Nursing Issue - Medication Aides

txspadequeenRN, BSN, RN · Apr 6, 2005

I am a LTC nurse in Texas. I work the weekends only and my primary job is to function as a Med-aide . They allow me to do this because I am the fill in nurse when needed and I am also the on call nurse. One of my other jobs is to supervise student med aides during their 10 hour clinical. Now, one of the things that amazes me is that these students have no clue what any pill is for, much less side effects. When I say "Ok now that is a Toprol tab, what is that for and what do you have to do before you give that pill". Most of the answers are "I dont know or something completly off the wall. I would not have so much of a problem with med aides if I knew they were trained right and had more clinical. The requirment here is 10 hours, what can you learn in 10 hours. When you hit the floor to pass meds you need at deep knowledge of at least the common drugs given in LTC. This just does not happen while they are a student and as a result our patients are at risk.

txspadequeenRN, BSN, RN · Apr 6, 2005

OH MY!!!!

I work as a hospice field manager, and deal with a few assisted living facilities that use med techs. As an RN, I can tell you it's truly frustrating to have nonlicensed staff giving meds to my terminal patients! I have one ALF that won't allow our patients to receive Roxanol (liquid morphine) unless their local pharmacy draws up individual syringes of the med. This means that instead of a bottle with an eye dropper for dosing, the techs have about a hundred individual syringes, each with 0.25ml of morphine in them! When I ordered a regular bottle of Roxanol from our mail-order pharmacy, you'd have thought I'd tried to kill someone - apparently, at this ALF, the med techs can't count liquid meds. The facility RN told me that in the past, the techs had been off count by bottles - yes, BOTTLES, not ml's - of Roxanol. :uhoh21:

txspadequeenRN, BSN, RN · Apr 6, 2005

The only person that should be fooling with blood sugars and insulins is the nurse... Period. And the doctors orders are way out of their scope of practice. I know you are just presenting the facts and Im not fussing at you. SO dont take me wrong.

Here's some interesting info on the training and other requirements which, apparently, vary widely from state to state. Check out this link. It gives a run down on each state's requirements.
http://www.alfa.org/membersonly/articles/MedAide_Spec_Rpt.pdf
4 states require 8 hours training
3 states require 16 hours
3 states require 20 hours
5 states require 40 hours
3 states require 60 hours
6 states do not list a specific number of hours (huh?)
6 states require that medication aides become CNA's first.
Other interesting info:
12 states restrict medication aides exclusively to assisted living centers
10 states restrict them to assisted living and skilled nursing centers
8 states restrict them to assisted living, adult day care and residential care.
What meds can be administered by medication aides?
With few exceptions, most states allow medication aides to administer orals, suppositories, topical creams, eye and ear drops, nasal sprays and inhalants.
Insulin:
6 states allow medication aides to draw up and administer insulin shots. 6 states allow them to hand out pre-filled insulin shots, 7 states allow them to administer pre-filled shots. 7 states don't allow insulin injections at all.
Blood Sugar:
18 states allow medication aides to test blood sugar, 10 states don't.
PRN Drugs:
22 states allow PRN meds to be administered. 2 states allow PRN meds to be administered after a nurse delivers the first dose. 5 states don't allow PRN meds.
Doctor's Orders:
17 states don't allow medication aides to take doc's orders. 5 states do allow medication aides to administer doc orders that are signed and faxed (nurse consultation is sometimes required). 2 states allow medication aides to take doc orders verbally. 4 states allow med aides to take doc orders but the orders must be signed/faxed.
:uhoh21:

boulergirl, CNA · Apr 8, 2005

Well, I made a big decision today. At the staff meeting this afternoon our boss asked each of us to decide if we want to be a med tech or not. Very few hands went up. (Well, I wonder why. :rolleyes: ) I chose NOT to raise my hand because I no longer want the responsibility. So as of today's date next month, I will no longer be a med tech and will probably have my hours reduced because there will be too many nurse's aides on the floor (it's just as well--I need an incentive to look for a day job closer to home).

