Medication Nurse Assistants

nursemomruns · Nov 16, 2005

In all states a national certification is required, most states require licensing, and within the next few years all states will require licensing.
So, to answer your question, within a few short years it is "both" but for now everyone is certified currently, soon everyone will be licensed as well.
I may be biased for two reasons, I was a pharm tech in school and I currently teach (now just PRN) CPhT classes. I know what they have to know.

So, will the title change to LPhT? Is the same certification exam used in all 50 states, like the NCLEX exams for nurses?

Bipley · Nov 16, 2005

So, will the title change to LPhT? Is the same certification exam used in all 50 states, like the NCLEX exams for nurses?

The same certification exam is used throughout the country. No, they won't be changing it to LPhT as far as I know. Currently most states require licensing, eventually they all will.

DusktilDawn · Nov 16, 2005

Bear in mind I'm not knocking Pharmacy techs here, my sister was one for a few years before becoming an RN. Granted she certainly has a leg up in regards to medication knowledge and the effects of medication.

Bipley, correct me if I'm wrong, but in regards to the training of Pharmacy techs, is it not geared towards working in conjunction with a Pharmacist, and the Pharmacist also double checks their work in regards to preparing medication for dispensing. Is it also geared to working within a pharmacy, not in regards to working with patients within a facility setting. I don't doubt Pharmcy techs have the knowledge in regards to adverse reactions, contraindications, synergistic reactions, additive reactions, antagonistic reactions, drug interactions, and side effects. When a nurse assess a patient it is not just the effects of the medication we give that we are also assessing. Bear in mind Bipley that you not only know what a Pharmacy tech has to know but also what an RN has to know. Can you honestly say that as a pharmacy tech, without any nursing background, you would have known how to assess a patient?

You know a Pharmacist can't prescribe medications, yet that would be the first person I would contact in regards to any medication questions I have, prior to contacting the doctor in most circumstances. Just thought I throw that out there. :D

Bipley · Nov 16, 2005

Bear in mind I'm not knocking Pharmacy techs here, my sister was one for a few years before becoming an RN. Granted she certainly has a leg up in regards to medication knowledge and the effects of medication.
Bipley, correct me if I'm wrong, but in regards to the training of Pharmacy techs, is it not geared towards working in conjunction with a Pharmacist, and the Pharmacist also double checks their work in regards to preparing medication for dispensing. Is it also geared to working within a pharmacy, not in regards to working with patients within a facility setting. I don't doubt Pharmcy techs have the knowledge in regards to adverse reactions, contraindications, synergistic reactions, additive reactions, antagonistic reactions, drug interactions, and side effects. When a nurse assess a patient it is not just the effects of the medication we give that we are also assessing. Bear in mind Bipley that you not only know what a Pharmacy tech has to know but also what an RN has to know. Can you honestly say that as a pharmacy tech, without any nursing background, you would have known how to assess a patient?
You know a Pharmacist can't prescribe medications, yet that would be the first person I would contact in regards to any medication questions I have, prior to contacting the doctor in most circumstances. Just thought I throw that out there. :D

I am on my way out the door right now to go to work and I don't have time to respond as I would want to. But I will tonight. I will get some info that is taught in CPhT classes and see if that sheds any light on the topic. Things have changed in a huge way over the last 5 years or so. I think you'd be surprised to know what your average tech is doing in a given hospital setting today. I doubt most have any idea. Such as a clinical tech.

Will finish this tonight.

oncologyangeldi · Nov 16, 2005

Hi !! Interesting Post you made. I have to ask, how many semesters of RN school did you complete? If you completed the first year sucessfully, you may be allowed to sit for the LPN Exam in your state. Did you investiage this possibility?. This may vary by state and you would have to check with your state's Board of Nursing>

I had 2 more semesters to go..The RN program i was in had dropped the offer of taking LPN exam after so long in the program the year before i was accepted into the program...

If i was younger i would consider going back to an LPN program.( i will be retiring in 5 years, so this is what i have decided to do) All my friends are either LPNs or Rn's and i have had many discussions about being a nurse and i have found that many have quoted to me that nursing today is not what they went into nursing for. They have little time with patient contact. As i worked for 10 years along side them on oncology, I learned how frustrated they were.

