computer skills, phlebotomy skills, and can do just about everything I can do, they start IV's and give injections and all the rest, and learn it in 9 months. Give us a break, as one day we might be taking care of you!

The issue I am having with CMA's is the statements many of them are making about how they are "doing the same job" nurses do, and are the same as nurse.

This is patently untrue, and these people need to understand the limits to their scope of practice.

CMA's (I assume you are talking about medical assistants not med aides) cannot perform a complete physical assessment.  Nurses can.

CMA's cannot identify patient problems (Nursing Diagnosis), nurses can.

CMA's cannot make a plan of care for a patient; nurses can.

CMA's cannot evaluate the effectiveness of a plan of care.  Nurses can.

CMA's cannot describe pathophysiology of disease.  Nurses can.

Refuge, it's great that you learned how to do all those things as an LVN.  I was an LPN myself for 12 years and worked cardiac stepdown and the ER.  I was ambitious and worked hard to be the best LPN I could be.  And I fell into the trap of thinking that because I taught myself to read telemetry, because I was good at starting IV's, was ACLS and PALS certified, and knew my meds, that I was on the same level as an RN. 

I had to go back to nursing school to get my ADN to find out how wrong I was.

Just FYI:  many of the tasks you describe are done by nurses in some environments:  I routinely ran CK and Troponin testing in the ER.  I used to have to use a specialized tool to measure specific gravity before they were phased out by urine strips.  I'm not impressed that a CMA can run a hematocrit because she hasn't the faintest idea what the results mean.

CMA's perform tasks that any monkey can be trained to do.  That does not make them the same as nurses and I refuse to share my hard earned title with them.

Do your students a favor, and impress upon them the limits of their scope.  It's an issue of patient safety, not pride.  It scares the hell out of me when I hear these CMA's on this site bragging about doing patient teaching when they have no idea what they are doing.

I just dont get why we have to have ANOTHER thread devoted to this topic. Go comment on one of the other ones! I know, I know I didnt have to read it, but really people, how much more can we beat a dead horse? The same people comment the same things.....over and over......

Oh it was rude and crude.....but like I said, the same people say the same things.....over and over.....

"Trained monkeys" very compassionate and caring. Glad your not my nurse!

I stand by my statements, Sevo, because so many people can't seem to get scope of practice through their heads.

Two people who can perform the same task do not equal holders of the same credentials.  I can start an external jugular IV, and it's in my scope at many of the ERs I've worked, not in my scope in others.  Having performed this skill does not put me on the same level as a physician when I'm working in a facility where it is not in my scope, nor did it where it was in my scope.

And yes, I've heard physicians use that same statement.  I didn't find it offensive because it is true.

When unlicensed assitive personnel (med assistants, CNAs, and med aides) stop equating themselves as nurses then I will not have to correct their misperceptions.

When a licensed nurse encourages their misperceptions, I'm going to speak out.

Look back through some of my other posts.  I've always been supportive of CNAs, and despise nurses who take advantage of them or treat them disrespectfully.  But I do draw the line at scope of practice.

Theala

I see..Now it is clear to me... anyone with more education than another person can say.. " A monkey could be trained to do that job". I'm sorry I am new to this foum and did not understand the rules....

Since I have more education than YOU do.. by virtue of numbers of degrees and the much longer and more intensive training inherent in CRNA school... and the fact I could do YOUR job......A monkey could do your job.... nice.. I kind of like that... it's empowering.

Thanks for clearing it up....

With all due respect, Sevo, I have worked with 91C and 91B and many CMA over the years. The 91C/B are very well trained. They have, for the most part, the professionalism imparted by military protocols and training. I worked SICU and ER at Fitzsimons AMC and William Beaumont AMC and have worked with many of them.

CMA trained by Computer Career Center and the like are not the equal of any 91C/B. I never met a 91C/B that thought they were a nurse when a 91C can actually write the LPN/LVN boards (or at least used to be able to but I am not certain about that now). I lay the blame for the problems that exist with many CMA with their instruction and basically the health care facilities that see them as a cheap substitute for a nurse when they are no substitute at all.

That said, I believe every member of the team contributes to the success and to the failures of said team. As I said in another post I include housekeeping and laundry in the team. I value them more than administration any day.

       Theala, I thinking that you don't get it.  The comments do not center on your statement in general terms, but your use of the Monkey statement which is just rude and belittling.  Your ego seems larger than the mirror you use to judge your own projection to others.  So once again let us see you train a monkey to be a CMA.  Don't you see how this undermines the better more educated parts of your statement.  It reminds us all of 'let them eat cake.'  Treat people fair even in your writing or you may find your self eating the shit sandwich your trying to feed us.  Mud slingers usually get mud thrown back at themselves, so clean up unless you enjoy the battles you start.

High hopes & God speed - Tim, R.N.

Okay, I kinda started this and would like to finish this. I'm going to be respectful of all, yet voice my "personal feelings".

I was an ICU nurse, actually a GVN, (that's a LVN waiting to take boards). I also was one of the few male nurses in critical care, about 25 years ago. I think I may have been the only GVN ever hired at the in crtical care, (ICU/CCU/ER),  I worked for for about 16 or more years.

Do you think for a minute, that I did not endure even more scrutiny than a CMA? I was told I had no place in critical care. Yet had spent my time absorbing everything from anything concerning nursing and my vocation. It took a while for me to be accepted, but I finally was, and had to "earn" it.  I had to go to extremes to be accepted, and it did not come easy, not so much as a nurse, but through my patient care. So what my point was, is we all know "nurses eat their young'. That's a fact Jack, as Bill Murray used to say.~grin~.

