Nursing Issue - Medication Aides

WOLFE, BSN, RN · May 30, 2005

Thank you all so much for your replies. I would like to clarify one thing. The RN is responsible for the delegation of med administration to the Med Aide. The only thing that med aides does is give the med. The nurse is responsible for review and follow up of the labs, side effects, and response of patient to the meds, etc. The RN is responsible for teaching the med aide about the med and questioning said person to make sure the RN is comfortable with this person fulfilling this task. If the RN is not comfortable, then don't delegate. My question is: Who would want to delegate this responsibility? These people are only listed in a registry. Are there problems with med errors? What are done to these people when an error occurs? How much drug diversion is there? There are just to many unanswered questions.
My biggest question is: HOW DID THESE PEOPLE EVER GET HIRED IN THE FIRST PLACE? What is really scary is legislation has been passed in 29 other states, with many, I am afraid, to follow. Yes, this is a real scary thing.
However, we as nurses and nursing students need to stand together as ONE VOICE to fight this. With the right stipulations and credentials, med aides might could be a good thing in some areas, and that is a BIG maybe. However, I feel that if the states and federal government contributed more money for educational facilities and nurse educators, a nursing shortage would not exist. I know 1,000's are being turned away yearly because there just simply are not enough slots.
NURSES WE MUST BECOME ONE VOICE ON THIS ISSUE! NAD OTHER ISSUES THAT INVOLVE OUR FUTURE AND ESPECIALLY ONE'S THAT COULD HAVE OUTCOMES THAT AFFECT OUR FAMILIES BECAUSE WE CAN LOSE OUR JOBS OVER THIS!

A nurse is not allowed to delegate medication administration......

tiffanycmt · May 30, 2005

the chain of command or responsibility in nursing homes in missouri:
the administrator has overall responsibility for a facility and supervises all operations including the nursing department.
the don is the nursing departments head honcho and is responsible for the day-to-day operation of the nursing department. by law this person must be a licensed registered nurse.
under the don is the assistant don, usually a licensed practical nurse. this person is also involved with the day-to-day operation of the nursing department and also oversees all the department's employees.
next comes the registered nurse and under the registered nurse is the lpn (which by law, a facility is required to hire). by law, an lpn cannot step-up to the role or duties of an rn.
under the lpn is the cmt. a cmt can temporarily step-up to the role of an lpn if there is another lpn on duty (with limits).
under the cmt is the cna.
lpn's, cmt's, and cna's are the only employees to work shifts. they work 7-3; 3-11; and 11-7. rn's work a different schedule (eg: 9-5), but by law, must be on duty 8 hrs/day 7 days/wk. however, the employer must have an rn on call 24 hrs/day.
during the day the rn oversees the lpn. the lpn's in turn oversee the cmt's and the cna's on all 3 shifts.
the lpn's are aka "charge nurses." one lpn is assigned to each nursing unit for every shift. each charge nurse is responsible for managing their unit. when a charge nurse is absent, a cmt functions as a "team leader" for that unit. by law, the only way this can happen is if there is more than one unit at the facility and another lpn (charge nurse) is on duty. then that charge nurse from the other unit is responsible for managing not only his or her unit, but also the unit where the cmt is acting as a team leader. if there are only two units in a facility, the lpn is then responsible for the entire facility for the evening and night shifts. during this time, no other employee has similar authority. it is the responsibility of the charge nurses to make sure the facility is staffed according to state laws and regulations. if a cna or cmt becomes sick during a shift and needs to leave, the charge nurse must contact and rn before permitting an employee to leave work.
rn's evaluate the performance of lpn's (charge nurses) and lpn's evaluate the performance of cmt's and cna's. the lpn cannot hire/fire/promote, but they do provide in-services for certifications.
http://64.233.161.104/search?q=cache:mngviiojlbej:www.dolir.mo.gov/sbm/boarddecisions/decision/94-017.pdf+missouri+certified+medication+techs&hl=en&start=6
what i wrote above is part of a descriptive court case i found online (the link) that describes the hierarchy for personnel in a nursing home. it's dated 1994, but as tiffany said, cmt's have been around a long time. the thing i found interesting about this document is no where does it describe the authority of a cmt to be one of, or similar to, a professional licensed person.
the following is from the rules of the department of health and senior services, division 30, chapter 84, title 19 csr 30-84.020 (certified medication technician training program). state of missouri:
http://www.sos.mo.gov/adrules/csr/current/19csr/19c30-84.pdf
how on earth could one know "nursing implications" if they're not a nurse?!?
much of these laws i found are contradictory (is that a word?) and confusing.
apparently this certification course can be challenged if a person meets a certain criteria. this is quite alarming, imo. there is special and separate certification required so a cmt can administer insulin.
missouri revised statutes, chapter 335, nurses, section 335.076 says:
http://www.moga.state.mo.us/statutes/c300-399/3350000076.htm
i am charge nurse." - tiffanycmt
no person under any circumstance should take the title of rn or lpn unless they are licensed to do so. it is against the law in any state. the facility at which tiffany works needs to change their "charge" wording to "team leader" when a cmt takes on that role. cmt's are not charge nurses. they may play a leadership role when an lpn (charge nurse) is not available on their particular unit, but they are still under the supervision and are the responsibility of another lpn (charge nurse) on duty somewhere in the facility. they are not supervisors and do not "run" a unit. i blame the facility for not being clear on what the role of their cmt's are.
http://www.carescout.com/resources/assisted_living/state_policies/mo.html
so nowhere, at any time, do placing restraints, taking orders from docs, or giving "treatments" come under the rules/regulations/laws of cmt's in missouri. the laws specifically state that a cmt is not trained to give parenteral meds. tiffany, you must understand that this is not a personal attack on you. this is about the law which is created to protect vulnerable folks from the vultures who don't give a crap about them...only about saving a buck and doing things as cheaply as possible. even that gets into a whole new can of worms where healthcare and senior care comes into play in this country. it goes so much deeper and is so screwed up. you must look beyond the surface.
i wholeheartedly believe that you are being used and abused by your facility. they have you illegally doing nursing work for a very cheap price that could, if they got caught, turn into a very expensive price to pay for cutting corners. this is exactly what nursing fights. not because we are afraid of people like you taking our jobs, but for patient safety and the safety of our licenses. there is a reason for all of these long-winded, complicated laws.
you want to be a nurse? well, we want you! you need to open your mind! start thinking like one though and explore exactly what is taking place at your facility. read the laws and know what your scope is. refuse do to anything outside of your scope. you need to look at the big picture, not just how it affects you, but how it affects the greater good of patient care.
just because someone says it okay to do something doesn't make it right or legal.

