CNA's passing meds - page 2
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
Sep 3, '02Occupation: Registered Nurse Joined: May '01; Posts: 204; Likes: 8I agree with youda........the statement was said point blank.....I do not know what this world is coming to...there are certain things that should not be taken lightly and medication passing is not a light duty. It is here again simply saying okay.....let the person have a course on the subject then certify them to do the task without the education of why or how.....I really like being a nurse and have yet to take my boards in about three weeks but I am considering changing my profession to something else as nursing is starting to be scary because too much contorversy is flying around with professional vs nonprofessional (meaning time put in education vs less time put in education) to start doing tasks that they are not qualified safely to do....
Sep 3, '02Joined: Nov '00; Posts: 931; Likes: 18Exotic Nurse, don't quit nursing. You know what's right, so stick to your guns when the suits start pressuring you to abandon your ethics and standards of care because it's more "cost effective."
Sep 3, '02Occupation: night charge nurse in 100+ bed long term care facility (Have also done management, and nurse aide training) Joined: Sep '02; Posts: 10; Likes: 6Here in MI CNA's can pass meds in assisted care facilities. I think it is a dangerous situation. There are too many interactions that can happen. I am always looking up drugs. And a 3 or 4 week class isn't enough for such responsibility. But cost control is more important
Sep 3, '02Occupation: Enterprise Application Systems Analyst Specialty: 27 year(s) of experience in Everything except surgery ; Joined: Mar '01; Posts: 5,601; Likes: 174Originally posted by P_RN
A LOT of states have these. I didn't see SC on the list, but it probably will be soon. I can see in the future that the hospitals will convince the legislature to "help the nurses shortage" by using techs in the hospitals. Why not? Grrrrrrrrr
Unfortunately there are nursing homes, and assisted living facilites where aides do the very same thing! I took a short term contract at ...what I thought was a very nice place! What I didn't know was...when I accepted the assignment, and even when I got report...that "I" would be the only licensed person in the building...!!! This place was very close to my home, and my daugher had preformed community service there as a volunteer!
To make a long story short....during the nite I got a call...from a unit upstairs that was being manned by CNA's, who were not only giving out scheduled meds...but who were giving prn's ...such as narcotics!!! I asked one of the CNAs what training they had been given...she told me NONE...except how to look up meds...and go by what the book said!!! She told me she was afraid about giving meds...but was afraid to refuse...as she was trying to get off welfare...and didn't want to lose her job!
I won't even go into all the details...but just say that was the shortest contract on record! I called the agency up the minute I got home...and told them I would not be going back...and why! I rarely did NHs then..and now I don' t do them at all!!!
The above happened over 5yrs ago...and it's going on in other states also! No training...and nurse's aide too afraid to say no!
Sep 3, '02Joined: Sep '02; Posts: 11In response to the many negative views on the subject of "techs" or what ever your particular location refers to them as... I myself am an RN, that works as an ADON in a LTC facility. I also am a part time instructor for the local college. I teach the Certified Medication Aide class, along with the assistance of an RPh. This is a non-credit course, however, there are educational and vocational requirements that have to be met, in order for a person to participate in the course. I won't take up space deliniating these, however, suffice it to say that in speaking for our program only, it is NOT a walk in the park! We take the responsibility for the fact that these people are going to be passing medications only because we say that they are competent to take the state examination, VERY seriously. I don't know the requirements of every state that has this particular job description allowed, but we educate our CMA's very well before they are allowed to pass ANYTHING. This includes clinical time passing under the direct supervision of a nurse. Our cirriculum includes drugs, drug laws and body systems emphasizing the effects of drugs on each one, etc. As to the question posed by one writer as to if anyone had ever seen a "tech" open a drug book, the answer would be a RESOUNDING...YES Maam!!! In our LTC, we have the most excellent med-aides on the planet. They keep their drug books close at hand at all times. I'am sorry for those of you that have never had the privilige of working with a truly GOOD med-aide... They allow you to actually NURSE....Last edit by ADONDonnaRN on Sep 3, '02
Sep 3, '02Joined: Jan '02; Posts: 562; Likes: 128Originally posted by Youda
These are things I've seen in LTC when a med tech was passing meds. Not technically a "med error" but definitely a lack of skill, knowledge, and understanding of meds.
1. Res. refused to take "water pill" (Lasix 80mg/qd) because she didn't want to pee so much. CMT circled it on the MAR, but continued to give the K+ for 3 weeks. Woman went to ER with heart dysarrythmias.
2. Blood in foley catheter bag, and CMT gave coumadin as ordered.
3. CMT gave albuteral nebulizer treatment. Res. c/o chest pain after treatment. AP was 140.
4. CMT gave antiobiotic when res. c/o "itching all over."
Yeah, CMTs can put a pill in a little cup and most of the time, it's actually the right med, but they don't have the training or understanding to make critical judgment calls. It's asking a CMT to have the knowledge of the nurse, and there are plenty of disasters because of it. But, nothing will change, and it isn't because of the nursing shortage, it's because they're CHEAPER than a nurse.
