I work as a nurse delegated CNA in a very small adult family home that is state certified and actually takes place in a big house, not a facility. It's actually a pretty neat set up as it truly feels like you're in a comfortable home and not in an institution. That said, because we are super small and independently operated, there are only two CNA's on staff and that's it. No RN's, no doctors, no anything. However, we do not administer anything beyond oral medications and insulin injections. We don't take anyone in need of acute care, so it's not a place designed where nurses must be present at all times anyway.
So, my schedule recently changed since I'm in school and I now work with someone who has a lot of experience in LTC (20+ years) and has been working for this company from its beginnings (which is still fairly new, less than 5 years in operation). He is a nurse delegated CNA like me. I am a new CNA, but personally? I don't like to work with him. He does things "his" way rather than what is normally expected and it drives me nuts as I am the type of person that likes to follow rules and regulations to the letter, especially when it comes to other people's health. He does a lot of little things that bother me, such as having the diabetic patients already eating before he takes a supposed fasting glucose test, is very vague in chart notes (says someone ate and drank "adequately" instead of giving measurements/ratios), things like that.
To make a long story short, he made a major med error by giving a resident someone elses meds. My heart dropped. I understand people make med errors, but that to me is a HUGE error. I always follow the 5 rights because I am paranoid of this exact scenario potentially happening, so I do everything in my power to not let it happen when I am the one administering. But more disturbing than this is that he didn't make a big deal about it at all. In fact, it was as if nothing happened. I said that I was calling the manager to tell them right away of the incident. He says, "Oh, don't worry about calling her. It's not a big deal. I'll just chart about it later. And anyway, it's not like the medications that this person is taking will effect the other person adversely anyway."
I felt my heart pulsating violently in my chest in anger. Does RN, MD, or PhD follow your name in any way, shape, or form? Are you a pharmacist or pharmacy tech? If the answer is no, you don't know JACK about how that medication well effect that resident! This is the kind of error that could potentially kill someone! And to have no sense of urgency is just...I couldn't believe it. Oh, and he didn't even chart it. This whole thing was just so, so wrong. He should have known better. It shouldn't have even been a hesitation. The fact that he didn't even want me to call and to just keep it quiet...OMG. No. I advocate for my patients, thank you very much, and to hell if I was going to just sit back while a resident has someone elses meds pumping through their system with no one speaking up for them!
I only had a few minutes left on my shift when this all went down, and decided that I was going to call the manager immediately after getting off to tell them what happened and I did. They were shocked and appalled and both the manager and the owner drove to the home that night to address him. They called me while I was home, put me on speaker phone so he could hear me, and I explained the entire thing from beginning to end. The owner asked him if my account was accurate, and to my surprise the CNA said yes, everything I said was true and accurate.
I am not sure what disciplinary action happened, but it's going to be extremely awkward when I have to work with him next shift. Ugh.
Totally ridiculous to have unlicensed personnel administering medications that require assessment and judgement calls.
Doesn't matter how well they are trained because its all lost on the fact that they are not licensed, b/c no license means there is no real personal risk when they make stupid errors and of course no motivation to be accountable for their actions.
OP do read the link that is provided by the pp. Seemingly, the company is REALLY extending the language of of the legislation. REALLY stretching it.
And I feel for the RN's who are putting their own licenses on the line for this.
(3) The home care aide is accountable for his or her own individual actions in the delegation process. Home care aides accurately following written delegation instructions from a registered nurse are immune from liability regarding the performance of the delegated duties.
This is mind blowing. And wouldn't want to know why it is this passed--for all of the certifications and education that may or may not be needed and learned, (and most online.....SERIOUSLY?) why in the world wouldn't they just have everyone be an LPN, and leave it at that? With their own license and responsiblities? Oh, cause then they would have to pay more than $10 an hour.
As an LPN, I am very mindful of my scope and limitations. However, should I become a CNA in the great state of Washington, I could seemingly perform any task at all...
Wonder how many lawsuits will come of this practice, and how many RN's will be affected--as noted above the CNA's are NOT held liable......
I'm a nurse in a residential group home and this is actually very common in community based homes. Pop over to the developmental disabilities thread and there are all kinds of threads about med administration and delegation to unlicensed staff (at least there used to be, I haven't looked in a while) As long as staff has passed a state medication adminstration course they are able to pass meds and if they pass a basic first aid course they are able to do wound care. Most places don't even hire CNAs, they hire anyone and call them a DSP (direct support professional), DSS (direct support staff), "tech" and other various titles. Only the staff who have taken the med course are able to pass meds. In my state they can't do injections or really anything more than oral meds and topicals. I had no clue that anyone other than nurses could administer meds till I got into this field and now I know it's very common. In my facility there are 8-9 residences and only one employs a nurse when the residents are getting a tube feeding. When the nurse isn't here our DSPs do all the topical meds. We used to have nurses here 24/7 but, the state decided that suctioning could be delegated to unlicensed staff. Facilities like mine are all around and some don't even employ nurses at all they'll just have one RN on staff to delegate. I work in a small town and there are at least 10 other residential facilities here that I can think of.
OP do read the link that is provided by the pp. Seemingly, the company is REALLY extending the language of of the legislation. REALLY stretching it.
And I feel for the RN's who are putting their own licenses on the line for this.
(3) The home care aide is accountable for his or her own individual actions in the delegation process. Home care aides accurately following written delegation instructions from a registered nurse are immune from liability regarding the performance of the delegated duties.
This is mind blowing. And wouldn't want to know why it is this passed--for all of the certifications and education that may or may not be needed and learned, (and most online.....SERIOUSLY?) why in the world wouldn't they just have everyone be an LPN, and leave it at that? With their own license and responsiblities? Oh, cause then they would have to pay more than $10 an hour.
