A bill that would allow medical assistants to perform vaccinations has received a mixed response, with physicians hoping that the provision will lighten their workload and nurses questioning whether medical assistants are qualified to perform the task.
The legislature has considered the legislation a number of times over the past five years, but the COVID-19 pandemic has given the issue a new relevance, as private practices and physicians say that the demand for COVID-19 vaccinations has left them without adequate staffing to administer the shots.
Supporters of the bill include the Fairfield County Medical Association, the Community Medical Group and the American Association of Nurse Practitioners, all insisting that having medical assistants administer vaccinations would reduce some of the stress on other medical professionals.
State Sen. Heather Somers, R-Groton, said that she’d spoken with a number of private practices, and that all had responded positively to the bill.
“One of the things that they have overwhelmingly said — whether it’s a cardiology practice or a pediatrician — is that having a medical assistant be able to administer the vaccine is critical, it will help them be more efficient and help them be able to see more patients,” Somers said at a meeting of the legislature’s Public Health Committee on Feb. 22.
“When [physicians] do have LPNs or RNs in the office, they want them to practice at the top of their training level, and not spend most of their time giving the injections” said State Rep. William Petit, R-Plainville, who is also a physician and the co-sponsor of the bill.
Petit told CT Examiner that the bill could be particularly helpful for pediatricians, who regularly administer a large number of vaccinations. He said that 48 other states allow medical assistants to take on this role.
Other groups — and particularly nurses — expressed concerns that medical assistants do not have the training necessary to perform vaccinations.
Nurses express concern
State Rep. Peter Tercyak, D-New Britain, argued that the bill was being raised purely for economic reasons — a medical assistant, he said, makes a far lower salary than a Licensed Nurse Practitioner. He said the issue was not a shortage of LPNs, but a lack of places where they could work.
Sherri Dayton, an emergency room nurse at Backus Hospital and the president of the Backus Federation of Nurses, said she also believed that this decision was financial, especially for private practices.
Dayton said that anyone administering a vaccine needed to be trained in how to respond to a potential allergic reaction.
“It’s not like any other medication — there’s a high risk of reactions,” said Dayton. “You have to watch people. You have to monitor people.”
Dayton said individuals performing vaccinations needed to know how to administer epinephrine, how to perform advanced cardiac life support and, ideally, how to administer an IV. She said that while it was possible to educate medical assistants in these things, the flip side was that they would need to be paid more.
State Rep. Berger-Girvalo, D-Ridgfield, told CT Examiner that she’d spoken to eight nurses, none of whom had testified at the hearing for the bill, and all of whom had said they were facing a shortage of LPNs.
“They each used words like ‘relief’ and ‘blessing’ to be able to take some of this off of their workload,” she said in the committee meeting.
Lynn Rapsilber, chair of Connecticut Coalition of Advanced Practice Nurses, said that having medical assistants administer the vaccine could be extremely helpful.
“I think there’s a shortage of all hands on deck for administering vaccines,” said Rapsilber.
Training and liability
Programs that train medical assistants vary widely in rigor and in requirements, and some can be completed in as little as 10 weeks. Donald Basala, president of the American Association of Medical Assistants, said he understood concerns about that variability, but that the bill clearly outlines a minimum requirement of training for medical assistants to administer a vaccine.
Language in the bill requires medical assistants with the ability to vaccinate to be accredited by one of four institutions: the American Association of Medical Assistants, the National 4 Healthcareer Association, the National Center for Competency Testing 5, or the American Medical Technologists. The bill also requires that the medical assistants have attended a two-semester-long accredited post-secondary program.
Basala said these programs cover anatomy, physiology, pharmacology and how to administer injections, including vaccinations. The bill also requires an additional 24 hours of classroom training and eight hours of clinical training in vaccination before a medical assistant would be allowed to administer vaccines in Connecticut.
Craig Olin, president of the Fairfield County Medical Association, said in his testimony that the training provided to physicians assistants “far exceeds” the training given to pharmacist interns and technicians, who are allowed to administer the COVID-19 vaccine.
The bill also requires that a supervising physician be on the premises to monitor the vaccine injection. The physician would be liable for any errors that took place, which, Somers told CT Examiner, would give the physician an incentive to be judicious over which medical assistants they allowed to administer the vaccine. Petit also told CT Examiner that there was no data from other states to show that malpractice rates increased as a result of having medical assistants perform vaccinations.
But Dayton said that the bill’s language is still too vague. She said that there was too much ambiguity in what could constitute a “supervisor.”
In a letter he sent to State Sen. Saud Anwar, D-South Windsor, Basala suggested that the bill be modified to emphasize that a physician must be “onsite and immediately available.”
Rapsilberger agreed that “supervision” needed to be better defined, and she also suggested that there be a way to monitor a medical assistant’s competency.
The State of Connecticut does not license medical assistants, and therefore cannot revoke licenses. However, Basala said that the certification bodies do have the authority to revoke licenses, and that the state could issue a complaint to the body that certifies the medical assistants in order to open a disciplinary procedure.
“I think ninety-nine percent of the physician practices out there want this to go forward, and I think we should wholeheartedly support it,” said Petit.
This story has been corrected to reflect that Lynn Rapsilber is chair of Connecticut Coalition of Advanced Practice Nurses. A previous version of this story misstated her title and affiliation.