who's license do med techs work under?

FlyingScot, RN · Feb 23, 2009

Nobody's!

flightnurse2b, LPN · Feb 23, 2009

yours!

they don't have a license. if you are the licensed nurse on the property, you're supposed to be "supervising" them.

FlyingScot, RN · Feb 23, 2009

No...that is absolutely untrue. The only person working under your license is you. If you delegate correctly and they screw up your license is not in jeopardy. If you delegate incorrectly (ie have them do something out of their scope of practice) and they screw up then it is your responsibility because it was your mistake. Still they are not working under your license. They are working under the policies and procedures of your institution.

flightnurse2b, LPN · Feb 23, 2009

i thought that med techs were technically were working outside of their scope of practice and are supposed to be supervised by a LPN/RN?

i was taught in nursing school that the licensed person can take the fall for the unlicensed person who they are supposed to be supervising.

FlyingScot, RN · Feb 23, 2009

Yes we technically supervise unlicensed personnel but they are supposed to be trained to follow the policies and procedures of their facility. There is a difference between direct supervison (as in watching them as they do their tasks) and indirect supervision (making sure they are not doing things they are not supposed to do). For example. We have PCAs that do vital signs. They are taught not to take BP's over top of PICC lines as it is against policy. They are given direct supervison during their training period to assure they are applying what they've been taught. They are signed off on BPs at this time. If a PCA who has been signed off knowingly takes a BP over a PICC line and there are complications it is not the fault of the nurse who is in charge of that particular patient. The mistake was made by the PCA who disregarded what they were taught during their training. Now if the PCA has not been signed off on BPs and the nurse lets them take one anyway and there are complications then yes it is the nurses fault. Do you see the difference? In the second instance the mistake made by the nurse was allowing somebody to perform a procedure for which they were not trained and therefore is out of their SOP. If we were truly responsible for every action a UAP took then we would have to follow them around and directly supervise every little thing they did to make sure they were doing it correctly. That's why we have P and Ps and educational records and sign-off sheets and such. They take the place of direct supervisoin.

flightnurse2b, LPN · Feb 23, 2009

no i understand all that scot, but when it comes to meds, thats different. i dont follow the techs at work around at all, i trust them, but i wouldn't let them give my meds.

what if the UAP gives dig without checking a pulse... or fails to monitor respiratory status when giving demerol... or makes a med error...and the pt has a negative outcome? who calls the doctor and when you say "sorry the med tech didn't monitor the patient properly" he would say... well, why weren't you watching them... YOU are the licensed nurse??

i dunno. it's weird to me. not trying to argue, just trying to learn.

FlyingScot, RN · Feb 23, 2009

No, I know you aren't arguing. I'm just trying to dispel this pervasive myth that people are working under our licenses. As far as this scenario I'm making an assumption that the med techs have been through some sort of training on the administration of medications. Let's face it, this is something anybody with half a brain could do. If they are following the facility's policies and procedures there is absolutely no issue and no need to worry about losing your license if a mistake is made. It is the nurses job to know, for a fact, that the person doing the job is trained and functioning within their SOP no matter what their duties are. That is our "supervision". I would think that the particular meds you are concerned about would not be medications a UAP would be giving with the exception of oral Dig (which BTW I was never taught to check the pulse for oral Dig just the IV form). These kind of meds do require a nursing assessment but regularly scheduled normal meds (Zocor, etc) really don't.

flightnurse2b, LPN · Feb 23, 2009

No, I know you aren't arguing. I'm just trying to dispel this pervasive myth that people are working under our licenses. As far as this scenario I'm making an assumption that the med techs have been through some sort of training on the administration of medications. Let's face it, this is something anybody with half a brain could do. If they are following the facility's policies and procedures there is absolutely no issue and no need to worry about losing your license if a mistake is made. It is the nurses job to know, for a fact, that the person doing the job is trained and functioning within their SOP no matter what their duties are. That is our "supervision". I would think that the particular meds you are concerned about would not be medications a UAP would be giving with the exception of oral Dig (which BTW I was never taught to check the pulse for oral Dig just the IV form). These kind of meds do require a nursing assessment but regularly scheduled normal meds (Zocor, etc) really don't.

the reason why i ask is that a friend of mine is an new CNA by a 8 week training course who took a two week med-tech class and now is referred to as a "med nurse" in a nursing home. she gives coumadin, nitro, darvocet, digoxin, morphine, etc, etc, etc......... the other CNA's report the vitals to her and she makes a judgement on them. she doesn't know to check a PT/INR, or a BP before nitro, etc... she said it is just her and one other LPN in the building and that she cannot give injections for IM's or insulins, etc but she does everything else including PEG meds....

i think that in itself is dangerous and i dunno how intense two weeks of med-tech training really is. my pharm course was one whole semester plus all the supervised two yrs of clinicals in nursing school. she was kinda just let loose and i know the nursing homes i did my clinicals at also had med-techs with similar duties.

truern · Feb 23, 2009

the reason why i ask is that a friend of mine is an new CNA by a 8 week training course who took a two week med-tech class and now is referred to as a "med nurse" in a nursing home. she gives coumadin, nitro, darvocet, digoxin, morphine, etc, etc, etc......... the other CNA's report the vitals to her and she makes a judgement on them. she doesn't know to check a PT/INR, or a BP before nitro, etc... she said it is just her and one other LPN in the building and that she cannot give injections for IM's or insulins, etc but she does everything else including PEG meds....
i think that in itself is dangerous and i dunno how intense two weeks of med-tech training really is. my pharm course was one whole semester plus all the supervised two yrs of clinicals in nursing school. she was kinda just let loose and i know the nursing homes i did my clinicals at also had med-techs with similar duties.

I know there's a big push to have med techs but isn't making judgement calls about giving/holding a med a NURSE'S responsiblity?? Dang.

It's also scary that she doesn't know how to check a PT/INR before giving coumadin or the PTT before heparin. I hope we don't get med techs at the hospital!!

Atheos · Feb 23, 2009

the reason why i ask is that a friend of mine is an new CNA by a 8 week training course who took a two week med-tech class and now is referred to as a "med nurse" in a nursing home. she gives coumadin, nitro, darvocet, digoxin, morphine, etc, etc, etc......... the other CNA's report the vitals to her and she makes a judgement on them.

She's NOT making judgments. She's following a scale that is most likely in the MAR. If bp = X then this or if this then Y or if this call Doctor.

Med Techs do NOT get to make independent decisions.

Also, unless your state is strange MOST states make you have at least a year of CNA experience before being allowed to become a med aide. Of course, some states don't actually license them but let the nursing home handle it in which case the nursing home is liable, not the nurse. In states where we get licensed by the state like here in VA if we make a mistake it goes on OUR license and/or the Director of nursing. Not the supervising nurse but the nurse in charge of the facility.

Also, in many states, in LTC if there are specific guidelines then it most be noted on the MAR. Like if such and such lab is

caliotter3 · Feb 23, 2009

Check with the Board of Nursing in your state. My state's Board of Registered Nursing has a position paper concerning the supervision of unlicensed assistive personnel posted on the website.