The scope of practice for the certified medical assistant

Introduction

There is a long history of debate as to whether occupations, such as nursing, count as professions (Currie et.al, Pp. 539-564). Certainly those who constitute Advanced Nurse Practitioners in the US refer to themselves as a profession. Following Hughes (1984), occupations are taken to describe a division of labor within society in which certain classes of individuals exhibit commonality in role and functions that arise from a claim to carry out activities that differ from those that other people do, and to do so in exchange for money. Those in occupations have a sense of solidarity and identity (however loosely defined) and a claim to profess 'proper conduct with respect to matters concerning their work' (Hughes, Pp. 287) and modes of thinking relating to that work. ANPs are a rarity in primary care and their position unclear. In primary care doctors employ nurses to take bloods or run profitable clinics. The business of diagnosing is seen as a purvey of doctors. This paper discusses the scope of practice for the certified medical assistant.

Discussion and Analysis

The occupational success of the medical profession is a result of its ability to claim a largely exclusive right to practice based on: controlling access to an esoteric body of knowledge; for which state authorities provided a license to practice; and societal mandate affords trust with respect to power over regulation, definition, pronouncement and deviation. This has been reinforced by professional discourses that provide 'durable and symbolically powerful means for socializing practitioners' that are 'remarkably stable' (Atkinson, Pp. x) and which are themselves maintained through medical training, apprenticeship, peer reinforcement and practice, pursuant to a sense of occupational solidarity (Dingwall, Pp. 31-56). Moreover, medicine asserts a right to challenge the legitimacy of other occupations. There is a strong suggestion then, that the practice and professionalization of medicine has been a complex and problematic process emerging not simply through societal need but intimately intertwined with doctors' own interests and wider political negotiations. The concern here is with the relations between medicine and nursing. Relatively disadvantaged, nurses continue to be positioned as 'one of the ''handmaidens'' to clinicians' (Currie, et.al, Pp. 543).

Doctors' work is privileged as special, thanks to its association with scientific discourses, abstract knowledge and tightly defined and rationed interventions. Nursing work by contrast is difficult to bound, a position not assisted by a heavy reliance on social scientific knowledge. Nursing work is the messy and dirty work of emotions, bodies, fluids, relations, attending, nurturing and being there.

Historically, advanced nursing practice has emerged as a response to supply-side concerns over access to services and shortages of doctors (Cox, Pp. 169-171) coupled with demand pressures for greater autonomy of practice and clinical career progression in nursing (Daly & Carnwell, Pp. 158-167). Emerging first in the USA in the 1960s, then in UK in the 1980s, and more recently in countries such as Ireland, Australia and New Zealand (Furlong & Smith, Pp. 1059-1066), the tag 'advanced' refers to broad range of ...