Nursing Issue - Medication Aides

Nurses Safety

Published

You are reading page 11 of Nursing Issue - Medication Aides

mattsmom81

4,516 Posts

I just do not understand why an intelligent nurse would agree to delegate meds to a UAP, while maintaining full liability. I just don't understand why a nurse would take this risk.

Where is the ANA and other 'voices' of nursing???? :(

This is just another example of how nurses allow others to define their role. :(

allnurses Guide

Spidey's mom, ADN, BSN, RN

11,304 Posts

I just do not understand why an intelligent nurse would agree to delegate meds to a UAP, while maintaining full liability. I just don't understand why a nurse would take this risk.

Where is the ANA and other 'voices' of nursing???? :(

This is just another example of how nurses allow others to define their role. :(

I don't understand this either except to phase out RN's and LVN's . . . what Tiffany describes as her job is one of the definitions nurse's job. Her duties are nursing duties.

Fab4fan is right - the facility that falsely represents a CMT as a nurse is headed for trouble and so is the CMT.

This is the weirdest thread . . . .

steph

Specializes in Cardiac.
I don't understand this either except to phase out RN's and LVN's . . . what Tiffany describes as her job is one of the definitions nurse's job. Her duties are nursing duties.

Fab4fan is right - the facility that falsely represents a CMT as a nurse is headed for trouble and so is the CMT.

steph

I think you are right, this is a way to phase out nurses, in the LTC setting, that is. CMTs or med aids, they will never make it to a hospital. But if you can just have one LPN and the rest are "charge aides", then that is more $$$ in the pocket.

The fact that you see no problem calling yourself a "charge nurse" shows that you lack the maturity and judgement to see how dangerous this situation is. Just because "nothing" has happened yet doesn't mean it won't

This is so well said. It really covers it all.......

nelligolitely

25 Posts

Tiffany, it sounds like you do a lot of work. I think some RN's won't admit but they just do what you do on a daily basis, and they probably make THREE TIMES what you make! Yes, a good RN knows the value of the physiology behind insulin, and all the things that can go wrong with a G-Tube or wound care, but in the hurried world we live in, I've known a few who cut corners or get comfortable just doing what you mentioned you do. You are gypping yourself out of a lot of money!

As for the title, "Charge Nurse", it seems to be the facility's brunt of the responsibility. Shame on them, but you know the scope of your practice, and your nickname isn't "TiffanyNurse" so I wouldn't worry too much. You have a good head on your shoulders. I wish you could work in NJ.

fab4fan

1,173 Posts

As for the title, "Charge Nurse", it seems to be the facility's brunt of the responsibility. Shame on them, but you know the scope of your practice, and your nickname isn't "TiffanyNurse" so I wouldn't worry too much. You have a good head on your shoulders. I wish you could work in NJ.

Not so. If she gets caught by the state, the least that would happen is she would be barred from obtaining a nursing license in the future. It would not be all on the facility. I get a flyer quarterly from my state nurses' assn. and you would not believe the number of people listed who have had disciplinary actions taken against them for falsely representing themselves as nurses. The state takes a very dim view to this.

And I would be willing to bet dollars to doughnuts that when the state inspects Tiffany's facility, the schedules they see are not the schedules that show her as "Charge Nurse."

This facility sounds like it is teetering on the brink of Medicare fraud.

tiffanycmt

75 Posts

Tiffany, it sounds like you do a lot of work. I think some RN's won't admit but they just do what you do on a daily basis, and they probably make THREE TIMES what you make! Yes, a good RN knows the value of the physiology behind insulin, and all the things that can go wrong with a G-Tube or wound care, but in the hurried world we live in, I've known a few who cut corners or get comfortable just doing what you mentioned you do. You are gypping yourself out of a lot of money!

As for the title, "Charge Nurse", it seems to be the facility's brunt of the responsibility. Shame on them, but you know the scope of your practice, and your nickname isn't "TiffanyNurse" so I wouldn't worry too much. You have a good head on your shoulders. I wish you could work in NJ.