Those who chose to be med techs will get a pay raise, but along with it comes a ton of responsibility. The med techs will be thoroughly acquainted with the pressures our boss lives with daily as a nurse. Do I want that much liability and stress with no formal nursing education? No thanks! :eek:

LPN1974, LPN · Apr 8, 2005

Well, I made a big decision today. At the staff meeting this afternoon our boss asked each of us to decide if we want to be a med tech or not. Very few hands went up. (Well, I wonder why. ) I chose NOT to raise my hand because I no longer want the responsibility. So as of today's date next month, I will no longer be a med tech and will probably have my hours reduced because there will be too many nurse's aides on the floor (it's just as well--I need an incentive to look for a day job closer to home).
Those who chose to be med techs will get a pay raise, but along with it comes a ton of responsibility. The med techs will be thoroughly acquainted with the pressures our boss lives with daily as a nurse. Do I want that much liability and stress with no formal nursing education? No thanks!

I do NOT blame you, boulergirl. You made a big decision.

These NHs are saving money off med techs. I'm sure they don't pay you all that much more than a CNA position pays.

If CNAs would refuse to take these positions, maybe the government would be forced to come up with grant money to help people like you or others go on to LPN or RN school.

That's what they need to be doing to help relieve the nursing shortage...help people become nurses instead of passing those nursing duties on down the line.

Marie_LPN, RN, LPN, RN · Apr 8, 2005

If CNAs would refuse to take these positions, maybe the government would be forced to come up with grant money to help people like you or others go on to LPN or RN school.

Unfortunately there are a few CNAs that might think that passing meds might be a way of getting more respect for what they do. Reason why i say this is that i've seen a few of the CMAs say this on other boards (were said today, actually).

boulergirl, CNA · Apr 8, 2005

Unfortunately there are a few CNAs that might think that passing meds might be a way of getting more respect for what they do. Reason why i say this is that i've seen a few of the CMAs say this on other boards (were said today, actually).

I used to think this way, at least in the beginning. Now I realize how stupid it is to take on this level of responsibility without the proper education. It's dangerous. For $8/hr., I don't need the headache.

VickyRN, MSN, DNP, RN · Apr 10, 2005

We are dealing with this same issue right now in North Carolina. It is very disturbing that this trend is occurring across the country. Slowly and insidiously, we are losing bits and pieces of our profession. Once gone, these wonderful components of nursing will be lost to us forever Who is orchestrating this attempt to deskill and deprofessionalize nursing?

http://www.ncbon.com/Education-factsheet.asp

On March 17-18, the North Carolina Council of Practical Nurse Educators (NCCPNE) came out with the following press release concerning both the medication aide and geriatric aide:

Position Statement of the NCCPNE
Geriatric Aide and Medication Aide:
While we as an organization acknowledge the increased demand for more qualified nurses, we do not believe that the solution to the problem exists with creation of a larger unlicensed workforce. The average geriatric client that is in long term care is a person with age related physiological changes and multiple chronic diseases that require a variety of medications, critical thinking skills, complex health care, and other health services. We believe that we need more licensed nurses not more unlicensed personnel to safely care for our geriatric population. Issues exist that have not been addressed as to competency evaluation, supervision, number of unlicensed persons supervised, access to controlled substances, etc. We believe that the movement will produce adverse effects in a vulnerable, valuable population.

The worst part (besides putting the public at grave risk) is that these unlicensed personnel will be working under the RN or LPN's license. If these people make an error, who do you think will be held accountable??? In case you are still wondering about the answer, see:

http://www.ncbon.com/forms/Interface%20between%20Licensed%20Nurse%20and%20Med%20Aide.pdf

This latest action by our Board is perplexing, as they are the agency who is entrusted with safeguarding the health of the public by ensuring "safe, effective nursing care." Instead, they are giving away vital components of our profession, and putting the health of everyone who enters an acute care facility across the state at risk.

We need to contact our state legislators ASAP! This bill (House Bill 783 and Senate Bill 662) has already been introduced into committee. This is legislation that could cause medication errors to skyrocket. A representative from our Board, with the Institute of Medicine's blessing, made a presentation before the subcommittee in support of these bills. We have reliable reports that there are large numbers of physicians backing these bills. The Senate bill has support from the large counties including Mecklenburg, Wake, Guildford, and Durham.

