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Unlicensed healthcare personnel can perform a variety of functions in the medical office setting. It is important to be aware of state-specific considerations, which are discussed below. For additional information and resources, please refer to Curi’s Unlicensed Healthcare Personnel Toolkit.

What are the TRAINING AND CERTIFICATION REQUIREMENTS?

Neither certification nor post-secondary education is required for unlicensed healthcare personnel (UHP) in Kentucky.  The minimum educational and training requirement for a medical assistant to practice is a high school degree or GED and training from a medical practice. A medical assistant, certified medical assistant and registered medical assistant may all perform the same functions. There is no certification or training required for phlebotomy in this state.  Per the American Society of Radiologic Technologists, UHP may not perform x-rays.

WHAT TASKS CAN BE DELEGATED AND WHAT SUPERVISION IS REQUIRED?

Kentucky does not have specific rules defining delegation of tasks or supervision of UHP by physicians. Provided that the task is within the scope of practice for a licensed nurse and that the RN has assessed the patient, the nurse may delegate tasks that a reasonable and prudent nurse would find is within the scope of sound nursing judgment and practice to delegate; can be competently and safely performed without compromising the client’s welfare; and shall not require independent nursing judgment or intervention. The nurse delegator of the task is responsible for assuring that the delegated task is performed in a competent manner and providing supervision.  The degree of supervision is based on: the stability and acuity of the patient’s condition; the training and competency of the UAP; and the complexity of the task (Ky. Bd. Of Nur. AOS#15 Supervision and Delegation Rev. 10/2019).

WHO IS RESPONSIBLE IF THE PHYSICIAN IS ALSO AN EMPLOYEE?

In some settings, unlicensed personnel and physicians may both be employees of another business entity or corporation.  The employer may hire and train unlicensed personnel and may develop policies and procedures to guide the practice of these assistants.  However, the employed physician remains responsible for the practice of medicine, which includes providing appropriate delegation and supervision of clinical tasks performed by unlicensed personnel to patients under that physician’s care. Kentucky law exempts nonprofit entities providing medical services as charitable health care providers from any prohibitions relating to the corporate practice of medicine.  The Kentucky Medical Board has also indicated that the employer should not interfere with the physician’s independent medical judgment.  (Ky. Rev. Stat. § 216.940; Ky. Bd. Of Med. Op. No. 36 (Feb. 10, 1995).)

HOW CAN WRITTEN PROTOCOLS BE USED?

The Kentucky Board of Medical Licensure has issued opinions stating that standing protocols could not be used to authorize nurses to initiate prescriptions without physician approval nor could standing protocols be used by UHP for the initiation of lab orders.  These opinions have been interpreted to imply that UHP should not transmit refill prescriptions to the pharmacy without physician/prescriber review and approval.

REFERENCES

Per the American Society of Radiologic Technologists,

Ky. Bd. Of Nur. AOS#15 Supervision and Delegation Rev. 10/2019

Ky. Rev. Stat. § 216.940

Ky. Bd. Of Med. Op. No. 36 (Feb. 10, 1995)

American Association of Medical Assistants. https://www.aama-ntl.org/docs/default-source/legal/ky-bome-9-2020-prescription-refills-bhs_medical_assistant_medication_refill_protocols-(002).pdf?sfvrsn=0