What ever happened to the RN or LPN/LVN in the office?

[Reality Check 2]

Disclaimer 

 

Having a cranky day with a very young, very inexperienced MA.

 

NO offense intended to anyone here who is, has been or will be an MA at any point in their lives.

 

Whatever happened to having an RN in the office? Or an LPN/LVN?

 

I have had good MAs and not so good MAs and terrifying MA students and everything inbetween.

 

Currently, I have a youngster who has her CMA but couldn't fight her way out of a paper bag with a flashlight AND a map.

 

Can't spell hemorrhoid much less pronounce or discuss what to do with one. Can't remember that LDL is the BAD cholesterol - even taught her that L can stand for LOUSY - easy to remember. HDL - H stands for HAPPY. Simple, right? Guess not.

 

"is tretinoin an athlete's foot cream? this patient wants a refill for her feet?"............................. deep sigh of exasperation.

 

Boss doc is supportive that she is not going to last but will the next one be any better?

 

Why can't I have an LPN????? - perhaps NOT old enough to be my child and perhaps a bit more worldly knowledge and ability to advise patients legally about their hemorrhoid, constipation, chest pain, headache, etc.

 

And who exactly is supervising these MAs? It's not me. And our office manager is 10000% nonmedical.

 

Just ranting but I am disappointed over time in our flux toward minimally trained, not licensed (just registered) MAs who can only parrot what we tell them (if they can remember). 

 

One good RN in a sizable office or a couple of LPNs would make my freaking day right now......

 

Anyone else experience this or see this cost saving (really???) shift and any reasonable explanation?

 

Deep sigh - back to typing on 3rd grade level instructions and verbage to use with patients.

[DiggySRNA]

It's 100% cost saving. I'm currently a MA (not CMA or RMA) just a regular ol' MA. I was trained on the job and based on my reviews...have picked up quite well and fit in perfectly.

 

My office and the others under the same franchise do not hire LPNs or RNs because they cost more.

 

My supervisor is my office manager (MA) and district manager (LPN), and I work under the medical director's license.

 

Unmotivated + inexperienced = bad combo.

[Reality Check 2]

Dig - your motivation seems to go beyond MA to PA and that does make 100% difference.

 

Then, we get good MAs like you who move on to bigger and better. No shame or blame - just a fact of life.

 

We need a stable nursing pool who wants to be nurses and fill that niche in the team. 

 

A good LPN is worth gold - licensed, smart usually and taught some skills.

 

My current MA went to a local school advertised on TV and passed the CMA test - somehow, baffles me at this point.

 

Your future sounds bright. Hope for more like you!!

[EMEDPA]

agree, it's all about cost.

realistically, the difference between an MA and an lpn is the ability to start IVs and give IV meds. the difference between an lpn and an rn is the ability to hang blood and push a few cardiac meds. how often do you actually need an IV started or blood hung in a primary care office? rarely.

in an urgent care dept I work in occasionally our MAs take xrays, do foleys, give IM injections, do neb tx, run labs, etc

same question about why have 3 md's when you can have 1 doc and 4 PAs for the same price. how often do you need someone who can recite the krebs cycle from memory or talk about the biochemistry of new drug development? rarely...

[DiggySRNA]

Thank you for the kind words RealityCheck2.

[Reality Check 2]

But in an established 35 yr old Family Practice with one doc and 2 PAs - and over 10,000 registered patients ---

 

we NEED intelligence and consistency and perhaps someone with a license who can work patients on the phone and before being seen to make US more efficient.

 

When the MA doesn't sound or act intelligent enough to deal with the patient's needs - it reflects on US and then the patient's confidence in the whole practice goes down. "well that girl didn't know what she was talking about - must be idiots to hire folks like that" - actual patient quote.

 

So, Cost is one thing - adequate knowledge base, licensing and patient care is another. I need patient care and confidence.

[EMEDPA]

don't hire new grads unless you trained them yourself....

[Reality Check 2]

We don't have the capacity to train and mine has been out a year - still baffled.

 

So, we are a tiny private practice without the time or capacity to train at this point. 

 

I am going to push for an LPN on the next go round. The local hospitals fired them all a few years ago and replaced them with RNs - go figure

[mackjacks]

Maybe you can get someone pre-PA to work as a MA for a couple years while they go to school part time or gain clinical experience before applying to PA school? A few friends from my PA program did that, and I interviewed with a cardiology group who has a few "lifetime MAs", older with a lot of experience, and a few younger ones who are pre-med or pre-something. They ask the younger ones to help them recruit a new MA from their pre-professional school cohort to pass the job along when they're ready to leave. If you're rural this might not be doable. 