okay i wasnt planning on even looking @ this thread anymore but i read what you wrote and had to comment on it. tonight @ work i was working as a aide on the east floor the west floor had a charge nurse call in. they tried to replace but of course were unable d/t it being 10:30 and who wants to get out of the bed. i'm trying to explain this as clear as i can on the west hall the charge nurse (lpn) for eve shift said she wasnt staying so my charge nurse on my end called the don and asked what to do. she said if all the med tech's and licensed nurses were refusing to volunteer then we could not leave till someone stayed to cover the west charge nurse position. well all of us med tech's stayed b/c we dont want to lose are med tech license and they finally got it replaced by a day shift rn. but what im trying to say is it was a charge nurse postion that they wanted us (med techs) to cover there for wouldnt you assume you are being called a charge nurse. also state is well aware that med techs are known as charge nurses so apparently it is very legal in fact i have charged when state has been there and there is a lpn in the building on the opp end. they come down if there is any schedule 2 drugs or any neb tx's d/t us being unable to do those. as i said before i dont give any injections other then insulin. i dont take t.o's my facility doesnt allow it. i dont give meds via feeding tube my facility doesnt allow it. also when state was @ our facility last year they complimented my charting that was in the cmt/lpn nurses notes. also tonight a lpn asked me to show her how to draw blood b/c she had only done it in a inservice and she said she would do it if i would observe and i take that as a honor although im sure some of you will find a way to say something against that. but for the nurses that are posting out of concern and not "hatefulness" thank you very much god bless tiffany oh one more thing i'm trying to explain things as simple and accurate as possible.

SmilingBluEyes · May 30, 2005

I think Karen's post says it all.

leslie :-D · May 30, 2005

tiffany,

you sound like such a lovely young woman.

somehow, somewhere, something is getting lost in communication.

i'm wondering that in the absence of an rn or lpn, your facility goes down the chain of command and leaves you responsible until help arrives.

so while you might be in charge, you're still not a charge nurse and for the facility to actually tell you that you are a charge nurse is 100% fraudulent.

and what really stuck out is when you stated the state is aware....what are they aware of?

there's nothing wrong in writing in cmt notes but you can't write where the rn's do; you have your own section. maybe they combine the lpn w/the cmt's for charting.

so if the state observed you in the capacity of a cmt, then of course there is nothing to question.

if they heard you being referred to as a charge nurse, then i am confident that would not be acceptable.

nonetheless, i hope your facility recognizes and appreciates the gem of an employee they have.

and i hope you do pursue nursing as you would shine.

peacefully,

leslie

begalli · May 30, 2005

oh one more thing i'm trying to explain things as simple and accurate as possible.

You do a fine job!

Tiffany - click on and read a few of the links that NurseKaren and I posted. These are not opinions, these are factual laws. It takes time to search out the information that talks about what you are specifically describing, but it's all there in black and white.

