[PANurseRN1]

Originally Posted by Daytonite

I'm sorry, but I just can't help but laugh at what hypocrites some of you are. I heard RNs protesting that they weren't going to let LPNs pass meds or start any of their IVs when the laws changed before. To qualify, LPNs had to take a medication course and I'm not sure it was even 70 hours long. The IV certification course was only 30 hours long. The hospital I worked at gave it's LPNs 2 years to get their medication certifications. LPNs were saying they were going to quit before they'd start giving any medications. Where are all of those RNs and LPNs now? They've changed their minds, dudes! Because it all worked out. LPNs still don't give IV narcotics, but no one ever questions their ability to give oral medications. I think that most of you didn't live through that transition. But, let me assure you that it was a big controversy. Every night at work that was one of the topics of conversation between the RNs and LPNs on the staff. RNs were mad that LPNs were being given such a big responsibility; LPNs were mad that they were being forced to do something they never asked for. Medication administration never used to be taught in LPN school, so when this was granted to LPNs to do they had to learn it from no knowledge base at all--just like medication aides are going to have to. Some procedures are very, very routine and lend themselves to this kind of delegation.

One thing about nursing and healthcare that never changes is that it is always changing. It you can't deal with change then leave, go, bye-bye. Go sit out on a porch somewhere and stagnate and wallow in your negative energy. Step aside so others who aren't afraid to pick up the torch and run with it can carry on and move things forward.

I'm trying to square this with your numerous comments on the inferiority of ADN/diploma nurses.

[PANurseRN1]

Originally Posted by VickyRN

My thoughts exactly. If you go to the NCBON website, it is abundantly clear that the licensed nurse is responsible for any and all adverse events that may occur with medication aides under his or her watch.

That's what exasperates me about unlicensed health care personnel who claim to have a "license." At least with other truly licensed staff you know they've met the minimum standard for licensure; with this kind of job it's a cr*p-shoot.

[indigo girl]

When I moved from Philly to Maine, I was amazed that someone was going to give my meds (CMT's). In philly, it would have been an LPN in LTC. And you know what, I WAS GRATEFUL!!! I have worked with some awesome med techs. They really knew the patients, and the meds, and I learned to trust their judgments. We all worked together every day. You soon get to know if someone can be trusted or not. In RI, again, we had CMT'S. In Connecticut, no. The nurses here delegate almost nothing. Consequently, they work a lot harder, have less time for assessments, and everything else they are responsible for which is everything but housekeeping apparently. When you have 60 patients to care for, CMT's look mighty good. Don't look a gift horse in the mouth. My guess is, they are mostly utilized in LTC's or assisted living situations in most states. And, training varies according to state requirements. Once you find a good one, you won't want to let them go. When I was a unit manager, my med tech and I were a team.

[earle58]

is a cma going to report cramping, nausea, urticaria/pruritis, dizziness, etc?
potential se's r/t polypharmacy is a huge concern.
i need to see how my pts are tolerating their meds.

leslie

[lindarn]

Originally Posted by indigo girl

When I moved from Philly to Maine, I was amazed that someone was going to give my meds (CMT's). In philly, it would have been an LPN in LTC. And you know what, I WAS GRATEFUL!!! I have worked with some awesome med techs. They really knew the patients, and the meds, and I learned to trust their judgments. We all worked together every day. You soon get to know if someone can be trusted or not. In RI, again, we had CMT'S. In Connecticut, no. The nurses here delegate almost nothing. Consequently, they work a lot harder, have less time for assessments, and everything else they are responsible for which is everything but housekeeping apparently. When you have 60 patients to care for, CMT's look mighty good. Don't look a gift horse in the mouth. My guess is, they are mostly utilized in LTC's or assisted living situations in most states. And, training varies according to state requirements. Once you find a good one, you won't want to let them go. When I was a unit manager, my med tech and I were a team.

I have a novel idea- how about hiring more RNs in Nursing Homes and Assisted Living Facilities? That will decrease the need for unqualified, uneducated individuals taking over the professional practice of RNs. As long as RNs are stupid enough to allow this to go on, and take the responsibility for these unqualified care givers, how ever fancy a title that they are given by the mucky- mucks, the de- skilling of nursing will continue.

But the martyr maries of nursing just wring their hands, and say, "Heavens to Betsy", however did this happen? When nursing positions are eliminated in favor of staffing with the housekeepers, nurses will say, "now how did that happen?". Just like they did when hospitals decided in 1994, to go all out and eliminate nurses left and right, in favor of unlicensed assitive personnel. And we thought that it would never happen. And we were blindsided when it did.

Think that medication aides are the greatest thing since sliced bread? Call me when you are handed a pink slip. Be careful what you wish for you might really get it. Medication aides passing meds to my patients? Not on my watch.

