Should medication aides exist?

pawashrn · Jul 4, 2009

Due to the advancement in medicine assessment aides already exist. They're called monitors, dopplers, ultrasounds, xrays. So, I think I'll stay. Because someone has to be there to put the assessed information into a definitive cohesive informative format to be further assessed and diagnosed by a physician. I am sure you mean well.

arelle68 · Jul 4, 2009

Sorry gotta disagree. Maybe not in hospitals but in ltc when I have had up to 36 pts I was glad to have a med aide.

I got work for two of 'em. Bring 'em on!

Crash_Cart · Jul 5, 2009

NO NO NO!!!! Med aides don't get trained to citically think!!! They just blindly pass the meds. LPN's or RN's should be the only ones passing medications. Even in LTC facilities. LTC needs more nurses though. No nurse should have to take 36 patients, ever. Even if the patients are " stable ". There are just too many variables for me to trust a med-aide with my license.( no matter how long the med-aide has been there) It only takes one time, one error in judgement to do the damage.

Completely agree...

My take on it is that the patient or the patient's family may have questions or concerns about the medication taken.

What should I do? ...stand there and say duh.. I don't know know.. perhaps it's your birth control pills or something??

Not appropriate patient care in my opinion...

I would rather position, ambulate and feed patients or empty Foley's and tell funny jokes in the process of my work. I wasn't exactly trained about medications, their contraindications, reactions, or other similar potential harm they may do. Nor am I a registered pharmacist for that matter.

Basically, if I wanted to give meds to patients as part of my job, I would have gone to school to learn about medications. The only medication they teach us anything about is insulin. This is not an appropriate education for the function they wish us to perform.

If you are in a position you need extra hands to give out meds, tell the admin to hire another RN/LPN for this purpose and stop using us for this important function as it should be.

My Best.

Crash_Cart · Jul 5, 2009

I'm a CNA and we have a med tech on every shift. I can't count the times I've walked into a room to see meds sitting on a bedside table or had a med tech say "so-and-so was asleep when I went in so give them their meds when you go in there". and then I have to get the nurse because no way am I administering pills to anyone until I get my RN liscense!
I think overall it's a huge liability- the administrators are giving nursing duties to the techs and then they try to pass off those responsabilities to the aides. I don't think most techs see passing meds as this huge deal- mainly because after a 1 semester class they were able to do it!
I just personally think it's not the best idea.

Exactly....

It is a huge liability whether you are licensed or unlicensed either way you go.

You have no way of knowing if that medication was left there from a previous shift, or if the patient had just been administered the same exact medication under an hour ago... Some "med aides" don't even have the latitude to even think about that fact and may give them to the patient anyways.

They don't teach us anything about medications in school. So naturally, we should have no business giving them to patients. This is a "risky" proposition at best.

Let's face it, they are just using us to save a buck here and there. We need to refuse doing, what we clearly don't know anything about. It's simply not within our scope or job function. Similarly, I wouldn't have my tire changed on my vehicle by a stereo repair person any differently.

This is obviously an RN/LPN shortage issue and it needs to be properly recognized and addressed as such. I fully support the idea we need more licensed nursing staff as the remedy and solution to the problem.

Mentos · Jul 9, 2009

I was a med tech, and if you had asked me this question last year I'd have argued about how much easier CMTs make it on the nurses. BUT Let me share a personal expirience with you guys and hope I don't get flamed!!

My LTC routinely sends it's CNAs to a one semester class, and upon passing said class you are a CMT (certified med tech) and can pass meds. BUT they send more people than they need CMTs so they always have someone to call if they need a CMT. As a result, sometimes the CMT on the med cart hasn't passed meds in quite a while. Within 3 months of starting this job, I went to CMT school. I trained for 1 week on the cart after passing the class, but there were no full time positions as a CMT so I continued to work as aide. One day I got called in to work the cart (I had probably worked it 5 times or so in 4 months). I was cocky, no problem, passing pills was easy. Until I almost gave a resident a BP med...as he was bottoming out! I didn't understand the phisilogical aspect of passing meds. Thank god for the nurse who was around and stopped me from giving the pill. I was ashamed of myself. It's not that I was trying to hurt anyone, I was just ignorant. I never worked the cart again and let my CMT liscense lapse. I will never pass another pill until I am an RN.

If we keep letting CMTs pass pills blindly, the residents will suffer. And they are blind in the sense that they are taught little about drug effects with medical conditions, different reasons you shouldn't pass a med, etc... I know-i passed the class. We were taught major med groups and little else.

Please don't get to mad at me, I was naive and I have MORE than learned my lesson! I just thought some insight from someone who was a med tech would be helpful to the debate.

PALPN4018 · Jul 9, 2009

Mentos - don't fell guilty about what almost happened. The administration at your facility is not utilizing CMT's properly. Experience can be the best teacher and in your case you did not have adequate experience before being thrust onto that position on short notice.

