CNA's passing meds - page 12

1. 
   Sep 26, '02

   Occupation: LPN, Volunteer Fire Fighter Joined: Sep '02; Posts: 173; Likes: 5

   I'm sorry if I lost my temper earlier. It just frustrates me when LPN get mad at RN saying "I don't want to be responsible for what my LPN does" and then say the same thing about CMAs.
   
   At my facility the CMAs have somewhat of a supervisory position over the CNAs. We do our rounds every two hours and make sure the patients are dry, turned, ask them if they need anything. Check on things the LPN or RN wants us to check. And report anything unusual about the residents back to the nurse. And if we see the CNA hiding in a closet, taking a nap and not working we bring that to the attention of the nurse too.
   
   As far as my experience goes, CMA's in Oklahoma are not here to replace "real Nurses" (you have some people say LPN's are not real nurses either). They are a very valuable resource for the nurse if proberly trained. We pass her meds (following the same Dr.'s orders and MAR as the licensed nurse would), evaluate the patients response to the meds and if anything happenes that is in the slightest remark unusual, report it to the nurse. CMA and CNA with years of experience and knowledge can be just as usefull as licensed nurses. Believe it or not, but being around you LPN's and RN's all the time, we do pick up a thing or two. I do not in any way consider myself a licensed nurse, I am very well aware of my scope of practice, and what I need to do if anything falls outside of that. I am however a person that is able to have more one on one contact with the resident, and by that I can pick up on any changes that might escape an LPN or RN who is racing down the hall trying to get the work done that she cannot delegate to anybody else. I hope that more states take the opportunity to use this resource to help the patient recieve better care.
2. 
   Sep 26, '02

   Occupation: RN, PI Coordinator at NM State Veteran's Home Joined: Sep '02; Posts: 20

   MarcusKspn,
   
   Having begun as an orderly and now serving as an MSN (after having served as an LPN) and having worked in a variety of settings, I understand what you say. You should consider entering nursing school. We need more like you in positions of change.
   
   Thanks again and continue to speak up.
3. 
   Sep 27, '02

   Occupation: home health aide Joined: Sep '02; Posts: 9

   [QUOTE]Originally posted by mario_ragucci
   [B]How can that be? exactly what they are thinking
   
   unforunately, yes I am serious. It was on the 4th floor medical unit in an area hospital. HOWEVER, I did not say I did these things I said I was asked to do them. Fortunately I have been blessed with a great supply of common sense and know my scope of practice which as a cna is primarily patient care, adl. Needless to say when I told my instructor of this she was not at all happy either. I replied to this message only to say that there are times when cna's are asked or told to go beyond their scope and because they are afraid to say NO for whatever reasons they get into hot water; as well as the patient and co-workers. I am a great believer in education and and do not feel comfortable doing anything without a true and complete understanding of the task at hand an then only if I am permitted to do so by the nurse practice act.
4. 
   Sep 27, '02

   Joined: Nov '00; Posts: 931; Likes: 18

   I checked with my BON concerning its position on unlicensed personnel passing medications. I learned a couple of things I didn't know or hadn't thought of.
   1. The CMT must have DOCUMENTED training, experience and compentency before performing the task.
   2. The NURSE delegating the task MUST HAVE documented experience, competency, and training before delegating the task, as well as demonstrable DELEGATION SKILLS.
   3. The nurse remains legally responsible for the delegated task and assumes ALL responsibility for the task, even though performed by someone else, although the unlicensed person has legal responsibility as well.
   4. No nurse may delegate ANY task unless he/she is able to appropriately supervise and monitor EVERY aspect of the task.
   
   My BON suggested that all nurses who use CMTs to pass meds become familiar with the Delegation Decision-Making Tree
   
   http://www.ncsbn.org/public/res/uap/delegationtree.pdf
   
   and the Delegation Decision-Making Grid
   
   http://www.ncsbn.org/public/res/uap/delegationgrid.pdf
   
   from the National Council of State Boards of Nursing. If the situation does not ENTIRELY meet the criteron for delegating, then DO NOT DELEGATE THE TASK.
5. 
   Sep 27, '02

   Occupation: RN, PI Coordinator at NM State Veteran's Home Joined: Sep '02; Posts: 20

   Youda,
   
   We are entering into the design porition of the CMA proposal; these two elements will likely be useful. Thank you.
   
   It might also be useful to point out that they will only be effective in supporting a nurse who chooses to not delegate a task if the authorative bodies (including the employer) accepts them. Otherwise the nurse is asking, at the very least, for an employment-based confrontation with their employer, (please remember the borrowed-servant doctrine that allows employers to assign duties to employees that are not necessarily within the scope of their profession). In most cases medication administration by a CMA is not a delegated task, it is a formal position and role that the nurse does not have a choice about. To refuse to supervise a CMA in that case could amount to a very serious employment related issue; could cost a nurse her/his job. The nurse would need to be able to show that there were some real or potential jeopardy involved in a specific circumstance probably even with a specific individual; not just a principle-based concern. Especially if there were no other problems with the CMA program.
   
   Nurses who want to use these to support a decision of no-delegation should check to see if they have been supported in case law before they take a stand.
   
