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:) .
The problem is that ultimately, the licensed nurse is liable, not the med tech.
And as Tweety said, little by little, nursing is being de-skilled. To say that it's no big deal for unlicensed personnel to start doing nursing tasks is to hold your own education in little value.
It's not about elitism. I personally just don't want to have to assume responsiblity for a minimally trained individual to perform tasks under my license. Maybe going to nursing school was a walk in the park for some, but it wasn't for me. I'd like to hold on to my license, thank you very much.
The problem is that ultimately, the licensed nurse is liable, not the med tech.
And as Tweety said, little by little, nursing is being de-skilled. To say that it's no big deal for unlicensed personnel to start doing nursing tasks is to hold your own education in little value.
It's not about elitism. I personally just don't want to have to assume responsiblity for a minimally trained individual to perform tasks under my license. Maybe going to nursing school was a walk in the park for some, but it wasn't for me. I'd like to hold on to my license, thank you very much.
I would rather have the time to do assessments and the time to do the things in nursing that require true critical thinking. Letting go of these tasks does not devalue my education, quite the contrary, actually. With competent assistants, I have the ability to complete the more complex parts of the job in a way that really benefits the pateint, rather than rushing through the day getting countless tasks done. I do not believe for a minute that as busy as nurses are, that they are able to research all the meds the give and do everything else as well. Not possible. But, if the nurse can oversee the care and really delve into each case without basic tasks taking up all of the time, then he/she can really focus on the patient and treatment. Nurses are far more knowlegable and involved with the actual treatment and have more responsibility than in the past. If we continue to try to keep doing all we have done and add on more all of the time, we can expect to be ever more burned out and discouraged with nursing overall. The supernurse mentality where we believe we must do all and fear for our license, if we don't, is futile thinking and basic martyrdom, IMO. Time to let go of the old ways and embrace nursing in a way that works for today. Fifty years ago nurses did aide work and doctors did many of the things nurses do now. Hec, even I remember when only the doc would touch the dressing. Healthcare is evolving and personally, I'm glad to see it.
Well, I don't consider medication administration to be a task that doesn't require critical thinking. I think it's asking for trouble to view giving meds as a mindless, rote activity.
If you're comfortable with it, good for you. I'm not, and that doesn't make me "old-fashioned."
Well, I don't consider medication administration to be a task that doesn't require critical thinking. I think it's asking for trouble to view giving meds as a mindless, rote activity.
If you're comfortable with it, good for you. I'm not, and that doesn't make me "old-fashioned."
I did not refer to passing meds as mindless, rote activity...that would be insulting a lot of very capable and intelligent med techs, which of course I would never do. Through lots of experience working with med techs, I have become very comfortable with them. By and large, they are a huge asset.
I would rather have the time to do assessments and the time to do the things in nursing that require true critical thinking. Letting go of these tasks does not devalue my education, quite the contrary, actually. With competent assistants, I have the ability to complete the more complex parts of the job in a way that really benefits the pateint, rather than rushing through the day getting countless tasks done. I do not believe for a minute that as busy as nurses are, that they are able to research all the meds the give and do everything else as well. Not possible. But, if the nurse can oversee the care and really delve into each case without basic tasks taking up all of the time, then he/she can really focus on the patient and treatment. Nurses are far more knowlegable and involved with the actual treatment and have more responsibility than in the past. If we continue to try to keep doing all we have done and add on more all of the time, we can expect to be ever more burned out and discouraged with nursing overall. The supernurse mentality where we believe we must do all and fear for our license, if we don't, is futile thinking and basic martyrdom, IMO. Time to let go of the old ways and embrace nursing in a way that works for today. Fifty years ago nurses did aide work and doctors did many of the things nurses do now. Hec, even I remember when only the doc would touch the dressing. Healthcare is evolving and personally, I'm glad to see it.
Sbic56, my experience with UAPs has not been good. I've worked at a hospital that did not have UAPs providing patient care (RNs and RPNs/LPNs) and am currently working at a hospital that has CNAs and RNs. I found a better team approach, more through patient care, more accountability & responsibility, in essence the patients in general received better care at the facility that had RNs and RPNs/LPNs.
I would actually have an easier time doing my current job if the UAPs did theirs. It's pretty sad when patients will not be turned & positioned, changed if incontinent, have water provided, have their beds changed, be cleaned if necessary, have their urinals emptied, I could go on here. The gist is, I'm working with people who will do the bare minimum that they have to. The unit clerk and CNAs have plenty of time to socialize and play on the computer, but no initiative to assist with providing care for the patients. BTW, yes I have discussed the situation with my UM as have other nurses on the unit. I have even discussed strategies to improve team work between the RNs and CNAs. I've also discussed the situation with the unit clerk, because I am sure it is not in her job description to shop for shoes on E-Bay. The bottom line is because I cannot trust that they will do their job, it creates more work for me.
