Medication Nurse Assistants

[K205]

Hi everyone. I just found out that an MNA will be working on our 50 bed LTC unit:eek: ! Has anyone worked with an MNA? I'm a new LPN, just got used to passing meds to 25 pts, and am really on the fence about this. On one hand, I'm disgusted that I spent 13 G's obtaining my LPN, and struggled through a tough Pharmacology course :angryfire . On the other, maybe this will be a help. I really like working alone on my side. I keep people(LNAs, residents, visitors) around my cart at a mininum, cause I find it distracting. Am I going to be constantly bumping into the MNA? How does it work? BTW, there has been NO mention of an orientation for the nurses in regards to this. Oh, and the MNA will be earning 3 dollars an hour more than I do. Hmmm. any feedback will be welcome:) .

[blueeyedangel]

as an after thought....i do not make nursing assessments...never have and i don't want to. I just follow orders and do as i'm instructed. I have never claimed to be nothing more than a cna who cares about people...especially caring for the elderly. I was introduced to it when i was 17 and fell in love with the people and i learned alot from my mentors. I do agree however that passing meds is a very serious job and i only do what i'm taught and believe me i never give a med if i have any doubts. I understand where as a nurse you will be worried about us passing meds and there is nothing i can do about your worries. I wish all of you the best ...

[Marie_LPN, RN, LPN, RN]

It just bothers me and deeply concerns me that a person giving meds is not the person assessing the pt., nor are they a nurse. To me, the medication administration, and the assessment tie together, for numerous reasons.

So, to avoid more repetition of the same things i've said in this thread, until the next med aide thread rolls around, so long...

[DusktilDawn]

blueeyedangel: We have had 5 other nurses loose their positons because of their med errors ...so what i'm saying is this...it doesn't matter what title you hold ...we are all just human. Every one makes mistakes...even licensed nurses.

The fact that licensed nurses make mistakes IS NOT A VALID ARGUMENT in support of Medication Aids. Oh well we all make mistakes so it's OK:smackingf Nurses make mistakes too so it's OK for us to:smackingf We're all human so it's OK to make mistakes:smackingf The fact that licensed nurses make mistakes dosen't tell you that a less qualified individual would be more apt to make mistakes?

I realize that may not be what you are actually saying here, but as a nurse the fact that I am human and therefore can make mistakes is something I take very seriously which is why I find remarks such as "Nurses make mistakes too" very offensive in regards to the issue of Medication Aids. It sounds more like an excuse to use Medication Aids, not a valid point at all. Nursing jounals/magazines, nurse educators, etc, are constantly inundating licensed nurses with continued education in regards to medication errors and how to prevent them. Nursing in on-going continuously in regards to education, and it's not just all about experiencal edcuation.

The investigation found that since 1995 at least 1,720 hospital patients have died and 9,548 others have been injured due to nursing medical errors. Most problems occurred when patients were given the wrong drug, too much of the correct drug, or life sustaining treatment was delayed.

The investigation placed much of the blame on hospitals' increasing reliance on unlicensed nurses' aids, most of who earn just $9 per hour. A shortage of funds and licensed registered nurses has resulted in nurses' aids taking on much of the work a registered nurse used to be responsible for. One hospital has resorted to assigning the housekeeping staff to dispense patients' medications.

"I wake up every day and hope I don't kill someone today," said registered nurse Kathy Cloninger. "Every day I pray: God protect me. Let me make it out of there with my patients alive." Such sentiments are common in the underpaid and overworked world of the registered nurse.

http://injuryissues.com/find/article-148.html

From the New Hampshire Board of Nursing: Frequently asked question about Medication Nursing Assistants (New Hampshire does licensed Nursing Assistants)

Question: If the MNA makes a mistake, is the RN's license at risk?

Answer: Licensee who delegates, or had delegated a specific nursing activity or task in compliance with this chapter (RSA326), shall not be subject to disciplinary action because of the performance of the person to whom the nursing activity or task is, or was delegated.

What does RSA326 say?

26-B:28 Delegation of Nursing Activities and Tasks:

A nurse holding a currently valid license as an RN or an LPN may delegate specific nursing activities and tasks under the circumstances, and in accordance with constraints, set forth in the rules of the board adopted under RSA 541-A.

326-B:29: Circumstances Not Subject to Disciplinary Action by the Board of Nursing:

I. A licensee who delegates or has delegated a specific nursing activity or ask in compliance with this chapter shall not be subject to disciplinary action because of the performance of the person to whom the nursing activity or task is or was delegated.

