Phasing out LPN's.

Hellllllo Nurse, BSN, RN · Dec 8, 2004

I think that CMAs should be phased out, or never should have existed in the first place. I believe that only a licensed nurse should pass meds.

As an RN, I hate being responsible for unlicensed persons' actions. The people who thought up CMAs should have to be responsible for them.

rach_nc_03 · Dec 8, 2004

I think that CMAs should be phased out, or never should have existed in the first place. I believe that only a licensed nurse should pass meds.
As an RN, I hate being responsible for unlicensed persons' actions. The people who thought up CMAs should have to be responsible for them.

I'm a student nurse in an ADN program, working as a CNA in an ICU so I can have insurance while I'm a student. I didn't know CMA's could pass meds- that's awful! I know plenty of techs/nursing assistants who are professional and care about ensuring patient safety, but I've also seen PLENTY whom I wouldn't trust with my family member.

I'm also saddened when I see RN's who don't bother finding out what's in the scope of practice for a CNA, and let them do things they aren't allowed to do. When I get my license this coming summer, I intend to be more protective of it than they are of theirs.

rachel

ADN grad may 2005

Hellllllo Nurse, BSN, RN · Dec 8, 2004

All RNs know what is in the CNA's scope. Some just don't care.

When I was a CNA, a few nurses tried to get me to do things beyond my scope, in order to lighten their load, but I refused.

These nurses were rare, fortunately. Most were great.

Some CNAs felt flattered that a nurses asked them to do the nurse's work. It is plain ignorance to be flattered by that.

In many states, LPNs no longer pass most meds at nursing homes. CMAs ( CMA = certified med aide, usually a CNA with anywhere from 8 hrs to 2 weeks training in passing meds) pass the meds.

Sadie04 · Dec 8, 2004

In the hospital I work in, they recently increased the level of responsibility for LPNs. They can now flush central lines and give IV meds in the form of parfills premixed by the pharmacy. They can also do central line dressing changes. The hospital does require that LPNs take a class and demonstrate competancy before they can work with central lines.

VickyRN, MSN, DNP, RN · Dec 8, 2004

in north carolina, there is a controversial new proposal by our board for a medication aide. this is an unlicensed person who will be able to administer medications in acute care facilities after only a 9-week or so course.

see links:

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

of course, this wonderful "med aide" (who will undoubtedly be payed minimum wage) is operating under the rn or lpn's license: "as defined in nursing law and rule, the licensed nurse may only delegate technical components of medication administration to unlicensed personnel. nursing judgment and decision making related to when or if a medication would be administered by the med aide and monitoring the client's response to medications are responsibilities of the licensed nurse that may not be delegated to assistive personnel."

this med aide position, if enacted, will undoubtedly put many lpn's out of work across the state of north carolina. this new unlicensed position will also endanger the practice of many rn's across the state. can you imagine the nightmare of being responsible for 30 patients and having medication aides dispensing medications right and left under your license?

i personally feel very disappointed and puzzled by the actions of our board, right now. i know that our board was never meant to be the "nurse's friend;" like all state boards it exists to protect the interests of the public from nurses who are incompetent and to ensure "safe, effective nursing care." our board is unique in that it is elected (the only one out of 50 states elected by the nurses of the state)--and we nc nurses have always been very proud about this. however, this latest action goes directly against the interests of the public in our state and will make nursing practice in our state very unsafe indeed.

eagnd · Dec 8, 2004

Recently Read That They Want To Make It Legal For Extra Staff To Also Pass Some Medications Due To The Nursing Shortage. I Find This Rather Scarey. About 8 Years Ago I Was Working And A Cna Came To Me And Said A Pt Was To Tired To Go To Lunch So She Was Going To Let Her Sleelp Awhile More..as I Entered The Room I Found The Pt. Going In To Diabetic Shock Symptoms Were Very Obvious To The Trained Nurse. I Realize There Is A Nursing Shortage And Rn's Are Becoming Very Involved With More And More Responsibilities...........lpn's Are Vital And Are Recieving More And More Education........lets Hope This Is Realized To Many Lives Would Be At Risk...

