Potential new law to be passed...to help nursing shortage

nurz2be · Sep 14, 2007

hi everyone,
i am an RN student and for an assignment we must post 2 questions and have someone respond. my husband is an ADON in a long term care facility and he read an article that stated our state is going to pass a law to have med pass aides pass meds in LTC facilities. i just wanted to know if anybody has heard anything about this in their state and what your opinion is? they are doing this to cut back on the work load of nurses. do you think this is a good way to solve the nursing shortage? thanks, maggymae

I was a CNA in Oklahoma back in 1994. At that time, anyone who worked in a LTC and had their CNA could go to Oklahoma City and take the 2 day med course to become "certified" to pass meds. Once you went back to your LTC facility you were placed with other CMA's (certified Medication aides) and you went with them for 2 months on rounds. All meds that were pill form were in bubble packs,sent from pharmacy this way, with times, med information, and times to be given on each packet. Narcotics were kept in lock up and given to med aides by LPNs when it was to be given to patients. Meds in liquid form were kept in a bottle with the patients picture on the front and again amounts and info was on bottle....there was also a med chart that contained a page for each patient, their meds, and treatments and so on. Once these were done you signed off on them, by placing your initials in a little box on person med sheet.

Each shift, 7-3, 3-11,11-7 had CMAs, normally we had 2 per shift. Each was in charge of 3 wings, we had a 6 wing building, and each wing had its own cart of meds. Each shift change began and ended with a med count. LPN in charge of that shift would come in and count Narcotics and would have to sign off on outgoing CMA's med count. It had to have 3 signatures, LPN in charge of Incoming shift, CMA leaving shift and CMA entering shift.

CMA's (certified Medication aides) also went on a 2 month prep with LPN's who were the only nurses on staff except for, n our case, 1 RN who was the director. The LPNs taught the CMA's how to give B12 injections, check blood glucose levels and give insulin when needed, how to take blood pressures, how to do sterile dressing changes, how to start Foley's.

CMA's (certified Medication aides) also charted in medical charts once they had performed any type of injection of B12 or insulin, dressing changes, or Foley insertion.

How do I know this? Because I did this myself. Now, that I am in RN school I think that it is NOT NOT NOT NOT NOT in the best interest of the patient, client or whatever you prefer to call the people in your care. I PERSONALLY feel THIS IS FOOLISH to believe that after 2 days of classwork anyone could be anywhere NEAR capable of giving out meds. or performing the duties CMA's are allowed to perform.

I have a few friends who still are in this capacity as CMAs in LTC facilities.

KimmieKoo72 · Sep 14, 2007

WOW. Reading that entry really scared me! Being a new nurse if I had to delegate those types of duties to a CMA, I think my head would explode! I'm not saying these people (CMA's) are incompetent... but they do NOT have the critical thinking skills of a nurse. The fact that they are allowed to give insulin is definately not a good idea! Along with other invasive procedures! Wow. I completely agree with everyone here... CMA's should not be doing nurse type duties, and they are not going to help the nursing shortage by doing this. If anything they're going to make it harder for nurses to find jobs! I can understand how a CMA would lighten the load for a nurse... but personally I would not want the responsibility of being responsible for them in addition to everything else! :uhoh3:

Katnip, RN · Sep 14, 2007

it would be interesting to know where (what state) you are in. i work in michigan and have worked in two critical access facilities where med nurses are used routinely. both are small hospitals with maximum of 24 bed capacity, and that capacity includes the emergency department beds. that being said, the first facility that i worked at utilized a lpn to administer the meds and she is not allowed to do iv pushes. the facility that i am currently at utilizes the l & d nurse (myself or two others and only one per shift) all of which are rn's. i still am not entirely comfortable in this role even knowing what i know in regards to contraindications, adverse effects and when not to give meds. i feel that the person giving the med should know the patient. when i go into a room to pass a med, i am not able to assess whether this patient "does not look right" or has a change in mentation, or whether his/her respiration rate has changed significantly. all of those things that an rn whom has this patient for the whole nite or day will know. with an rn passing the med, it may reduce some med errors, it also increases her liability if she administers a med that the patient at that time may be contraindicated due to other factors that she cannot assess, because to her, that patient is a room number and a diagnosis. as a med nurse i sit in report and listen and try to glean as much information as possible and i will report to charge nurse any contraindications that i can recognize as the arise, but i do not believe that it is in the best interest of the patient to be utilizing this practice. if a laboring patient comes in to deliver, i am whisked off the floor with just a short report off to the charge nurse to indicate which meds have been passed and which need to be passed. if you have a med nurse that is uap with certification i can see more chances of a med being given that should not be due to an underlying factor that i am sure that she would not be able to assess. i believe that nurses (rn's) should administer their own meds because the have a more encompassing view of the patient and his or her current needs. whether one utilizes and rn, an lpn, or a certified med tech, i believe that this practice is dangerous.

this isn't about med nurses. it's about med aides. they are unlicensed employees who take a course in how to pass meds, usually less that 20 hours. there are some with a bit more.

in my in-laws old facility the med aide didn't speak english. that didn't last long. the really scary thing is often the supervising nurse is held responsible for what those med aides do or don't do.

i do believe that tptb actually believe this is a good, safe practice, when in reality you're going to see more and more med errors, some of the lethal. and who is going to get the blame? not management.

RNperdiem, RN · Sep 14, 2007

Laws are not passed to make a nurse's job easier. That will never happen.

Medication aides are cheaper to hire than a new nurse.

When there is a shortage, a nurse will hear all about how we didn't go to nursing school to do (fill in the blank) duties that can be handled by a lesser trained person. In the new scenario, the nurse would be responsible for those higher nursing functions while leaving the lesser duties to less trained personnel. Somehow, reality never works as well as theory.

This is a fancy way of saying that the nurse can be fully, legally responsible for loads more patients, become a supervisor of aides, and take the fall when things go wrong.

ann945n, RN · Sep 14, 2007

A good way to solve the nursing shortage would be to pay nursing instructors a whole lot more money. One of the reasons the schools can't admit more students is because their are not enough instructors. Problem now is that a lot of nursing instructors make less than a new grad would in a hospital setting. That is not right.

Amen to that!

lvnandmomx3 · Sep 14, 2007

A classmate of mine during nursing school worked weekends passing meds at a nursing home. Don't even think she was a CNA think she might have been an MA ans she had this job well before applying to nursing school.

jjjoy, LPN · Sep 14, 2007

There needs to be some cut off between licensed vs unlicensed give meds. At home, patients take their own meds and caregivers give meds and sometimes make mistakes but we don't say they can't take their meds without licensed supervision. What about a hired caregiver assisting with meds? These patients often has just as many comorbidities as those in nursing homes.

So how to determine the cutoff for the need for licensed personnel administering meds versus unlicensed? In an ALF with highly functional patients, no license would seem necessary. Just someone to help open bottles and the like. However, once you move to sick patients who are in a facility for close monitoring, then administration by licensed personnel is necessary. Where do nursing home patients fall on the spectrum? It gets tricky here because it depends upon the patient. There may not be an easy solution between being both cost-effective and safe.

Medic2RN, BSN, RN, EMT-P · Sep 14, 2007

Here's an idea to help the nursing "shortage", why not pass laws to make safer patient ratios and create a better working environment on hospital floors. Perhaps then all the nurses that have left bedside nursing due to the horrendous conditions will return or those that are on the floors now will decide to stay instead of "doing time" to get enough experience and running to non hospital jobs.

Call me crazy, but I would rather see that situation change than give me one more person I need to supervise to get the job done....and safely!