Unlicensed personnel administering medications - page 2

I recently moved to a new state that has very different scope of practice laws than the state where I come from. I was trained as an RN to take my responsibility of administering medications... Read More

  1. by   Have Nurse
    We too have T.M.A.s (Trained Medical Assistants) to give orals, eye drops, ear meds and topicals. But nebs and insulins, no. The nurse has to do those due to assessments of lungs and also doing blood glucose. Injectables are invasive so we don't allow that duty to fall on the T.M.A.s.
  2. by   Ddestiny
    Before I went to nursing school I was a Certified Medication Aide (basically a CNA plus additional hours of learning about medications, how to administer them, etc) at a couple different LTC facilities. We could give POs, eye drops, ear drops, suppositories, topicals and inhalers/nebs. In my state we could not give injections but I remember in the workbook from which we did some of our CMA homework, there was a section for insulin injections so some states must allow it.

    At the time I felt fairly comfortable with it but after going to nursing school and learning how much I really *didn't* know....also, we weren't allowed any room for critical thinking and we could not hold any medications unless we were told that the patient was NPO. So, for example, when one of my residents was having nausea/vomiting/diarrhea for a couple days, I technically wasn't supposed to hold her Lasix so I got a bit of a finger wagged at me for doing so even when it was agreed that it was probably the right thing to do. In one of my facilities it was Assisted Living so we only had a nurse available during office hours. The CMAs were the leaders of the shift. If there was an incident or fall we had to call someone over from another building.

    I think there are some great CMAs and some that really don't really appreciate the weight they carry and their ability to influence others' lives and health. It probably is equivalent to any other field where the employee is very busy, under strict time constraints and expected to fulfill a very important but repetitious job. It is a lot of responsibility for literally $0.50 more per hour. It scares me that some people don't take appropriate precautions, or may not have been fully educated about them in the first place. I can't give insulin in a hospital setting without having another RN dual-sign with me -- why is it only one CMA or one LPN/RN in LTC appropriate?

    Bottom line, I can appreciate some concern about having unlicensed personnel administering medications. I don't equate it exactly the same as having family members administer meds because you're giving it to *so many* with so many different circumstances, and honestly have less room to use any kind of critical thinking. I feel like having a nurse administer meds acts as a "check and balance" for the providers that order since they can make sure there aren't interactions, duplications, odd dosing, etc but you can't expect that from a CMA and they often work in areas where they don't have their own pharmacies available 24/7 to answer questions. I don't consider it to be an ideal situation.
  3. by   slauren
    I live in Florida. When I worked in LTC/rehab, only the nurses gave the medications. I once interviewed for a job at an assisted living facility and the techs administered medications. I was curious about that myself and they explained that assisted living is still offering the residents independence, it's just someone to make sure they take the right medications at the right times. For the facility, there was only one nurse (position I interviewed for) and it was checking on the residents and being available to help, I believe also managing doctor appointments. I didn't take the position, I now work at a hospital, they are no longer accepting LPNs, therefore, only the nurses give medications there.
  4. by   verene
    I was a medication aide in an ALF before nursing school. So basically a CNA with additional training in how to pass medications (or rather supervise self-administered medications). It was for PO meds only and I could provide minimal assistance for things like eye-drops. Diabetic residents who could test their own CBGs and draw up and administer their own insulin I could watch to record that it had been done. At the time it made me a little nervous but thought it was fine especially since I had the same crew of residents with the same medications every shift. It was a stable population with very few medication changes.

    After going to nursing school and taking pharmacology classes I really began to see the lack of knowledge I'd held while in this role. In retrospect I'm rather uncomfortable with what I was allowed to do.
  5. by   ivyleaf
    In our clinics, Medical assistants used to be able to give all injections (except insulin, we dont keep that in stock) including rocephin, depo, testo, b12 and all vaccines. they have recently changed the rules so that MAs can now only give vaccines (and nebs, which i didnt mention before).
  6. by   beachynurse
    I have a Certified NUrsing Assistant as an assistant, and she is able to pass out meds. When she is hired we do medication safety training, and will review it on an annual basis. It is a task that can be delegated, as the nurse is supposed to go over any medication orders that come in. I have done this for 14 years and there hasn't been an issue with medications.
  7. by   BostonFNP
    In this state they just recently passed a law that allows for me to delegate, to my (certified) medical assistant, vaccines when I am present in the building. It's a huge help to workflow, but there have also been a few (thankfully) minor incidents.
  8. by   ruby_jane
    Just make sure that if the tasks are being delegated under your license, that you're comfortable that the unlicensed staff can do the job, and is willing to do the job.
  9. by   UC nurse
    MAs have a broad scope of practice in my state. They are working under the Drs. license, so they can pretty much do anything delegated by the provider (other than starting IVs, inserting urinary catheters and phone triage). That is why in outpatient settings, you typically see RNs in the phone room. MAs are a cost savings for health care facilities and this seems to take precedence over safety.
  10. by   Amethya
    It depends where and what state you are in. I'm a CMA from Texas and we were trained on medications and administering medications. It also depends of the school we went to, mine drilled it on us the 7 rights and such, but mainly RNs, NP and MDs are responsible for us.
  11. by   sswinner
    NYC.. Its all up to the doc. I have some that give dexa shots, some that start I.V's, and others all they can do is vitals and venipuncture.
    Though I wonder why M.A's are called unlicensed. We are licensed. **Though we dont have to be** if i recall correctly.
  12. by   BostonFNP
    Quote from sswinner
    NYC.. Its all up to the doc. I have some that give dexa shots, some that start I.V's, and others all they can do is vitals and venipuncture.
    Though I wonder why M.A's are called unlicensed. We are licensed. **Though we dont have to be** if i recall correctly.
    Are there states that license medical assistants? I know there is a national certification and there are some states that require certification to practice but I've never seen a license.
  13. by   sswinner
    Quote from BostonFNP
    Are there states that license medical assistants? I know there is a national certification and there are some states that require certification to practice but I've never seen a license.
    I double checked. It isn't a license, it is a certification. I will have to make some corrections when I get to work. I think I was confused because my students keep telling me their employers ask for a license number. I'm guessing they were too lazy to change it to certificate number.

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