I just wanted to thank you for your kind words. You know its positive feedback like this that really makes me want to pursue nursing. I have meant some very encouraging ppl on this site praise god for that. I have decided i have voiced my opinion on this thread enough and if there opinions havent changed by now there not going to. But i would like to say i get paid 8.00 an hour for what i do. Its not like im making the big bucks. I hope one of the nursing skills I will always have is an open mind and listen to other people thank you everyone for posting on this thread God Bless Tiffany

Kalico

151 Posts

Specializes in NICN.
i understand what you are saying and i am not caling myself a nurse i am a charge nurse @ my facility that is what they have my labeled as and that is what i work as. as i previously said the state of missouri allows certified medication tech's to 1. pass med's but we are not allowed to pass scheduled ii's. we are allowed with training from your facility to give med's thru a feeding tube (which are facility chooses not to do). we are allowed to take t.o's (which are facility chooses again not to do) but yes some in the state of missouri do. i take bs's and give insulin. i chart in the nurses notes i chart the vs when and if i put a restraint of someone and the reason the time, every possible direction i went to avoid the restraint. i chart a change in the residents condition. i chart on about everything. i have to count narc's coming on and going off. i have two aides and a unit helper underneath me on my unit. i am in charge of doing tx's. i have alot of responsibility and i would like to think i do a good job at what i do. that is why i picked the name tiffanycmt b/c i am proud of my title, i do agree the 24 hr training is just plain stupid. but between the two states i have worked @ i have had 160 hrs of class time and to numerous to count otj hours. as far as i can see everyone that posted has not worked with a cmt/cma each stae calls them something different. i'm just saying open your mind up a little and see that were nto just someone that walked in to the door and got handed the med cart. god bless tiffany

ok...correct me if i am wrong but you have to be licensed in order to call yourself a "charge nurse" of any kind. and as far as the comment in an earlier post by you, it totally appalls me that you think you learned as much as an lpn by taking a "$300" class as opposed to investing the "$7000" it takes to obtain a license and be able to say that you are truly a nurse.

point number 2: charting about actions you take to avoid putting someone in restraints and the how and why you put someone in restraints should only be done by a "licensed" nurse. taking orders should not be done by someone who is not trained and licensed.

now when i did my preceptorship in ltc there was a med aide on the floor 2 of the 6 days that i was there. the first girl had never passed meds on my hall before and didn't know the residents well enough to give them their meds, let alone know what to do when giving certain meds. the second girl never even made sure the residents took their meds. scary situations each time. i can tell you that i am glad that i will never live in missouri and hope that when i graduate with my hard-earned and worth every penny of the $20,000 adn that i never have to work in a facility that allows the dangerous practice of med aides. especially in the so-called charge nurse capacity.

SmilingBluEyes

20,964 Posts

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Tiffany, you can't be "charge nurse" because you are not a nurse. Falsely representing yourself as a nurse could land your butt in jail (which would seriously interfere with your plans to become a licensed nurse). It is unethical, to say the least. Your facility is also setting itself up for some hefty fines if the state ever found out that you are being designated as a "charge nurse." That's the law; not just in my state, but in every state.

If you want the title as a nurse, then do the work. I'm sick of people trying to do it on the cheap. The fact that you see no problem calling yourself a "charge nurse" shows that you lack the maturity and judgement to see how dangerous this situation is. Just because "nothing" has happened yet doesn't mean it won't. (Following that line of logic, why have car insurance if you haven't had an accident?)

