CNA's passing meds - page 4
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 4, '02Apparently, you are reading what you want and simply ignoring the rest! I will repeat for at least the third time, that the course is for much longer than 6 weeks! However, my question to you is this.... For how long have you worked with an apparently poorly educated, low performing med-aide and why is the course that they are required to take so poorly put together that they allow someone that is obviously incompetent to "slip through?" Surely you are not making judgements about people and circumstances that you have no personal, first-hand knowledge of, are you? That to me would be "punting" responsibility... The responsibility of forming intelligent, educated opinions, and if you have never worked with a med-aide directly or been to a class where they are certified, then that is what you're doing. And THAT would be "putting a bullet straight into the heart of the profession".
Sep 4, '02I do not doubt that there are some very dedicated CMTs/CMAs. I have worked with a few that are conscientious and dependable. Many also have the initiative to look-up drugs for which they are unfamiliar. I don't have a problem with that part.
Where I start to have problems with them, no matter how dedicated, no matter the length or breadth of their course, is the deficiency in critical thinking skills and assessment skills. These skills are not, technically, a part of a med pass, but integrated into every aspect of nursing care.
Here's a couple of scenarios as examples:
Can a CMT/CMA giving Lanoxin to a pt. with a dx of a-fib, be able to EVALUATE the effectiveness of the med and when there is a change in heart rhythm and function? Could that CMA/CMT hear via apical pulse when the heart rhythm was converting to a v-tach instead? Or, do we wait in LTC until the pt. is a smurf before interventions are initiated?
Can a CMA/CMT when giving a med to someone with a swallowing difficulty determine if the person needs referral to speech therapy by a physical assessment at bedside?
Well, I could go on with examples, but you get the idea. If the nurse is so swamped that he/she can't spend a few minutes at bedside giving a few pills and eye-balling each res., then the facility is short-staffed. Part of the ANA Standards of Care, and in many NCLEX exams now, EVALUATION and continuing assessments is integral to nursing, and keeping your license, I might add. A CMA/CMT is not trained to know those things, only the nurse is. BUT, the nurse remains legally responsible for those evaluations and assessments, and is not relieved of that responsibility just because someone else was at bedside handing out pills.
So, if you have someone passing meds who is not trained to RECOGNIZE problems, not trained to EVALUATE OUTCOMES, and do ASSESSMENTS, then the RN just as well burn her license. The only thing that saves the RN is that most LTCs are not mandatory reporters, so most of these ommissions just cost the resident their well-being, not the RN his/her license. That, IMHO, is a violation of ethical standards of practice. The elderly in the USA are treated horribly in LTC. And, this is one example of how they do not get quality of care.
Sep 4, '02To attack levels of care being given by "LTC" in general is irresponsible, and erronous. Unless you personally are in a long term care facility itself, then to make judgements about it are judgments without merit.... And only comments about a long term care facility that you are in and incidents that you witness, do you have enough knowledge of to comment on intelligently, although, if you have any knowledge of confidentiality, you wouldn't. I wonder, if a patient goes to long term care, due to a HUGE med error, that was committed by an RN in a hospital, and the person is now a vegetable... Does this give me the right to condemn all nurses in all hospitals as incompetents? Not hardly.
Sep 4, '02Originally posted by ADONDonnaRN
To attack levels of care being given by "LTC" in general is irresponsible, and erronous. Unless you personally are in a long term care facility itself, then to make judgements about it are judgments without merit.... And only comments about a long term care facility that you are in and incidents that you witness, do you have enough knowledge of to comment on intelligently, although, if you have any knowledge of confidentiality, you wouldn't. I wonder, if a patient goes to long term care, due to a HUGE med error, that was committed by an RN in a hospital, and the person is now a vegetable... Does this give me the right to condemn all nurses in all hospitals as incompetents? Not hardly.
An error is an error. Period. The difference is that if I'm gonna lose my license for an error, I'd rather it be my own error, and not someone else's.
Sep 4, '02I do apologize if I took the comment "The elderly in the USA are treated horribly in LTC" and "how they do not get quality of care" the wrong way; if I'am emotionally defensive about a subject, please understand that it would most definintley be a comment like that, far ahead of weather or not to use med-aides. Yes, I do think that they have a place. Others, obviously don't, and that's alright too. However, those of us in LTC have to fight off stereotypes of incomptenency or laziness alot of the time and it gets to be wearing. And just for the record, I can completely see your point of view on an error... Your right, an error is an error.Last edit by ADONDonnaRN on Sep 4, '02
Sep 4, '02Donna, I've worked LTC the better part of my 30 years in nursing. I've worked in several states. When I compare the ideal with the reality, when I compare current standards of care with what the elderly actually receive, when I evaluate what is optimal staffing with what is "budgeted," when I compare the staffing of RNs vs. other employees, when I see the deficiencies vs. what JHAC would allow in a hospital setting, when I see facilities providing rehabilitative services only for as long as Medicare will pay for it, then I can only conclude that the "elderly are treated horribly in LTC."
I don't care how good or deficiency free a facility may be. The "bar" is always set lower for LTC. We don't staff according to individual needs or acuity, we staff according to mathematical ratios. We admit cardiac res. without a nurse who's qualified in cardiac care or rehab. We admit res. with a hip fx without a qualified nurse in orthopedics. We admit res. with altered renal function without the dynamics and inter-department resources to properly address those needs. The overall lack of understanding of the unique problems affecting the gerontological populations, and the stigmas and stereotypes (as you mentioned) actually having some basis in fact when compared with standard of care, then I can only conclude that the elderly are "treated horribly in LTC."
