CNA's passing meds

fab4fan · Sep 4, 2002

Originally posted by ADONDonnaRN
Youda,
I will agree that you have several valid points. However, I still maintain that you are making blanket statements concerning LTC. I can see where you might come to your conclusions, with a long time history in LTC. However, I guess that I'am just exceptionally lucky, in the fact, that I work for a non-profit org. where ALL money goes into the support of and improvement to our home. We happen to have on staff several nurses that specialize in the different areas of which you speak. I guess it's easy for me to forget that we are the exception, not probably the rule...So you see, where I sit, Med-aides are not a "short-cut." They are simply an extra pair of hands to help us continue to give the highest quality of care possible...Where I'am at, LTC DOSEN'T have a long way to go....We have accomplished the journey..We just keep building a bigger mansion.

A bigger MANSION?????????

That speaks for itself, or else you need training in using metaphors. :rolleyes:

Teshiee · Sep 4, 2002

Six weeks is still not enough. To be a licensed nurse is 1-4 years depending on what route you take. How can you justify 6 weeks. Every day the powers that be try to take a way every aspect of nursing. It is crazy unethical and I would NEVER work in a facility that does this. No one is going to make me responsible for someone else passing meds. Then when the s*** hits the fan they will seek out a nurse saying why did you not do this or that. Pretty soon you will have 6-8 unlicensed people doing what licensed nurses are trained to do. I don't care how good someone is, get a license!!!!!!!!!!!!!!!

mboyce · Sep 4, 2002

If the only issue were getting nurses to work in NFs I don't think that any nurse would disagree that currently, the best provider to pass medications to the institutionalized elderly is a nurse. Pragmatically the issue is more complex . . . not only are there not enough nurses to staff all the open positions but the number of needed positions are most likely understated. I base that on quantitative data, not opinion. It is almost certain that there are resident needs that can only be met by nurses . . . that are not being met.

It has been this way for a long, long time and it is from this situation that the perceptions (and realities) of poor care arise.

A central question is not as simple as how to fill positions with nurses but what are the core nursing duties that residents need and what duties can be delegated. To ignore this question in the hopes that somehow nurses will arrive is to make the problem worse. I would remind nurses that there are many tasks that were at one time considered "medical" now being exercised by nurses ,e.g., collection of blood pressures. I would remind nurses that there were at one time tasks (and disciplines) considered nursing now being exercised by others, e.g., respiratory therapy, physical therapy, et al. The nurse role has evolved in the past and perhaps needs to evolve again.

Here in New Mexico we are preparing an amendment to the Nurse Practice Act to allow for a trial study of CMAs in NFs with the support of advocate groups like the BON, BOPh, NMHCA, university-based nursing programs and others because we think that medication administration can be successfully delegated. It has been shown in othe states. To read some of the comments presented here is to get a sense of fear and I am not sure that the fears are sound. I read fear for error and resident well-being, I read fear for caveat superior, I read fear for the profession of nursing.

There already are CMAs in the NM DD and NM ICF-MF settings; these programs are responsible to the NM BON and are substantially successful. We have learned that while there have been actions toward CMAs for practice issues, there has not been any action toward a supervising nurse. Other fears need to be addressed and resolved or we continue as we are; struggling to provide care without sufficient resources because we have limited our own thinking.

night owl · Sep 4, 2002

NRSKarenRN,

I know of one individual who works/worked as a "charge aide" in a fellowship nursing home on night shift in PA and she gives/gave out meds... (ie) Restoril, Tylenol, insulin. Are you sure PA hasn't approved of this? This person was doing this in 1992 when I met her. I haven't seen her in about 8 years now and she may not even work there

at this time, but...that was then. I always thought that this person was working beyond their scope of practice. Scarey...

Rustyhammer · Sep 4, 2002

Hiring "trained" med passers is not going to allieviate the nursing shortage or enable better care.

Promoting the profession and fighting for better wages and working conditions will help.

I feel that NMDD and NMMF facilities have taken a step backwards with their use of CMA's.

All facilities both acute and LTC are becoming more and more inundated with redundant paperwork and regulatory watchdogs that todays nurse must not only have his/her skills top-notch but must also be acutely aware of regulation changes, osha requirements, federal and state guidlines and regs. as well as the many legal issues.

I know there are times when we all would be glad to have the extra help to pass meds and we could concentrate on dealing with "more important issues" but it will be difficult to convince me that med aides are a viable answer.

-Russell

Flo1216 · Sep 4, 2002

I often wonder why, if tasks that were once the responsibility of RNS continue to be delegated to PCAS, LPNS, etc , do we even need RNS at all? To do all the mounds of paperwork? I always hear LPNS and others indignantly say things such as, " Well, I do the same things the RN does...I just get paid less," hmmmm.....

ADONDonnaRN · Sep 4, 2002

Originally posted by fab4fan

A bigger MANSION?????????

That speaks for itself, or else you need training in using metaphors.

What I would like to see, is you being able to discuss the issue at hand without making personal attacks on me! I am on one side of the issue, you are on the other. Period. I won't defend my earlier comments to you any more. I see the med-aide as a viable solution under well controlled and monitored situations, such as we have here in Texas. Obviously there are people that understand that concept and there are those who perhaps understand it, but still don't agree. I can see the view point of people from either side, but in simply debating the pros and cons, I see absolutely no reason to be uncivilised. I honestly believe that the program works and can be of great benefit to nurses and patient (residents) alike. Due to multiple studies, done by reliable institutions, with preset parameters, I do believe that more and more states will eventually turn to this type of solution. Anger, fear and a closed mind, won't do any of us any good. :kiss

fab4fan · Sep 4, 2002

Personal attacks go both ways, my friend. You made assumptions about my background, presuming that I was ill informed on this matter. Do you really know that? I didn't think you had to post your CV to be able to respond to a post.

