New to Assisted living: Help?

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    Hi all:
    Looking for a little advice from all you great nurses out there. I just started a new job at an assisted living near my home. I previously worked Med-Surg/Oncology but left to find my "niche" because I didn't feel fufilled and came home stressed out all the time. I began to forget why I became a nurse. I love my new job, but am having a really hard time learning the differences between the hospital setting and LTC. For example, I feel like my new co-workers think I'm overly cautious and paranoid. Our residents on my unit(memory care) have pre-filled pill boxes that are filled by a different RN once a month. I am supposed to dispense the pills without checking(there are like 10 per person per time period). I have pulled the pills myself so far. Is that normal practice? Also the CNA's dispense meds in Assisted living, and sometimes will on our unit too if there is no RN on that shift.Suppossedly its because we are assisted living and not skilled so the cna's just give them the pills. I am sorry if I sound naive, this is all so new to me. But the residents do seem very happy, and everyone is so well taken care of here and also it is a private institution. I just feel like there are unorthodox practices. Sorry if I sound naive to all this. Anyone have similar experience? Can anyone tell me about the Assisted Living Center's they work at? Thanks for any help you have!!
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  3. 12 Comments so far...

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    That sounds similar to the assisted living i work at. We have LPNs that set up the pill boxes weekly and the cna's will pass out the medication. We have a sheet that they refer to, it says how many pills they are supposed to be giving and they are supposed to just count them before they give the pills. Me and the other RN who work at this facility have nothing to do with the medication. At first it seemed odd to me too, and somewhat unsafe, but there has never been a problem with medication errors or anything in the past. The lpn is trusted to dispense them in the med box properly.
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    Maybe it's different here in Florida, but I've never heard of CNAs being allowed to pass meds. If I'm the one pulling the meds out, I want to be absolutely sure the patient is receiving them, you know? I wouldn't feel comfortable with that setup at all.
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    I have heard about that. I am personally uncomfortable with that. I know at the ltc I worked in ks, they used a cma. They are cna(6 wks training) and then they take cma course which is (6 more weeks in med admin) and meds are given using a MAR(bp and hr for certain meds). Any changes, new orders were added to the MAR by the nurse and any problems were directed to the nurse. My question would be if something happen in assisted living who would be held responsible.
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    Quote from rn4life2009
    My question would be if something happen in assisted living who would be held responsible.
    Exactly.. what if a med tech or CNA gave an anti-hypertensive and the resident's b/p was low to begin with and they ended up bottoming out after receiving the med because it wasn't checked? That would probably fall on the shoulders of the licensed nurse assigned to that resident at the time, even though she technically wasn't the one who actually gave the med, right?
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    Actually, the responsibility for giving medication correctly lies with the medication assistant.......as long as s/he has been properly trained and/or delegated by an RN. No, they usually don't have licenses or certifications that can be revoked, but it's really hard for them to find another job in AL if they have a history of med errors or diversion. Believe me, the management and staff at these places talk to people at other facilities all the time, and everybody knows each other's business only slightly better than they know their own.

    I can relate to the OP's nervousness about unlicensed staff administering meds, because it scared the hell out of me when I was new to this area of nursing. I'm the DNS for a fairly large ALF in Oregon, where very few med aides or resident assistants are certified even as nurses' aides; training programs are short and informal, but relatively intense (if they're done right). I personally have rarely given meds in AL, except when I've worked a floor shift due to short staffing; the RN's role is more managerial/administrative than anything else in this environment.

    The key to a safe and effective medication system in AL is knowing how and when to delegate, choosing good staff, and providing ongoing training and supervision. My own medication assistants do a better job than many of the CMAs and even nurses I've worked with in the past; they are consistent about their documentation, they know their stuff, and they can find their way around a nursing drug book when they don't know what a med is or what it does. They also know that they must ask questions and continue to learn, because no one (not even the nurse!) ever gets it all wired.

    This is still a relatively young area of nursing, and the RN's role has evolved a great deal in just the 11 years since I started my first ALF job. Back then, I don't think anyone truly realized how critical proper delegation was; even the state surveyors were more concerned with the appearance and the food than they were with the medical piece. Now, we are more tightly regulated, and nursing has an enormous responsibility for the well-being of the residents. But it's still exciting and ever-changing, and the autonomy is wonderful---especially for those nurses who know their craft, don't need a lot of supervision, and have a knack for staff development.

    Good luck, and let us know how it goes.
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    Quote from kittah
    Exactly.. what if a med tech or CNA gave an anti-hypertensive and the resident's b/p was low to begin with and they ended up bottoming out after receiving the med because it wasn't checked? That would probably fall on the shoulders of the licensed nurse assigned to that resident at the time, even though she technically wasn't the one who actually gave the med, right?
    In our facility if there's a a med like that the cna's will check their blood pressure and pulse first. They have a sheet they go by and it will say anything they need to do before giving the med such as "Don't give if pulse is below 60". They have a spot in the MAR where they sign we know they did check it. Ultimately though, the nurse is responsible for everything that happens. Although I'm sure a CNA who made the mistake would also get punished!
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    Quote from kittah
    Maybe it's different here in Florida, but I've never heard of CNAs being allowed to pass meds. If I'm the one pulling the meds out, I want to be absolutely sure the patient is receiving them, you know? I wouldn't feel comfortable with that setup at all.
    here in Floria, you can take med tech as a CNA and dispense meds.
  11. 0
    Quote from cna23
    here in Floria, you can take med tech as a CNA and dispense meds.
    Really?? I didn't think Florida did the whole medication tech thing? Didn't know that. I do think it's a good idea for some of the less risky medications, such as vitamins, stool softeners, etc. Especially in LTC facilities, where every resident has 15 medications per med pass.
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    Thank you so much for the feedback everyone. i am learning so much each day I work. And it is true so true that the nurses role in AL is ever evolving. I know I am lucky to be at a well run facility and I just keep reminding myself that I am not in the hospital anymore (YIPEE!)


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