CNA's passing meds

Nurses General Nursing

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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 diverse than in a state where they cannot.

I wish i had a list of the suspect states but i have no idea which, if any, actually let this happen.

Thanks for any input

NurseLeigh

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! 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.

Typical that management thinks this is a "good thing."

fab4fan:

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??

Originally 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.

Why do you think that education regarding meds is continued throughout most nursing programs, not just for 6wk.

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.

Apparently, 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". :confused:

I 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.

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.

Originally 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.

You are getting emotionally defensive about this topic. Understandable since you are an instructor of a CMA/CMT course and you feel that it is a good program with good people who pass your course. But, you did miss my point. I won't repeat it.

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.

I 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.

Donna, 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.

I 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.

Youda,

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.:rolleyes:

Purdue91,

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.

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