Advice if CNA is asked to do med pass

Specialties Geriatric

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Hi I'm an RN who no longer works in Healthcare. My 20 year old daughter just got her first job as a CNA in an LTC/Rehab center (she's doing her pre-reqs now for BSN program next fall). Here is my question, at a different LTC that she had applied to she shadowed a CNA (not med tech) for the day. When she got home she said the CNA passed all the meds and hung bags of what to my daughter looked like IV meds but I'm not sure she'd know... To me this seems totally out of scope of practice for a CNA and rather freaked me out (but I only ever worked in hosptials). So the question is, how does she handle this if she is asked to do this in her first 'real' job? Is this common? Is my reaction unreasonable? I'm figuring forewarned is forearmed so any other advice for her would also be welcome. Thanks!

Specializes in critical care, ER,ICU, CVSURG, CCU.
No offense but maybe your daughter has a career in fiction. I've worked in many facilities and CNAs NEVER give medications or hang IVs....ever.

i agree with capecod, but of course I have only been an RN for 41+ years:roflmao:

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

With all do respect CapeCod and Sally....some states they do.:yes:

Thanks to everyone for the responses and I'm really happy to hear that this is not something that they are familiar with/common practice! My daughter had 'learned' in CNA class that she was never to give meds "even if an RN told her to" and so asked me if that was the case after her shaddowing day. To the poster who wondered if she was making it up, that's not her style and no, she wouldn't. Like a couple poster's suggested it IS possible that the CNA (definately not an LPN she'd asked) was hanging feeding bags not IVs -- she doesn't have the experience to know the difference. But the oral meds pass was equally concerning to me since so much could go wrong. I had discouraged her from pursuing a job in that LTC -- and am happy to hear that it's unlikely she'll see the same thing where she took a job. Thanks to the person who recommended reading "couldn't beleive he did this"...gave me the willies but thanks.
That thread....Can't believe he did this" was in a residential home.

OP...you need to check with your states nurse practice act. Some states allow non licensed personnel to pass meds ONLY after a "competency exam" in LTC and home care.

I used to work in Illinois.....they did at one time allow this ...however they no longer do.

4. Can a CNA administer medications to patients in a hospital, nursing home or

assisted living center?

Answer: As per the changes to the nurse practice act regarding delegation, a registered nurse shall not delegate any nursing activity that requires the specialized knowledge, judgment and skill of a licensed nurse (such as medication administration) to any unlicensed person or cna.

Nursing FAQ

In Indiana another state I practiced in does.....only with special training

A qualified medication aide is a CNA who has completed additional training, annual in-service training, and demonstrated competency while dispensing and passing medications and or applying/administrating treatments under the direct supervision of a registered nurse or a licensed practical nurse. A qualified medication aide has met the following requirements:

  • Completed a state-approved CNA training program. Must have completed 1,000 work hours as a CNA before making application to the QMA training program.
  • Passed a QMA competency evaluation program consisting of a written test, and
  • Be listed in good standing as a QMA on the Indiana State Nurse Aide Registry.

ISDH: Frequently Asked Questions about Certified Nurse Aides

In my present state of MA...they do not.

In Oregon they do.....http://www.oregon.gov/OSBN/pdfs/policies/macurr_1.pdf

OP it is imperative that you Check with your state

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...So the question is, how does she handle this if she is asked to do this in her first 'real' job?...

Refuse if it's outside the scope of practice for CNAs in her state of practice.

...Is this common?...

Unfortunately, yes - especially in LTCs. Haven't heard of CNA's hanging IV's, but nutrient solution for G-tube feeders I have. Administering oral meds? Yup...had it happen to me more than once. Ticked off a few LVN's in the process, too. :madface: It's still illegal AFAIK (at least here it is).

...Is my reaction unreasonable?...

Nope - would YOU want an UAP giving YOUR loved one care that they didn't know how to do?

...I'm figuring forewarned is forearmed so any other advice for her would also be welcome. Thanks!

Unfortunately, in a chronically short-staffed LTC this sort of thing will almost certainly happen, and it's up to the CNA to use proper judgement. For instance...had to do a pt. escort run with a quadriplegic pt. I assumed responsibility for the pt. & was told specifically not to give the pt. her oral meds. The solution - had the transport driver (co-worker at that facility) open the bag & do the administration. Silly? Yup - but, as a CNA I can't legally do it.

----- Dave

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I've seen nurses hand off poured meds to CNAs to pass to the patient when the nurse is behind schedule. It's messed up, totally illegal and dangerous, but it happens.

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I live in Washington state & poured/passed meds as a med-tech for 2 years while I was in Nursing school. I had my CNA license & the required "Nurse Delegation" training- which is basically just a certificate. I was able to pass/pour narcs also. It was wonderful training- learning all the pharmacology- for Nursing school. Now that I am the nurse, I have my own med-tech & 6 CNA's. The other CNA's are not allowed to be involved giving meds.

The med-tech works fairly independently since it is an Assisted Living facility, with mostly routine meds for 50+ residents. Any med changes, she is notified of right away & I answer any questions.

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There are some "out of scope" of things LTC facilities might turn a blind eye to when it comes to CNAs. Hanging IV meds is not one of them. An aide administering IV medication in a nursing home simply doesn't happen, and if it were to, I can't imagine how many heads would be rolling.

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Thanks so much for your response. And we are in Illinois so now I know it is not legal. Frankly I'm happy to 'not' hear a bunch of folks telling me that it's SOP and not to worry -- because I would worry and most importantly want my daughter to start out her career practicing good, legal, safe and loving care. We'll spend time this weekend working on polite ways of saying no to this request if it comes up in this LTC.

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CNAs should never be passing medications in LTC. There have been cases where residents refuse to take the med from the LN and the NAC assists , but that is used in very rare cases. Creams and lotions to be applied per a MD order fall into the same class as medications. If she is asked to give a med, she can refuse to do so. Any retaliation from the LN or facility is unacceptable.

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I've seen nurses hand off poured meds to CNAs to pass to the patient when the nurse is behind schedule. It's messed up, totally illegal and dangerous, but it happens.

Sometimes nurses hand crushed meds to an aide who is feeding the patient and the aide gives the meds in with the pudding or mashed potatoes.

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I just graduated lpn school and we did clinicals at two different nursing homes and they ALWAYS had the CNAs give the patients meds. The lpns would get them together but if it was feeding time the CNAs have it to the patient. Our instructors told us that in the real world never ever do that because it's illegal but it really does happen all the time everywhere.

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Specializes in LTC, Memory loss, PDN.
I just graduated lpn school and we did clinicals at two different nursing homes and they ALWAYS had the CNAs give the patients meds. The lpns would get them together but if it was feeding time the CNAs have it to the patient. Our instructors told us that in the real world never ever do that because it's illegal but it really does happen all the time everywhere.

I've done that myself, but only if the CNA had a CMA certificate and was familiar with the meds

in my area, many CMAs work as CNAs on some days

are you sure the CNA was not certified as CMA as well?

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In Oregon, RNs are allowed to delegate medication administration without any certification (limitations, to exempt things such as IM & IV injections).

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