It just seems to me this is a little more of the same. Since most people don't even know what their (CMA's) scope of practice really is, please let me enlighten you.

They can do ANYTHING, repeat ANYTHING, that the doctor they work for is comfortable with. So if you think this is out of their scope of practice, who's butt is really on the line? The Doctors,that's who! As they work under the doctors license. So whomever posted the list of "who can do what?" let me enlighten you, with all due respect. NRCMA's which my students are (Nationally Registered Certified Medical Assistants), can do everything I can and more. You see the MD can train them to do everything from assisting in surgery, to whatever applies to their specific practice. Normally they would have to have a Nurse Practioner, or the equivalent. So we all know money is tight. So if you were a MD, and could have 1 RN, or 2 NRCMA's that you trusted and felt comfortable with? What would you do in this time of recession, cutbacks on reimbursment, and unpaid bills? I remember one time when a patient had a bad abdominal infection and surgery. The surgeon wanted it to heal by secondary intention. So we were told to stick our hands through the wound, and actually touched the friable fascia, and pack it with betadine soaked 4x4's. My director called the boards, as we were doing an invasive prcedure, and she was advised, it was beyond "our scope of practice", and would be liable for any complications for us performing the procedure. (that was RN's and LVN's). SO the MD had to further close the wound or do the packing himself. SO do you get the picture? Each MD has a specialty, and only needs to train the NRCMA in his or hers. As nurses we have to know everything. So compare the truth.  Easier said then done is my judgement.

Also what as we as nurses been always taught? Continuity of Care. If you were the patient, how would you feel if the person you booked your appointment with, coded your diagnosis, and took care of your insurance issues for you, was also the same person you saw every time you went to see your MD, took your V/S and took your history, drew your blood, and performed simple lab tests, and vaccinated your kiddos, and gave you patient education on the procedure you had to go to the hospital for, and also was there during, and after the procedure, and the one you saw for followup?

So my point is this, YES the whole CMA, RMA thing is affecting nursing. Some are caring and nurturing to these people, some are angry, afraid of being replaced, and the effect on heathcare, but they DO have a place. Most all work in Doctors offices, so they are not a threat to licensed nurses. So give them and me the "GVN" a break, we all just love medicine, caring for people, and feel this is a calling in our lives. So forget the letters behind our names, and see each other for what we are.

PEOPLE WHOM HAVE CHOSEN TO SPEND THEIR CAREER, AND LIFE, CARING FOR PEOPLE!

We are all on the same team, from the CNA, (nurses aide) to the RN BSN MSN, and all in between. We can do more for humanity by being on the same team and encouragin each other, rather than chastizing each other. DO you know what the 2 most respected proffesions are? Nursing, and teaching. I'm Blessed to be able to do both at the same time. Be Blessed for what YOU do!

I once wrote a letter to RN magazine, telling my story after 3 years of nursing. I was tired of wearing my wedding ring at work, and carrying my baby pictures with me so my patients didn't think I was gay. (2 of my ex-wives were nurses and worked with me on the same unit!). Tired of noting having any recipe tips, makeup tips to share during the slow times. Tired of not having anyone to tell about the big fish I caught. Tired of my patients staring at me in disbelief when I told them I was there nurse, as they thought I had to be either the orderly, or the Doctor. Tired of patients asking for a "nurse, nurse) since I don't have breasts.

Finished it by what my students would say in agreement with Arethra Franklin.... "We all just want a little respect"

Humbly, and with respect to all.....

Bob

humbly,

Refuge33 ( Jesus died at 33, and is my refuge!)

Okay Theala, I see your point. Yet you must remember a few bad apples does not make the bushel. I work for a chain of privately owned career colleges, started in 1957. I have state of the art equipment in my clinical lab. More than I ever saw in nursing school, and even when I was a instructor in the hospital. The quality of the students is directly related to the quality and concern for giving the best patient care possible from the instructor. I had a student that was only 2 weeks from graduatin from another school in a nationally known chain of career colleges. She thought she could just have me test her skills, and CLEP out of clinicals. After sitting in on one of my classes, and seeing the level of education and training I do, she decided to retake the entire course with me.

My students can recognize heart rhythm strips, pulse paradox'us, hippus, and in a pinch, can even deliver a baby if need be. So again it's the school and the teacher that makes the student. I don't argue there are bums out there who just want a paycheck, or steady job. They do not make it out of my classes. So again there also are some crappy nurses out there, so I don't judge the good caring ones in the same category as the crappy ones. You should not either. If they are bragging about their scope of practice, I would agree that is unacceptable behavior, as I teach mine to respect licensed staff, to see them as mentors, and role models. So again I am fairly new here, and don't come often, but enjoy this site, and feel us licensed persons should set an example for the rest. Re-Reading the whole post, IF I looked at it as a 3rd, party, I would think... well you re-read all of this and see if are acting in a manner to acheive the respect from others we deserve. I was going to show this to my students, many of whom are using this as a stepping stone to go on the nursing school, but it kinda looks like we are all just "drama queens" so maybe we should think before we type, and the effect it will have on others considering nursing as a career, as we damn sure need the help!

In closing no respect to anyone, and as Rodney would say..."can't we just all get along?"