Donald A. Balasa, JD, MBA
AAMA CEO and Legal Counsel
public affairs
T
he Florida Medical Practice Act
defines a medical assistant as “a pro-
fessional multiskilled person dedi-
cated to assisting in all aspects of medical
practice under the direct supervision and
responsibility of a physician.”
1
Because of
this definition, some medical practice con-
sultants have taken the position that medical
assistants are only permitted to work under
physicians. This argument is flawed, how-
ever, because of the language in the regula-
tions of the Florida Board of Nursing. The
purpose of this article is to demonstrate
that Florida law permits medical assistants
to work under advanced registered nurse
practitioners as well as physicians.
Nursing Law Definitions
The Florida Nurse Practice Act contains the
following definitions:
(3) “Advanced practice registered nurse”
means any person licensed in this state to
practice professional nursing and who is
licensed in an advanced nursing practice,
including certified nurse midwives, certi-
fied nurse practitioners, certified registered
nurse anesthetists, clinical nurse specialists,
and psychiatric nurses.
…
(21) “Registered nurse” means any person
licensed in this state … to practice profes-
sional nursing.
2
The regulations of the Florida Board of
Nursing define unlicensed assistive personnel
(UAP) as follows:
(1) “Unlicensed assistive personnel” (UAP)
are persons who do not hold licensure from
the Division of Health Quality Assurance of
the Department of Health but who have been
assigned to function in an assistive role to
registered nurses or licensed practical nurses in
the provision of patient care services through
regular assignments or delegated tasks or
activities and under the supervision of a nurse.
3
Because medical assistants do not hold licen-
sure from the Division of Health Quality
Assurance of the Department of Health,
3
my
legal opinion is that medical assistants are
classified as UAP under the Florida Board
of Nursing regulations and therefore may
“function in an assistive role to registered
nurses or licensed practical nurses in the pro-
vision of patient care services through regular
assignments or delegated tasks or activities and
under the supervision of a nurse.”
3
Operative Legal Principle
A category of health professionals defined in
one statute may fall within a different defini-
tion in another statute. Thus, the fact that
medical assistants are defined in the Florida
Medical Practice Act does not preclude
them from being classified as UAP in the
regulations of the Florida Board of Nursing.
UAP Scope of Service under the
Regulations of the Florida Board of
Nursing
Regulations of the Florida Board of Nursing
set forth principles for determining tasks that
are and are not delegable to UAP:
[64B9-14.001—Definitions]
(6) “Delegation” is the transference to a
competent individual the authority to
perform a selected task or activity in a
selected situation by a nurse qualified by
licensure and experience to perform the
task or activity.
(7) “Delegator” is the registered nurse or
licensed practical nurse delegating authority
to the UAP.
(8) “Delegate” is the UAP receiving the
authority from the delegator.
3
…
[64B9-14.002—Delegation of Tasks or
Activities]
In the delegation process, the delegator must
use nursing judgment to consider the suit-
ability of the task or activity to be delegated.
6 MayJun 2022 | CMA Today
Delegation to Medical Assistants
under Florida Law
©2022 American Association of Medical Assistants
CMA Today | MayJun 2022 7
(1) Factors to weigh in selecting the task or
activity include:
(a) Potential for patient harm.
(b) Complexity of the task.
(c) Predictability or unpredictability
of outcome including the reasonable
potential for a rapid change in the
medical status of the patient.
(d) Level of interaction required or
communication available with the
patient.
(e) Resources both in equipment and
personnel available in the patient setting.
(2) Factors to weigh in selecting and delegat-
ing to a specific delegate include:
(a) Normal assignments of the UAP.
(b) Validation or verification of the
education and training of the delegate.
(3) The delegation process shall include
communication to the UAP which identi-
fies the task or activity, the expected or
desired outcome, the limits of author-
ity, the time frame for the delegation,
the nature of the supervision required,
verification of delegate’s understanding
of assignment, verification of monitoring
and supervision.
…
[64B9-14.003—Delegation of Tasks
Prohibited]
The registered nurse or licensed practical
nurse, under direction of the appropriate
licensed professional as defined in Section
464.003(3)(b), F.S., shall not delegate:
(1) Those activities not within the delegat-
ing or supervising nurse’s scope of practice.
(2) Nursing activities that include the use of
the nursing process and require the special
knowledge, nursing judgment or skills of
a registered or practical nurse, including:
(a) The initial nursing assessment or
any subsequent assessments;
(b) The determination of the nursing
diagnosis or interpretations of nursing
assessments;
(c) Establishment of the nursing care
goals and development of the plan of
care; and
(d) Evaluation of progress in relation-
ship to the plan of care.
(3) Those activities for which the UAP
has not demonstrated competence.
4
Medical Assistants’ Scope of
Service under Florida Law
On first analysis, medical assistants’ scope
of service under Florida law may seem com-
plicated. However, the key to understanding
the scope of service for medical assistants is
to first determine which licensed providers
are delegating to medical assistants the various
tasks and duties. Medical assistants working
under the authority and supervision of physi-
cians must comply with the scope of service
provisions in the Medical Practice Act. Medical
assistants working under the authority and
supervision of an advanced registered nurse
practitioner must comply with the scope of
service provisions in the regulations of the
Florida Board of Nursing. ✦
Questions about this article may be emailed to AAMA
CEO and Legal Counsel Donald A. Balasa, JD, MBA, at
References
1. Fla Stat ch 458, §458.3485(1) (2021).
2. Fla Stat ch 464 §464.003 (2021).
3. Fla Admin Code R §64B9-14.001(1).
4. Fla Admin Code R §§64B9-14.001(5) (2020) to
64B9-14.003 (1996).
5. Fla Admin Code R §64B8-2.001(1)(a) (2018).
Direct Supervision Definition
Direct supervision is defined in the regula-
tions of the Florida Board of Medicine as
requiring “the physical presence of the
supervising licensee on the premises so
that the supervising licensee is reasonably
available as needed.”
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