II. No person may coerce an RN or an LPN into compromising client safety by requiring the nurse to delegate a nursing activity or task when the nurse determines that it is inappropriate to do so. A licensee shall not be subject to disciplinary action for refusing to delegate or refusing to provide training related to such delegation may compromise client safety except as provided in RSA 325-B:37, II9h)(2).

http://gencourt.state.nh.us/rules/nur100-900.html#nur400

PART NUR 404 DELEGATION OF AUTHORITY TO PERFORM TASKS OF CLIENT CARE is the area you focus on in regards to delegation.

Funny thing is that those in support of Medication Aids will argue that it in no way endangers a nurse's license. All states have legislature in regards to the delegation of patient care, all nurses are subject to disciplinary/legal action in regards to this type of legislature. The delegation issues for nurses are in regards to the SAFE AND APPROPRIATE delegation of tasks. The gray area is who is determining what is safe and who is safe to do it and who is responsible to determine WHO is safe to delegate to. As nurses we are responsible to assess and determine the competency of those we delegate to and are accountable when we delegate. YES NURSES CAN BE RESPONSIBLE FOR WHAT THEY DELEGATE!!!!!!! The state surveyor (an actual nurse or not?) is not entirely correct in telling you that your DON is only responsible blueeyedangel.

http://www.nursingworld.org/ojin/tpclg/leg_12.htm

http://www.nursingworld.org/gova/hod97/uap.htm

blueeyedangel: as an after thought....i do not make nursing assessments...never have and i don't want to. I just follow orders and do as i'm instructed.

Really, you don't assess for adverse reactions, side effects, change in patient status that should be reported? That is assessment, which I'm sure you do. I don't believe you blindly follow orders and don't know what to report. You're passing med to over 45 residents, I don't consider that safe for a licensed nurse, there is no way I would consider it safe for a Medication Assistant. I do believe you take your job seriously which is why I'm sure you do assess your patients. I don't think medication administration should be considered just a "task," because it is not. What's the average number of medications an adult over 60 is on, I've seen some pretty impressive medication lists when I've admitted patients and the majority are on 5 or more medications (5 is usually the least amount they will be on):uhoh21: You don't find it curious that in your state Nursing Assistants are licensed (very few states do license Nursing Assistants, all should IMHO), but Medication Nursing assistants are not?

This is from a course description from WITC for Medication Assistants:

http://www.witc.edu/programs/medication/index.htm

PROGRAM OUTCOMES*

Employers will expect you, as a Medication Assistant, to be able to:

Define legal and ethical responsibilities.

Identify factors that influence the effects of medications on individuals.

Follow administration guidelines common to all medications.

Use systems of measurement for medication.

Administer medications safely and efficiently.

Identify effects of common medications on body systems.

Apply aging principles to pharmacokinetics.

*In addition to the program Outcomes, you will also develop specific core abilities that WITC has identified as important to your personal and professional success after graduation

http://www.witc.edu/programs/medication/index.htm

Both course descriptions have descriptions that include assessment.

[Thunderwolf, MSN, RN]

i do not make nursing assessments...never have and i don't want to. i just follow orders and do as i'm instructed. i have never claimed to be nothing more than a cna who cares about people...especially caring for the elderly

if you are a med aide, this statement (in red) scaries me worse than any horror flick ever could.

also, i would like to interject here. no one is saying anyone is inferior. what nurses are saying is that med aides do not have the background or the "science" of nursing in order to apply it. this means, having actual classes in biology, micro, pharm, anatomy and physiology, pathophysiology, math, and chemistry. this also means having instruction in assessment and clinical experience in doing it. this also means having a knowledge base as to how to evaluate medication effectiveness and critical thinking skills. the list goes on.... if you did, this all would be a mute point. this is the crux of the debate. if a med aide doesn't have the internal strength to go to nursing school and learn what needs to be learned, then sit for a license... then what makes you think that a med aide is prepared and is qualified to pass meds...just because "the ltc needs us to do it"? bad excuse. won't fly with most nurses. getting to the issue of a certificate. a certificate is inferior to a nursing license...but, not the person. you need to hear that. there is much truth to that statement. the person is not inferior, but your preparation is.

if a cna truly cares about their elderly residents, receiving the best care possible that they can receive with regards to medications...become a nurse. this is it in a nutshell.

