Can I Delegate This Task to a Medical Assistant?

Carolyn Buppert, MSN, JD

Disclosures

July 07, 2017

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Question

An advanced practice registered nurse (APRN) working in an urgent care setting has a question about the role of medical assistants.

According to the Texas State Board of Nursing delegation rules, an APRN cannot delegate medication administration or injections to a medical assistant. The supervising physician for the clinic (who has his own private practice and is not physically located at the urgent care center) says that delegation to the medical assistant "is done all the time." I understand that the physician can delegate to a medical assistant in his or her office practice. To delegate these tasks to a medical assistant, this supervising physician wants the APRNs to write the order for the medication or injection and then add "as ordered by supervising physician," with the rationale that it's acceptable because it means that the order for the injection or medication comes from him. He states that this is "how we can get by with it." I disagree. I feel responsible for the orders I write and am uncomfortable with this plan for getting around the state law.

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

The authority of nurses to delegate to an unlicensed individual, and specifically whether an APRN may delegate nursing functions to an unlicensed individual, is an issue of state law and usually is regulated by the board of nursing or, in some states, the board of medicine. In some states, whether delegation can occur depends on the setting, the task to be delegated, or the type of assistant. Every APRN who works with a medical assistant should understand his or her state's requirements before delegating a nursing task. This is the administrator's responsibility; the clinic owner or supervisor should be aware of state law requirements and pass them along to the employees. The clinic's attorney should advise the supervisors on this issue. But if that doesn't happen, it falls on the individual clinician to do the legal research. Usually the law is found in the nurse practice act, but it also may be found in any act authorizing or regulating medical assistant practice. If in doubt, contact the board of nursing for guidance.

The APRN who submitted this question is correct in the interpretation of Texas state law. In Texas, APRNs must follow the rules for RN delegation, and those rules prohibit delegation of medication administration. However, Texas law allows physicians to delegate. Texas law doesn't regulate medical assistants, so the law on general delegation by physicians applies. That law says that a supervising physician may delegate tasks when he or she is satisfied that the delegate is "qualified and properly trained" and the task delegated can be "properly and safely performed." So, the supervising physician might write up a protocol stating that he or she has evaluated the medical assistant's qualifications and training, and delegates to a specified medical assistant the authority to administer specified medications to specified patient groups for specified conditions. If something goes wrong, it is the physician who will be held liable.

It was appropriate to decline to participate in an ill-considered plan to work around the state's law. Here, the physician has not developed and signed a protocol, and is asking the APRN to indicate that there is a delegation plan when there isn't. The APRN should stay out of the delegation issue. That is for the clinic administrator and the physician to figure out.

Here is more information on scope of practice of medical assistants.

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