Getting back to Med techs. One said "are we really being fair to the patient, by having less than a licensed personnel handling their care and medications. That it is an insult to those who spent years and money to be educated in what med techs are doing. I understand fully. But i do think that there can be a place for med techs, if the states restrict the care to only certain places and not going to far with where they are placed. Definitely NO in any hospital setting. Assistant living is the only place i feel we should be. And The facility should be monitoring, educating. I have only 24 residents with 4 CNAs. For the most part they are all on basically the same meds. If a resident becomes ill they are sent to another unit where there are RN's and LPN"s until they can return to us. Any medication changes are monitored by an RN then she educates the Med techs on those new meds. side effects, allergies to them and so forth. We have to know every residents meds, who each individuals DR. is. We also know how each Dr is going to respond with their patient. On the day shift our nurse manager is there. 2nd and 3rd we have a nurse upstairs who we call if needed. we have very strict rules from our nurse manager because yes we ARE aware we are under her license. And even though all we have is a certificate and not a degree. We take pride in being responsible for our scope of practice. And yes the Nurse has alot more to loose than the med tech and we understand that also. And even though we have just a certificate that is minor to a licensed personnel, we want to protect it also.I don't know how other states run the system for med techs, but here if your in a nursing program and loose your med tech certificate for any reason you cannot continue in the program. Maybe that should be a requirement also. Students only. I have not yet heard or read where a nurse lost her license because of a med tech. Things change in the medical field for good and bad. But no matter what they are changing. And it seems to me the state is going to do what they want to do. Med techs can be useful, but only under certain conditions, so not to take away from the Nurses. Our facility has memory unit, assistant living, skilled nursing units and PT unit. Med techs are only used in assistant living. All the licensed personnel in our entire facility doe's not have a problem with this. But it must only stay within an assistant living unit. Most nurses would be bored out of their minds working in an assistant living. there's not much nursing care to do. It's not what most nurses go into nursing for. We don't admit, we don't assess, we don't make decisions on their care. We only follow instructions. strict instructions.And there is always a licensed personnel there to make the decisions. The state also monitors med errors which I'm proud to say we have had only a small amount of errors in the 3 years this facility has been opened. compared to how many med errors have been made at our hospital.And those errors consist of nothing that was threatening to the resident. other than them missing a dosage. ( not that this is acceptable) we are as human as the other, including licensed personal. If med techs are being used for more than assistant living then i understand we have a problem.

A Med tech and proud to be.

nursemomruns · Nov 16, 2005

In all states a national certification is required, most states require licensing, and within the next few years all states will require licensing.
So, to answer your question, within a few short years it is "both" but for now everyone is certified currently, soon everyone will be licensed as well.
I may be biased for two reasons, I was a pharm tech in school and I currently teach (now just PRN) CPhT classes. I know what they have to know.

I believe pharmacy techs have to register with their states, but national certification is not required in all states. Indiana requires that you graduate from an educational program OR take the certification exam. Illinois requires that you are 16 years old and pay the fee. 16! The exam is voluntary. I didn't see anything mentioned about an educational program for them. It appears that the pharmacy tech state of affairs is better in that they have a unifying exam available, but otherwise there are many of the same issues as there are for medication assistants.

nursemomruns · Nov 16, 2005

Bear in mind I'm not knocking Pharmacy techs here, my sister was one for a few years before becoming an RN. Granted she certainly has a leg up in regards to medication knowledge and the effects of medication.
Bipley, correct me if I'm wrong, but in regards to the training of Pharmacy techs, is it not geared towards working in conjunction with a Pharmacist, and the Pharmacist also double checks their work in regards to preparing medication for dispensing. Is it also geared to working within a pharmacy, not in regards to working with patients within a facility setting. I don't doubt Pharmcy techs have the knowledge in regards to adverse reactions, contraindications, synergistic reactions, additive reactions, antagonistic reactions, drug interactions, and side effects. When a nurse assess a patient it is not just the effects of the medication we give that we are also assessing. Bear in mind Bipley that you not only know what a Pharmacy tech has to know but also what an RN has to know. Can you honestly say that as a pharmacy tech, without any nursing background, you would have known how to assess a patient?
You know a Pharmacist can't prescribe medications, yet that would be the first person I would contact in regards to any medication questions I have, prior to contacting the doctor in most circumstances. Just thought I throw that out there. :D

There is some info in this link about what the exam covers:

(Assisting the Pharmacist in Serving Patients, Maintaining Medication and Inventory Control Systems, and Participating in the Administration and Management of Pharmacy Practice).

http://www.ptcb.org/Exam/information.aspx

There is some information there about knowledge covered. A&P and some assessment is covered.

tlhubbard · Nov 16, 2005

I suppose that in assisted living this may be a good idea. However, if we are still seeing facilities paying nurses to be available for these residents, is this truly cost effective? I know CNAs are often understaffed (as are the nurses) if we spread the budget even further by specialilzing everyone's role, aren't we making things more difficult.

