Critical Advice for NPs Who Delegate to Medical Assistants

Thanks to the predicted surge in the number of medical offices and outpatient care facilities, technological advancements and the growing number of elderly Americans in need of medical treatment, the medical assistant profession is growing much faster than the average for all occupations according to the United States Bureau of Labor Statistics. For nurse practitioners, properly utilizing medical assistants in your clinical setting can certainly make your day run much more efficiently. While these healthcare workers are quite versatile, misunderstanding their role and what can be delegated to them may cause you to violate your state’s rules and regulations.

Here’s what nurse practitioners need to know in order to ensure you’re effectively and efficiently utilizing the medical assistants in your practice without breaking any rules.

The role of a medical assistant

A medical assistant’s role is to work alongside physicians, primarily in outpatient or ambulatory care facilities such as medical offices and clinics. They are cross-trained to perform both administrative and clinical duties. Although it varies from office to office depending on location, size, specialty and state law, a medical assistant’s administrative responsibilities can range from answering phones, greeting patients, updating and completing patient medical records, coding and filling out insurance forms, scheduling appointments, arranging for hospital admissions and laboratory services and handling correspondence, billing and bookkeeping.

On the clinical side, a medical assistant’s responsibilities may include taking medical histories, explaining treatment procedures to patients, preparing patients for and assisting providers with exams, collecting and preparing laboratory specimens, performing basic laboratory tests, instructing patients about medication, transmitting prescriptions refills as directed by the provider, drawing blood, taking ECGs and removing sutures and changing dressings.

The scope of practice

While there is not currently a national definition of a medical assistant’s scope of practice, some individual states, such as California, do have a scope of practice for the profession; others have regulations and statutes on how providers and facilities may utilize their medical assistants. In states wherein there is not any specific regulatory guidance, a medical assistant’s scope of practice is generally based on their education, clinical competency and the comfort level of the providers who are delegating.  

Generally, medical assistants can perform basic clinical procedures under the direct supervision of a licensed medical practitioner. Tasks that are considered practicing medicine, or which state law permits only certain health professionals to perform, cannot be delegated to unlicensed professionals such as medical assistants as though they can become certified, there are no state licensing authorities for the profession. Specific regulations vary by state but this means that under no circumstances can medical assistants perform tasks that the state constitutes as practicing medicine or performing a medical act, even if a physician instructs a medical assistant to do so. As an example, a medical assistant can take vital signs and administer medications to patients but they cannot perform a physical exam on a patient nor can they diagnose or make treatment decisions for patients.

Who is authorized to delegate tasks to the medical assistant

Depending on which state you practice in, there may be regulations as to who can delegate tasks to medical assistants. In some states such as Texas, supervising physicians can delegate tasks to medical assistants through licensed professionals such as physician assistants, nurse practitioners or registered nurses. However some states will only allow physicians to delegate tasks. So before you delegate a task to a medical assistant in your practice, make sure that you are legally authorized to do so.

If you live in a state that allows NPs, PAs or RNs to delegate tasks as an intermediary to a physician, it’s best to have the supervising physician or an administrator authorize in writing which tasks can be delegated based on the medical assistant’s competency and training, and which healthcare providers can delegate tasks.

Who is liable if a medical assistant makes a mistake?

In most states, physicians and employers or supervisors are responsible for monitoring the medical assistant and making sure that he or she is acting within their scope of practice and the standard of care. If a medical assistant acts negligently or incompetently, it’s unlikely that you as an NP working at the practice would be held liable for the actions of the medical assistant, unless you have supervisory responsibilities.

When used safely and effectively in your practice, medical assistants can be a unique asset to your team. But because they are not required to be formally licensed or registered by most states, it’s important to understand your state’s definition of their scope of practice and whether you can legally delegate tasks to them. Most scope of practice laws for medical assistants as well as information on who has delegation authority can be found through the American Association of Medical Assistants.