Melinda Rhynes, MEd, CMA (AAMA), president of the Arkansas Society of Medical Assistants and the program director at Arkansas Tech University in Russellville, asked me to assist the Arkansas Society in drafting a proposed change in the rules of the Arkansas State Board of Nursing (ASBN) that would permit advanced practice registered nurses (APRNs)—especially nurse practitioners—to delegate to educated and credentialed medical assistants certain types of medication administration. The rationale for the proposed rule change is as follows:

The health needs in Arkansas have increased in recent years. There is a shortage of health care professionals across the state, which could jeopardize the quality of care that Arkansans receive as a result of this decline. The AR State Board of Nursing recognized this trend years ago and initiated prescriptive authority to APRNs. APRNs are wanting to delegate to CMAs (AAMA) medication orders in the ambulatory health care setting. We believe this would increase the quality of care for Arkansans.1

Based on language that Ms. Rhynes and I drafted, the Arkansas State Board of Nursing Practice Committee offered to the ASBN the following rule change for consideration at its May 11, 2017, meeting1:

Chapter Four—Advanced Practice Registered Nurse

Section VI—Standards of Nursing Practice

. . .

B. Standards for All Categories of Advanced Practice Registered Nursing

. . .

8. The advanced practice registered nurse may delegate medication administration to a medical assistant who has graduated from a medical assisting program accredited by either the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES) and holds a current certification or registration that is accredited by the National Commission for Certifying Agencies (NCCA). The routes in which medications may be administered include: oral, topical, drops for eye, ear, or nose, vaginal, rectal, transdermal, inhalation, subcutaneous, and intramuscular. The advanced practice registered nurse shall be on the premises and immediately available whenever such individual is administering medications. Such medications shall not be a controlled substance.

The following explanation (as abbreviated and paraphrased) was submitted by the Nursing Practice Committee to the Board of Nursing1:

Medical assistants (MA) are multiskilled members of the health care team who perform administrative and clinical procedures under the supervision of licensed health care providers. . . . MAs work primarily in outpatient delivery settings such as medical offices and clinics under direct supervision of the physician or the APRN. Direct supervision is defined in most state laws as the physician or APRN being on the premises and reasonably available when the medical assistant is carrying out clinic duties except the most basic and non-patient-jeopardizing ones, such as taking vital signs, and collecting certain specimens. Because physician assistants (PAs) work under general physician supervision, the laws of most states empower physicians to assign MAs to work under the direction and supervision of their PAs.

Medical assistants may elect to obtain certification. Certification is voluntary and an individual need not be certified in order to practice as an MA. However, under this requested exception to delegation, APRNs would only be allowed to delegate to a medical assistant who holds a current certification that is accredited by the National Commission for Certifying Agencies. . . .

These are the only two accrediting bodies that are recognized by the United States Department of Education or the Council for Higher Education Accreditation as programmatic accreditors of postsecondary medical assisting programs. . . .

  1. The Commission on Accreditation of Allied Health Education Programs (CAAHEP). CAAHEP accredits medical assisting programs in both public and private postsecondary institutions in the United States that prepare individuals for entry into the medical assisting profession;
  2. [The] Accrediting Bureau of Health Education Schools (ABHES). ABHES accredits postsecondary institutions and programs preparing individuals for entry into the medical assisting profession.

The outcome of this proposed rule change of the Arkansas State Board of Nursing will be announced on my blog, Legal Eye: On Medical Assisting, which can be found on the AAMA website. 

Questions? Contact Donald A. Balasa, JD, MBA, at dbalasa@aama-ntl.org or 800/228-2262.