We have a long ways to go before the elderly receive the dignity and quality of care they deserve.
We come from the same place and the same background. I just believe there is a long ways to go before LTC comes close to what it should be, where you seem to believe we have already arrived by finding short-cuts to optimal care, such as using a CMT to pass meds.
Sep 4, '02I work with some good QMA's in the LTC facility. They free me up to be with the residents and families. Charting has become a monster. I rely on these educated people to work with me to provide the care that is needed. I would not consent to have someone working under my license if I did not know they were trained and experienced. I do a lot of teaching myself. I let them know what I expect and what is to be reported to me. We are a team. I have been exposed to QMA's since 1983. I am thankful we have them. Teachers out there; keep teaching. I do understand where some of you are coming from.Last edit by purdue91 on Sep 4, '02
Sep 4, '02Youda,
I will agree that you have several valid points. However, I still maintain that you are making blanket statements concerning LTC. I can see where you might come to your conclusions, with a long time history in LTC. However, I guess that I'am just exceptionally lucky, in the fact, that I work for a non-profit org. where ALL money goes into the support of and improvement to our home. We happen to have on staff several nurses that specialize in the different areas of which you speak. I guess it's easy for me to forget that we are the exception, not probably the rule...So you see, where I sit, Med-aides are not a "short-cut." They are simply an extra pair of hands to help us continue to give the highest quality of care possible...Where I'am at, LTC DOSEN'T have a long way to go....We have accomplished the journey..We just keep building a bigger mansion.Last edit by ADONDonnaRN on Sep 4, '02
Sep 4, '02Purdue91,
Thank you for your response. I agree, that a large part of our jobs as nurses should also be as teachers. Thank you for the encouragment... I enjoy sharing my knowledge with others and I always learn something myself, in the process. As far as anyone I know, at least here, we also consider med-aides to be a god-send.
Sep 4, '02Originally posted by ADONDonnaRN
I will agree that you have several valid points. However, I still maintain that you are making blanket statements concerning LTC. I can see where you might come to your conclusions, with a long time history in LTC. However, I guess that I'am just exceptionally lucky, in the fact, that I work for a non-profit org. where ALL money goes into the support of and improvement to our home. We happen to have on staff several nurses that specialize in the different areas of which you speak. I guess it's easy for me to forget that we are the exception, not probably the rule...So you see, where I sit, Med-aides are not a "short-cut." They are simply an extra pair of hands to help us continue to give the highest quality of care possible...Where I'am at, LTC DOSEN'T have a long way to go....We have accomplished the journey..We just keep building a bigger mansion.
That speaks for itself, or else you need training in using metaphors.
Sep 4, '02Six weeks is still not enough. To be a licensed nurse is 1-4 years depending on what route you take. How can you justify 6 weeks. Every day the powers that be try to take a way every aspect of nursing. It is crazy unethical and I would NEVER work in a facility that does this. No one is going to make me responsible for someone else passing meds. Then when the s*** hits the fan they will seek out a nurse saying why did you not do this or that. Pretty soon you will have 6-8 unlicensed people doing what licensed nurses are trained to do. I don't care how good someone is, get a license!!!!!!!!!!!!!!!
Sep 4, '02If the only issue were getting nurses to work in NFs I don't think that any nurse would disagree that currently, the best provider to pass medications to the institutionalized elderly is a nurse. Pragmatically the issue is more complex . . . not only are there not enough nurses to staff all the open positions but the number of needed positions are most likely understated. I base that on quantitative data, not opinion. It is almost certain that there are resident needs that can only be met by nurses . . . that are not being met.
It has been this way for a long, long time and it is from this situation that the perceptions (and realities) of poor care arise.
A central question is not as simple as how to fill positions with nurses but what are the core nursing duties that residents need and what duties can be delegated. To ignore this question in the hopes that somehow nurses will arrive is to make the problem worse. I would remind nurses that there are many tasks that were at one time considered "medical" now being exercised by nurses ,e.g., collection of blood pressures. I would remind nurses that there were at one time tasks (and disciplines) considered nursing now being exercised by others, e.g., respiratory therapy, physical therapy, et al. The nurse role has evolved in the past and perhaps needs to evolve again.
Here in New Mexico we are preparing an amendment to the Nurse Practice Act to allow for a trial study of CMAs in NFs with the support of advocate groups like the BON, BOPh, NMHCA, university-based and others because we think that medication administration can be successfully delegated. It has been shown in othe states. To read some of the comments presented here is to get a sense of fear and I am not sure that the fears are sound. I read fear for error and resident well-being, I read fear for caveat superior, I read fear for the profession of nursing.
There already are CMAs in the NM DD and NM ICF-MF settings; these programs are responsible to the NM BON and are substantially successful. We have learned that while there have been actions toward CMAs for practice issues, there has not been any action toward a supervising nurse. Other fears need to be addressed and resolved or we continue as we are; struggling to provide care without sufficient resources because we have limited our own thinking.
Sep 4, '02NRSKarenRN,
I know of one individual who works/worked as a "charge aide" in a fellowship nursing home on night shift in PA and she gives/gave out meds... (ie) Restoril, Tylenol, insulin. Are you sure PA hasn't approved of this? This person was doing this in 1992 when I met her. I haven't seen her in about 8 years now and she may not even work there
at this time, but...that was then. I always thought that this person was working beyond their scope of practice. Scarey...