CNA's passing meds

mlolsonny · Sep 17, 2002

Originally posted by Youda
1)A related problem IS the staffing shortages. If we had RNs lined up waiting to put in applications at LTC, and the pay was reasonable, would anyone use a CMT? If money wasn't THE issue, would CMTs be used at all? If there were plenty of RNs, would anyone use CMTs? I doubt it.

2)when I compare the staffing of RNs vs. other employees,

3)Mrs. Jones gets a new order for Lanoxin and goes into v-fib, dies, and no one notices and so I get sued. Will the BON say, "there, there, Nurse Betty. Don't worry about it. You did the best you could." No, the BON won't say that. They'll yank my license.

4)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?

5)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.

I work as a medication aide in a LTCF, in addition to going to nursing school. It sounds to me as if you think that only RNs should be giving meds in LTC.

I was a certified Pharmacy Tech before I became a CNA/ medication aide. As a Pharmacy Tech, I have nurses asking me questions about meds. Don't assume that medication aides don't take their jobs seriously.

In our facility, CMAs aren't allowed to give Coumadin, schedule II narcs, injectables, or PRNs (without the LPN's approval). Our DON hand picks the CNAs that will go to the CMA class. She looks for an intelligent, articulate person, who isn't afraid to ask questions. It's not as if we have 16 year-olds passing meds...

*1 We have 62 residents and 6 RNs(two of whom work one day a week), none of whom pass meds on a regular basis because they're too busy with MDS, care planning, and MD rounds, etc.

*2 We are mandated to have an RN in the building 8 hours per day, that's it. We usually have more than just mandatory coverage, but 8 hours is all the state requires.

*3 Mrs. Jones and her V-fib will be in the hospital, not my LTCF.

*4 As an LPN student (with 3 months to go), we have been taught to count the apical pulse, not to evaluate it or assess it. Assessing heart sounds is under the RN's scope of practice. Evaluating is also the RN's job, not the LPN's.

*5 The cardiac patient that we admit is a stable cardiac patient or is one on Hospice. Same with your hip Fx and renal patient. Our residents are stable, or they're in the hospital...

You're right about the CMT/CMAs not being able to evaluate, but LPNs aren't really prepared to evaluate a lot of it either. We are taught to look for adverse reactions. We are also taught to look up any drug we are unfamiliar with, 5 rights, etc.

Realistically, if you had 31 residents assigned to you, how likely is it that you'd have time to assess the efficacy of the Lanoxin?

mboyce · Sep 18, 2002

Youda,

Re: your response that the RN (or LPN, please don't limit this issue just to RNs, it's an egocentric position especially in LTC) are responsible for actions delegated to supervised staff is an argument against CMAs;

Do you have experience with CMAs?

Do you work in LTC?

Do me a favor (because I am going to do the same thing) . . . count the responses so far that are pro or con by author, not by entry, and by author type. Maybe this quantification will suggest something?

For others; I am preparing a fact sheet to distribute as we begin our preparation for legislative action in this coming session and I would like to use comments from this site. I don't intend to use anyone's name or title. Is there anyone who would object to my using their remarks or is there anyone who would like to make a specific remark, based on their experience with CMAs?

blackbelt · Sep 18, 2002

I have worked as a MA. EMT. paramedic and er tech- on all these jobs I passed meds. I also read every single package insert so I would have an idea of what I was doing. When I was hired to work in an ER I was given the same med administration test the hospital gave to the RN's. The day I took the test I was told that four RN's failed the testthe same week. I passed without difficulty. I had to put up with RN's writing the local paper to tell the community an unlicensed assistive personel was endangering the lives of people in the community. One of these same RN's put a silicone coated foley in somebody with an allergy to latex-instead of a clear solid silicone foley. I knew the difference and why it should have been used. I have had my hand on a femoral pulse and advised the doctor there wasn't one- he pointed to the monitor showing PEA and said the patient was alright. But I will be the first person to admit that we don't all have the same training. But if you learn doing the job it dosn't mean you are less intelligent without that sheepskin. And since I have been looked down on because of a lack of a piece of paper I'm almost finished with my BSN. I don't plan on changing my attitude towards the learned experiences of others. It is when we think we know it all that we get into trouble.