The largest part of nursing is critical thinking....asking questions....seeking the answer that best fits a situation by piecing together bits of factual information and then coming to a conclusion.

That's what we're doing here. Nursing is an evidence based practice. Once a person becomes a nurse, this skill or attribute of critical thinking carries over into all parts of life. So, we are analyzing the laws pertaining to CMT's in Missouri and applying those laws to your description of your situation (collecting information). The conclusion that we reach is that your role at your facility in Missouri, as you describe it, is not in accordance with the laws pertaining to CMT's in your state. And that's detrimental to the licensed professionals who oversee your work (btw, you do not hold a license - you are certified - big difference).

Not that we are saying you are not doing a great job, but just that your facility may be misleading you in what exactly your role is by the words that they use to describe you. Could it be just semantics? Sure. Because what you describe in your last post sounds much like the laws that describe your role EXCEPT for the term "charge nurse." I think what you don't get is ANY use of the term NURSE in ANY situation ANYWHERE when one is NOT a NURSE......is illegal and punishable by law. No matter what.

I hope my thoughts have come across clearly. It's sometimes difficult when my brain is running a marathon on a topic and my fingers can't keep up!

Be well.

tiffanycmt · May 31, 2005

tiffany,
you sound like such a lovely young woman.
somehow, somewhere, something is getting lost in communication.
i'm wondering that in the absence of an rn or lpn, your facility goes down the chain of command and leaves you responsible until help arrives.
so while you might be in charge, you're still not a charge nurse and for the facility to actually tell you that you are a charge nurse is 100% fraudulent.
and what really stuck out is when you stated the state is aware....what are they aware of?
there's nothing wrong in writing in cmt notes but you can't write where the rn's do; you have your own section. maybe they combine the lpn w/the cmt's for charting.
so if the state observed you in the capacity of a cmt, then of course there is nothing to question.
if they heard you being referred to as a charge nurse, then i am confident that would not be acceptable.
nonetheless, i hope your facility recognizes and appreciates the gem of an employee they have.
and i hope you do pursue nursing as you would shine.
peacefully,
leslie

I think you very much for your kind words. Okay we have four different sections to our nursing home. I have charted in the nurses notes on all four halls. The LPN'S,RNS and CMTS as well as social services all chart in the same book. On the eve shift they only label you as a charge nurse if your in the unit alzhiemers unit i know im sure i mispelled that. NOW on the noc shift is when they label you as a "charge nurse" and you perform all the duties i have described before. The HOUSE NURSE as they call it only comes over to give schedule 2 drugs and neb tx's and any wounds that need packing. I dont work noc's anymore only to fill in here and there but when i did/do i would pass all my med's no nurse would ask about them. No nurse would check on my residents they see that as MY JOB. So by the things i'm reading you are saying it is not my job overall it is there's PLEASE correct me if im wrong. On that hall i also have to chart if i draw blood location and that stuff. If i take vitals, If i use a restraint and IF i do i have to okay it with the nurse first i explain the situation and if she okays it i chart on it and im VERY cary to put per ... charge nurse. Basically the point im trying to say is they call the lpn or rn the HOUSE NURSE and the cmt when they west charge west charge nurse. So apparently they are false labeling us which doesnt surprise me b/c i knwo alot of stuff goes on that shouldnt but I know state is aware that we chart in teh nurses notes b/c they do a HEAVY review on nurses notes espically when it comes to restraints. We have two resdients that use a puma cusion ( a cushion that goes between there legs to keep them from sliding out of there chair) which is considered a restraint. Also we use a few lap n locks which is also considered a restraint which im sure you are all fully aware of. But it is my job to chart when they are used, when they are released, Why they were there every shift i work in the UNIT. So my question is Do you think that would be considered illegal 2. Why am i being told to do this and im NOT the only one being told other cmt's are as well. 3. Why hasnt state addressed this. God Bless Tiffany

