CNA's passing meds - page 3
I have heard tales that in some states the CNA's are the ones who pass meds. I was just wondering if any of you live in any of these states that supposedly do this and if the CNA courses are more... Read More
Sep 3, '02Originally posted by NRSKarenRN
Still keep my drug book at my side after 25 years of practice. Anyone ever see a Medication tech ever refer to a drug book??
Proof that it sunk in? Three years later, in nursing school, I aced a pharm test that I had no time to study for, that most of the rest of the class nearly flunked.
However, having done both, I agree that this is a position that should be eliminated and replaced with NURSES.
Sep 3, '02Thank you for acknowledging that there are some programs that are well structured and maintained. Here in Texas, all of our Medication Aides have to renew their certifications yearly, inclusive of having CEU's, just like the rest of the nursing profession. I also have the privilidge of teaching one of those courses. Unfortunantely, you are VERY correct, in that not everyone plays by the rules as they should. I don't blame you a bit for refusing to work in a facility that would allow that type of incrediably dangerous and unprofessional behavior. However, I hope that everyone is understanding the difference between the CNA's and the CMA's. A certified nurse's assistant and a certified medication aide are two entirely different "animals". Under no circumstances, should a certified nurse's assistant be giving out ANY medications...EVER!!! This is illegal and unethical, to state the least. A medication aide, on the other hand, is in school for at least a semester, and must pass a state examination before being allowed to practice, and be under the direct supervision of a nurse. Done correctly and maintained appropriately, these professionals can be the very backbone of a well run facility.:rollLast edit by ADONDonnaRN on Sep 3, '02
Sep 3, '02I am DON of an assisted living facility,,,, yes the state did pass law,, that with 4 hour class non licensed staff could assisted with medication administration,,,,
You are to have the resident sign he/she knows and has no problem with unlicensed person,,, doing thier medications,,,
A MOR has to be made ( medication observation record ) and the cna cannot do prn meds,,, thought behind this is they don't have assessment skilles to determine,,, prn needs,,,,,
How do I handle this in my facility,,,, I have nurses!!!!! I am not going to be responsilbe no matter how good an employee,, thier history in healthcare,,, etc,,, for someone unlicensed to give meds on my watch,,,,
Just my 2 cents,,,,
Sep 3, '02I agree with Youda, I'll give my own meds, thank you. I'll also choose to work in a facility that hires licensed nurses to perform the tasks of licensed nurses, at the pay rate of a licensed nurse.
Sep 3, '02Originally posted by Youda
These are things I've seen in LTC when a med tech was passing meds. Not technically a "med error" but definitely a lack of skill, knowledge, and understanding of meds.
1. Res. refused to take "water pill" (Lasix 80mg/qd) because she didn't want to pee so much. CMT circled it on the MAR, but continued to give the K+ for 3 weeks. Woman went to ER with heart dysarrythmias.
2. Blood in foley catheter bag, and CMT gave coumadin as ordered.
3. CMT gave albuteral nebulizer treatment. Res. c/o chest pain after treatment. AP was 140.
4. CMT gave antiobiotic when res. c/o "itching all over."
Yeah, CMTs can put a pill in a little cup and most of the time, it's actually the right med, but they don't have the training or understanding to make critical judgment calls. It's asking a CMT to have the knowledge of the nurse, and there are plenty of disasters because of it. But, nothing will change, and it isn't because of the nursing shortage, it's because they're CHEAPER than a nurse.
To make this more bizarre is that none of the examples above were ever written up as med errors, and the CMTs were never counseled because it was "beyond their training" to have "known not to give." And, most of the CMTs I've worked with didn't even understand that they should have TOLD THE NURSE about these things!! <big sigh>
A WELL TRAINED CMA WOULD KNOW "NOT TO GIVE OR WHAT TO REPORT" CMA'S ARE USED TO GET THE NURSE BACK AT THE BEDSIDE WHEN DONE PROPERLY, NOT TO REPLACE THEM.