A-MEN!

begalli

1,277 Posts

Specializes in Critical Care/ICU.

the chain of command or responsibility in nursing homes in missouri:

the administrator has overall responsibility for a facility and supervises all operations including the nursing department.

the don is the nursing departments head honcho and is responsible for the day-to-day operation of the nursing department. by law this person must be a licensed registered nurse.

under the don is the assistant don, usually a licensed practical nurse. this person is also involved with the day-to-day operation of the nursing department and also oversees all the department's employees.

next comes the registered nurse and under the registered nurse is the lpn (which by law, a facility is required to hire). by law, an lpn cannot step-up to the role or duties of an rn.

under the lpn is the cmt. a cmt can temporarily step-up to the role of an lpn if there is another lpn on duty (with limits).

under the cmt is the cna.

lpn's, cmt's, and cna's are the only employees to work shifts. they work 7-3; 3-11; and 11-7. rn's work a different schedule (eg: 9-5), but by law, must be on duty 8 hrs/day 7 days/wk. however, the employer must have an rn on call 24 hrs/day.

during the day the rn oversees the lpn. the lpn's in turn oversee the cmt's and the cna's on all 3 shifts.

the lpn's are aka "charge nurses." one lpn is assigned to each nursing unit for every shift. each charge nurse is responsible for managing their unit. when a charge nurse is absent, a cmt functions as a "team leader" for that unit. by law, the only way this can happen is if there is more than one unit at the facility and another lpn (charge nurse) is on duty. then that charge nurse from the other unit is responsible for managing not only his or her unit, but also the unit where the cmt is acting as a team leader. if there are only two units in a facility, the lpn is then responsible for the entire facility for the evening and night shifts. during this time, no other employee has similar authority. it is the responsibility of the charge nurses to make sure the facility is staffed according to state laws and regulations. if a cna or cmt becomes sick during a shift and needs to leave, the charge nurse must contact and rn before permitting an employee to leave work.

rn's evaluate the performance of lpn's (charge nurses) and lpn's evaluate the performance of cmt's and cna's. the lpn cannot hire/fire/promote, but they do provide in-services for certifications.

http://64.233.161.104/search?q=cache:mngviiojlbej:www.dolir.mo.gov/sbm/boarddecisions/decision/94-017.pdf+missouri+certified+medication+techs&hl=en&start=6

what i wrote above is part of a descriptive court case i found online (the link) that describes the hierarchy for personnel in a nursing home. it's dated 1994, but as tiffany said, cmt's have been around a long time. the thing i found interesting about this document is no where does it describe the authority of a cmt to be one of, or similar to, a professional licensed person.

the following is from the rules of the department of health and senior services, division 30, chapter 84, title 19 csr 30-84.020 (certified medication technician training program). state of missouri:

(3) the objective of the certified medication technician training program shall be to ensure that the medication technician will be able to--

(a)prepare, administer and chart medications by all routes except those given by the parenteral route;

(b)observe, evaluate, report and record responses of residents to medications given;

©identify responsibilities associated with control and storage of medications;

(d)identify appropriate reference materials;

(e)relate side effects, interactions and nursing implications of common medications;

(f)identify lines of authority and areas of responsibility; and

(g)identify what constitutes a medication error.

(4) the course shall consist of at least sixty (60) classroom hours of instruction and a minimum of eight (8) hours of clinical practice under the direct supervision of an instructor or licensed registered nurse (rn) designated by the sponsoring educational agency, including a minimum of a two (2)-hour final practicum in a licensed icf/snf and a final written examination.

http://www.sos.mo.gov/adrules/csr/current/19csr/19c30-84.pdf

how on earth could one know "nursing implications" if they're not a nurse?!?

much of these laws i found are contradictory (is that a word?) and confusing.

apparently this certification course can be challenged if a person meets a certain criteria. this is quite alarming, imo. there is special and separate certification required so a cmt can administer insulin.

missouri revised statutes, chapter 335, nurses, section 335.076 says:

3. no person shall practice or offer to practice professional nursing or practical nursing in this state for compensation or use any title, sign, abbreviation, card, or device to indicate that such person is a practicing professional nurse or practical nurse unless he has been duly licensed under the provisions of sections 335.011 to 335.096.