I said it before and I'll say it again: There are always people who will excuse ways to de-skill nursing until a lawsuit happens, then that pesky little priciple of respondeat superior rears its ugly head, and where is the poor charge nurse. Will management defend her? Probably not...they will find some way to make it her fault. So as long as there are people who try to excuse this, I will respond with "both guns blazing." There's a real Western metaphor for you.

If this level of care is OK, then it has to be OK for all...your family and VIP's. Somehow I think a VIP would not be getting his/her meds in this manner (This reminds me of the old commercial, "I may not be a doctor, but I play one on TV...").

Healthcare on the cheap is not care. And that is my final answer.

NrseK · Sep 4, 2002

"Both guns blazing" on the issue, is one thing. However, just for what it's worth, and I'am quite sure that you won't think it's much, if your attacks on ADONDONNARN are any indicator, she simply stated her views on the subject matter, and the fact that she's a teacher.

You are the one that began the personal attacks, not her.

I work in Texas and med-aides are one of the most useful tools that can be imagined; properly supervised, and it sounds like they certainly are in her case.

I hear fear for your job more than a fear for your patients. Any nurse worth their salt will use the best of what is available to them to enable them to care for their patients, not attack someone else for doing their best.

I don't usually respond to these things, I just read. However, your unwarranted attacks on her are enough, already! I personally hope that the last post WAS your final word!!! :rolleyes:

NurseAngie · Sep 5, 2002

I am a LPN currently enrolled in a RN/ADN program and just this morning I had a conversation with a classmate who is a Medicaid nurse aid that left me a little concerned and worried. My classmate said she works as a nurse at the nursing home. I said you mean as a nurse aid..she said NO...I WORK AS A NURSE! I asked her to clarify what she had just said thinking I had heard wrong and she cocked her head to the side and repeated herself. I asked her to go into detail as to HOW she represented herself and worked as A NURSE. Apparently she is the ONLY employee on the unit at her nursing home and she does all of the nursing care for the patients.( There are nurses close by on the other skilled units.) She got really mad at me because I said that she better be careful since she was working under the license of the charge nurse! I asked her what she would do if she ever got into trouble and she said " I will drag them them down with me. I ain't goin' down alone!!!!) :eek:

I am NOT saying that this person isn't a FINE Medicaid Nurse Aide. This has got me to thinking.....and it's NOT GOOD what I am thinking at this point. :rolleyes:

Scared to stick with it,

~Angie

sunnygirl272 · Sep 5, 2002

NurseAngie-

what's a Medicaid nurse aid?

Youda · Sep 5, 2002

To turn this back to the issue . . .

One of the things I've worked very hard at is understanding the chemical reactions involved in medications. I've studied those kinds of reactions (chemistry and cell biology) until I thought my brain was fried. Some would say it already was. :) But, in learning those chemical reactions, and what happens at a molecular level when a chemical compound is introduced into the body via a medication, gives me a different perspective on the idea of medication aides. As mundane as a med pass often becomes, we are still initiating some very real actions on tissues and muscles. A med aide can certainly watch for "side effects" and "adverse reactions" if they are listed in a PDR or whatever drug book they happen to use. Yet, it makes me very uncomfortable that they can't evaluate the drug's effects until that reaction becomes so pronounced that it would be obvious to anyone.

In all my previous posts on this topic, that is the one element that no one has commented upon. The fact that these CMTs/CMAs, no matter how conscientious or kind-hearted or dedicated they may be, can NOT evaluate a medication's effectiveness, whether or not the med is achieving it's desired effect, or whether it is causing a drug interaction or indiosyncratic effect or adverse reaction. These meds often start "working" within 20-30 minutes via a po route, immediately when via nebulizer.

How can the nurse doing ANYTHING else, no matter how "important," evaluate the results of these meds if he/she isn't there on the floor to see it?

There's talk of fear being a factor in this thread. I'm not talking about this from a fear point of view. I'm talking about this as a part of the responsibility of delivering a medication to a client, part of the "nursing process." The evaluation is just as important as giving the right med to right pts., at the right time, etc. How can we possibly forget the evaluation process and deem it unnecessary? How can you evaluate if you aren't giving the med? How can such an important part of our care and treatment be delegated? How does the nurse know, for example, when Lanoxin is being effective if the NURSE isn't the one listening to the apical pulse before administering the med?

I fear, yes. I fear that those who are proponents of this are doing so from a lack of understanding or knowledge about the effects of medications and the entire responsibility for that, a lack of exposure, perhaps, to the fairly recent changes in Standards of Care, and the ANA's position on the "Nursing Process." Please don't take that as a putdown. If it sounds that way, it is a lack on my part of finding the appropriate words, or less offensive language.

I've sat here for two days reading the "pro" posts and trying to have an open mind to new ideas and ways of doing things. But, I just can't shake off this feeling that surely you've forgotten, or don't understand, that "evaluation" is just as important as the "implementation" of ANY aspect of nursing. A CMA/CMT is not qualified to evaluate without assessment and critical thinking skills.

Sorry I've taken up so much of the baud rate on my thoughts.