"Omg. I just got my CNA license, and I'm giving narcs."

[Guttercat]

...said a friend of mine in a recent email. She's never even been in direct patient care.

She was just hired into a large LTC/Rehab/Sub-Acute facility.

Perhaps I'm beating a dead horse, but I post these threads, because "all" nurses and or aspiring nurses need to be aware (and constantly reminded) of what is going on politically and the fiscal drivers behind the changes.

I'm not saying a CNA (or a plumber or a sous chef or a janitor or a jet propulsion engineer) can't be "trained" to dispense medications.

I just want all of us to realize and stay cognizant of what is going on under our noses. What we do with the information is up to us. Throw our hands up and hope we still have a job next year? Be "thankful we still have a job" as our salaries decline or remain stagnant?

Supply-demand, supply-demand....The demand side goes down with the nursing glut (supply), and former nurse responsibilities are farmed out to UAP's. It's like a double whammy.

It's not all doom and gloom, but the times they are a' changin'.

[classicdame, MSN, EdD]

licensure is awarded by the state after specific criteria is met. Otherwise it is a certificate. But the real problem is that no one is turning this facility in to the state health department or BON. Just because your boss asks you to do something and you are afraid of being fired will not keep you from being sued by angry patients/families if this is discovered. Plus there will legal action from the state for practicing without a license and that could involve jail time if criminal charges are involved. So no one is winning with this practice. Beware.

[runnergirl86, BSN, MSN]

When I worked as a CNA I had my medication administration certificate. I believe it was a 6 hour class going over the 5 rights (at least at the time, I don't know how many there are, 20? lol), how to follow a MAR, document, etc. I worked at assisted living facilities and would administer narcotic medications. We also would perform finger sticks and based on the MAR give a prefilled, properly marked insulin syringe. I know we were not authorized to administer insulin, but we could hand the insulin to the resident and they would inject themself. I think having this certificate is fairly standard in most states and I think CNAs are much needed in this sort of setting.

[Guest219794]

Frankly, the thought of a LNA or a CNA giving any meds when she's working under my license scares the holy heck out of me. I don't have enough fine motor control in my hands now to take pills from the bottles without dropping some, so my husband puts them in daily pill containers and as careful as he is, I check every cubby before I take every dose, I check every single pill. He's never made a mistake, but the possibility always lurks just around the corner, just as it does with every dose given by an RN, LPN, or unlicensed person -- be it a spouse or a non-nurse allied health person.

Non-licensed persons know which pill is ordered but not about side effects, which pills and capsules can be cut in half and which can be safely crushed. While my husband was in rehab following foot and ankle surgery three years ago, his elderly roommate who had dementia, was given what amounted to a triple dose of Buspar for four days before his daughter visited and caught it. EEK!

My husband said the roommate was acting stranger than usual but no one listened to him or checked. Those doses were given by RNs and LPNs who knew about the 5 rights, but an aide could easily have made the same error and never have realized that a 3 pill dose each time was just too many pills to be a correct dose.

No one is perfect. We are all mere mortals. We make mistakes. I don't want the nurse who says she has never made a mistake to give me so much as a Tylenol because she's not an safe nurse. I'll take full responsibility for any and all meds mistakes I make but nt for an unlicensed employee who has had a few hours of meds training. No way! No how!

What does it mean to have somebody work under your license? AFAIK, I am the only person who works unde my license.

[SoldierNurse22, BSN, RN]

What does it mean to have somebody work under your license? AFAIK, I am the only person who works unde my license.

Sharpeimom is talking about the ability to delegate certain nursing duties to unlicensed personnel. For instance, taking vital signs, giving a bed bath, etc are all duties that can be delegated by a nurse.

There are certain duties that cannot be delegated. In my state, those duties include patient education, assessment, and medication administration. Sharpeimom is making the point that if that duty is legally allowed to be passed on to someone who is unlicensed, it can and probably will come back on you, the licensed person, should something go wrong.

[JDZ344]

What does it mean to have somebody work under your license? AFAIK, I am the only person who works unde my license.

I imagine it means you are also responsible for whatever the nursing aide does or does not do. I suppose it depends on what the NA does. If they did something they were not supposed to be doing, without the nurses knowledge, I can't see how it would be the nurses fault, but if they didn't do any vitals for a whole shift, and the nurse didn't catch it, then I suppose they would, because they didn't check up on the NA's work.

[vintage_RN, BSN, RN]

Where I live (Ontario, Canada), CNA's are called PSW's (Personal Support Workers) and they are not licensed or certified. I believe they write a test at the end of their program but they have no regulating body.

[roser13, ASN, RN]

Simply put, I would not take a position in which anyone other than an LPN was issuing medication under my license. Someone has to draw the line somewhere and I am doing my best, in my teeny little corner of the world. All of my non-medical friends, family members, and yes, my patients, have undergone an education as to who may and who may not administer meds to them.

I instruct them to refuse any meds offered by non-licensed personnel and to request that the charge nurse come to their room and explain any attempts by CNA's etc., to give meds.

I may be fighting a losing battle but I will not go quietly.

[DedHedRN]

As far as I can tell, from my many many conversations with med techs, they know absolutely nothing about the medications they give, why they are giving them, what they are, or the side effects. They cannot even recognize if they have given the right medication and when I ask if they are sure they gave such and such a med, they answer, "I dont know, I gave what was in the cup". They don't know what kinds of symptoms to hold a med for and often will continue to give a med even when the situation has turned dire for the pt. They are cheap for the agency, but dangerous. They know how to sign out a medication, follow and order and thats about it. I am not worried at all about losing my job to these people, because they have no knowledge of what they are doing and it shows, no prudent hospital would hire them, unless they want dead pts and lawsuits.

[pinkiepinkPN]

I don't know about CO but I know that the Arizona BON also licenses CNAs. They get a number and a card and everything.[/quote']

I was a CNA here on Colorado before becoming a nurse and I got a card with a license number on it. Also, when you go to look up a license number for a CNA, it asks for the LICENSE number. Not arguing with the distinction between licensed and certified, just sayin what I see.

[classicdame, MSN, EdD]

Texas does not recognize "working under someone's license". Every person is responsible for their own actions. Nurses are responsible for delegating to unlicensed assistive personnel, but can never delegate away their own scope of practice responsibilities. So in the scenario provided by Katiep86 in the UK, the Texas nurse would be held responsible for not following up with the UAP and the UAP would be responsible for not following their job description (which included follow-up with nurse). The UAP may get their certificate revoked if the Health Dept. determined just cause. The nurse may have to go to a peer review and MAY have to be disciplined by the Board of Nursing. But neither person will automatically lose their certificate or license without proper review. However, the employer has the right to fire both of them. Nurses in Texas do not sign after someone either, unless they witness the event. I guess what we are all saying is that RN/LVN's need to monitor the UAP's appropriately.