http://www.moga.state.mo.us/statutes/c300-399/3350000076.htm

i am charge nurse." - tiffanycmt

no person under any circumstance should take the title of rn or lpn unless they are licensed to do so. it is against the law in any state. the facility at which tiffany works needs to change their "charge" wording to "team leader" when a cmt takes on that role. cmt's are not charge nurses. they may play a leadership role when an lpn (charge nurse) is not available on their particular unit, but they are still under the supervision and are the responsibility of another lpn (charge nurse) on duty somewhere in the facility. they are not supervisors and do not "run" a unit. i blame the facility for not being clear on what the role of their cmt's are.

medication aides may administer or assist with medications. injections must be administered by a licensed nurse or physician except that insulin injections may be given by a certified medication technician or a level i medication aide. medications must be reviewed by a pharmacist or registered nurse every other month in level ii facilities and every three months in level i facilities.
http://www.carescout.com/resources/assisted_living/state_policies/mo.html

so nowhere, at any time, do placing restraints, taking orders from docs, or giving "treatments" come under the rules/regulations/laws of cmt's in missouri. the laws specifically state that a cmt is not trained to give parenteral meds. tiffany, you must understand that this is not a personal attack on you. this is about the law which is created to protect vulnerable folks from the vultures who don't give a crap about them...only about saving a buck and doing things as cheaply as possible. even that gets into a whole new can of worms where healthcare and senior care comes into play in this country. it goes so much deeper and is so screwed up. you must look beyond the surface.

i wholeheartedly believe that you are being used and abused by your facility. they have you illegally doing nursing work for a very cheap price that could, if they got caught, turn into a very expensive price to pay for cutting corners. this is exactly what nursing fights. not because we are afraid of people like you taking our jobs, but for patient safety and the safety of our licenses. there is a reason for all of these long-winded, complicated laws.

you want to be a nurse? well, we want you! you need to open your mind! start thinking like one though and explore exactly what is taking place at your facility. read the laws and know what your scope is. refuse do to anything outside of your scope. you need to look at the big picture, not just how it affects you, but how it affects the greater good of patient care.

just because someone says it okay to do something doesn't make it right or legal.

begalli

1,277 Posts

Specializes in Critical Care/ICU.
I have decided i have voiced my opinion on this thread enough and if there [their] opinions havent changed by now there [they're] not going to. But i would like to say i get paid 8.00 an hour for what i do. Its not like im making the big bucks. I hope one of the nursing skills I will always have is an open mind and listen to other people thank you everyone for posting on this thread

No, you will never change anyone's opinion because we base our opinions on fact and law, not on emotion. If you want to work as a CMT within your scope with the training required by law in your state...that's great! But you'd better believe that most nurses will STILL, knowing what we know about patient care and the delivery of healthcare in this country, oppose CMT's and we will fight tooth and nail to stop the creation of them and question the safety of the role that already exists.

You know, I'm not trying to change your "opinion" either. I just want you to open up your eyes.

leslie :-D

11,191 Posts

hi tiffany,

it's obvious you take your job and the accompanying responsibilities very seriously, and for that, you are to be commended.

yet when you comment that there are people/nurses that need to open their eyes, it works both ways.

if the state ever walked in unannounced and saw what you were doing, the facility would probably lose their medicare/medicaid funding and in great danger of shutting down.

for your superiors to state/write you're acting as charge nurse is as fraudulent as it gets.

as others have stated, they are using you, and saving themselves approx 70% of hourly wages by imposing these duties on you. yet their risk of liability is priceless.

i strongly suggest you contact your state's board of nsg and anonymously ask them if what you do is within the scope of a cmt's practice. THAT should open your eyes to the reality of your situation. you can just ask if a cmt is able to do a,b,c,d......you'll get your answer there.

i think you'll be an awesome nurse but just because you chart in nurse's notes and you're called charge nurse, still does not make it so. it's just downright illegal and dangerous.

best of luck.

leslie

Home Health Columnist / Guide

NRSKarenRN, BSN, RN

10 Articles; 18,296 Posts

Specializes in Vents, Telemetry, Home Care, Home infusion.

dear tiffany:

i am glad to see that you are a conciencious cmt who loves the work they are doing.

