HELP! Am I asked to be doing something SAFE and Legal??

[newtonursing123]

Hello,

I am a new CNA. I have been working in home care. I was recently asked to covertly administer medications (I have been a medication (certified) aid) before. Also, for the family, there are two people needing care. One with a serious chronic illness (male) the other a female with memory care issues. The family wants me, ME (5 foot 5, 125) to lift the male (non-ambulatory, no lifts, hallucinations, late stage disease) who is at least 6 foot 4? and 150 pounds, shakes, not ambulatory, incontinent, into his wheelchair without assistance or occasionally with assistance by a family member (without medical training). AND, they want covert administration of calming medications (benzos). I don't think this is legal. The pay isn't that great!! But more importantly, how much am I putting myself AND the family at risk? I think the care manager might be losing their marbles. Do I need to report? Thank you.

[newtonursing123]

And what happens if I just can't show up?!!! I already hurt my back once!

[nurse2033, MSN, RN]

You are right to question it. If you can't safely lift the patient you must say so. And I think you know the answer about being asked to "covertly" do anything. Your CNA training should have covered what you are allowed to do. Good luck.

[nursel56]

No, it's not safe to lift your male patient in the manner you describe. In some countries they have what are called "lift laws" in which it actually would be illegal to require you to do an unsafe (for you and the patient) transfer.

No job is worth permanent disability, or a lifetime of dealing with chronic pain, or injuring your patient. Believe me, if that should happen, you'll be on your own.

Having worked as a nurse in home care, I've noticed a strong tendency (myself included) to go ahead and risk your health and well-being "just this once" or because you're being pressured to do that, sometimes by your own employer. It's not worth the risk.

As to the medication issue, from what I've seen a caregiver is permitted to administer medications following the orders of a licensed provider. If they're using the word "covertly" you can probably assume they plan to deviate from the order, so no way. You don't mention if you are employed through an agency, but both of these issues should be clarified with your supervisor, pursuant to a written policy.

This conflict between what families request (or demand) that we do vs our knowledge and experience of proper procedure is always there when caring for people in their homes, with family members who are also caregivers, and actually can teach us the most effective way to accomplish something, though obviously not always.

You absolutely did the right thing to question this and ask for feedback.

[JKL33]

You absolutely cannot administer medications except as allowed by applicable laws and in accordance with you company's policies, the physician's orders, and the company's agreements with this family. [ALL of those elements must be met, not some or any of them]. So that's a huge no.

Whether your company tells you to or not, you should not attempt to lift this gentleman. You are a human being, not a people-mover. So, if the family or your company instructs you to do this, don't - even if you must resign from the case. You need to be strong about these kinds of things because your handling of matters like this helps inform people of the kind of treatment you will tolerate. You wouldn't want to be rude, but you would want to pleasantly and firmly state, "I'm sorry but I can't safely do that."

You should report both of these concerns to your supervisor neutrally and carefully: "Mr. X's family has asked me to administer benzodiazepines during visits in the home. I have not complied with their request."

"Mr. X's family would like me to physically move him from one place to another and I am unable to do that safely so I have not complied with their request."

An important word of caution: We had a post here where a care aide was the victim of sexual abuse by a patient. As soon as the patient sensed her unease - but before the aide informed her supervisor of the situation - the patient made up a lie and reported the aide to her company. Be aware that when people feel threatened they do things like this. This family knows that what they are asking is wrong. Please inform your supervisor right away.

[newtonursing123]

That was very, very helpful. Thank you JKL, I had no idea such things happened. And, thank you all. Very helpful information. So I work with an agency, but also know people (that got me into the field) that work independently with no agency. I would assume in a case like that then they would have to take care of it themselves and say no, as there would be no protections without an agency (of course!). I will keep this information in mind as I become better trained.

[canoehead, BSN, RN]

Absolutely no way. Remember, if they go around procedures now, if you are injured or reported, they will again do whatever is easiest on them. They might say "we'll take care of you if something happens." They don't have the abiilty to fix an injury or regain your integrity. This is a no brainer for me, but as a young nurse I could easily have been sucked in by promises and manipulation. Don't waver on these issues.

[KelRN215, BSN, RN]

In what capacity are you employed and by whom?

In my state, if you are a CNA employed as a home health aide, you cannot administer meds. If you are trained as a CNA but employed as a PCA, however, you can administer most meds.

I once had a patient when I was a home infusion liaison whose stepmother was a CNA and I believe was working either as her PCA or HHA. I was teaching stepmom and Dad to administer home IV antibiotics and they had to schedule them in such a way that they weren't scheduled during stepmom's shift because she could administer the IV meds as a stepmom but not as the unlicensed caregiver.