mtymom · May 31, 2005

I think you very much for your kind words. Okay we have four different sections to our nursing home. I have charted in the nurses notes on all four halls. The LPN'S,RNS and CMTS as well as social services all chart in the same book. On the eve shift they only label you as a charge nurse if your in the unit alzhiemers unit i know im sure i mispelled that. NOW on the noc shift is when they label you as a "charge nurse" and you perform all the duties i have described before. The HOUSE NURSE as they call it only comes over to give schedule 2 drugs and neb tx's and any wounds that need packing. I dont work noc's anymore only to fill in here and there but when i did/do i would pass all my med's no nurse would ask about them. No nurse would check on my residents they see that as MY JOB. So by the things i'm reading you are saying it is not my job overall it is there's PLEASE correct me if im wrong. On that hall i also have to chart if i draw blood location and that stuff. If i take vitals, If i use a restraint and IF i do i have to okay it with the nurse first i explain the situation and if she okays it i chart on it and im VERY cary to put per ... charge nurse. Basically the point im trying to say is they call the lpn or rn the HOUSE NURSE and the cmt when they west charge west charge nurse. So apparently they are false labeling us which doesnt surprise me b/c i knwo alot of stuff goes on that shouldnt but I know state is aware that we chart in teh nurses notes b/c they do a HEAVY review on nurses notes espically when it comes to restraints. We have two resdients that use a puma cusion ( a cushion that goes between there legs to keep them from sliding out of there chair) which is considered a restraint. Also we use a few lap n locks which is also considered a restraint which im sure you are all fully aware of. But it is my job to chart when they are used, when they are released, Why they were there every shift i work in the UNIT. So my question is Do you think that would be considered illegal 2. Why am i being told to do this and im NOT the only one being told other cmt's are as well. 3. Why hasnt state addressed this. God Bless Tiffany

Are you saying you can draw blood also? Please clarify b/c if you do then that is illegal.

begalli · May 31, 2005

Are you saying you can draw blood also? Please clarify b/c if you do then that is illegal.

No, phlebotomy is not illegal.

SmilingBluEyes · May 31, 2005

Please refer to NRSKARENRN's post for accurate information.

txmustang · May 31, 2005

hi i am a med. aide from Tx. I have seen some negative feedback from nurses . I spent alot of time in this profession 8yrs I have come across CNA,CMA,LVN,RN and i wonder how did you get through school. I have worked for nursing homes, hospice,hospitalsand grouphomes.I have good feed-back from my hubby an LVN & RN's who respect what i do. I am not a fly-by-night person. I constantly look inPDR's . I have sufficient training in Tx. and no one can show me diff. I have Nurses from Africa that u can't understand and one asked me what is this order Calcium cabonate Hello nurses and you think med. Aides are incompedant. i've been one sice19999 and parial Nursing (divorce) but 95.3 average in phar. psyc, and 57 hrs. college Gie the girs a break till you know the whole story. Have a good day

Hi. I am new to the post. Very shortly a bill will be presented to our legislation on Medication Aides for my state. I am looking for some feedback regarding these aides. I know other programs have been implemented in many other states. How is it working? What are the current problems? Where can I go to find out more information?
In my state they will be mandatory in non-health focused care settings such as: schools, prison, assisted living, daycares, and group homes. The health focused areas are: long term care facilities, rehab centers, home health, hospice, public health depts., clinics, and acute care settings. However, some say it optional for health care facilities. The training is 24 hours. I feel this is very dangerous. It is being implemented to help alleviate some of the nursing shortage we will experience in the near future. Plus, a lot of these med aides already work in some of these facilities and there has never been any formal training. How they were hired is beyond me, but now there is a need to train these individuals. The only requirement to date is: 21 years old and a high school graduate. No prior medical experience. Scary!!!
I am looking for information on how programs of this type are working in other areas? Any problems experienced with the program? Is there an increase in med errors? Where I can go to gather more information?

leslie :-D · May 31, 2005

tiffany,

if they are calling you a charge nurse, that is illegal.

if you are charting in nurse's notes but signing your name w/cmt beside it, that is legal. obviously all staff there chart in the same book.

if a pt requires a restraint, it is the nurse's initials that should be charting, not yours. it is the nurse that should be writing the nurse's note on why the pt was restrained, if md was aware, how pt was tolerating, skin checks, etc. THAT is one area that you should not be charting on.

you should refer to your policies and procedures manual to peruse the scope of a cmt's duties and make a copy of it.

this facility sounds very shady and i'm just trying to protect you from any sort of liability.

if the p&p manual doesn't have a job description, then request to have one made up.

if you have any questions, there should be on the wall, the number of the facility's ombudsmen. you can call them (confidentially/anonymously) and explain that you're a cmt and this is what they have you doing; and is it legal. at least you'll get some input as they will definitely be able to answer any questions you have.

best of luck to you sweetie.

leslie

txmustang · May 31, 2005

you know if you have to come home and cry about your education(why) phar. is not hard i used my instincts as a med. Aide and look meds. up in a Pdr at least the most common given but reading is the best policy in Nursing. Even down the road read anything you can find or learn about comming out or past good luck

I try not to let things upset me very much, but, when I think about the months of studying that I did in pharmacology and the oh so many days that I came home from class and cried because I just knew I would never learn everything I needed to know to give meds, and then, I read something like this. 24 hours training!!!!! I just get down right mad. Sorry for the rant, but it just sounds down right dangerous to me. Most of us still keep a drug book handy because with sicker pt. and newer meds there is always something to learn. Or is it that people in "non-healthcare facilities don't deserve the same quality of care". If I had a child in school that was on medication, I would want someone overseeing that child that had more than 24 hr. "training".