[DogLovingPA]

We have some MA's in urgent care I'd trust over some of the LPN's and then we have some doozies. I had one MA a few months ago that couldn't find the Tylenol I ordered because the box said acetaminophen. Seriously. I feel your pain.

[BruceBanner]

We use MAs, LPNs, and RNs. The LPNs do most of our rooming/setups/injections, etc, and MAs are a close second. RNs screen pt calls and emails and treat routine stuff like UTIs and sore throats via protocol. Saves us a TON of time.

[Reality Check 2]

I would give up a kidney right now to get ONE decent LPN

 

Patients are noticing and don't feel confident with the MA.

 

Changes will be made -- soon.

[DizzyJ]

Feel your pain......working in an MA only practice right now.  I like them just fine, but would love to have someone who had some understanding of medicine and the conditions I am treating.  

[Mainer]

I work with an RN with 25 + years of experience who is worse than the MA you describe. 

 

"Pick your soldiers", not the title or degree. 

[sk732]

I worked solo in my last family med clinic - my SP was 35km away, the RN's/LPN's in the attached nursing home couldn't start IV's (a long term care thing in alot of the regional health authorities here) and my receptionist wasn't MOA qualified.  I had to do all my own vitals, weights, point of care labs, blood draws, emergency IV starts in both the clinic and the care home (even the public health nurse had forgotten how to sart IV's).  I did a lot of my own vaccinations the public health nurse didn't do (I dabbled in travel medicine - Army training is very helpful for that).  I had no dictation software or capability, so typed all my own referrals.  Strangely enough, still saw 25-35 patients a day, including house calls and still did daily rounds in the PCH.  The one thing I did appreciate was that the folks next door were damn good at wound care, and they'd come and deal with my complex dressings and such for me.

 

A nurse of some sort on staff for just me would have been a God Send.

 

SK

[Michigander]

At my last job, we had MAs (some certified, some not) who "triaged" phone calls and roomed patients. The most nerve wracking things would happen: NSTEMI, septic patients coming to the office, they sent me messages about accuchecks of 400-500 through the EMR that I wouldn't see for hours.

 

Now I'm in a job where LPNs triage phone calls and the difference in problem solving and information collecting is amazing. When they need to page me, they have all the information I need. They help with contacting patients and other providers. I feel much safer as a provider with that kind of backup. 

 

In the SNFs, which are usually staffed by LPNs, they vary in abilities. Some of them can't remember that they need the chart open when they page us and some give a great patient presentation with suggestions of what they think the pt needs.

 

A lot does depend on the individual and the work culture. At my last job, pretty much anything was OK and people could skate by.  At this job, there is an expectation of providing great care and working together. Maybe an MA here would do well if they were trained and an LPN would be unmotivated and unhelpful. 

[SwarleyWoo]

Ugh. I feel for you. One of the "MAs" is "someone's mom" (let's call her MA1) and the other "MA" is a CNA with nursing home experience (MA2). I work in a primary care clinic. The other day I caught the MA2 ok'ing a new prescription over the phone. The pharmacist had called to ask if it was ok to give the patient lidocaine ointment for his pain and she said yes, then asked me. I flipped. I told her she is not allowed to give any medical information over the phone, whether it is to the pharmacy or to a patient. In the past, she has told a patient to drink lemon juice for their acid reflux (apparently an old Mexican remedy). Or tells them their BP is high when it's not. MA1 has less formal medical experience but does better with the patients. MA2 just lacks motivation and knowledge. I think she has great potential, but she just always acts like she doesn't care. Sometimes I have patients waiting to be roomed and I can't find her and she will be out back smoking. Both of them can't spell to save their lives. I frequently have to ask the patient what meds they are taking because they spell them so poorly. 

 

There's a big difference between a "lifetime MA/CNA" and a "MA/CNA working towards a better job". More or less, complacency versus ambition and willingness to change. 

 

And yep, I get messages through the EMR that I sometimes don't see for a day if I have a busy day. Sometimes serious things like suicidal ideation or severe hypokalemia. Bleh. You can mark them as urgent, but if I don't check the messages, they won't be seen.

[Reality Check 2]

Update

 

Office Manager FINALLY listening to me about MA.

 

She has also called in 3 times during 90 day probation period......................

 

She is going to be exited soon.

 

However, I am struggling to change the interview process and who picks whom. Our "lead" MA isn't even certified and would never pick anyone who would threaten her or be smarter. 

 

So, banging head lightly for now and trying to intervene in interview process to help choose more wisely. Also asked for LPNs to be included in pool.

 

Office Mgr countered that we can't afford LPN. Local hospital system fired a ton of them last year and switched to all RN. I bet they are out there looking for work and might be a tad more mature and experienced.

 

Small sigh - hoping for improvement.