Medication Aides: Public Hearing May 19th

[VickyRN, MSN, DNP, RN]

A public hearing concerning the controversial Medication Aide (21 NCAC 36 .0403 and 21 NCAC 36.0406) will be held at the Board of Nursing on May 19th.

OPEN COMMENT PERIOD (8:35 am – 8:55 am)

Opportunity for members of the public to bring issues of concern to the Board but not to testify regarding rules to be heard at Public Hearing.

PUBLIC HEARING (1:00 – 1:45 pm)

Opportunity for formal comment on proposed rules revisions

21 NCAC 36 .0403 QUALIFICATIONS

21 NCAC 36 .0406 Medication Aide Training Requirements

http://www.ncbon.com/forms/BoardMtgAgenda.pdf

21 NCAC 36 .0403 is proposed to be amended as follows....

(d) Pursuant to G.S. 131E-114,2 and G.S. 131E-270, the medication aide is limited to performing technical aspects of medication administration consistent with Rule.0401(b) and © of this Section, Rule 21 NCAC 36.0221, and only after:

(1) successful completion of a high school diploma or GED;

(2) successful completion of a medication aide training program approved by the Board of Nursing;

(3) successful completion of a state-approved competency evaluation program ; and

(4) listing on the Medication Aide Registry.

http://www.ncbon.com/forms/Rule403Proposed.doc

21 NCAC 36.0406MEDICATION AIDE TRAINING REQUIREMENTS

(a) Faculty for the medication aide training program are required to:

(1) have a current, unrestricted license to practice as a registered nurse in North Carolina;

(2) have had at least two (2) years of practice experience as a registered nurse that includes medication administration;

(3) have successfully completed a Board-approved instructor training program; and

(4) maintain Board of Nursing certification as a medication aide instructor.

(b) The medication aide instructor certification shall be renewed every two (2) years provided the following requirements are met:

(1) the individual has taught at least one medication aide training program within the preceding two (2) years; and

(2) the individual successfully completes a Board-approved review of the current medication aide training program.

History Note: Authority G.S. 90-171.56; G.S. 131E-114.2; G.S. 131E-270. Eff. July 1, 2006.

http://www.ncbon.com/forms/Rule406Proposed.doc

Curriculum and Training: Curriculum for med aides focuses on the six rights of medication administration via oral, topical and instillation routes. It is a 24-hour course and addresses these common routes of medication administration but excludes injections. After passing the course the med aide may take the state competency test. The med aide must pass the state test and is then placed on the Medication Aide Registry. The RN with two years practice experience including medication administration is eligible to take a 16-hour teacher training course which is required in order to teach med aides. The teacher is certified after taking the course and is placed on the teacher certification registry which will be maintained by the Board of Nursing. The med aide curriculum and teacher training curriculum will be reviewed periodically by a Medication Aide Advisory Committee appointed by the Board. This committee will make recommendations for change to these curricula and other related recommendations based on the results of periodic survey of those involved in the med aide process. (Please note that persons being trained to perform this medication administration task must also meet the Nurse Aide Requirements in addition to the medication aide requirements before being allowed to perform these tasks in health care settings.)

As defined in nursing law and rule, the licensed nurse may only delegate technical components of medication administration to unlicensed personnel. Nursing judgment and decision making related to when or if a medication would be administered by the med aide and monitoring the client’s response to medications are responsibilities of the licensed nurse that may not be delegated to assistive personnel.

http://www.ncbon.com/education-factsheet.asp

The licensed nurse on duty remains accountable for any adverse events that may occur with medication administration involving the medication aides:

...© accountability maintained by the licensed practical nurse for responsibilities

accepted, including nursing care given by self and by all other personnel to

whom such care is assigned or delegated...

...RN accountability is outlined in Administrative Rule 21 NCAC 36 .0224

(i) (4) which states that the RN has:

(i) (4) “accountability for nursing care given by all personnel to whom that care is assigned and delegated;”

...The registered nurse has the overall responsibility for assessing the capabilities of the medication aide to include validation of the medication aide’s qualifications, knowledge, and skills in carrying out the technical role of medication administration. In addition the registered nurse is responsible for providing the medication aide with ongoing supervision, teaching, and

evaluation within the delegation framework as defined in Administrative Rule 21

NCAC 36 .0224 (i) and (j) “Components of Practice for the Registered Nurse.”

...Accountability for any professional judgments or decision-making surrounding medication administration is the responsibility of the licensed nurse and may not be delegated to the medication aide.

http://www.ncbon.com/forms/Interface%20between%20Licensed%20Nurse%20and%20Med%20Aide.pdf

[RNSuzq1, RN]

Hi Vicky,

I'd love to know your thoughts about this. I just finished an RN Program and several months ago one of our Instructors wanted to know what our class thought about the possibility of being responsible for an unlicensed person giving out medications to our patients after only 24 hours of training - we all said "NO Way"....

We've spent the last few years in school with a large majority of the time being spent on learning to assess our patients - this includes assessments before, during and after Med. Admin. - looking for possible problems, side effects, etc, plus learning all about hundreds of meds.... One of the big "no no's" we were taught is - never have another Nurse give meds. that you're responsible for because if something happens - we're ultimately responsible.

The entire class agreed 100% that we've all worked too hard for this to jeopardize our licenses letting med techs. hand out meds. I heard that one of the reasons the NCBON is doing this is to "free up" the Nurse to do other things, but when you're working on a floor - one of your biggest responsibilities is Med. Administration, even CNA's with 20 years experience aren't allowed to do this - why on earth would they let someone with no more than a few hours of training do this job?

