Delegation

pagandeva2000, LPN · Oct 21, 2007

Never heard of this, but, I don't work in assisted living, either. I'd be uncomfortable, because if THEY make one mistake, YOU may be UNlicensed, also.

perfectbluebuildings, BSN, RN · Oct 22, 2007

I wouldn't be comfortable... there are too many things that can go wrong in that scenario, in my opinion. I don't know for sure though; I just picture people getting boluses too fast and throwing up and aspirating, or something. As far as med administration, that would make me nervous too; it would be under your license since none of these people would have any kind of license or certification (it sounds like; correct me if I am wrong). I guess I am rambling; to answer your question, I've never heard of this being done. I know assisted living can be different somehow though; I worked in an ALF before nursing school, but none of the patients had G-tubes, but things were more "lax" than I realized till I had more experience.

Long Term Care Columnist / Guide · Oct 22, 2007

I'm an ALF health services director and assistant administrator, and for me, the deciding factor in whether or not to admit a prospective resident is: if this were my parent, would I be comfortable with my weakest staff member caring for him/her?

There are certain conditions and care needs that, in my mind, should not be handled at the assisted-living level of care. Feeding tubes fall into this category because there are too many things that can go wrong, and while anyone can be taught how to administer feedings and flush a G-tube, only a nurse can assess the resident and troubleshoot problems with the tube. As good as my staff is, they wouldn't know if someone may be aspirating, if the insertion site is infected, or what to do if the tube were to become clogged or dislodged.......do you see where I'm headed with this?

Yes, it's YOUR license, and even though a nurse technically is off the hook if a staff member---whom he/she has properly taught and delegated---does something wrong, I wouldn't want to bet MY license on that. So no, I wouldn't take a resident with a feeding tube, or a trach/vent, or a new ostomy (established ostomies, especially with residents who are independent, might be a different story), and I wouldn't recommend you do either. I know administrators want to fill the units, but sometimes the nurse has to say No to an admission when their care can't (or shouldn't) be managed in the ALF setting.

Good luck to you!

leslie :-D · Oct 22, 2007

have to agree with marla.

but admittedly, i am a control freak and prefer to do things myself.

yet, i keep on asking myself, "what if"?

what if they don't understand the importance of checking placement?

what if they don't understand why the hob should be elevated?

what if they don't appreciate why residual should be checked?

or what is so darned important about flushing?

what if they ignore the resident's c/o abd cramps?

and what does that distended abdomen mean?

and why shouldn't i crush that ec tab?

nope.

let the licensed/registered personnel do this one.

leslie

pagandeva2000, LPN · Oct 22, 2007

Well, I can at least say that your administrator asked for your input. What lead to this conversation? Did you say that you needed assistance, or are they short of nurses? Or was she asking you, but really saying that this is to be?

If you have a choice in the matter, I would say no, I'd rather do it myself.

I used to be a certified AMAP at a psych hospital. Had about a week of med administration training when I was in my very early 20s. Not knowing any better, I used to forget and give night meds in the morning, omit some drugs without telling the nurse because I really didn't know any better. This is the same for the aides that may be doing this for you. I remained at this job for 12 years, and once I was written up for missing a dose of colace. But, that was no big deal; I went to the union, who blamed the nurse for not enforcing to me the importance of getting that medication each day. About 6 years down the road, they took the certification away from us for way too many errors. There were things worse than that that other aides did. The unruly patients were double and triple dosed so that they slept all day long. And, I am sure nurses were blamed. Now, as a nurse, I shudder when I think of how lightly I took that responsibility. There is no way to make the aides realize the seriousness of this because ultimately, they are not as responsible as the nurse. A write up is nothing compared to the possibe litigation you may experience.

tudugger · Oct 22, 2007

Hmmm, I'm also in Oregon; what a coincidence!! I have a daughter named Melanie also. My prayers are already with her and will be daily. Thank you so very much for your feedback/infomation.

tudugger · Oct 22, 2007

I work 20 hrs/week doing oversight of what Medication Aides do and performing audits of systems. I am not required to do skills; the corporation does not employ me to do that sort of work. I am not there enough to do skills anyway. I am the only RN on site and that is only 20 hrs/week. Thanks to all!!!

CHATSDALE · Oct 22, 2007

i wouldn't thnk that this would be advisable, if you are presented with this is the direction we are going then it might be advisable for you to give notice, with the understanding that you will do jobs that are best served by a competent nurse..

sometimeas this happens even with jobs that suit you in every other way

leslymill · Oct 22, 2007

Well, I can at least say that your administrator asked for your input. What lead to this conversation? Did you say that you needed assistance, or are they short of nurses? Or was she asking you, but really saying that this is to be?
If you have a choice in the matter, I would say no, I'd rather do it myself.
I used to be a certified AMAP at a psych hospital. Had about a week of med administration training when I was in my very early 20s. Not knowing any better, I used to forget and give night meds in the morning, omit some drugs without telling the nurse because I really didn't know any better. This is the same for the aides that may be doing this for you. I remained at this job for 12 years, and once I was written up for missing a dose of colace. But, that was no big deal; I went to the union, who blamed the nurse for not enforcing to me the importance of getting that medication each day. About 6 years down the road, they took the certification away from us for way too many errors. There were things worse than that that other aides did. The unruly patients were double and triple dosed so that they slept all day long. And, I am sure nurses were blamed. Now, as a nurse, I shudder when I think of how lightly I took that responsibility. There is no way to make the aides realize the seriousness of this because ultimately, they are not as responsible as the nurse. A write up is nothing compared to the possibe litigation you may experience.

Thanks for your honesty. That is an eye opener and a little....no a lot scary.

Daytonite, BSN, RN · Oct 22, 2007

You're an RN and presumed to know your state nurse practice act. Check your state board website and see if there is a position statement on this. However, my first thought would be, what if something goes wrong? Who would be responsible? Probably you if it ever went to litigation.

classicdame, MSN, EdD · Oct 22, 2007

I believe if the UAP is Certified (through a specially designed program, either inside or outside the facility) they would be able to do this task. However, it would still require an RN to assess the patient appropriately. This could be construed as a discretionary task - like checking blood sugars. The UAP would need parameters to know when to notify the nurse. If you check for residuals then let someone help administer the bolus that COULD be ok - as long as you are comfortable with the UAP's competency. Remember, you cannot delegate away your responsibility. So if you are not comfortable with someone else doing it, you have to do it.