Here is an excellent template to use:

Dear ______
This letter is in reference to House Bill 783, filed on March 16 and sent to the Committee on Health. This bill will allow medication aides to give medications in health care settings. The Division of Facility Services along with the Board of Nursing introduced this as a measure to improve the medication delivery in unskilled facilities such as group homes, rest homes, and other residential settings.
In the update on nonlicensed personnel, it was reported that the intent was to require at least minimal training to unlicensed personnel who currently give medications to individuals (not patients) in residential settings. The Board of Nursing updates also stated this. However, in the bill there is no exclusion from using these technicians in acute settings or in skilled nursing home facilities.
As I am sure you have read and seen in the media, medication errors account for a huge amount of mortality and morbidity in our country. The residents in skilled nursing homes are requiring more complex care now than ever. The medication regimen, if not followed correctly can be ineffective or harmful.
I am certain that you would agree that for our loved ones and potentially for ourselves in the future, the person administering our medications needs more than 24 hours of training (primarily by video). I would venture to guess that a fast food employee obtains more than this amount of training.
I implore you to restrict the use of these technicians to only unskilled residential settings. Thank you for your careful consideration of this matter. The safety of health care across our state is at stake.
Sincerely,
______________

This is a link that should tell you who your NC state representative is:

http://tm.wc.ask.com/r?t=c&s=a4&id=30787&sv=za5cb0d88&uid=0FB508AAC527FAD14&sid=3ccd325ddccd325dd&p=%2ftop&o=0&u=http://www.ncga.state.nc.us/House/House.html

We also need to send letters-to-the-editor to newspapers across the state. Here is an excellent template to use:

Dear Editor:
I am a registered nurse/ licensed practical nurse who is concerned about a bill being introduced into the Health and Heath Care Committees. This bill, if passed, would allow unlicensed medication aides to administer medications to patients in health care settings. These "med aides" are only required to have 24 hours of video training, whereas a licensed practical nurse has a minimum of one year of training in pharmacological theory, lab, and clinical. You have to ask yourself, "Would I want someone with only 24 hours of training giving me or my loved ones medications rather than a licensed nurse with extensive knowledge of medications and their side effects? I think the answer is obvious.
This bill has been proposed as a solution to lessen the strain of the nursing shortage and to address rising healthcare costs by replacing licensed practical nurses with med aides. I believe that this is the wrong solution and can seriously jeopardize the health and well being of our patients. The very people that have proposed this solution are the ones that would like the bill to pass without public knowledge. If you feel as strongly as I do that this poses risks you are unwilling to take, please write your state representatives and senators requesting only licensed nurses be allowed to give medications and vote "no" for med aides.

If we act NOW, we can stop this!!!

LPN1974, LPN · Apr 10, 2005

We are dealing with this same issue right now in North Carolina. It is very disturbing that this trend is occurring across the country. Slowly and insidiously, we are losing bits and pieces of our profession. Once gone, these wonderful components of nursing will be lost to us forever Who is orchestrating this attempt to deskill and deprofessionalize nursing?
http://www.ncbon.com/Education-factsheet.asp
On March 17-18, the North Carolina Council of Practical Nurse Educators (NCCPNE) came out with the following press release concerning both the medication aide and geriatric aide:
The worst part (besides putting the public at grave risk) is that these unlicensed personnel will be working under the RN or LPN's license. If these people make an error, who do you think will be held accountable??? In case you are still wondering about the answer, see:
http://www.ncbon.com/forms/Interface%20between%20Licensed%20Nurse%20and%20Med%20Aide.pdf
This latest action by our Board is perplexing, as they are the agency who is entrusted with safeguarding the health of the public by ensuring "safe, effective nursing care." Instead, they are giving away vital components of our profession, and putting the health of everyone who enters an acute care facility across the state at risk.
We need to contact our state legislators ASAP! This bill (House Bill 783 and Senate Bill 662) has already been introduced into committee. This is legislation that could cause medication errors to skyrocket. A representative from our Board, with the Institute of Medicine's blessing, made a presentation before the subcommittee in support of these bills. We have reliable reports that there are large numbers of physicians backing these bills. The Senate bill has support from the large counties including Mecklenburg, Wake, Guildford, and Durham.
Here is an excellent template to use:
This is a link that should tell you who your NC state representative is:
http://tm.wc.ask.com/r?t=c&s=a4&id=30787&sv=za5cb0d88&uid=0FB508AAC527FAD14&sid=3ccd325ddccd325dd&p=%2ftop&o=0&u=http://www.ncga.state.nc.us/House/House.html
We also need to send letters-to-the-editor to newspapers across the state. Here is an excellent template to use:
If we act NOW, we can stop this!!!