UAPs were once allowed to do more tasks where I work: NGs, foleys, trach care, T&C, for example. I don't doubt for a minute that this changed because there were problems that arised because there were those who did not do these things correctly. I am now left to deal with UAPs who are now disgruntled over this issue. 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. We also need to be careful that the delegation of these tasks doesn't add in creating a more difficult work environment, IE: your UAPs are busy "tasking" and your left providing basic care (turn & positioning, cleaning incontinent patients, etc), sort of defeats the purpose of delegation.
Patient assessment is always ongoing with each interaction a nurse has with her patient. We cannot assess and evaluate what we don't see. Critical thinking is also based on what we assess, it is also a continuous process with nurses.
Most acute care hospitals in the area I currently work in do not utilize LPNs, now there's a vast unused resource right there.
I do not believe for a minute that as busy as nurses are, that they are able to research all the meds the give and do everything else as well. Not possible.
A new nurse, probably not, but at least a new nurse knows who to ask or where to look for info and will ask questions. I cannot see how a new medication aide would have more knowledge concerning medications than a new grad. An experienced nurse does know about the medications that are most frequently used on a unit, the nurses become very familiar with them. It is knowledge accumulated through schooling and experience. Our education concerning med administrations begins at the start of schooling, continues through that schooling, and continues to wherever we are presently.
The key word in you post: competent. Any job is easier if you have a competent person doing it that you can rely on to do their job. If I cannot rely on someone to do their job competently and professionally it is more of a burden than a relief. Who's determining competency here?
I would rather have the time to do assessments and the time to do the things in nursing that require true critical thinking.......... I have the ability to complete the more complex parts of the job in a way that really benefits the pateint, rather than rushing through the day getting countless tasks done. ................ Healthcare is evolving and personally, I'm glad to see it.
The big problem I see here is that the UAP's aren't easing my burden and freeing me up to do critical thinking roles. Management is increasing the RN to patient ratio using UAP's. My ratio when I started was 4:1 14 years ago at this facility. Now it's 7:1 or 8:1 with a UAP. My ability to do critical thinking is diminished in this atomosphere.
I'm happy to let go of tasks and don't feel it devalues my education. With 8 patients I have to let go of a lot of things to the UAP. I think in acute care settings in hospitals, meds and injections are best left to licensed personnel. In places like an ALF, group home, or even LTC med techs are appropriate.
Specializes in Med-Surg, Geriatric, Behavioral Health.
Sbic56, my experience with UAPs has not been good. I've worked at a hospital that did not have UAPs providing patient care (RNs and RPNs/LPNs) and am currently working at a hospital that has CNAs and RNs. I found a better team approach, more through patient care, more accountability & responsibility, in essence the patients in general received better care at the facility that had RNs and RPNs/LPNs.
I would actually have an easier time doing my current job if the UAPs did theirs. It's pretty sad when patients will not be turned & positioned, changed if incontinent, have water provided, have their beds changed, be cleaned if necessary, have their urinals emptied, I could go on here. The gist is, I'm working with people who will do the bare minimum that they have to. The unit clerk and CNAs have plenty of time to socialize and play on the computer, but no initiative to assist with providing care for the patients. BTW, yes I have discussed the situation with my UM as have other nurses on the unit. I have even discussed strategies to improve team work between the RNs and CNAs. I've also discussed the situation with the unit clerk, because I am sure it is not in her job description to shop for shoes on E-Bay. The bottom line is because I cannot trust that they will do their job, it creates more work for me.
UAPs were once allowed to do more tasks where I work: NGs, foleys, trach care, T&C, for example. I don't doubt for a minute that this changed because there were problems that arised because there were those who did not do these things correctly. I am now left to deal with UAPs who are now disgruntled over this issue. 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. We also need to be careful that the delegation of these tasks doesn't add in creating a more difficult work environment, IE: your UAPs are busy "tasking" and your left providing basic care (turn & positioning, cleaning incontinent patients, etc), sort of defeats the purpose of delegation.
Patient assessment is always ongoing with each interaction a nurse has with her patient. We cannot assess and evaluate what we don't see. Critical thinking is also based on what we assess, it is also a continuous process with nurses.
Most acute care hospitals in the area I currently work in do not utilize LPNs, now there's a vast unused resource right there.
A new nurse, probably not, but at least a new nurse knows who to ask or where to look for info and will ask questions. I cannot see how a new medication aide would have more knowledge concerning medications than a new grad. An experienced nurse does know about the medications that are most frequently used on a unit, the nurses become very familiar with them. It is knowledge accumulated through schooling and experience. Our education concerning med administrations begins at the start of schooling, continues through that schooling, and continues to wherever we are presently.