To make this more bizarre is that none of the examples above were ever written up as med errors, and the CMTs were never counseled because it was "beyond their training" to have "known not to give." And, most of the CMTs I've worked with didn't even understand that they should have TOLD THE NURSE about these things!! <big sigh>
The key is communication between the nurse and the other care workers.... yeah big bad mistakes will happen when the nurse just lets the tech pass meds without getting involved. And if the tech notices anything unusual, the nurse must be told. But how is this crucial aspect of communication any different than any other configuration of care.Last edit by pebbles on Sep 3, '02
Sep 3, '02Occupation: Enterprise Application Systems Analyst Specialty: 27 year(s) of experience in Everything except surgery ; Joined: Mar '01; Posts: 5,601; Likes: 174ADONDonnaRN,
I applause your facilitiy for taking the responsiblity of teaching CMAs seriously! I'm familiar with a good program in Tx...where I have a friend who is one. However.... the eduation and knowledge that she was given, and that she possessed...was by no means the same as they aides I ran into! Like I said I won't go into details...but I instructed those CNAs to not give another med while I was in that building!!! They didn't have even a clue as to what they were giving or why!!!
And this wasn't the only place I had the displeasure of working in. I went to a facility in WA...while between contracts...and really desperate to work. It was a beautiful NEW facility...but I later found out they too had no nurses! And they too also didn't have any training beyond walking off the street, and being told they would be giving meds...as a part of their job description!! One young lady wasn't even certified as NA yet!!!And the only reason I was there...was because the state was to becoming thru! This I found out from the aides themselves! Even as desperate as I was to work...I didn't go back there again either!!!
Sep 3, '02Joined: Nov '00; Posts: 931; Likes: 18I'm sure you do a very thorough and excellent job teaching your CMAs/CMTs. But, you can't get around the fact that it is a delegated task; they are passing meds under someone else's license. I do disagree that having a CMT allows me to do "nursing." Meds are a part of nursing, too. The length of the course, if for no other reason, prohibits even the best CMA/CMT from having the same understanding, critical thinking skills, and knowledge of meds and body systems as does an RN or even an LPN. Surely no one would disagree with that fact. So, it comes down to the question of do you want someone with limited and superficial training, or someone with ALL the skills and deep learning that is necessary to safely perform a task? The bottom line, for me, is that the NURSE is legally responsible for administering the med, even if the MD wrote the order with a serious error in it. So, who takes the responsibility when a CMT gives the med? I still have that legal responsibility. So, I'll give my own meds, thank you.
Sep 3, '02Joined: May '01; Posts: 12,087; Likes: 15,948Originally posted by Youda
I'm sure you do a very thorough and excellent job teaching your CMAs/CMTs. But, you can't get around the fact that it is a delegated task; they are passing meds under someone else's license. I do disagree that having a CMT allows me to do "nursing." Meds are a part of nursing, too. The length of the course, if for no other reason, prohibits even the best CMA/CMT from having the same understanding, critical thinking skills, and knowledge of meds and body systems as does an RN or even an LPN. Surely no one would disagree with that fact. So, it comes down to the question of do you want someone with limited and superficial training, or someone with ALL the skills and deep learning that is necessary to safely perform a task? The bottom line, for me, is that the NURSE is legally responsible for administering the med, even if the MD wrote the order with a serious error in it. So, who takes the responsibility when a CMT gives the med? I still have that legal responsibility. So, I'll give my own meds, thank you.
Sep 3, '02Joined: Nov '00; Posts: 931; Likes: 18Originally posted by pebbles
Aren't those people supposed to be working under the SUPERVISION of a nurse?.... If the nurse saw blood in a foley bag and knew that a resident was on coumadin, The nurse should tell the med tech not to give the coumadin and call the dr herself. What is so hard about that? But meanwhile, the nurse has had time to do more of the rest of her nursing care because she doesn't have to spend twenty minutes getting granny to swallow her twenty pills.... Also, some of these errors could easily have been made by an RN as well... lets not get too deeply into the blame game.
As for taking 20-minutes to get granny to swallow her pills? I can think of about ten or twelve interventions that a nurse should start initiating and evaluating after a thorough assessment to deal with that problem. If it takes granny 20 minutes to swallow some pills, there's a bigger problem there than TIME. Unfortunately, a CMT/CMA wouldn't know that or how to do a good bedside assessment to find out what was wrong. Again, you make my point for me.
Sep 3, '02Joined: Jul '01; Posts: 357; Likes: 5I never realized how diverse of a problem this was. I couldn't imagine with the minimal amount of training to become a CNA in illinois that anyone would trust them to pass meds. Don't take that the wrong way, I AM A CNA, and proud to be. but i would not dare try to hand out medications with my little knowledge. I am almost done with nursing school though and will gladly do it then.
I cannot believe that any state can have a LTC facility with no nursing staff or even just one. That is insane and seems like a lawsuit waiting to happen.
Sep 3, '02Joined: Nov '01; Posts: 765; Likes: 14I don't care what training they have they are not nurses!!!!!!!! You don't see RN's doing what MD's do? So why in the world should it apply here. Sure a nurse goes to school and become an ADVANCE NURSE practitioner with his/her higher education and expertise. This is only about the dollar. But in the long run it will cost facilities that goes for this millions of dollars. I would not work in a facility that would allow unlicensed individuals to pass meds and then try to make me responsible, NOT!
Sep 3, '02Joined: Jul '02; Posts: 3,872; Likes: 18Yeesh, I wouldn't want to be held responsible for someone like that....