CNA's passing meds - page 10

I have heard tales that in some states the CNA's are the ones who pass meds. I was just wondering if any of you live in any of these states that supposedly do this and if the CNA courses are more... Read More

  1. by   mboyce

    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).
  2. by   Youda
    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).
  3. by   mboyce

    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.
  4. by   mlolsonny
    Originally posted by CaliNurse

    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.

    I live in a rural area and the closest big hospital with an in-house pharmacy is 27 miles away. Not very geographically desirable.

    I actually interviewed in a small hospital nearby for a Pharm Tech job, but they needed full-time and I wasn't willing to leave nursing school for it.

    In a community pharmacy, I'd only make about $6-7/hr. And I thought the experience as a CNA/ CMT would be very valuable for the future. My SIL was an LPN before she ever had to even feed anyone, and now as an RN she feels above it.

    I work in a great facility where I'm not afraid to ask questions. It's been wonderful and I've seen many things that I would never have seen if I wasn't a student.

    I'm surprised how little Pharmacology we have learned...not much IMHO. But the pharm tech background has gotten me through a lot so far. It has definitely helped.
  5. by   beckymeds
    I am a Certified Medication Aid and have been for 6 years. I only give routine meds. Any prn meds are decided by the nurse. I personnally do not see how our nursing homes in my state could survive without them. This is coming from my scheduling side. Most CMA's that I have worked with are more familiar with pills than the nurses are because that is all they do. CMA's should in no means be a replacement for nurses. When used properly they are a huge help for nurses to spend more time assessing and caring for patients than passing carts. Just my opinion. For the record meds are not enough, which is why I am currently in school for my R.N. Speaking from that aspect I don't know how I would feel about CMA's. I guess maybe my opinion will change. For now though I know that I am improving the care for my residents because they get more time from the nurse I work under.
  6. by   Youda
    Originally posted by mboyce
    Not yet read a valid argument? You need to reread the postings, you're ignoring what people are saying.
    Yeah, I've read every one of the posts of this thread. And, I have been listening. Just because I don't agree with you, or that you haven't been able to change my mind, doesn't mean I haven't been listening or that I've ignored points just because they're contrary to my opinion.
    The problem is not the nursing shortage . . . the problem is umet patient needs.
    Just the same song sung in another verse.
    Last edit by Youda on Sep 18, '02
  7. by   Nurse_Bonita
    I an a first year ADSN and a Patient Care Tech or CNA whatever. I cannot believe they would be insane enough to let someone with the minimal training that we get pass meds. I have also hear of student RN's who work as CNA being allowed to pass meds. I, for one, would never want to do such a thing. It is unsafe and unwise. If I was asked to pass meds I would laugh at them and tell them they had better wait until I am a fully trained ASN. I can't believe that !!!
  8. by   Spstudent
    Hi all,

    This really upsets me!

    I am from Connecticut, and I am a student nurse in a BSN program. I also work as a "PCA," which is basically equivalent to CNA, only I am in a hospital setting. Under NO CIRCUMSTANCES are PCA's allowed to pass meds!! We cannot have any contact with medications, and we are not even allowed to disconnect oxygen to bring a pt. to the bathroom (we all do, but we are not supposed to.)

    When I am in clinical for school, we are required to have a decent amount of knowlege about every medication we give a patient, and are not allowed to administer them without the supervision of a nurse!

    I think it is very poor judgement on someone's part to allow any untrained, or slightly trained individual to pass medication!

    Just another example of cost-cutting, I suppose.

  9. by   Sekar
    I've worked at all levels of Nursing in the last 26 years. I've been on the bottom and on the top of the field. I've even taught nursing for a couple of years. Certain tasks can be delegated and certain ones cannot. The dispensing and administering of medications should only be handled by LICENSED personnel. We are the ones that are accountable if something goes wrong.

    I've been in facilities that used CMAs, CNAs to pass meds but they NEVER passed them on my shift and they never will. Certain levels of training and education are necessary to obtain a Nursing license and that is why there are licenses in the first place. The margin of error in medications is too thin to allow an unlicensed person to pass medications. True licensed personnel make mistakes, but they tend to make less of them than unlicensed personnel. There must be a line drawn on who can and who cannot pass medications. That line was drawn years ago, that line is our Nursing License. Certifiations and extra training programs DO NOT make it acceptable for an unlicensed person to pass medications. LPNs are, and should remain, the entry level of training and experience necessary to pass meds, NOT CNAs nor CMAs with extra training.

    The cure for our dilemma of not enough Nurses is as complex as the issues that caused it in the first place. The solution is many faceted but one of the facets should NOT be to allow unlicensed personnel, no matter how dedicated and educated, to pass medications. If they want to pass meds, let them go to Nursing school and pass the state boards.

    If some of you out there are willing to risk your license on letting unlicensed personnel pass meds, be my guest. It has not and WILL not be allowed on my shift using my license. If the facility I work at chooses to allow unlicensed personnel to pass meds they will do it with one less nurse on their roster.
  10. by   mario_ragucci
    Originally posted by happy
    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.
    little cna is in the top 3 of her class of 70 :-)
    How can that be? You must mean on a dummy, right? Would you let a cna do a Heperin flush on one of your PT's? How could that be? I'm sorry, and am not calling you a liar. I wished someone would ask me to do that, after they showed me and told me exactly what they are thinking and doing completely with the PT. I'm sorry :-(
  11. by   CaliNurse
    I have not seen this position first hand. I frequent this thread to read the updated posting becuase it has really blown me away that this exist out there.

    After reading this tonight I am wondering how many people would like to be in court defending the actions of those who work under them and now it will be medications passes by CNA's that will be defended. I can see this coming. I wonder what patients think.