The key word in you post: competent. Any job is easier if you have a competent person doing it that you can rely on to do their job. If I cannot rely on someone to do their job competently and professionally it is more of a burden than a relief. Who's determining competency here?
Your post....was most magnificent!!!
I almost broke down in tears.
And Tweety, you are correct....some places of management look at only quantity (bodies...increase UAP usage and jack up your ratio as a nurse ) vs quality...because, you and I both know, quality costs. At our hospital at least, UAPs are used in a limited fashion...they support the nurse by taking on the ADLs, call lights, pass water, pass out trays, insert foleys, ambulate, keep the rooms tidy, turn patients, and give baths/hs care. This IS the appropriate use of UAPs! I and all our nurses, RNs and LPNs alike, would just have a cow if they did much more than that. For one, these duties keep them very busy as it is already. These tasks are NOT essential tasks for the nurses to complete, but ARE essential to the patient and their perception of care. Secondly, I know many a nurse would walk if UAPs were utilized to perform "NURSING procedures" which entail a firm knowledge base as to how and why those certain procedures need to be performed in a particular way. In many, there are no shortcuts. There is "genuine rationale" why things are done in a certain way and in a certain order. I'm sorry, but I totally have to disagree that UAPs are appropriate in passing meds. They do not possess the necessary science of nursing. I'm sorry, it is not just like working at McDonald's flipping burgers. Management at some of these places would have you believe "you can train a monkey to do that"....borrowing an old expression and no disrespect here on my end. But, you have to think like upper management, distant to the actual goings on in their own facilities. UAPs as "little nurses" is insulting to us and to our profession, ridicules my license and my education as well as yours, and places patients at unnecessary risk. It is a totally unnecessary burden to UAPs to place "that level" of care and responsibilty on their shoulders. If mom or dad has a change in condition, do YOU want a UAP at your side to assess and immediately intervene or do YOU want the nurse? YOU can answer that question very simply as well as I can. No, YOU would want your nurse. But, let's say that change in condition is SUBTLE. Is your UAP equipted for this level of discrimination that is required? Hmmm, doubt it. But, many places in management have turned the perception of medical/nursing care from places of health care as the yardstick of quality to a customer service venue as a measure of outcomes...like, Disney or a restaurant service. Look at how your Press Gainey is structured. Shameful, just shameful. Some of this is beginning to turn around for the better where NOW indicators of good service are infection rates, mortality rates, and staff level of education. I honestly do not believe that UAPs are equipted to understand, to assess, and to intervene in the proper use of medication in a health care setting. I will even be so bold as to say, even in TLC. If I where an elderly resident on 13 different pills and I have a change in my condition, are you trying to say that that UAP has the knowledge, the wisdom, the assessment skills, and the authority to give or to withhold a particular medication based on my condition or change in condition? I hope you are not saying that, because it bears no merit to yourself as a nurse or to the care of your patient. Many have said that the use of UAPs is a response to the nursing shortage. Partially, this is true. But, what is more true is that there are NOT enough nurse educators or incentives for nurses to become educators to trim our long waiting lists to nursing schools across the country. Much of this is due to poor state and federal funding to our schools, the lack of educator incentives, and the BONs and state legislatures giving in to state lobbies to use UAPs as a "cost effective" measure to the nursing shortage. This rationale of the quick fix by creating UAPs is short sighted and degrades the profession. What would be more cost effective would be training more nurses without these long waiting lists. Put the energy there, not in creating aids to be nurses in a couple weeks of instruction...if that! Our patients deserve much better treatment than this. People ARE OUT THERE banging on the school doors to become nurses...that is not the problem. The problem is that the door has been barred for too long, to too many. Many potential nurses give up because they have waited too long outside the door to enter. This is shameful. Down right shameful. No, I totally disagree. UAPs are NOT appropriate.
The key word in you post: competent. Any job is easier if you have a competent person doing it that you can rely on to do their job. If I cannot rely on someone to do their job competently and professionally it is more of a burden than a relief. Who's determining competency here?
I just copied part of your post to save space, but I hear you loud and clear regarding bad UAP's. Competency is an individual thing. Good management is very important everywhere, but if a facility is going to use UAP's, it's imperative. I think some UAP's may be more apt to do sloppy work as they have not had to sacrifice as much as the nurse to get where thye are. Better standards for training need to be set, as well. This is a concern to me, too. That had to happen in nursing, too. Not all UAP's have to be on a registry either and I don't think that should be allowed. Yes, there are problems, but I am more for solutions than turning a blind eye to a staffing problem that isn't going away anytime soon. In a perfect world I would love to see ideal nurse/patient ratios, but I have to be relaistic.
The big problem I see here is that the UAP's aren't easing my burden and freeing me up to do critical thinking roles. Management is increasing the RN to patient ratio using UAP's. My ratio when I started was 4:1 14 years ago at this facility. Now it's 7:1 or 8:1 with a UAP. My ability to do critical thinking is diminished in this atomosphere.