Obviously it doesn't take much training to teach someone to hand a pt. a pill, give an injection, etc. - but what's missing is the assessment that the Nurse does before she gives any of these meds out. I've heard that there are already Techs. doing this in Nursing Homes - not that I agree with it, but usually the patients there are stable and only getting meds that they'd take themselves at home. In a hospital where you're dealing with unstable, critically ill patients - it makes absolutely no sense. And, if another person will be giving out Meds. we're responsible for - it's not really freeing up our time, it's actually making our job harder because we'll have to keep checking up after them.

After a couple of semesters, we could pull our patients meds without an Instructor watching, but for the entire 2 years of school - we weren't allowed to give any meds until we had verbalized to the Instructor what each one was for, what precautions to take, side effects, etc. and could never, ever give anything until they had initialed the MAR - giving a med without her consent was grounds for dismissal from school.

Several of my classmates were wondering - if they're allowed to do this - what was the point of us going to school for several long years at school, having hundreds of hours of clinicals, etc. - if they're going to let someone with 24 hours of training do the most important part of our job???

As you can tell, I really have a problem with this and wanted to know yours and others opinions about this.

[VickyRN, MSN, DNP, RN]

Hi Vicky,

I'd love to know your thoughts about this. I just finished an RN Program and several months ago one of our Instructors wanted to know what our class thought about the possibility of being responsible for an unlicensed person giving out medications to our patients after only 24 hours of training - we all said "NO Way"....

We've spent the last few years in school with a large majority of the time being spent on learning to assess our patients - this includes assessments before, during and after Med. Admin. - looking for possible problems, side effects, etc, plus learning all about hundreds of meds.... One of the big "no no's" we were taught is - never have another Nurse give meds. that you're responsible for because if something happens - we're ultimately responsible.

The entire class agreed 100% that we've all worked too hard for this to jeopardize our licenses letting med techs. hand out meds. I heard that one of the reasons the NCBON is doing this is to "free up" the Nurse to do other things, but when you're working on a floor - one of your biggest responsibilities is Med. Administration, even CNA's with 20 years experience aren't allowed to do this - why on earth would they let someone with no more than a few hours of training do this job?

Obviously it doesn't take much training to teach someone to hand a pt. a pill, give an injection, etc. - but what's missing is the assessment that the Nurse does before she gives any of these meds out. I've heard that there are already Techs. doing this in Nursing Homes - not that I agree with it, but usually the patients there are stable and only getting meds that they'd take themselves at home. In a hospital where you're dealing with unstable, critically ill patients - it makes absolutely no sense. And, if another person will be giving out Meds. we're responsible for - it's not really freeing up our time, it's actually making our job harder because we'll have to keep checking up after them.

After a couple of semesters, we could pull our patients meds without an Instructor watching, but for the entire 2 years of school - we weren't allowed to give any meds until we had verbalized to the Instructor what each one was for, what precautions to take, side effects, etc. and could never, ever give anything until they had initialed the MAR - giving a med without her consent was grounds for dismissal from school.

Several of my classmates were wondering - if they're allowed to do this - what was the point of us going to school for several long years at school, having hundreds of hours of clinicals, etc. - if they're going to let someone with 24 hours of training do the most important part of our job???

As you can tell, I really have a problem with this and wanted to know yours and others opinions about this.

I thoroughly agree with you, Susan. Here are some posts which sum up my thoughts very well:

https://allnurses.com/forums/1128881-post6.html

https://allnurses.com/forums/1153784-post7.html

https://allnurses.com/forums/f165/nursing-homes-without-nurses-140011.html?highlight=medication+aides

[RNSuzq1, RN]

Hi Vicky,

I was almost afraid I was way off base with my opinion, glad to hear you feel the same way. I'm graduating this Friday on the 19th, so I can't show up for the hearing, but would if I could. Could you please either post to this board or send me a pm to let me know what they decide?

One of our Instructors frequently told us to get involved with Nursing Organizations once we get our license and make our voice heard. In your opinion, which would be the best ones to join, especially here in NC. I'm going to post something about this to the Student Nurse Board that I've belonged to for the last few years just to see what others think. Thank You, Susan

[VickyRN, MSN, DNP, RN]

Hi Vicky,

I was almost afraid I was way off base with my opinion, glad to hear you feel the same way. I'm graduating this Friday on the 19th, so I can't show up for the hearing, but would if I could. Could you please either post to this board or send me a pm to let me know what they decide?

One of our Instructors frequently told us to get involved with Nursing Organizations once we get our license and make our voice heard. In your opinion, which would be the best ones to join, especially here in NC. I'm going to post something about this to the Student Nurse Board that I've belonged to for the last few years just to see what others think. Thank You, Susan

Don't have any information yet about what occurred in this meeting. Will post when I find out. Official minutes from the board site are posted here: https://www.ncbon.com/about-boardmtgminutes.asp (This usually takes several weeks to months.)

The only professional nursing organization in the state is the NCNA. From all accounts, the NCNA was strangely silent concerning the Medication Aide. In fact, the NCNA actually supported the Medication Aide initiative (See 2006 NCNA Legislative, Regulatory, and Political Platform, "Promulgates other recommendations of the NC Institute of Medicine Task Force on the Nursing Workforce.").

Despite the fact that it struck out concerning the Medication Aide, the NCNA has done much to advance the profession of nursing across the state and there are many benefits in becoming a member.