As an LPN, I am very mindful of my scope and limitations. However, should I become a CNA in the great state of Washington, I could seemingly perform any task at all...
Wonder how many lawsuits will come of this practice, and how many RN's will be affected--as noted above the CNA's are NOT held liable......
In a way I do too, but keep in mind that they volunteer and choose to delegate CNAs off of their license. They are not forced to do it. The nurse that delegates us has no reservations of doing it at all, and is even happy to do it. So it is a risk of their own choosing (and they are aware of the risk).
Now, why would a nurse be so willing to delegate off her license? Don't ask me! I'd protect my license with my life.
But like the last poster noted, this stuff is relatively common these days. Curious if this the first time you're hearing of med passing and such being delegated? It has been going on for awhile now.
What? Sorry but if people need meds administered, especially insulin - a high alert drug(!), Potassium (!!), wound care, etc that IS skilled nursing! Sounds like they are getting away with paying CNAs less to do a nurse's job. A 9 hour course to do what it takes an LPN or RN several semesters to learn? There is a REASON it takes that long to become a nurse and perform those tasks, even though it may look easy to hand out a med - nurses actually have a mental component to their job too, that you only learn by going to school (and thus becoming licensed). So if the CNA messes up while performing a task that really should only be done by the nurse, is it on the nurse's license, who isn't even there? What a mess. I would never ever work for a facility like this as a nurse. The only one i trust with my license is myself!
Med errors happen, nurse or not, so I wouldn't fault him that, although his response was horrible and an example as to why unlicensed people should not be "delegated" true nursing responsibilites. You need to ASSESS the patient (something only an RN can legally do! even LPNs can only "data collect," not do a nursing assessment. so a CNA definately cannot), and report the incident.
I'm not ragging on you personally, as you sound like a really responsible person and they're lucky they have YOU working there, and as you said, you're "just" a CNA doing their job. It sounds like it's only legal d/t semanics of wording. I know your place is not alone, I know of a few similar places in my area that do things like that too.
You did right by reporting what happened. I also hope you know that you are being used by the company. They are getting you to perform nursing duties without paying you for them. Seriously my advice would be to get out of there ASAP!
If for the last day or two there is a repeated pattern of high agitation then we would take a urine sample (and inform the nurse). If there is no UTI but the agitation is still peaked and PRNs do not suffice we then make a call to their doctor and go from there. But usually it is either a UTI or occasional outburst purely related to their dementia.[/quote']
Let me begin again by saying I don't think that you are doing a bad job. However, I still think that this kind of set up allows for a potentially large delay in proper treatment because you simply aren't trained to perform assessments. Yes, UTIs are common and it is good you know that. It sounds as though you are very careful and thorough in your job, so again I am not faulting you. But what if your coworker from your original post had such a patient? Repeated PRNs given for agitation that was actually a symptom of something else, but he never bothered to inform the nurse or physician because the patient was agitated and we give this med for agitation. Can you see why I and others might be concerned about that?
One is mindful and careful until a family develops some sort of amnesia, has "no clue" that Mother is not suitable for an assisted living and should be in a nursing home, has "no clue" that there's not an RN in house 24/7...and sues the pants off the company. At the only expense (per the "regulations") of the licensed nurse who delegates. Quite a gig, and I have not a clue what nurse would "volunteer" to take that chance. You even mentioned that you have at least one bed bound resident (appropriate for assisted living....NOT!) who is getting decubitus (which is a hot mess--and can progress rapidly) and that you have at least one resident who has received an incorrect medication that you witnessed at least once. This is dangerous practice. And in the case of the decubitus resident, can be a reportable issue. Here's a link regarding some general reportable issues.
Again, how did this ever, ever pass legislation? I can't imagine there's a strong RN union presence in the state of Washington! If I was going to write out "instructions" to delegate by, I would rather just do it myself.
In any event OP, it is good that you are getting out and getting out now. As you go through your schooling to become an RN, and then become an RN, you will look back on this thread and think "what the heck"?!?!?!?! However, I would also caution you greatly on the delegation stuff when you become an RN, as it is not a chance to be taken lightly.
I know nurses have a hard time hearing about stuff like this, but how do you think Group Homes are run? If every person who needed a structured living environment had nurses on hand 24 hours/day it wouldn't be economically feasible.
I can see both sides of the debate as a former group home worker and as a soon to be RN. However I also worked in case management and had to place people in homes so know how the fee structure works.
Let me begin again by saying I don't think that you are doing a bad job. However, I still think that this kind of set up allows for a potentially large delay in proper treatment because you simply aren't trained to perform assessments. Yes, UTIs are common and it is good you know that. It sounds as though you are very careful and thorough in your job, so again I am not faulting you. But what if your coworker from your original post had such a patient? Repeated PRNs given for agitation that was actually a symptom of something else, but he never bothered to inform the nurse or physician because the patient was agitated and we give this med for agitation. Can you see why I and others might be concerned about that?
Yes, I completely understand the concern and frustration.
Although frankly, I was thinking about it, and I actually don't feel sorry for at least one of the nurses assigned to us. She is comfortable delegating over the phone. Yes, over the phone, without showing you/watching you. I'm pretty positive that isn't legal for ANY type of skill whatsoever.
Ugh. I want to flee and never come back. I don't even want to put in a two weeks notice but I feel like I have to.
LaRN
272 Posts
Totally ridiculous to have unlicensed personnel administering medications that require assessment and judgement calls.
Doesn't matter how well they are trained because its all lost on the fact that they are not licensed, b/c no license means there is no real personal risk when they make stupid errors and of course no motivation to be accountable for their actions.