I'm happy to let go of tasks and don't feel it devalues my education. With 8 patients I have to let go of a lot of things to the UAP. I think in acute care settings in hospitals, meds and injections are best left to licensed personnel. In places like an ALF, group home, or even LTC med techs are appropriate.
If management is going to abuse the system, then they are to blame, not the UAP. Such ratios are infuriating, aren't they?? And, yes, my experience with Med Techs, CRMA's have been out of the hospital setting. I have not worked with them in the hospital here. I know CNA's were a breath of fresh air returning to the hospitals though, as they were out for about 10 years until the nurses were ready to drop. There was a UAP who posted here awhile back who had an extensive course and did start IVs, as well as many other tasks in a hospital in a well respected hospital, so I can see where it can work if done right. I'm open to changes, but it does need to be done right.
) vs quality...because, you and I both know, quality costs. At our hospital at least, UAPs are used in a limited fashion...they support the nurse by taking on the ADLs, call lights, pass water, pass out trays, insert foleys, ambulate, keep the rooms tidy, turn patients, and give baths/hs care. This IS the appropriate use of UAPs! I and all our nurses, RNs and LPNs alike, would just have a cow if they did much more than that. For one, these duties keep them very busy as it is already. These tasks are NOT essential tasks for the nurses to complete, but ARE essential to the patient and their perception of care. Secondly, I know many a nurse would walk if UAPs were utilized to perform "NURSING procedures" which entail a firm knowledge base as to how and why those certain procedures need to be performed in a particular way. In many, there are no shortcuts. There is "genuine rationale" why things are done in a certain way and in a certain order. I'm sorry, but I totally have to disagree that UAPs are appropriate in passing meds. They do not possess the necessary science of nursing. I'm sorry, it is not just like working at McDonald's flipping burgers. Management at some of these places would have you believe "you can train a monkey to do that"....borrowing an old expression and no disrespect here on my end. But, you have to think like upper management, distant to the actual goings on in their own facilities. UAPs as "little nurses" is insulting to us and to our profession, ridicules my license and my education as well as yours, and places patients at unnecessary risk. It is a totally unnecessary burden to UAPs to place "that level" of care and responsibilty on their shoulders. If mom or dad has a change in condition, do YOU want a UAP at your side to assess and immediately intervene or do YOU want the nurse? YOU can answer that question very simply as well as I can. No, YOU would want your nurse. But, let's say that change in condition is SUBTLE. Is your UAP equipted for this level of discrimination that is required? Hmmm, doubt it. But, many places in management have turned the perception of medical/nursing care from places of health care as the yardstick of quality to a customer service venue as a measure of outcomes...like, Disney or a restaurant service. Look at how your Press Gainey is structured. Shameful, just shameful. Some of this is beginning to turn around for the better where NOW indicators of good service are infection rates, mortality rates, and staff level of education. I honestly do not believe that UAPs are equipted to understand, to assess, and to intervene in the proper use of medication in a health care setting. I will even be so bold as to say, even in TLC. If I where an elderly resident on 13 different pills and I have a change in my condition, are you trying to say that that UAP has the knowledge, the wisdom, the assessment skills, and the authority to give or to withhold a particular medication based on my condition or change in condition? I hope you are not saying that, because it bears no merit to yourself as a nurse or to the care of your patient. Many have said that the use of UAPs is a response to the nursing shortage. Partially, this is true. But, what is more true is that there are NOT enough nurse educators or incentives for nurses to become educators to trim our long waiting lists to nursing schools across the country. Much of this is due to poor state and federal funding to our schools, the lack of educator incentives, and the BONs and state legislatures giving in to state lobbies to use UAPs as a "cost effective" measure to the nursing shortage. This rationale of the quick fix by creating UAPs is short sighted and degrades the profession. What would be more cost effective would be training more nurses without these long waiting lists. Put the energy there, not in creating aids to be nurses in a couple weeks of instruction...if that! Our patients deserve much better treatment than this. People ARE OUT THERE banging on the school doors to become nurses...that is not the problem. The problem is that the door has been barred for too long, to too many. Many potential nurses give up because they have waited too long outside the door to enter. This is shameful. Down right shameful. No, I totally disagree. UAPs are NOT appropriate. 
sjrn85
266 Posts
The problem is that ultimately, the licensed nurse is liable, not the med tech.
And as Tweety said, little by little, nursing is being de-skilled. To say that it's no big deal for unlicensed personnel to start doing nursing tasks is to hold your own education in little value.
It's not about elitism. I personally just don't want to have to assume responsiblity for a minimally trained individual to perform tasks under my license. Maybe going to nursing school was a walk in the park for some, but it wasn't for me. I'd like to hold on to my license, thank you very much.