I miss the days when the CNA could go to the nurse and ask for lifting help and actually get it instead of being redirected to another CNA (that you've been looking for and can't find or is busy).

I just seen there being too many hands in the pot. What if you do a little "Late reflective charting" and because you have multiple people giving out meds you find that something is given more than once because you couldn't get it charted when you should have? I know manic charting at the end of shift is not unheard. I think too many cooks spoil the pot.

HappyJaxRN · Nov 16, 2005

I was a CNA that passed meds and was thrilled to do it. We were called medicine techs. I was disgusted at the requirements to be able to pass the meds. I found errors after errors from other staff members. One of which was NOT even a CNA. We had to go through a 4 hour class...ended up being 3 hours and BOOM...here's your certificate to pass meds!

I was working one day as a CNA in an Assisted Care Facility and someone else was a Medicine Tech that day. I watched her double up on someone's meds. I approached her and said, "What are you doing?"

Her explaination was that the resident didn't get his AM meds, now he was getting his afternoon and AM meds all at the same time. One of which was a CV med and I forget what the others were. I tried to tell her that you can't double up on the CV meds. She told me to mind my own business.

I think that anyone who handles these meds should be screened properly and put through a nursing school level pharmacology class. What a mess.

Bipley · Nov 16, 2005

I believe pharmacy techs have to register with their states, but national certification is not required in all states. Indiana requires that you graduate from an educational program OR take the certification exam. Illinois requires that you are 16 years old and pay the fee. 16! The exam is voluntary. I didn't see anything mentioned about an educational program for them. It appears that the pharmacy tech state of affairs is better in that they have a unifying exam available, but otherwise there are many of the same issues as there are for medication assistants.

I didn't know about places like Illinois. Obviously, as it stands now Illinois should be excluded from letting a tech do anything but run a cash register.

With that said, it is the Federal Pharmacy Board that is pushing for certification and licensing in all states and they are getting their way. The majority of states are already implimenting licensing.

Bipley · Nov 17, 2005

Bear in mind I'm not knocking Pharmacy techs here,

Oh, I realize that. I knew my position wasn't going to go over well but at least you are asking for details here so I will explain my thinking.

Bipley, correct me if I'm wrong, but in regards to the training of Pharmacy techs, is it not geared towards working in conjunction with a Pharmacist, and the Pharmacist also double checks their work in regards to preparing medication for dispensing.

Yes and no. That used to be more true than it is now. The reason behind an RPh checking a tech's work is the same reason as why a nurse can't pull a med out of the Pyxis until the RPh has entered the order. It requires an RPh to check the entire profile for drug interactions, appropriate use of the drug, etc.

Consider this, if you get a new admit and send orders to pharmacy, what happens? Depending on the hospital the RPh enters the orders, a single label is printed for a first dose, the tech fills the first dose, puts it in a baggy, the RPh checks it, and it is sent to the floor. A couple of hours later the Pyxis system will print out a report of all the meds that need to be placed in Pyxis machines throughout the hospital. Perhaps the Pyxis tech pulls the drugs, takes them to the floors, places them in the Pyxis, and who checks the drugs? Nobody but the tech. What's the difference between the single dose and the Pyxis fill? Nothing except for the Pyxis fill is on a larger scale.

Twenty years ago there really weren't techs, there were clerks. The RPhs did absolutely everything. Then techs came along and everything they did was checked by an RPh. Today techs fill Pyxis equipment and they often times don't have an RPh checking a bloody thing. It's up to the tech to fill the proper drug. It's also up to the techs to pull the correct generic in many cases or replace with brand when generic isn't available. Nobody is checking that either.

What about clinical CPhT's? They go ahead of the PharmD on floors such as a transplant floor, review labs, meds, etc. and it is the tech that notifies the RPh of something s/he needs to know about. It is the tech reviews labs before the tech makes the chemo, it is the tech that picks up that a WBC is dropping in an Enbrel patient, etc.

What about IV's? Let's say a tech makes a 5FU IV. The RPh enters the order, the system prints a label, the tech makes the IV... do you think anyone is checking those syringes to make sure the correct amount of drug is in the syringe before injecting it into the bag? Not usually. The drug is checked, not the quantity.

Before everyone gets their knickers in a wad you should know that nationally techs have a MUCH lower error rate than RPhs. You put an RPh and a tech side by side making that 5FU IV and odds are, the tech will stand a better chance of making it correctly. However, the error rate for pharmacy is pretty low anyway. But the error rate is less than half for a tech vs. an RPh.

What about a chemo tech in an Onc's office? The drug is ordered, the tech (working under his/her own license) makes the IV and hands it to the nurse. Some offices the nurse checks that the correct drug was used, more cases than not the tech hands the nurse the IV and it's a done deal.

So the functions of techs are drastically different than they were just 5 years ago.

Con't next post...

Bipley · Nov 17, 2005

Is it also geared to working within a pharmacy, not in regards to working with patients within a facility setting. I don't doubt Pharmcy techs have the knowledge in regards to adverse reactions, contraindications, synergistic reactions, additive reactions, antagonistic reactions, drug interactions, and side effects. When a nurse assess a patient it is not just the effects of the medication we give that we are also assessing. Bear in mind Bipley that you not only know what a Pharmacy tech has to know but also what an RN has to know. Can you honestly say that as a pharmacy tech, without any nursing background, you would have known how to assess a patient?

Well, let's look at this. In an ideal world only a BSN is going to give meds. But this isn't an ideal world. I am going to get slammed for this but I'm going to write it anyway. Let's compare a CPhT (licensed and certified such as my students will be) against an LPN. The LPN has learned a great many skills in school including patient care, procedures, etc. The tech has really focused on what? Meds. I'm sorry but a licensed and certified tech is going to know more pharmacology and pharm related issues vs. an LPN. When passing meds what is the primary focus? How to insert a foley and start an IV or how to know when to give HGH, how to administer it, and what the side effects are going to be? While the LPN is going to be able to do more tasks than a CPhT, the CPhT is going to know more about the drug, who should be getting it, what it is for, and what side effects to watch for.

My thinking is this... medicine has become SO huge, so complicated, so specialized that what docs used to do, RNs do today. What RNs used to do, LPNs do today. What LPNs used to do, PCTs do today. We have to have these allied professionals because there is no way a nurse could do everything. It's impossible. As it stands now we don't have enough time with our patients, when we have one go sour the rest are sometimes not given the time they need, we are running our back sides off and really, we are spinning our wheels. We aren't doing our jobs the way we are supposed to and whether or not we like it the money just isn't there to replace allied health with nurses. It isn't going to happen.

So instead of screaming and kicking and letting others make the decisions about who will give our patients their meds, why shouldn't we be proactive and help create a workable system. How much time would you have if someone else did ALL your POs and perhaps SQs? Maybe even IMs? How much time would that free up? What could you do now that you aren't able to do because you simply don't have the time? It isn't going to change, we aren't going to replace allied health with RNs so let's create a GOOD system vs. what the idiots have created with CNAs that are passing out pills like they would water pitchers? There is NO CNA that is going to pass MY meds, it won't happen. While I am quite sure there are a couple of really good ones out there, I don't know them and they aren't touching my keys and there is no discussion about it. I wouldn't work in any facility where a CNA could pass meds. Not even a Tylenol.

However if I had an option I could work with, it would be CPhTs. They have the potential to do a good job.

Are you aware that pharmacy has been lobbying for a new level of pharmacy? It's more than a tech and less than an RPh. In a retail setting they would do refills and essentially anything except for new orders and patient counseling. No RPh checking their work. It would be a 2 year program vs. the PharmD trend now. It would free up the RPh to do the same thing we are looking for in having our time opened a little. They need time to do what someone else can easily do. We need time to do what someone else could easily do.

Currently techs are giving flu injections at flu injection clinics, they are doing vitals at BP clinics, they are already out there doing this. This isn't something brand new.

BTW, techs currently go to school from 9 months - 2 years depending on the program. When they leave school they can do the same with a 9 month program as with a 2 year program. So in some cases they have as much education as an RN and more than an LPN.

You know a Pharmacist can't prescribe medications,

LOL... that's changing too. RU486??? I forget what it's called. The morning after pill. In some states it most certainly is prescribed and dispensed by an RPh. There are a few other exceptions too.

yet that would be the first person I would contact in regards to any medication questions I have, prior to contacting the doctor in most circumstances. Just thought I throw that out there. :D

And when a nurse calls a hospital pharmacy, depending on the hospital often times it is the techs answering your questions. :)

I just want to see a system that works. Otherwise the idiots (whoever they are that create stooooopid rules, regs, and laws) will have CNAs pushing morphine in no time.