Sep 3, '02from nakitamoon
yes the state did pass law,, that with 4 hour class non licensed staff could assisted with medication administration,,,,from adondonnarn
a medication aide, on the other hand, is in school for at least a semester, and must pass a state examination before being allowed to practice, and be under the direct supervision of a nurse.
vast difference in how each of these persons would function based on their training.
i've worked ltc/snf. been responsible for giving meds for up to 60 patients / shift with two med passes. difficult, yes but i'm out on the floor and can eyeball all the patients each day and can recognize changes more quickly that way than just being the treatment nurse for fewer patients.
some assisted livings have stable long term clients. that can be safe if not too may patients. med techs at granmom's alf were great, watched her like a hawk...called me with any questions. also had lpn charge nurse working with them for prn's/ support on 7-5, 3-11 shift with lpn on call on nights.
was visiting rn seeing patients at alf/boarding home licensed that "housed" mostly psych patients under pa ma benefits. pts. went to day programs. 1 lpn dayshift as director for 80 patients. she prepared monthly med kardexes and saw patients with doctor only if patients attended weekly sick call---that was all the involvment in their meds. med techs gave meds on all three shifts. if pateints refused meds, just circled on kardex, no calls to pcp---no wonder bp skyhigh...or they refused to give my surgical post-op patients prn pain meds on nights as only one tech covered two buildings/40 patients and they were tied-up or didn't want to come back to building. this alf also set up own outpatient offsite pharmacy that all the patients meds were obtained from---charged to state's ma program (another sore point with me).
some company's alf patients are almost sub acute/rehab with onsite rehab services. sorry, these clients are too unstable to have onlya medtech on duty passing meds.
until regulations changed and standardized to program like texas: too high risk. please rn/lpn's be aware of potential for your license to be on the line.
Sep 3, '02In regards to passing meds in an Assisted living setting... the laws are different for these places and for hospitals than they are for LTC. That is probably the difference in the legnth of the programs.... I was not born an RN. I had to learn. Be taught. I also was quite fortunate, in that the people who instructed me also taught me humility, and that just because I had earned those two letters after my name, it did not make me a superior human being. I worked as hard, if not harder than some others that I know, for my license.... And I feel that I have a true appreciation of who I work WITH...not "over"... We all work to give our residents the best possible care, that there is to be given... this includes our med-aides... They are some of the most intelligent, caring, supportive, compassionate people that I have ever had the honor of working with. They are not a threat to me... They are instead, an extra pair of eyes and hands with which to care for my residents.... I 've known RN's and LVN's that have more "education", and don't use their knowledge one-tenth as well as a well educated med-aide.... The med-aides I work with are dedicated individuals with kind hearts, sweet souls and an unwavering committment to our facility and the people that reside there.... This commitment certainly extends to their expanding their knowledge base and using it WELL. Education can be bestowed upon ANYONE.... Goodness of nature cannot. Therefore, it is my firm belief, that it is not only the amount of education that a person has, that makes them appopriate to delegate certain VERY serious duties to (such as passing medications) but just how well they use the knowledge that they are given. However, CHOICE, is what makes nursing such a wonderful profession...... We all are happy in different places, with different ideas of what we believe is right.
Sep 3, '02NO, NO, NO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!
There is no justification for this...dress it up and call it anhything you want...it is playing fast and loose with people's lives and your license.
Of course, if you are comfortable punting this resposibility to someone else, then don't come here for a shoulder to cry on when there is a bad outcome.
I don't care how competent anyone feels he/she is as a med tech, I did not go through the rigors of nursing education to let someone decide if it is OK to give a med.
I just love the people who say, "Well...it is still the resposibility of the charge nurse..." Yeah, that's because a med tech does not have a license to go after when there is a bad outcome.
Before you become a cheeleader for this harebrained idea, ask yourself this..."Would I want my meds (my husband's/wife's/mother's/father's, etc) to be given by someone who had minimal training, and absolutely no understanding of HOW meds work (Stupid me, I always thought there was more to giving meds than reading a MAR).