i want to state that i mean no disrespect to any cna who is a med aide/tech. if you took any offense, it came not from me, but from yourself. and yes, i am very pro cna...but, not in the realm of medication. it is a dangerous and ill thought out practice. maybe in the past about 1950's or earlier, this practice would have had some merit. there were only a few meds around then. but, this is today, where multiple meds abound, many more complications can result from their use, and people are much more elderly and ill than way back then (folks simply did not live as long back then). we have complex patients now and a whole bag of multiple, complex medications to monitor, assess, and intervene upon.

as a nurse, do you have any idea how many times i need to hold a med and/or discuss medications with our physicians due to patient changes in condition and/or med side effects? i spend a good amount of time performing bedside nursing and on the phone with docs regarding them. i don't know, folks. but, i think i do know a little about what i'm talking about. i've been a rn for 20 years, combination in both psych and med-surg, inpatient and outpatient. i am very much a patient advocate and have no difficulty asserting myself towards a nurse or a physician for the sake of the patient. it comes with the turf in being in this business for so long.

and in the court of law, do you really think a prosecuting attorney is going to be understanding and/or empathetic when a med aide states before a legal hearing (after a sentinel event) "i'm just a med aide...i didn't know that i shouldn't have given this medication...i just do what i'm told"? believe me, the attorney looks for the weakest link...and that will be you. do you really think that your ltc will back you up in such an instance or have the power to do so? this is something you must ask yourself and ask yourself honestly.

lastly, i do not wish to see this thread become a flame war between nurses or cnas. that is very pointless, and could earn folks points if it occurs.

wolfie

[Thunderwolf, MSN, RN]

BTW....DusktilDawn, excellent post.

[SmilingBluEyes]

if you are a med aide, this statement (in red) scaries me worse than any horror flick ever could.

if a cna truly cares about their elderly residents, receiving the best care possible that they can receive with regards to medications...become a nurse. this is it in a nutshell.

i

amen and amen wolfie.

[nursemomruns]

I did a Google search and looked at the regs. for many states. Not one showed medication assistants as being licensed; many had certification requirements and required registration with the BON.

But certification is not the same as licensure, and ultimately, a medication assistant is practicing under a nurse's license. So while a med. aide may be very conscientious, the ultimate responsibility for that aide's actions lies with the licensed nurse.

I am currently working on a study of just this topic. You are correct - none of the states have licensure for medication assistants. At most, they have certification. The requirements for certification vary from state to state, as well as the duties that are allowed. Some of the programs are as long as 200 hours and some are as few as 40 hours. Some states allow a nursing student to become a medication assistant if pharmacology has been passed, and some will not allow this, but will allow graduate nurses to become medication assistants while they await licensure.

[DusktilDawn]

I am currently working on a study of just this topic. You are correct - none of the states have licensure for medication assistants. At most, they have certification. The requirements for certification vary from state to state, as well as the duties that are allowed. Some of the programs are as long as 200 hours and some are as few as 40 hours. Some states allow a nursing student to become a medication assistant if pharmacology has been passed, and some will not allow this, but will allow graduate nurses to become medication assistants while they await licensure.

New Hampshire and Vermont license Nursing Assistants. I think there are about six states that do license Nursing Assistants. I do not think that Nursing Assisants are specificially licensed as Medication Assistants, but the role of Medication Assistant may be covered under the Nursing Assistants license instead. Blueeyedangel didn't claim to have a license as a Medication Aid, she stated she had a license as a Nursing Assistant.

Since your working on a study Nursemomruns, try focusing on the states that require Licensed Nursing Assistants and how the role of Medication Assistant is implemented under their licensure. I realize you may not be specifically researching Medication Assistants for licensure for your study, but it may be interesting to see how the role it is covered by states that do license Nursing Assistants. Good Luck with your research. I would definately be interested in your findings.

[txspadequeenRN, BSN, RN]

I work in a very large LTC facility and pass pills to 50+ people every sat and sun. I work exclusively (did I spell that right) with the medications, no paper pushing, no treatments, no families and no phones. So im not tied up with all the other hassell and just focus on the pill pushing. My point here is as long as I have been working in this capacity ,giving the same pills to the same people every week ; It still is a major job with major responsibility. With every pill I give, I do an assessment whether it be visual or physical. No one should be giving meds unless you are well aware of the side effects, purpose and med-surg that makes that pill needed. What does doubt consist of to you? Because there are alot of doubts when it comes to geriatric patients and their meds. It's not just following orders , its knowing when to hold that B/P med or when to give it. Knowing which drugs can cause a reaction with each other. Knowing just how much Tylenol is to much and then knowing which medication contain Tylenol so you can keep track of your mg. How about patients allergies and then giving a medicine that contains one of those allergies. Knowing if you have a pt that is allergic to Tylenol you cant give Vicoden. Or even that if you have a pt that has a allergy to PCN you shouldnt give a Cephasporin... You sound very caring to your patients ,but are doing them an injustice by handling their medications without the background to do so.