Lindarn, RN, BSN, CCRN
Spokane, Washington

[indigo girl]

Originally Posted by earle58

is a cma going to report cramping, nausea, urticaria/pruritis, dizziness, etc?
potential se's r/t polypharmacy is a huge concern.
i need to see how my pts are tolerating their meds.

leslie

Actually, yes they will report any s/s. It's part of their job. And, you are right there on the unit also. Anyway, of course, you can choose not to work in a place that uses them. My personal experiences have been positive, but each nurse needs to do what feels most comfortable. I would not take it personally if anyone disagrees. Besides, an opinion is not the person, it's just an opinion.
And, people are capable of changing their opinions based on their experiences.

[PANurseRN1]

Originally Posted by indigo girl

Actually, yes they will report any s/s. It's part of their job. And, you are right there on the unit also. Anyway, of course, you can choose not to work in a place that uses them. My personal experiences have been positive, but each nurse needs to do what feels most comfortable. I would not take it personally if anyone disagrees. Besides, an opinion is not the person, it's just an opinion.
And, people are capable of changing their opinions based on their experiences.

Sorry, no way am I going to lose my license/get sued because of a mistake made by a minimally trained, unlicensed health care provider.

And no, I would not trust the judgment of a CMA. They don't have the knowledge to make a clinical judgement, period.

Isn't it a sad state of affairs when our most vulnerable pts. (the elderly/mentally ill) are treated this way? It's maddening that they cannot expect the same level of care as pts. in a hospital (and that isn't so great, either).

This is about $$$, plain and simple, not about what's in the best interests of patients.

[Retired R.N.]

Originally Posted by lindarn

I have a novel idea- how about hiring more RNs in Nursing Homes and Assisted Living Facilities? That will decrease the need for unqualified, uneducated individuals taking over the professional practice of RNs. As long as RNs are stupid enough to allow this to go on, and take the responsibility for these unqualified care givers, how ever fancy a title that they are given by the mucky- mucks, the de- skilling of nursing will continue.

But the martyr maries of nursing just wring their hands, and say, "Heavens to Betsy", however did this happen? When nursing positions are eliminated in favor of staffing with the housekeepers, nurses will say, "now how did that happen?". Just like they did when hospitals decided in 1994, to go all out and eliminate nurses left and right, in favor of unlicensed assitive personnel. And we thought that it would never happen. And we were blindsided when it did.

Think that medication aides are the greatest thing since sliced bread? Call me when you are handed a pink slip. Be careful what you wish for you might really get it. Medication aides passing meds to my patients? Not on my watch.

Lindarn, RN, BSN, CCRN
Spokane, Washington

I have another novel idea. How about including the CNAs in our ranks of respected members of the nursing team and make sure that they get the proper education to be trusted with the duties that will be assigned to them?

If the nursing profession could offer a clear, reasonable path of upward career mobility for all levels of nursing, from CNAs up through Advanced Practice Nurses and educators with PhDs, we could come much closer to solving the problems we have in retaining the more experienced nurses we already have. We waste entirely too much talent because of burnout every year to tolerate the present "system" any longer. Nurses who have moved up into advanced fields requiring specialized knowledge should have no fear of being replaced by lesser skilled individuals, but should be delighted to be allowed the freedom to practice at the highest level of their present ability and to investigate even more advanced challenges.

It seems to me that the question nurses should ask themselves is, "Do I want to manage patient care, or micro-manage it by insisting on doing all these details myself?"

If there is any hand-wringing let it be over the actions of the ANA who created the division among RN ranks with their infamous "White Paper" that created the ADN class of nurses, and allows them to take the same licensing exams as those from BSN schools.

[sbic56]

At first when I saw this thread, I thought oh, no...here we go again. Time to trash the med aides. But, I am pleasantly suprised to see the tide turning in their favor. There is no statistic stating that nurses passing meds are any less apt to make an error than a med aide. If it were the nightmare that some fear it is, we'd all know about it. Plenty to worry about that really does make a differnece; this doesnt.

[PANurseRN1]

I hardly call wanting licensed nurses to give meds a form of "micro-management." If you don't see the need for licensed staff (as in nurses, not "licensed" med techs) to give medications, that's your prerogative. I just see medication administration as a serious responsibility, not something that should be done by people who aren't regulated and have a license that stands on its own. Med techs do not have this. As long as they can--sorry, I can't think of a more tactful way to say this--run and "hide behind Mommy's skirt" when something goes wrong, I don't see that they do that much good and can do a world of harm.

CNAs are indeed valuable; I don't think anyone here disputes that. They are not, however, nurses. In most states, "nurse" is a protected title that may only be used by a licensed nurse--an LPN/LVN or an RN.