   In researching this issue I note that where the CMA/T is being used there are requirements for BON approved curricula, educators, and BON driven testing. In NM ICF-MR facilities, (where the CMA is currently in use) the CMA is responsible directly to the BON for their practice and to their employer for their performance.
6. 
   Sep 27, '02

   Occupation: Health Department gopher Joined: Sep '02; Posts: 1

   I am going to college to get my CNA and it's crazy to think that they are letting CNA's pass meds in other states. In my area, they don't. I wouldn't do it, simply because I could get in serious trouble if someone ever got sick from it. It's not a CNA's job to replace the nurse's place as a primary care provider. Next to the doctor, the nurse is the boss and is a hell of alot more qualified to determine if a patient needs the meds in question. It scares me to think that once I get my degree, I could end up working in a facility that allows CNA's to pass meds and, if that CNA is below me, I could be liable if she/he screws up. I sometimes wonder if it will all be worth it.
7. 
   Sep 27, '02

   Occupation: RN Joined: Jan '02; Posts: 1,732; Likes: 1

   "RN's practice under the supervision of a Doctor."
   According to the Nusing practice Act; Nurses are "autonomous" meaning that after two years of nursing and passing the state boards if I so chose I could write my name on a shingle hang it outside my door and begin my practice. As long as I stay within my scope of practice as a registered nurse I will never have a problem. If, however I was to step out of my scope of practice then and only then would I be accountable for those actions. I do not nor will I ever be accountable to a Dr. We work as a team. There is a difference in the scope of practice and this is where this discussion should go. there is no way a CNA should be passing meds of any kind. nurses this is fair warning, refuse to allow it in your facilities. Someday nurses will be non-exsistant if you allow this to continue.
8. 
   Sep 27, '02

   Joined: Nov '00; Posts: 931; Likes: 18

   It was really helpful for me to hear my BON's "position statement" regarding CMTs. I forgot to mention earlier that the reason CMTs are allowed in Missouri at all is because of the nursing shortage, and because some institutions want to hold down the cost of health care. Otherwise, no CMTs! It was also enlightening that in Missouri, a LPN can NOT delegate the task of passing meds to a CMT unless the RN delegates the LPN to delegate the task (because LPNs are under the "direct" supervision of a RN, and are not trained for safe delegation of nursing tasks to unlicensed personnel). Something else to think about.
9. 
   Oct 10, '02

   Joined: Oct '02; Posts: 2

   I'm in NC going through the LPN Program. We had our last week at the nursing home. They also had people from the health occupations class there. They were giving out meds. I was shocked. I'm mentioning it to my instructor as I don't see how that's being allowed. Some of these kids were still in high school.
10. 
    Oct 10, '02

    Occupation: LVN in a LTC facility. Specialty: Mostly LTC, some acute and some ER, ; From: US ; Joined: Oct '02; Posts: 1,401; Likes: 126

    I am a CNA in the state of California, and it is SOOO Illegal to pass meds here. A CNA can loose their license for doing such a thing.
11. 
    Oct 10, '02

    Occupation: RN Joined: May '01; Posts: 124; Likes: 4

    In New York State, there is an exception in the Nurse Practice Act that allows people who complete a Medication Administration Certification class to administer meds in facilities for the mentally ill and MR/DD. The course is "suggested" to be 40 hours in length. Of course it is also mandated that an RN watch the med certified person pass meds ONCE A YEAR. When you think about all the side effects that psych meds cause....Extra Pyramidal Syndrome and Tardive Dyskinesia - and the fact that these side effects are potentially IRREVERSIBLE.............scary isn't it .......This is what made me leave the OMR/DD field.
12. 
    Oct 10, '02

    Occupation: RN Specialty: 7 year(s) of experience in ICU, nutrition ; Joined: Jan '02; Posts: 905; Likes: 281

    You'll never convince me that a CNA/CMA/med tech should be passing meds. There is no way in hell I would have a person working under me, with my license on the line if they make a mistake, passing meds, I don't care how benign they are.
    
    This is just another example of a way that management and hospitals have figured out to cut costs.
    
    It's bad enough that in many LTCs there is only 1 RN on staff and one LPN per shift, with CNAs to do the bulk of the work. And they call it a "nursing" home?? Not much nursing going on there if you ask me.
13. 
    Oct 11, '02

    Occupation: R.N.,STAFF DEVELOPER Joined: Aug '02; Posts: 13

    Working in RI as an RN certified in Gerentology I have been in many of the facilities and note that C>M>A>'S have been passing meds for many years. Each one of these educated people have had to go to a course, pass a qualifying exam and be oriented to this position with certian criteria being met. The nurse still does any narcs, gt meds/feedings/ injections/iv meds. The CMA does NOT count nor touch any narcotic. I have had positive feedback with this position because in my day on a busy subacute unit! I have to admit that I was resentful at first, but now appreciate the time I have to be @ the bedside doing treatments and assessments. The tech is never far from me.
    34 years of nursing have taken me from the "melting" of a morphine tablet over a b-burner then pouring the result into a glass syringe to the current demands this profession is struggling with. Do I feel comfortable with these changes? Not really, but change is inevetible....I firmly hold to basic nursing principles that will NEVER change....but I also see the need to grasp change and learn to use it wisely while striving to keep the patient safe. One thing that will never change is the fact that the nurse is the eyes, ears, advocate, leader, mentor of the assignment she accepts. Unsafe conditions should not be accepted if one feels that strongly about certian situations. Use your voice...you are the advocate for any patient or staff you are assigned to.

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