Medication aides taking nursing jobs?

crane32 · Jan 9, 2006

I am appauled. I work in skilled nursing. We have residents who are post-surgical, critical diabetics, COPD, high risk for aspiration. Yes, nurses do make mistakes, some CMAs would probably do a better job than some nurses. However, it is difficult to maintain and train quality CNAs and then we are to add meds to the list?

I have some CNAs that are heavily interested in socializing--need the supervision--thoughout the country there are high instances of abuse, not following plan of care, poor attendence of CNAs, difficulty training and recruiting CNAs. The CNAs are,of course, my eyes and ears. Usually when they tell me something is wrong there is. However, there are certain things that only a nurse may pick up on. An irregular heart rate etc.

Long term care is getting tougher. The residents are becoming more critical. The legal system is increasingly tackling Long Term Care. What we need are more licensed nurses at the bedside not fewer. There is a higher quality of patient care with more licensed professionals at the bed side.

DusktilDawn · Jan 9, 2006

OK, I'm a nurse working in LTC..could not survive with out my Med Aide.
In Texas, the courses ae not "24 hours". They are much longer..Jut did an online search, and the course seems to run around 100 hours, plus lab, plus clinical time of passing meds with supervision.
When I did the class several years ago, it was 8 hours class time per week x 12-16 weeks(can't quite remember how many weeks) PLUS lab time, PLUS clinical at local LTC facilities to observe and pass meds.
An RN taught the course. It was a basic pharmacology course, with classifications, indication, desired effect, adverse reactions taught, as well as HOW to give meds (eye gtts, ear gtts,nasal, PO, rectal, lady partsl, topical). when NOT to give meds, which need a BP or pulse before administration, *communication with the nurse*, and proper documentation
.
Med Aides may NOT administer initial doses, anything injectable, no PRNS without nursing approval or emergency drugs. They may ONLY work in Nursing facilities, Assisted living, correctional facilities, and intermediate care/community based facilities for the mentally retarded..places which are not acute care facilities, residents are stable, and meds are not often changed.
Clinical was "pass/fail", then there was a written test given by/proctored by/graded by the state for certification
Have I worked with "bad" med aides? YUP. I've worked with far more "bad" nurses though. Most med aides are very conscientious and work very hard. They frequently come to me with a mistake from pharmacy(wrong dose sent), questions about order changes, reactions to meds. Just like the CNAs, they help by being my eyes and ears down the hall. Part of my team.

What is the average amount of medications a patient over 65 will be on, I've seen some pretty impressive lists myself. Define stable, a dire change in a patient's condition can present itself in a subtle way. In what way do "bad" nurses suddenly make it OK to allow UAPs to administer medication?

doodlemom · Jan 9, 2006

A facility in the town where I live (assisted living) had its meds given by aides not even cnas just aides. A friend that was an LPN at the LTC facility where I worked decided to step up and out and be the nurse manager at this facility ,a position that an LPN could do because this facility was NOT a nursing home and there fore not under same guide lines .When she got there narcotics were mixed in with rest of meds,not under lock and key and because the ones giving pills had no clue about reactions and side effects restoril,ambien and a xanax may all be giving at one time cause MOMMA doesnt know to tell you she didnt take all 3 at one time,meds that had been long d/ced were given along with the drug that was prescribed to replace it because the aide didnt realize the Mrs smith didnt need to take 5 bp pills and 3 diuretics and no k+ replacement. My friend freaked began calling doctors to find out what had been dced and what this person should be on. Needless to say she turned in her notice and came back to LTC. Stated " I aint going out like this" Couldnt blame her..Ya gotta have guidelines .. :rolleyes:

Yeah, I've seen Assisted Living facilities doing this for years. God only knows what kind of medication errors there are in those places.

txspadequeenRN, BSN, RN · Jan 9, 2006

The clinical requirment for med-aides in the state of Texas is 10 hours ....10 hours . Most of the students I work with go to school 3 hours 2 days a week for 3 months. They are not being taught the right information in these courses. I do all the clinical for the med-aides that float through our facility and they have no clue what any meds are. The last one told me that "all you have to do is go by the MAR". She had no clue that Tylenol and Acetaminophen are the same thing and that she would give tylenol to a patient if they had a allergy to Acetaminophen for one because it would be on the MAR and two she doesnt know her generics from brands. This brought up a whole other can of worms because we all know tylenol is in many pain relievers.... and she had no clue. I have had these me-aide students looking in the narc box for colace and in the regular meds for vicodin...:rotfl: None of the med aides I have done clinical with know any blood pressure meds or that you must take the BP first. :uhoh3: Another scary thingis that medication admin guide lines vary from patient to patient.. For example and this is the one that scares me . I have a patient with a very brittle BP. It is consistantly in the 160/90 range and she takes clonidine 0.2 TID along with several other types of meds. Several times I have taken her BP and it has been 120/70 or so therefore I hold the clonidine . It is low for her and someone not knowing that could bottom her out. :uhoh3: :uhoh3: :uhoh3: I think the idea of having medication aids is ok . However they dont have near the training they need to function in a safe manner.

QUOTE

"In Texas, the courses ae not "24 hours". They are much longer..Jut did an online search, and the course seems to run around 100 hours, plus lab, plus clinical time of passing meds with supervision.

When I did the class several years ago, it was 8 hours class time per week x 12-16 weeks(can't quite remember how many weeks) PLUS lab time, PLUS clinical at local LTC facilities to observe and pass meds.

An RN taught the course. It was a basic pharmacology course, with classifications, indication, desired effect, adverse reactions taught, as well as HOW to give meds (eye gtts, ear gtts,nasal, PO, rectal, lady partsl, topical). when NOT to give meds, which need a BP or pulse before administration, *communication with the nurse*, and proper documentation

.

Med Aides may NOT administer initial doses, anything injectable, no PRNS without nursing approval or emergency drugs. They may ONLY work in Nursing facilities, Assisted living, correctional facilities, and intermediate care/community based facilities for the mentally retarded..places which are not acute care facilities, residents are stable, and meds are not often changed.

Clinical was "pass/fail", then there was a written test given by/proctored by/graded by the state for certification

Have I worked with "bad" med aides? YUP. I've worked with far more "bad" nurses though. Most med aides are very conscientious and work very hard. They frequently come to me with a mistake from pharmacy(wrong dose sent), questions about order changes, reactions to meds. Just like the CNAs, they help by being my eyes and ears down the hall. Part of my team.

joyflnoyz, LPN · Jan 9, 2006

In other words, vulnerable populations, acute or not.
Frightening.

EVERY patient is vunerable..acute or not.

joyflnoyz, LPN · Jan 9, 2006

> However, it is difficult to maintain and train quality CNAs and then we are >to add meds to the list?

The med aides I work with do nothing except meds ..they do NOT do regualar CNA work, and concentrate on the one job they have. it would really be STUPID to have them do both.

.> What we need are more licensed nurses at the bedside not fewer. There is a higher quality of patient care with more licensed professionals at the bed side.

I agree..but that aint gonna happen. Our supplies have been cut, personel cut (if a CNA calls in, she is NOT to be replaced and we work with 3 for 45 patients) Administrator gets a big fat bonus if she cuts expenses.

makes me want to puke.

I've even made the suggestion for a "tasking nurse" to work 1100-1900, to help out of both shifts where needed--take off orders, do admits, treatments, whatever. That was shot down fast, with the statement

"Then we'd have to cut a nurse from 1900-2300" Loses the point.