Typical that management thinks this is a "good thing."
Sep 3, '02Oh, and a "kind heart and sweet soul" does not make someone a competent person to give meds.
Sorry for all the typo's, I was so angry when I read this I just started typing fast and furious.
"Hi Mr. President, here are your meds. I am fully capable of giving them to you...I just passed a 6 week med course. I'm not a nurse, but hey, what does that matter."
Sep 3, '02I am so adamantly against this!
For all the above reasons and more.
There should NOT be untrained people giving medications PERIOD!
Sep 3, '02Apparently, neither of you read either the length of the course, which is longer than 6 weeks, thank you, or the fact that there is a course, which means, that they are NOT untrained, and that body systems and the effects of different drugs on each one is covered in the course. Attributes of their personalities don't make them capable of passing meds... It simply makes them good people. And as for "punting" any responsibility, I don't feel it is. If I didn't believe that they had enough knowledge to do the job, they wouldn't be hired to do it. That's called delegating with responsibility! A med-aides job is strictly to pass meds. They're attention is not divided between multiple numbers of tasks, therefore, the attention to correctly administering medications is more concentrated than either an LVN or an RN that is responsible for 30 people on one hall, including treatments, SVNs, narcotics, Doctor's orders, charting, family members... and the list goes on. I still work the floor, therefore, the "management" comment dosen't hold water with me... I don't expect the other nurses to depend on them when I wouldn't. Everything that we do not do ourselves, is a delegation... And I repeat, it is NOT ONLY the amount of education, which certainly plays a role, but how effectivly it is used by the person... Having a license does not mean that you use your knowledge appropriately... Regardless of your title. However, to repeat myself, CHOICE is what makes nursing a wonderful profession... Each of us is allowed to make our own choices about how and where we work.Last edit by ADONDonnaRN on Sep 3, '02
Sep 3, '02Typical that management thinks this is a "good thing."
Don't assume that all of "management" thinks this is a good thing. I'm a nursing administrator and would never allow an unlicensed person to pass medications. I would never work in a facility that thought it was OK to have unlicensed personnel passing medications. The LTC conditions that our seniors must endure in some (but not all) facilities are truly horrible. I could not believe the post from NRSKaren RN who described an ALF who had only unlicensed personnel in the building and a LPN on call at night. That is truly scary. To me, that is asking too much of the on-call LPN and certainly putting the resident in jeopardy.
I shudder to think of it. Is anyone else afraid to get old??
Sep 3, '02Originally posted by ADONDonnaRN
Apparently, neither of you read either the length of the course, which is longer than 6 weeks, thank you, or the fact that there is a course, which means, that they are NOT untrained, and that body systems and the effects of different drugs on each one is covered in the course. Attributes of their personalities don't make them capable of passing meds... It simply makes them good people. And as for "punting" any responsibility, I don't feel it is. If I didn't believe that they had enough knowledge to do the job, they wouldn't be hired to do it. That's called delegating with responsibility! I still work the floor, therefore, the "management" comment dosen't hold water with me... I don't expect the other nurses to depend on them when I wouldn't. Everything that we do not do ourselves, is a delegation... And I repeat, it is NOT ONLY the amount of education, which certainly plays a role, but how effectivly it is used by the person... Having a license does not mean that you use your knowledge appropriately... Regardless of your title. However, to repeat myself, CHOICE is what makes nursing a wonderful profession... Each of us is allowed to make our own choices about how and
where we work.
Like I said, if you don't value your license, fine. This kind of "de-skilling" is one of the things that is tearing the profession apart...don't be surprised when the suits decide that you are superfluous ("Heck, let's just send housekeeping to a 6wk inservice on reading EKG's, starting IV's, assessing breath sounds, etc.).
Just wait until there's a big mistake...will mgmt. back you? I can't even respond anymore; it's attitudes like this that are putting a bullet straight into the heart of the profession.