I trained detention center youth care workers on medication administration. This occurred in a former place of employment. These individuals that I trained had to be observed passing medications every six months and they regularly passed medications when it was my day off. In many ways, they did a better job passing medications than I, a nurse. They were more self conscious of making any errors than a seasoned nurse.

Experience is a teacher - ask for more opportunities to pass medications under supervision.

BradleyRN · Jul 9, 2009

I will never pass another pill until I am an RN. If we keep letting CMTs pass pills blindly, the residents will suffer. And they are blind in the sense that they are taught little about drug effects with medical conditions, different reasons you shouldn't pass a med, etc... I know-i passed the class. We were taught major med groups and little else.I just thought some insight from someone who was a med tech would be helpful to the debate.

That was a beautiful post Mentos. A few med aides have told similar stories to yours, and they all seem to paint the same frightening picture. If you ever need any help in any subject while working towards your RN, please let me know. The world needs caring nurses like you who can advocate for their residents. :yeah:

Moogie · Jul 9, 2009

Agreed. Mentos, you rock and you're going to be an amazing RN. Thank you for your story. :heartbeat

diane227, LPN, RN · Jul 9, 2009

Way too dangerous. They are just not well trained enough to know when to hold a medication or what all the side effects are that they need to be mindful of. I would never work with one.

Mentos · Jul 9, 2009

You guys are to sweet!

greeniebean · Jul 14, 2009

Mentos- The facility I work at has a similar program. They have offered it to me before but I never went, because of witnessing situations like you described. I think it is very admirable of you to admit your mistake, and learn from it. Most CMTs I work with would have never gave it another thought, and kept passing meds.

I think it's awful that LTCs, driven by the almighty dollar, are recruiting CNAs with promises of "easier" work and better pay. Seriuosly, that's what my DON told me when trying to get me to go. That I wouldn't have to do bedside care, and that passing meds was less stressful! I can see why a burnt out CNA would jump at the chance. Sadly, not all of them are as mature as you.

Thank you again for your post. It really reinfoced in my mind that I made a good choice and hopefully it will inspire other CNAs faced with the same desicion.

jjjoy, LPN · Jul 14, 2009

They are just not well trained enough to know when to hold a medication or what all the side effects are that they need to be mindful of. I would never work with one.

As a fresh new grad, I certainly didn't feel that I truly knew enough about when to hold a med or what all the side effects were that I needed to be aware of. Outside of the basics of looking out for low BP when giving anti-hypertensives and checking blood glucose when giving insulin, I would have to look up almost every medication to be able to confidently tell you when to hold a med, the side effects, etc. That would be the same for a responsible medication assistant. Their first few weeks and months might required a lot of oversight and self-study. Key to that, though, is a strong training course for CMAs that not only teaches the basics of safe medication administration (5 rights, double checking pt ID, etc) but also emphasizes the importance of knowing the basics about what they are giving (is it for constipation? high blood pressure? what are contraindications? what are potential side effects?) and that emphasizes the importance of utilizing one's drug book and other resources and to communicate with the nurse whenever they aren't sure about something or soemthing doesn't feel right.

I could easily see the argument that nurses shouldn't be allowed to administer many medications because they don't have the same depth of knowledge as physicians. What depth of knowledge IS relevant to practice in different contexts? Memorized lists of drug purpose, contraindications, & side effects? A cursory grasp of medication classes and mechanism of action? An understanding of the drug's actions at a cellular and molecular level? If nurses can serve at a level of between the average lay person and physicians, is it impossible that CMAs can serve at a level between the average lay person and nurses?

I personally didn't feel that my nursing program trained me up all that well in pharmacology. I like to thoroughly understand things and the nursing school approach to pharmacology was not much more in depth than a good nursing drug book. Without a strong foundation in biochemistry, you can't do much more than memorize the mechanisms of action and get the "gist" of it. The class gave me a broad overview and a framework for looking at meds (classes of drugs, pharmacokinetic, pharmacodynamics, etc) but I didn't retain much of the details of any specific drug and it's contraindications, side effects, etc. That was learned by coming across a drug in clinicals several times and looking it up several times and seeing the drug in context of a real, live patient in and real, live health professionals (actually seeing the symptoms, reactions, the precautions and actions taken by the professionals, etc). I imagine that would be the same for CMAs.

Anyway, my view on the topic is that if a med course is well-structured and of good caliber and the CMAs are well-supervised and their job role well-regulated and the meds being given are "routine" - such as the type administered to oneself in the home environment, then I don't see it as an unsafe practice. Of course, there are budget conscious administrators who would push the limits to what's beyond safe and there are issues of where responsibilities fall when mistakes happen (a nurse shouldn't have to take the fall for a CMAs error) and that's where strong regulation & clear boundaries in job responsibilities comes in.