CNA's making medical decisions.

  1. Just wondering how many nurses know about the assisted living laws in Arkansas, they are pretty much the same in all states but this is about Arkansas. CNA's "assist" with medications, take Dr's orders and post to a MAR, make decisions about which narcotics/ meds to give in a PRN situation, assess residents for change of condition send them to ER. Draw up insulins and administer without it being checked by another person as long as the resident is touching the bottle and syringe it's assisting they are taking the CNA's word that everything is correct. State Board of Nursing say it's legal by the word "Assisting".CNA's are not required to know what the medications are for, the side effects etc. There are 2 levels of Assisted living in Arkansas 1 & 2. Level 2 an RN has to be on call with no required number of hs. in the building and the residents meet criterial to be in a nursing home. I couldn't believe it myself till I was told then went to the OLTC site and read the regulations. On level 2 it does state LPN can be used for medication administration but in most places according to stats I've seen, CNA are assisting due to cost. CNA are doing the job we had to go to school for get a licenses and being accountable for our actions. Med errors, I don't even want to think about it.
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    About Nurse-C

    Joined: Jul '07; Posts: 6


  3. by   Jo Dirt
    If I knew a CNA was doing all of this in a facility where my family member was you had better believe I would be in their face about it.
    Frankly, I believe the BON's should have someone above them who they should answer to...but this is fantasy because the BON (who is supposed to be there to PROTECT the public) is obviously voting the way the healthcare corporations that have the most clout want them to operate.
    It makes me sick. But that is the way things are in the greatest country on earth.
  4. by   sirI
    Nurse-C, would you please give the link that outlines the duties you've described above?

  5. by   Nurse-C
    Quote from sirI
    Nurse-C, would you please give the link that outlines the duties you've described above?


    This will direct you to OLTC ( Office of long Term Care )then you can go to providers then to regulations for level 1 & 2. Thanks for your relpy
    reg 702.1.1.1, 702.1.1.5
    Last edit by Nurse-C on Aug 12, '07
  6. by   sirI
    702.1.1.2 facilities must comply with applicable state laws and regulations governing the administering of medications and restrictions applicable to non-licensed personnel/staff/employees. however, licensed nursing personnel (rn, lpn) may administer medication in accordance with sections 504.2.2 and 504.2.3 of these regulations in cases in which the resident is assessed as being unable to self-administer his or her medication. in such cases, the facility shall document, and shall be responsible to ensure, that medications are administered by licensed nursing personnel/staff/employees, and are administered without error.

    702.1.1.5 residents who self-administer their medications must be familiar with their medications and comprehend administration instructions. facility staff shall provide assistance to enable residents to self-administrator medications. for clarification, examples for acceptable practices are listed below:

    a. the medication regimen on the container label may be read to the resident;

    b. a larger sterile or disposable container may be provided to the resident if needed to prevent spillage. the containers shall not be shared by residents.

    c. the resident may be reminded of the time to take the medication and be observed to ensure that the resident follows the directions on the container;

    d. facility staff may assist the resident in the self-administration of medication by taking the medication in its container from the area where it is stored and handing the container with the medication in it to the resident. in the presence of the resident, facility staff may remove the container cap or loosen the packaging. if the resident is physically impaired but cognitively able (has awareness with perception, reasoning, intuition and memory), facility staff, upon request by or with the consent of the resident, may assist the resident in removing oral medication from the container and in taking the medication. if the resident is physically unable to place a dose of oral medication in his or her mouth without spilling or dropping it, facility staff may place the dose of medication in another container and place that container to the mouth of the resident;

    504.2.4 certified nursing assistants (cna)

    the facility shall employ cnas to provide direct care services to residents. cnas shall be permitted to perform the nurse aide duties set forth in part ii, unit vii of the rules and regulations governing long term care facility nursing assistant training curriculum. these nurse aide duties include taking vital signs (temperature, pulse, respiration, blood pressure, height/weight); recognizing and reporting abnormal changes; death and dying and admission/transfer/discharge. the cna can perform all job functions and duties of pcas. all cnas must be certified by, and in good standing with, the state of arkansas, and must comply with all requirements, including continuing education, as established by law or regulation. no individual who is uncertified may be employed as a cna, with the exception of cna trainees. cna trainees may be employed to perform those cna duties for which they have completed their cna training, and have been determined competent by the cna program instructor. when utilizing cna trainees, the facility shall have verification on file that demonstrates each trainee's competency to perform assigned duties and shall utilize cna trainees in the manner and for the time permitted by long term care facility nursing assistant training program regulations.

    504.2.5 personal care aide (pca)

    the facility shall employ pcas who have attended and successfully completed an established curriculum for personal care aides to provide direct care services to residents.

    here is the curriculum for the cna. note there contains no formal education on medication administration:

    here is the brochure from the arsbon regarding ma (medication assistant, certified) which states:

    [font=humanist521bt-light][color=#2b3796]duties of a ma-c:

    [font=garamondnarrow][color=#231f20]administer non-prescription and legend drugs
    [font=garamondnarrow][color=#231f20]by the approved medication routes, when
    [font=garamondnarrow][color=#231f20]delegated by a licensed nurse, to no more
    [font=garamondnarrow][color=#231f20]than 40 patients during a shift.
    [font=garamondnarrow][color=#c5151c]* [font=garamondnarrow][color=#231f20]document medications administered.

    [font=garamondnarrow][color=#231f20][font=humanist521bt-light][color=#2b3796]approved medication routes:
    [font=garamondnarrow][color=#231f20]oral, topical; eye, ear, and nose drops; vaginal,
    [font=garamondnarrow][color=#231f20]rectal, transdermal and oral inhalers.