bengalli is 100 percent correct here:#129 and so is earle58.

your facility by labeling you "charge nurse" when you do not hold a nursing license is opening themseleves and you to a potential lawsuit in case of any adverse patient event. if you call yourself charge nurse to other cna's in your facility and or family members confer with you as "charge nurse", your dream of a nursing license can be swept away under missouri laws if this is reported to the missouri board of nursing. as a "prudent person" it would behove you to bring these concerns to your supervisors and request that future schedules have you listed as team leader.

regulations for certified medication assistants are listed under department of health and senior services, division of health standards and licensure, training program for nursing assistants

http://www.sos.mo.gov/adrules/csr/current/19csr/19c30-84.pdf

utilization of unlicensed health care personnel

http://pr.mo.gov/nursing-focus-unlicensed.asp[/url]

the mission of the missouri state board of nursing is to assure safe and effective nursing care in the interest of public protection. the board of nursing has the legal responsibility to regulate nursing and provide guidance regarding the utilization of unlicensed health care personnel. the board acknowledges that there is a need and a place for competent, appropriately supervised unlicensed health care personnel to assist, but not replace, licensed nurses.

unlicensed health care personnel who perform specific nursing care tasks without benefit of instruction, delegation, and supervision by licensed nurses may be engaged in the practice of nursing without a license. such actions by unlicensed health care personnel are a violation of the missouri nursing practice act [335.066(10), rsmo]. unlicensed health care personnel remain personally accountable for their own actions.

the missouri state board of nursing recognizes that activities of unlicensed health care personnel need to be monitored to protect the health, welfare, and safety of the public. registered professional nurses may teach, delegate, and supervise licensed practical nurses and unlicensed health care personnel in the performance of certain nursing care tasks [335.016(9)(e), rsmo; 4 csr 200-5.010 definitions]. under the direction/supervision of registered professional nurses or persons licensed by a state regulatory board to prescribe medications and treatments, licensed practical nurses may teach, delegate, and supervise unlicensed health care personnel in the performance of specific nursing care tasks [335.016(8), rsmo; 4 csr 200-5.010 definitions].

registered professional nurses and licensed practical nurses must make reasonable and prudent judgments regarding the appropriateness of delegating selected nursing care tasks to unlicensed health care workers. licensed nurses must ensure that unlicensed health care personnel have documented, demonstrated evidence of appropriate education, training, skills, and experience to accomplish the task safely. carrying out responsible and accountable supervisory behavior after specific nursing care tasks are delegated to unlicensed health care personnel is critical to the health, welfare, and safety of patients [335.016(9)(e), rsmo; 4 csr 200-5.010 definitions]. licensed nurses who delegate retain accountability for the tasks delegated. to assist licensed nurses to competently perform the critical processes involved in delegating, the missouri state board of nursing subscribes to the use of the national council of state boards of nursing's concept paper on delegation and delegation decision-making tree available at the national council of state board of nursing's web site address, http://www.ncsbn.org/public/regulation/delegation.htm

missouri state board of nursing

http://pr.mo.gov/nursing.asp

use of the term "nurse" by unlicensed assistive personnel (uap) or non-nurses

titles, r.n. and l.p.n., who may use.

http://www.moga.state.mo.us/statutes/c300-399/3350000076.htm

no other person shall assume any title or use any abbreviation or any other words, letters, signs, or devices to indicate that the person using the same is a licensed practical nurse/registered nurse.

use of fraudulent credentials prohibited.

penalty for violation.

335.096. any person who violates any of the provisions of sections 335.011 to 335.096 is guilty of a class a misdemeanor and, upon conviction, shall be punished as provided by law

a few perspectives on unlicensed assistive personnel

we would hate to see your lack of understanding of state regulations cause you be convicted of a misdemeanor which would make you inelligible to attend nursing school.

form your description, you are working under the lpn's delegation. make sure there is a policy/procedure at work to cover you. protect yourself, ok?

+ Add a Comment