    I just don't think as trained as trained is for their ? ??? position that they have enough to pass meds. For two years I stayed up late studying the drug cards that I had to make for my instructors routine of questioning me at the med cart the next day before I was alowed to pass "tylenol". As nursing students we can't even give insulin before we study that system of the body. How can it be possible for any course to put that into a few months of training. In NURSING school you study the whole patient, you focus at each system of the body and not just the drug and side affects or normal doses.

    A few years into my career I was working acute rehab and I had a patient that was receiving thorazine for hiccups. He had a CVA. I also noted that his blood pressure was very low and his pulse very high. Everyone was so concerned about him because he had these hiccups going on for 24 hours periods one after the other. I mean hiccups in his sleep, not stop for 7 or 8 days. So, they kept giving the thorazine as order, within the normal accepted dose and frequency. He was so lethargic the morning I took care of him. I have not seen this since but IT WAS THE THORAZINE causing his b/p to bottom out and his pulse to go tachy.
    The hiccups were caused by the area of the CVA. Unfortunately there was no treatment to help him with the hiccups at that point.

    I have seen patients come in and they have a long history of taking digoxin. Their apical pulse is above 60. They have n/v. DIG TOXICITY !!!!! Thats when the nurse will call for the doctor to order a dig level.

    My point is without the proper training HOW do you know to look for these things. Its like a preprinted care plan system. You look at the problem and expect everyone to follow the normal expected signs, symptoms, and outcomes. Just as they are focusing on the medication, the tablet, the pill, the name of the medication ............. the normal dose, the normal side affects. What happens to the patients who don't fall in this window of normal? Don't they deserve a professional trained in medication administration?

    I don't think this helps that nursing shortage either. I think it puts the "nurse" further away from what is going on with the patient. So then we will end up with more staff on the floor but how effective are we to our patients needs. Do these CNA's that give meds to everyone receive report on everyone?????

    How many of you have seen a patient impacted but they are seeping feces around the fecal plug? This looks like diarrhea to the untrained eye !!!!!! How many of these patients would be given a medication to stop the loose stools when what they really need is the opposite ???????????

    This really does scare me. I feel sorry for our profession if this is the answer.

    Why are the classes limited in nursing school? Why do people have to wait to get into nursing school? Why are nurses required to do JURY DUTY when we are so short? Insurance companies will pay for illnesses to be treated in the hospital but they won't pay for preventative medicine. Why? These patients could have been treated before the point of a CVA, MI, DM, DEPRESSION, to name a few. But they do not pay for weight reduction until there are medical complications. Why?

    Our health care world is so full of stress which is difficult for employee retention. Why aren't we taking action to reduce stress and help our staff handle the stress that we can not reduce? I have seen nurses leave the field after 15 years and start over in a less paying job ..... due to stress.

    I know I am getting off the subject of CNA's passing meds but it is indirectly related.

    This is just my opinion but I don't see one benefit to CNA's passing meds!

  12. by   mboyce
    If this were only an academic discussion the con arguments might be reasonable but it's not, and they're not. There are residents in nursing homes not getting the care they need, right now, for several reasons:

    1. There aren't enough nurses;
    2. The nurses who are there are physically and emotionally fatigued;
    3. The need is being understated;
    4. Change is not being considered even though the wailings are familiar . . . find more nurses.

    What about the 17 states that are using them successfully . . . what about the experiences (and I emphasize experience not opinion) of the people (nurses and non-nurses) on this site who report success?

    What would you say to the person who needed to be assessed for impaction or pain or any other symptom but had to wait because the nurse was passing medications or otherwise occupied with an unreasonably large resident group?

    What would (will) you say if it were your person in the bed?

    What do you say to the nurses who need the help but can't get it?

    and what will you say when its your turn to be in the bed?

    I read, "what ifs" . . . but no account from anyone who has been acted against for a CMA error (and I stress Certified Medication Aide, not CNA), only speculation and fear. I read accounts of nurse errors, despite their formal preparation . . . I would suggest that pragmatic circumstances lead to errors as much as anything. The USP-ISMP medication error program attributes errors to product issues, dosage miscalculation, errors in drug interpretation, mental fatigue, and availability of stock medications. Another source cites four major reasons, inadequate knowledge or skills, failure to comply with policies or procedures, failure in communication and disruptive personal experiences. These are nurses, not CMAs.

    It troubles me that nurses won't consider innovative approaches to problems that cause others to suffer even when the data support the intervention. In nursing homes I think some nurses believe that passing medications is nursing, that it has become their core work task and they are threatened by having to step up to nursing process. They are not looking beyond the pill, that's why errors occur; suppose that you were free to assess medication effects because you weren't passing medications?

    Nothing changes much does it . . . we keep shooting ourselves in the foot and wondering why we can't get anywhere?
  13. by   Youda
    Quote, "It troubles me that nurses won't consider innovative approaches to problems that cause others to suffer even when the data support the intervention. "

    Where's this data? I want to know where I can look to see that nursing homes, (who are not mandatory reporters, who have every reason NOT to self-report med errors) have been "successful" with CMAs? I'm not asking to be inflammatory to the "pros" of this discussion. I'm asking because you accuse the "cons" of not looking at this data, and I want to see it. Prove your point here, please.

    You say patients suffer because other nurses (paraphrasing here) won't use the "innovative" approach of using CMTs. I believe that the opposite is true. That patients suffer BECAUSE Cmt's are used. If you can show me some hard data to prove me wrong, I will retract every concern that I've voiced on this thread.
    Last edit by Youda on Sep 24, '02