NOT on my Nurse's license.

Why would any nurse want to be responsible for a med aide to pass pills?

If the aide is "monitored" and the client is "monitored" the nurse will have to be right by the aide's side every step of the way to observe all these things.

The nurse could do it herself and be done with it in half the time it would take the med aide to do it.

Big huge mistake, IMO.

boulergirl, CNA · Apr 11, 2005

Why would any nurse want to be responsible for a med aide to pass pills?
If the aide is "monitored" and the client is "monitored" the nurse will have to be right by the aide's side every step of the way to observe all these things.
The nurse could do it herself and be done with it in half the time it would take the med aide to do it.

I've asked myself the same thing concerning my boss. Why would she risk her license by working in a place where the med pass has to be delegated? Recently she had to take someone off the med tech position because she was making too many mistakes in the books. I'm sorry, but this med tech had a grand total of 10 minute's orientation (probably rushed). What did they expect?

Last night I came in to work and not only did I have to pass meds for the whole building, but several people's BPs had not been taken, so I had to take them (the med tech on duty that day was not familiar with some of the residents). One of the residents also has to have his pulse taken before he gets his morning meds because he takes Lanoxin. It wasn't done. I was not a happy camper.

What do you think? The nursing profession certainly didn't come up with the concept of "med techs" or "med aides". Nurses are too smart for that. I think whoever hatched up the "Assisted Living" model of care came up with this. Functionally, my boss has become a paperwork nurse.

sbic56, BSN, RN · Apr 11, 2005

It's interesting to see the responses from nurses regarding med aides. I am the nurse for a mental health crisis agency that employs CRMA's (Certifield Residential Medication Assistants). At first, I thought "oh, boy, I don't know about this", but having been there over a year now I have changed my view of using CRMA's in this environment, at least. I can see where it may become necessary to use them in hospital settings at some point, the way things are going. A couple of years ago, I'd have said no way, but having actually worked with some very good CRMA's, my position has softened alot.

There have to be strict, black and white, guidelines in place. Yes, close supervision is necessary. In my case, I am on call 12 hours a day and all the CRMA's know they can call me for anything and do so. Training regarding meds is ongoing. If there is a med error, I respond to it immediately. Is it a perfect sutuation? Heck, no. Still there have been no errors resulting in harm to a client since I have worked there. With good systems in place it does work.

I am also a CRMA instructor. All CRMA's are taught the same 40 hour state mandated curriculum, recently increased from 24 hours. This consists of a basic overview of the systems, intensive concentration on their scope of practice and pharmacology overview. Following the course they have a clinical where they have to pass meds X6 passes under the supervison of an RN, making no errors. All have had a background check of criminal records.

With cuts happening in healthcare all the time, we need to become accustomed to these types of solutions. The agency where I work would never be able to afford LPN's or RN's for these CRMA positions. These crisis residential units are a fairly new idea. They were instituted when the state institution downsized and the mental health consumers needed to receive treatment elsewhere. Funding is poor, so this is one way these much needed services can be offered. The interesting part is, the clients receive more therapeutic and safer psychiatric treatment in these residential units than they did in the state system.

boulergirl, CNA · Apr 26, 2005

Recently I had made a decision to step down from my med tech duties (effective next month).

Now I have coworkers telling me that, according to our boss, those of us who chose not to be med techs are getting an unpleasant surprise when see our schedules next month. In other words, she thinks we made this choice in order to "get off easy" and she's going to mess around with our hours in order to make us sorry. :angryfire

I did NOT choose to step down from my med tech position to "get off easy". I did it because I am tired of playing nurse. If anything, my job will be harder, because soon I will be working in the Alzheimer's wing EVERY night (only med techs can work in the AL section of the facility). I will have about 15 people to get up by myself every morning. I also have an hour-long commute now.

If this is true, and my boss has a trick up her sleeve for us, I might just have to leave. :madface: