NEW YORK NURSE: November/December 2011
Q.: We have several medical assistants who work alongside our provider in a private office setting. Our provider has informed the nursing staff that the medical assistants will be administering immunizations. Is this acceptable practice?
A.: No. In New York state, medical assistants and other unlicensed personal assistants (UAPs) are not allowed to administer medications, including immunizations or other injections, in the majority of settings.
The State Education Department (SED) State Board for Nursing has determined that medication administration is a "professional responsibility." Professional responsibilities fall within the protected scope of nursing practice and thus cannot be assigned to unlicensed personnel, except in a few well-delineated areas.
The most notable exception is due to a 1938 exemption in the Nurse Practice Act, whereby unlicensed personnel in facilities certified by the Office of Mental Health and/or the Office of Persons with Developmental Disabilities, who work under the supervision of appropriately licensed personnel, may administer medications. This may occur only in adequately supervised facilities that have been certified by these state agencies.
In certain settings, unlicensed persons are allowed to assist patients with self administration of medications. These settings include home care, adult homes and schools. It should be noted that the line between administration of medications and assistance with self administration of medications can be hard to determine. Remember that "assistance" merely means "help"; the helping hands to get the top off the bottle, the eyes to help read the label, etc., and that assistance with self administration of medication is applicable only when a "self directing patient" is involved. Self directing patients, according to the SED, are those who are capable and competent to understand a procedure, can correctly carry it out each time it is required, have the ability to make choices about the activity, understand the impact of these choices, and assume responsibility for the results of their choices. A self directing person may also be one who knows the correct procedure or method of administration but is unable to physically self administer the medication or carry out the procedure. If the patient is not self directing, UAPs have no role relative to medications.
In April 2010 and August 2011, the New York State Office of the Professions promulgated guidance that can be found at http://www.op.nysed.gov/prof/nurse/nurse-rnlpnissues.htm regarding the appropriate utilization of medical assistants in clinical and private medical offices. The guidance stresses the importance of licensed personnel knowing what functions medical assistants and other unlicensed persons may or may not perform based on the law.
If you have medical assistants or unlicensed persons working in your setting, it is important that you understand their limitations and ensure that they are being appropriately utilized. Section 6530 (11) of state education law states that “permitting, aiding or abetting an unlicensed person to perform activities requiring a license” constitutes unprofessional conduct.”
If you have questions regarding this information, you can contact the State Board of Medicine at firstname.lastname@example.org; the State Board for Nursing at email@example.com or NYSNA’s Education, Practice & Research Program at 518.782.9400 ext. 282 and ask to speak to an Associate Director.
This is a sample of the questions NYSNA’s experts answer each day. The advice given is specific for the situation described and may not be applicable generally. If you have questions about your own work setting, it is recommended that you contact your NYSNA nursing representative or the Education, Practice, and Research Program, 11 Cornell Road, Latham, New York 12110-1499 or call 800.724.NYRN, ext. 282.