Medication Nurse Assistants

Kikumaru · Nov 17, 2005

I'm pretty sure that would be against the state laws.

VA is NOT regulated by state laws!!

Bipley · Nov 17, 2005

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.

I've been thinking about this and I realized something.

I collect antique medical books. I used to have a nursing textbook from the early 1900s. Chapter one was how to cook oatmeal.

Nurses used to do everything, absolutely everything. The did all the routine cleaning, cooking, they washed the linens, they bathed the patients, took people to the BR, did vitals, the procedures, interpreted orders, they did everything. How do you suppose the first nurse with an NA felt? I'll bet a dollar she came up with every reason why a non-nurse should not bathe a patient. Wound care, scrubbing too hard, sensitive skin, the works.

We have become specialized now. Some specialize in med/surg, some OR, ER, Trauma, Oncology. We can no longer do it all. I'd venture a guess this was just as hard for the first nurses as it is for us today.

Today we have farrrr more responsibility vs. any other time in nursing history. We have no choice but to give up some of the duties so we can do the things that require a nurse. It's no longer an option.

sjrn85 · Nov 17, 2005

I guess I just don't see how giving meds can be considered an unskilled task. Maybe, maybe in a group home setting a med tech would be OK, but in acute care? No way. Even in nursing homes, the pts. are very fragile. I would rather deal with the stress of having to give a lot of meds than wonder if the meds given by a tech were given correctly.

DusktilDawn · Nov 17, 2005

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.

Actually the issue is about unlicensed assistive personnel giving meds. In an ideal world qualified licensed personnel would be providing medication to patients. Sorry BSN isn't the end all and be all in regards to being a Registered Nurse. That is all I will say on that subject.

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.

Actually at present in my facility, only narcotics, benzodiazepines, barbituates, or other wise controlled substances are in the pyxis. I can actually access narcotic analgesics prior to the order being entered by pharmacy. For some reason we do have to wait until the order is entered for benzodiazepines, prior to the pyxis system being upgraded 6 months ago we could access benzodiazepines. Basically the rest of our patient medications are place in their assigned drawers in a medication alcove. Not all places will use the pyxis system the same way. Irregardless of who, how, or how many checks are done prior to my receiving a medication, I am still required to check it prior to administration.

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?

Actually if someone did all my medication administration it may save me 30-45 minutes probably for the whole shift and that would only be in regards to administering medication alone, no interruptions. I may enter a paitent's room with medication, but medication administration will not be the only thing I will do in regards to that patient's care. Bear in mind my usual patient load is 6. In LTCs and NHs their patient load in regards to medications is significantly higher. What would save me time is if the CNAs I worked with actually considered it part of their job to provide basic patient care. Basically if your support staff is not doing their job competently and professionally, it affects how you provide care.

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.

Actually as a nurse I check any medication that my patient receives. In fact, it is triple-checked. In fact in regards to certain medications it is required that another RN checks the dosage. In fact it has occured with some IV meds that the rate pharmacy indicated was wrong (ooops someone goofed, that's why WE ALL check).

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

Actually it will be the pharmacist answering my questions, yes I am 100% positive on that.

BTW, techs currently go to school from 9 months - 2 years depending on the program.

According to this program, they can fast track in 4 months.

http://www.rxtechschool.com/

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.

Don't have them at my facility. I'm actually lucky if lab informs me of values that they should when they should. Guess if they did their job.....

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.

Agreed. I can give a rather extensive list of things that take time away from my patients that have absolutely nothing to do with anything I learned as a nurse and could most certainly be delegated elsewhere. Medication administration is not on this list.

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?

The primary focus is the patient. Can they assess and relate to patients the way nurses are trained to do?

Today we have farrrr more responsibility vs. any other time in nursing history. We have no choice but to give up some of the duties so we can do the things that require a nurse. It's no longer an option.

How about making facilities accountable in regards to providing a workplace that facilitates nurses in regards to providing care for their patients, instead of letting them get away with continually making it increasingly more difficult to do our jobs. I think when you look at delegation of tasks that have traditionally been under the scope of a nurse's practice has to be reviewed carefully, otherwise our patients are placed in danger.

Bipley I actually see where your coming from in regards to Pharm techs passing out medications because of their knowledge. The training is not geared the same towards patients as it is for nurses. It's the whole patient that needs to be looked at, not just the effects of the medication we provide. If a patient is being treated for COPD for instance, it will be the nurse who assess the patient's lung sounds before and after inhalation Txs. If someone else is administering that medication, it can interfere with assessment of that patient. They may be ready to administer the medication, I may not be ready at that precise time to assess the patient. They may administer it anyway.