as an after thought....i do not make nursing assessments...never have and i don't want to. I just follow orders and do as i'm instructed. I have never claimed to be nothing more than a cna who cares about people...especially caring for the elderly. I was introduced to it when i was 17 and fell in love with the people and i learned alot from my mentors. I do agree however that passing meds is a very serious job and i only do what i'm taught and believe me i never give a med if i have any doubts. I understand where as a nurse you will be worried about us passing meds and there is nothing i can do about your worries. I wish all of you the best ...

[tiffanycmt]

I have responded to a similar post on here before and it just became a little to heated for me. I am a cmt "medication aide" I just started a second job and my job responsibilitys have gone way up. After seeing how some facilitys let med techs do about everything i can see both side of the argument/discussion. I myself would prefer if a med tech's job would be limited to just medications I prefer not to do insulins i believe that should be the job of a licensed nurse but when i do have to do the insulins i dbl check and triple check before giving. Also alot of med tech's would love to go to nursing school but just stick with med tech jobs d/t cost. I know that nebraska and missouri have utalized med tech's for quite some time and i dont believe there going anywhere.

[chadash]

I did not know any state licensed NA. I wonder what they base that on. In my state it is a certification that must be renewed every two years based on your supplying verification that you have worked as an NA under RN supervision for a part of that time period.

I frankly don't get the argument about who is less than who, never have. I see my job as valid. I have had enough years of experience to understand that there are very good reasons that I am limited in my scope. If I went to nursing school, that would broaden my scope of practice to include administering medications, not based on being "better", but based on having adequate knowledge and training to safely evaluate my pt, question orders that may be incorrect or dosages that may be inaccurate, be aware of drug interactions and contraindications, and know enough about physiology and the disease process to determine the effectiveness of the treatment prescribed. I don't believe a brief med course would be adequate. Also, I believe the objections being raised by the nurses on this post are based on knowledge, not emotion.

This does not invalidate us as Nursing assistants one wit.

[DusktilDawn]

I have responded to a similar post on here before and it just became a little to heated for me. I am a cmt "medication aide" I just started a second job and my job responsibilitys have gone way up. After seeing how some facilitys let med techs do about everything i can see both side of the argument/discussion. I myself would prefer if a med tech's job would be limited to just medications I prefer not to do insulins i believe that should be the job of a licensed nurse but when i do have to do the insulins i dbl check and triple check before giving. Also alot of med tech's would love to go to nursing school but just stick with med tech jobs d/t cost. I know that nebraska and missouri have utalized med tech's for quite some time and i dont believe there going anywhere.

No Tiffany, you really don't understand both sides of the issue, but you do have an understanding about the issues you face as a CMT. Unless an RN has functioned in the role of a CNA, LPN, or CMT they also don't understand all the issues one faces in those positions. Having been an RPN/LPN in the area I live, I have an understanding about the issues RPNs face and the issues between RNs and RPNs, most specifically in the area I live. A Medication Assistant that has then gone on an obtained a nursing license has a better understanding of both sides of this issue:

wa-rn: I was a med tech for 4 years before becoming an RN (Oh, yes...I also made as much as an LPN because I was per diem, but no benefits)

There were many things I was not aware of (that could have killed someone) regarding medications and food & drug interactions, necessary nursing interventions....

The entire post is on page 6 of this thread. I have also seen similar comments on other threads about Medication Assistants from posters who were CMAs and obtained their license as nurses.

I've seen it said more than once here on allnurses that all nurses should have to do the job of a CNA so that they can have an understanding and appreciation for what they do. I don't disagree with that. However, I think it is important that CNAs also have an understanding of our job, and not just what they see. More than one former CNA that has returned to work as an RN at the facility I currently work at has remarked that they really had no idea of all that an RN is responsible for when they were a CNA or how hard our job really was until they had to it do as an RN. I'll admit that there were issues I didn't understand as an RPN/LPN until I became an RN, despite the fact that I thought I paid pretty close attention to all that was going on.

I do think it is unfortunate when facilities don't offer some reimbursement in regards to the continued education of their employees, I know my facility does in regards to CNAs going back to school for nursing. I didn't have the opportunity to be reimbursed for my schooling, and I'm still paying back for my education.