happy · Sep 18, 2002

hi I am a cna and also a rn student. I have been working in faciclities of LTC,Assisted Living,Home health and Hospitals for the last year. I am from Chicago and we were told that in our CNA course that we were not allowed to pass meds ,UNLESS we were given a course in meds from the facility in which we work. I have been asked to pass meds, administer iv push morphine , flush ivs, suction and wound culture and care all by RNs who were my supervisor for the night. My simple reply was I am sorry I am not familiar with that policy if you could show me in the manual where it gives me the responsability and the training to do so I would definately like to see it. This usually gets me out of any situation that I find uncomfortable and beyond my scope. There are very good programs out there in our area that do extensive training on med passing but we are still not to administer anything without the "near" supervision of the nurse on staff. We are also told that in assessing a pt if we have ANY concerns we are to let the nurse know. the only problem with this is that it truly depends on the nurse on staff, some of them simply do not want to be bothered with the information or the questions we have. We hear alot of talk in class about the doctor/nurse relationship and how that it can sometimes be not so nice and i have to say from experience that cnas have this same kind of relationship with some nurses and we then get afraid to ask the questions that we should because we don't want to put up with the negativity of how much knowledge that we lack. although we have had a very short time in training compared to rns education we need to remember that the education never stops we learn from experiences and by our colleagues, most importantly by the questions we ask. I do not feel that cnas will ever be able to take the place of nurses but I do think that with more training and education at the proper levels we can help relieve some of the stresses for the nurses, after all we are a team. I hope to join your ranks in the next year. so far so good, this little cna is in the top 3 of her class of 70 :-)

CaliNurse · Sep 18, 2002

Originally posted by mlolsonny

I work as a medication aide in a LTCF, in addition to going to nursing school. I was a certified Pharmacy Tech before I became a CNA/ medication aide. As a Pharmacy Tech, I have nurses asking me questions about meds.

Mlolsonny,

You have my curiousity ! Do you make more in Minnesota as a CNA compared to a pharmacy tech. In California, from what I hear, our pharmacy techs make more than CNA's. But this may be people falsely bragging, who knows. I was under the impression that the pharmacy staff made more than the CNA's. I wish you luck in your education. You background will be of great value to you in school.

Cali

Youda · Sep 18, 2002

mlolsonny and mboyce

You make similar arguments of those already expressed on this topic. I can only speak for my own opinion and viewpoint. I'm not going to change your opnion, and you aren't going to change mine! :) However, you both seem to think that I'm speaking from a position of ignorance. So, a bit of my background may be in order. I have been in nursing for over 30 years, a large chunk of that time in LTC. I've been a CNA, CMT, LPN, and RN. There is no doubt in my mind that MOST people try to do their job well and except for periods of burn-out, are caring, dedicated, and competent, within their own training and limitations and experience.

I would not take 31 patients in LTC on a day or evening shift as the only licensed. There is no such thing as a "stable" patient in LTC. Age-related problems alone make each and every one of them in fragile health. My viewpoint is that most of these elderly *do* get shipped out to the hospital, when they have an acute problem, but most of those hospitalizations are unnecessary IF early recognition and interventions had been initiated. Often, the subtle signs are missed because they are not assessed often enough. How many of these folks go to acute care for falls, septicemia, dehydration, impactions, etc? that were all preventable, or at least the severity of the problem could have been minimized with earlier recognition and intervention? The idea that they are "stable" so they don't need as skilled of care or any higher staff-to-patient ratio often lulls someone into complacency so that these people are not monitored appropriately. By appropriately, I mean within the same framework as any BON or the ANA would consider as Standards of Care. No one would dream of not assessing a patient often in acute care, so why do we think that LTC is an exception when the population's health problems are more varied and complex? For example: if you have a cardiac patient in LTC (and they all have age-related cardiac problems), are they assessed frequently for tissue perfusion, heart sounds, mobility? Or do you wait until they have 3+ edema before you call the doctor? That isn't a putdown, please don't take it that way! It's just a reality of LTC in most situations. Whereas with frequent assessments, an RN should have been able to pick up on subtle changes in heart sounds so that an intervention could have been made much earlier.

And, yes, I understand the argument that every license or unlicensed category has been found to make horrendous and harmful errors. But, that argument is hardly a good reason to give the elderly in our country LESS care or less skilled care. Just because RNs make errors, it doesn't compute that, therefore, CMTs should have the same opportunity to make an error. As an LPN, I believe I was "better than the average bear" with my skills and continuing education. And, I have had the pleasure to work with exceptional LPNs. I have also worked with very skilled and terrific CMTs. But, I am ever-mindful that their level of education will forever separate them from the understanding that is given to a RN, especially one that is AS dedicated and terrific as the excellent CMTs and LPNs.

And, yes, there are dangerous, disinterested and uncaring nurses and CNAs out there. But, I believe that everyone of them started out excited and proud of the nursing profession. Something has happened along the way to steal from them that excitement and dedication. It is my belief that this is usually short-staffing or stupid management; managers who have no real education or effective training in management and should never be in those positions.

There is much that needs to be done for our profession. I've said it before and I'll say it again. Join a State and national nursing organization and get involved. If you can't get involved, then at least keep informed about the issues. And, keep learning and growing!

globalRN · Sep 18, 2002

Passing out meds is easy.

Knowing when NOT to give them is a whole different story.