SmilingBluEyes · Dec 9, 2004

Our own Rusty said it best once a while ago:

If you want meds administered, you hire a NURSE.................

NOT a UAP, not a CMA....not anyone else.......NO!

But in the name of the bottom line, it's easy to see why so many places are motivated to go to the lowest common denominator, even in issues as important as the administration of medications. There is NO WAY ON EARTH an CMA will EVER possess the knowledge of pathophysiology and pharmacology to administer meds safely that the LPN or RN will---- and yet they do, and yet under OUR licenses? It's a disgrace, and I wonder if the public even knows what is going on under their noses? Or cares????? Only when harm is done does anyone's attention get drawn to the issue, right?

Long Term Care Columnist / Guide · Dec 9, 2004

In some assisted-living facilities in my state, unlicensed caregivers can become medication assistants practically off the streets. I'm not joking. An ALF can hire someone who's never even had CNA training, give them three days' orientation, and turn 'em loose in the med room. They're paid $7.50 an hour to pass meds to as many as 50 residents, and they give everything except IVs and IMs....they even draw up and administer INSULIN!! They also give PRN narcotics, antipsychotics, and anxiolytics.

This is why I didn't stay with ALF nursing very long.......I worked hard for my license, and I'd like to keep it. :stone

VickyRN, MSN, DNP, RN · Dec 9, 2004

it's already legal in nc for medications to be given in assisted-living type facilities by unlicensed personnel (and this is bad enough). what makes this medication aide proposal so ominous is that this tech will be able to give meds in acute care facilities such as hospitals and nursing homes. :angryfire we are giving away bits and pieces of our profession, folks. once gone, these parts of nursing are gone forever. the worst part is that this is being perpetrated by our board. we really feel betrayed. i suspect it boils down to certain powerful interests on the board who do not like lpns nor adns. what better way to eliminate lpns than by promoting the med tech??? if the nursing homes can get away with it, they certainly would prefer to hire someone off the street at minimum wage, than pay an lpn $20/ hour.

Long Term Care Columnist / Guide · Dec 9, 2004

I hear you, Vicky! When I was a DON in assisted living, I used to watch these gals with barely a high-school education giving medications like digoxin and Coumadin, and I'd think WOW, I went to school for four years to learn how to do that!! It scared me that they could give these high-alert meds and not know the signs of toxicity, or what to do if somebody started bleeding and didn't stop, or even why they were giving them.

I don't know about anyone else, but I personally did not go to nursing school so I could be a paper-pusher. (That's why I left management.) If I wanted to do that, I could've gone to business school........The powers that be need to leave the medication-giving to the people who know how drugs work, why they work, and what to do when they don't work or when they actually harm someone. And that, my friends, is US---LPNs and RNs. I don't want to look down on CNAs or UAPs, because they do a hard job and most of them are wonderful at it; but they just do not have the education & training to give medications safely IMHO. I agree with Vicky: we should NOT give up this part of nursing, or allow it to be taken away from us without a fight. Our patients' lives may very well depend on it.

I wonder if the people who come up with these stupid ideas ever think to themselves, "Hey, what if the patient was MY mom or dad---would I want someone who can barely spell 'warfarin' to be giving it to them"? :stone

blessed02 · Dec 9, 2004

iam an lpn who works in an assisted living and i'm the only nurse on duty in my shift in a 7 floor facility so on top of having to pass medication on one floor with about 35 residents ,i'm in charge of the building plus about 118 total residents in case of any emergency, have to do some wound dressings,follow up on physician orders /residents change of conditions/ family members and a couple of times medicine aides have not been scheduled so have about 3 floors to pass meds_but the medicine aides come to my rescue.

Problem is they are not supposed to pass meds on more than two floors but i'm also overwhelmed and some of them they don't evn go thru the MAR to see if there are new orders and that freaks me out-My boss knows about this and she thought about hiring more lpn's to pass meds coz there are too many errors but the facility i work at thinks about saving money.It is frustrating just looking for another job right now coz i worked hard for my licence-rant