BTW, a friend of mine has one of her grandmother's notebooks from the 1920's, it includes notes on how to make window cleaner. I think when the public stops looking back at Florence Nightengale and how it used to be, and comes into the 21st century in regards to the nursing profession things will change. I think it is time nurses started educating the public about our profession. Nurse:Maid, two very different words, two very different jobs, unfortunately there seems to be a lot of confusion with the general public about the two. Also the upper echelon in most facilities has the same problem.

Bipley · Nov 17, 2005

I guess I just don't see how giving meds can be considered an unskilled task. Maybe, maybe in a group home setting a med tech would be OK, but in acute care? No way. Even in nursing homes, the pts. are very fragile. I would rather deal with the stress of having to give a lot of meds than wonder if the meds given by a tech were given correctly.

I never claimed passing meds was an unskilled task. If a CPhT has 9 months to 2 years of training and an LPN has 1 year of training, doesn't that make the LPN unskilled? I think that is an unfair comment. If a licensed LPN is a skilled professional, then so is a certified and licensed CPhT.

I don't think anyone but an RN should be giving meds in an acute care setting. However there are quite a few areas it would be acceptable. I'd rather a CPhT pass meds vs. a CNA, wouldn't you?

Someday it is going to come down to someone else passing our meds. We can help to set the scales now or we can live with what we are forced into later. I'd rather be part of making it a workable system.

Bipley · Nov 17, 2005

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.

Times are changing, they haven't updated the PTCB site since they started it a few years ago. I teach the classes, there is a required set if info that MUST be taught to maintain accreditation. I'm telling you, these people learn more than you think.

Again, if it was an ideal world nurses would be the only folks passing meds. But times are changing. We need to make it a workable system.

Bipley · Nov 17, 2005

Actually the issue is about unlicensed assistive personnel giving meds.

Right. And I don't support CNAs passing meds so I suggested an alternative, licensed and certified CPhTs.

In an ideal world qualified licensed personnel would be providing medication to patients. Sorry BSN isn't the end all and be all in regards to being a Registered Nurse. That is all I will say on that subject.

Not saying it is. But a BSN does have more education in pharm stuff vs. other levels. It's a reality, they do. RNs have more knowledge than an LPN. That isn't a slam, it's reality. That also isn't saying that an LPN can't be good at her job or passing meds. I'm just stating the facts.

Actually at present in my facility, only narcotics, benzodiazepines, barbituates, or other wise controlled substances are in the pyxis. I can actually access narcotic analgesics prior to the order being entered by pharmacy. For some reason we do have to wait until the order is entered for benzodiazepines, prior to the pyxis system being upgraded 6 months ago we could access benzodiazepines. Basically the rest of our patient medications are place in their assigned drawers in a medication alcove.

And if it is in a drawer it came from pharmacy, right? It's already been checked by an RPh which was my original point.

Not all places will use the pyxis system the same way. Irregardless of who, how, or how many checks are done prior to my receiving a medication, I am still required to check it prior to administration.

I never claimed otherwise. My point was regarding an RPh checking everything before it leaves the pharmacy. That just isn't true.

What would save me time is if the CNAs I worked with actually considered it part of their job to provide basic patient care. Basically if your support staff is not doing their job competently and professionally, it affects how you provide care.

I haven't heard many nurses that are overly thrilled with the way things are today. I know I'm not. I shouldn't have to stop what I'm doing to bring someone water when I have a CNA for six patients. There are good CNAs and bad ones. The good ones can make life fantastic! The bad ones are a mega PITA.

Actually as a nurse I check any medication that my patient receives. In fact, it is triple-checked. In fact in regards to certain medications it is required that another RN checks the dosage. In fact it has occured with some IV meds that the rate pharmacy indicated was wrong (ooops someone goofed, that's why WE ALL check).

I have found quite a few pharmacy errors over my career. Better lots of checks vs. just one. No disagreement there.

Actually it will be the pharmacist answering my questions, yes I am 100% positive on that.

In your facility, but not all. I wasn't referring to any specific facility, I was referring to current trends. However, my point still stands.

According to this program, they can fast track in 4 months.
http://www.rxtechschool.com/

Some do. Some don't. Let's set the rules NOW so that someone has to know what they are doing. Let's not leave it up to the idiots that assume a CNA can safely pass meds, let's find a workable system.

The primary focus is the patient. Can they assess and relate to patients the way nurses are trained to do?

Have you not read anything I have written?

How about making facilities accountable in regards to providing a workplace that facilitates nurses in regards to providing care for their patients, instead of letting them get away with continually making it increasingly more difficult to do our jobs. I think when you look at delegation of tasks that have traditionally been under the scope of a nurse's practice has to be reviewed carefully, otherwise our patients are placed in danger.

How do you propose we do that? Seriously, I would agree with you if it was possible. With budget cuts and everything else I don't see that happening.

Bipley I actually see where your coming from in regards to Pharm techs passing out medications because of their knowledge. The training is not geared the same towards patients as it is for nurses. It's the whole patient that needs to be looked at, not just the effects of the medication we provide. If a patient is being treated for COPD for instance, it will be the nurse who assess the patient's lung sounds before and after inhalation Txs. If someone else is administering that medication, it can interfere with assessment of that patient. They may be ready to administer the medication, I may not be ready at that precise time to assess the patient. They may administer it anyway.

I understand what you are saying. What I am saying is that this is a trend that will continue. It's going to happen whether or not we like it. Period the end. I'm not disagreeing this isn't the brightest move ever. What I do disagree with is that nobody other than a nurse can administer meds in a given setting. Is there validity to having a CPhT pass meds vs. a CNA? If you HAD to... just HAD to pick one, which is your preference?

BTW, a friend of mine has one of her grandmother's notebooks from the 1920's, it includes notes on how to make window cleaner. I think when the public stops looking back at Florence Nightengale and how it used to be, and comes into the 21st century in regards to the nursing profession things will change. I think it is time nurses started educating the public about our profession. Nurse:Maid, two very different words, two very different jobs, unfortunately there seems to be a lot of confusion with the general public about the two. Also the upper echelon in most facilities has the same problem.

We do more than Florence did. We have a huge responsibility that Florence never had. WE need to get with the program and realize we can no longer do it all. It isn't the public perception, it is our own perception of just what we can do in 8 hours. What we do, in the days of Florence two MD's did. Those days don't exist anymore.

I would still like to be part of the solution vs. the idiots that think a CNA can pass meds.

nurse4theplanet, RN · Nov 17, 2005

I'm coming in late on the back end of this discussion. I had posted some early on but I am going to give my thoughts on the most recent posts...

forgive me if I post a point that has already been made...hate to :deadhorse :smackingf :lol_hitti

CNAs/Med techs...I have already posted that I think this is not a good solution to the shortage of nurses. It is dangerous and just gives more of an argument for schools to not increase the funding of their nursing programs and increase instructor staffing Their rationale would be that if CNAs/Med techs are passing meds now, then a load is being taken off nurses, which would then lead to hospitals overloading their RNs and LPNs more than whats happening already...and I think we can ALL agree that nurses are overworked/stretched to their limits/underpaid...etc.

Certified Pharmacy techs passing meds? then who is going to be in the pharmacy? haha humor intended. On a more serious note, as someone said earlier I believe, they are NOT trained in assessment. Dig is going to have the same method of action, the same adverse reactions/side effects, drug interactions etc. for every person it is prescribed for BEFORE you administer, but each patient metabolizes and reacts to that med uniquely based on multiple d/o, current status, and so forth. So it is important to have more than even a detailed knowledge of medication to be responsible enough to give it...

For any of the above assistants, the nurse will still have to do an assessment before the med is given and after the med is given to document patient tolerance and level of therapeutic affect. If a reaction occurs, it is going to be the nurse that will implement the interventions that may save the client's life and we all know such incidences can happen in the blink of an eye. It is my belief that if you pass a med, then you are responsible for any further intervention that may be needed, and these technicians are not trained in this aspect....thus, that is why they are not nurses.

To advocate for these assistants, no matter how desireable it may seem to have the added help, is to disregard the importance and intricate training of our own profession. Essentially, the option of utilizing these occupations arose from the complications associated with nurses being loaded with too much responsibility, too many patients, and not enough time and support. It should be our (nurses) conviction to put pressure on the hospitals and nursing schools to hire/produce more competent nurses...not supplemental, unqualified staff to pass meds.

Let's leave the nursing to the nurses...we don't want to replace ourselves, nor do we want too many hands in the cookie jar...its our job to ensure the pt receives continuity of care.

nurse4theplanet, RN · Nov 17, 2005

a little aside to just for your consideration...

yesterday we were working a telemetry floor and had a overweight confused patient with a h/o CAD, uncontrolled HTN, MI, DM, etc...you name it he had it.

He was complaining about his room being hot so he took a chair out in the hallway to cool down (foreshadow). The nurses were preparing for a staff meeting and were not available. We (nursing students) were finishing up our charting when a CNA came up nonchalantly (sp?) and asked if there was any Tylenol left in the med room b/c she couldn't find it in the cart. We said, "who needs tylenol?" She mentioned the pt and said he was sweating and complaining of a toothache. We RAN down the hall to his room and called the charge nurse/pt nurse/clinical instructor leaving the poor CNA in our dust. Our intuition was correct...this guy was having a heart attack and the pain was radiating to his jaw...no toothache...he had dentures!

This CNA was a very smart cookie and she had worked there for many years, but it just didn't click for her. We are trained to look for the subtle changes in pt appearance, consider all the factors about that client's condition, and use our intuition/assessment/judgement to provide appropriate interventions. The poor woman was in awe that we (students) had seen a potential lifethreatening problem. Later, we were joking and she said "I just thought he had a toothache and I would never have questioned it...I should have known something was off cuz we lost his dentures the night before last and it took forever to find them!"

We got report from the hospital today that the pt ended up having to have emergency bypass surgery that evening after more episodes.

Marie_LPN, RN, LPN, RN · Nov 17, 2005

If a CPhT has 9 months to 2 years of training and an LPN has 1 year of training, doesn't that make the LPN unskilled? I think that is an unfair comment.

An FYI, some LPN programs are 2 years (mine was), and i know of a few that are even 3 years. Just addressing one of the misconceptions about LPNs that i've read on this thread, i'm not going through the other pages to pick the others, since it's not worth it if someone insists on what they went to school for automatically being more qualified to pass medications.

However, i'd like to suggest researching into an LPN's education, before just making assumptions that they aren't skilled enough.

Although i said i was done here, and after typing this, i'm definitely not coming back to continue to watch someone rip my chosen career apart on limited knowledge of it, or to watch those that agree with med techs being labeled "idiots". This does nothing to prove the validity of someone's point.

(and also, to address another comment, when i want to know about a med, i ask for the pharmacist, not the tech.)

DusktilDawn · Nov 17, 2005

The primary focus is the patient. Can they assess and relate to patients the way nurses are trained to do?

Have you not read anything I have written?

Actually I did read what you had written. All of it. I don't see where this question was answered. Is their training geared towards patients the way a nurses is? Is their practice setting patient focused the way a nurse's is?

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.

Yes, reviewing data and assessing the appropriateness of medication treatment. And actual patient interaction, seriously are they going in and assessing the patient, talking to the patient?

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.

Since the nurse is administering the medication it would be prudent for her to check. And patient interaction between chemo tech and patient?

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.

Medical Assistants are also performing these functions in doctors offices and clinics. Is the education geared towards a clinic practice setting? Is this where you are going to find the majority of Pharm techs?

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?

LPNs have learned more that procedures and patient care, I was a former LPN/RPN, and as such I encountered many RNs who really had no clue about the training or the qualifications of an LPN/RPN. BTW I noticed there are absolutely no LPNs in my current facility, they have been replaced. Previous facility had LPNs and RNs providing patient care, quess what, the patients received better care there IMHO. As I stated in a previous post pages back: THERE'S A VAST UNUSED RESOURCE RIGHT THERE.

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.

I think it would also be fair to say the role of Pharm tech continues to evolve, but is it evolving towards providing DIRECT patient care or more towards providing patient care in a similar manner as a Pharmacist.

Currently the course for LPN/RPN is 2 years where I live. It wasn't years ago. As with RN training and education, it continues to evolve. The direction the role of LPN has always been towards patient focused care and will continue in that direction. What bothers me is how they are underutilized in acute care settings where I currently practice.

The problem is when the PTB decide to "make my job easier" and it never seems to work out that way. What ever is taken away is replaced usually with twice the amount, and that tends to result in even less time focused on patients.

SmilingBluEyes · Nov 17, 2005

The problem is when the PTB decide to "make my job easier" and it never seems to work out that way. What ever is taken away is replaced usually with twice the amount, and that tends to result in even less time focused on patients.

Exactly. It's all a smoke screen. NEVER has it occured when the TPTB have said a change was coming to make our jobs easier, did it happen. Not with computer charting....not with central monitoring, not with anything. Usually with such changes, on the surface, it looks good---on paper and for the bean counters. But I have learned over 8 years, rarely does it make life easier for nurses, nor was it even intended it to be. It's just what they say to try and get us to buy on a concept that we RECOGNIZE as ridiculous, unworkable or DANGEROUS.