I have been there and made decisions to hold meds when the docs were ordering and the RNs were giving inappropriate meds that would have harmed the patient if given.

I would not want anyone who did not have a license passing out meds on my watch or my license. The more I have learned about pharmacology and pharmakinetics.....as a nurse practitioner....the more sure I am of how I feel: NO to anyone without a license passing meds.

mboyce · Sep 18, 2002

Youda,

I don't disagree with you . . . it just seems that it's time for new strategies. If you look at the membership (size and makeup) of most SNAs you will find that they don't really represent nurses in their states. Large groups are from the academic settings and membership numbers are small in comparison to total nurse populations and the issues being addressed are global and relatively distant.

Joining the SNA is one, longer-term strategy for dealing with issues related to the nurse shortage . . . but it doesn't do anything for the people in the beds right now that need help. You ask several questions in one of your previous entries along the lines of, "if there were enough nurses would people be advocating for CMAs"? Maybe, maybe not; probably not. But there aren't enough nurses are there?

So it falls to nurses to do something about people's needs. Nursing historically has difficulty getting together and helping itself . . . we can't seem to keep our own people in the profession (we have difficulty defining our profession). This current shortage is not much different than past shortages; some of us are tired of waiting and tired of hearing the the repeated and redundant call to arms. There are some analogies between what is being repeated now and avoiding a falling sky . . . except that for some people the sky is falling and we are watching it happen.

Nursing needs to change . . . right now.

Youda · Sep 18, 2002

mboyce, I agree with what you're saying, too! :)

Except I suppose my strategy is different for dealing with it. Instead of accepting temporary measures to the shortage, such as using CMTs, I refuse to work in those situations. If someone else is willing to let a CMT work under their license, then that person is more suited to the job requirements than I am.

I believe that by taking that stand, staff retention is better and bed occupancy is improved and mortality rates are lowered. Overall, it works for everyone, even the bean counters. If I begin to compromise my own standards, then I become less of a nurse in my own eyes, not to even mention the effects on my patients' health.

I can't change the world or the nursing profession as a whole all by myself. But, I CAN pick and choose what I allow on a day to day basis to protect myself (my first priority) and my patients (my second priority). And, if a place I'm working, gives me too few staff, I just refuse the assignment and go back home. A facility will staff it my way, or I'm not there. Goodness knows that I have my choice of jobs if anywhere I'm working doesn't like it! The irony is that because of the shortage, I can increase my wages and get a fat sign-on bonus check if I change jobs.

mboyce · Sep 18, 2002

Youda,

Unfortunately anecdotal accounts and data don't bear you out; taking your stand isn't working . . . for anyone. Nurses are leaving, fewer nurse candidates are arriving and while your approach may have worked at one time it isn't working now. Your obligation to the profession includes assessing the efficacy of strategies and discarding them when needed, in the same way that approaches to care are discarded when they no longer are effective e.g., removing rings while handwashing. By taking an intransigent position based on your feelings rather than facts you also close the minds of others. Refusing an assignment and going home is not addressing or engaging the problem . . . you're avoiding and encouraging others to do the same.

Temporary is how evolution occurs. If it's a successful transformation it survives; if it isn't . . . it doesn't. In any case, there are very few life forms that are unchanged by the environmental forces surrounding them (cockroaches and sharks are pretty efficient, but they are maintenance elements).

Youda · Sep 18, 2002

Again, I can't change the world. I can only control my own little corner of it. No matter what the shortage may be, or how others cope, or choose to evolve the profession, it doesn't affect me on a day to day basis; as you pointed out, those changes are too slow. I have to choose how *I* will nurse on a continuing basis. You've used some critical thinking techniques in your last post. So, since we're getting into critical thinking skills, the obligation to the profession is not to try shot-gun approaches and hope you hit on something that works. The obligation is to identify the problem, collect the data, weigh alternatives with the pros and cons, implement, and re-evaluate, make changes as needed, etc. If you're using that kind of framework to make care and staffing decisions, you also can't ignore the problems associated with CMTs passing meds. It may be a good solution, but maybe not. If we're going to use critical thinking skills in this discussion, then we also have to avoid assumptions, judgments, and quick-fixes, or solutions that do not adequately address the problem. If the problem is really a nursing shortage, then is the solution using CMTs? Are there other alternatives? You speak of the entire profession. But, we can't ACT as an entire profession when the voices who have commented on this topic are so opposite each other in viewpoint. The objections to CMTs are valid points, too. And, for all those who want to use them, I've yet to hear a valid argument FOR using them, except as a solution to a nursing shortage. That doesn't address the inherent problems WITH using them. Nor does it solve the problem (the nursing shortage).

mboyce · Sep 18, 2002

Youda,

Not yet read a valid argument? You need to reread the postings, you're ignoring what people are saying.

The problem is not the nursing shortage . . . the problem is umet patient needs.