"technician" dispensing meds under RN's licence (??)

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The other day I went for an interview at a private senior's residence. It's for semi-autonomous seniors and the job looks really interesting. There's just one thing that they do that made me really nervous. They use "technicians" trained by them to dispense the medications for the residents. They do that under the RN's license. In other words, the RN is responsible. The lady who was interviewing me told me that it would be my responsibility to do "spot checks" to make sure the meds were dispensed correctly.

My first instinct was "no way!" I worked too long and too hard to maintain my license and my good reputation to have it ruined by someone else's mistake. Several of my nurse friends agreed with me. It's ridiculous and certainly can't be legal. Yet someone else....a doctor actually.....told me that this is quite common, especially in the US. (I'm Canadian)

I'm going to contact my provincial order of nurses today to find out but I wanted to know from other nurses in other countries and even Canadian provinces if this is a common thing. Is it? Or is my first instinct to "RUN" right on the money?

It's a shame because the job looks really good but not so good that I'm willing to potentially risk my license.

Many thanks!

Laura

Specializes in PICU, NICU, L&D, Public Health, Hospice.

As a nursing professional who visits people living in facilities that practice this method of med delivery I will say that it is a sub-optimal system. People DO NOT get PRN meds, they do not get assessed regularly by a nurse. This is why, if you think an elderly dementia patient needs occas tylenol for OA, that med must be given ATC in scheduled doses...or they just simply won't ever get it.

Specializes in Education, FP, LNC, Forensics, ED, OB.

I see you are in Canada, so cannot address your issue.

But, in the US, only a licensed Pharmacist or Licensed Physician can "dispense" drugs.

Are you talking about "administration of drugs"? If so, each of the US BON addresses (where these personnel are utilized) this issue regarding Unlicensed Assistive Personnel (UAP) or Medication Assistive Persons (MAP) which are Medication Aides or Medication Techs.

Brief example below regarding administration of drugs:

A medication assistive person may perform the delegated nursing function of medication administration in accordance with rules set forth by the Board of Nursing.

A medication assistive person shall perform medication administration and related tasks only under the supervision of a licensed nurse.

Medication administration shall be limited to the administration of nonprescription and legend drugs ordered by an authorized prescriber by the following methods:

  • Orally
  • Topically
  • Drops for eye, ear, or nose
  • lady partslly
  • Rectally
  • Transdermally
  • Via oral inhaler

Medication technicians are not utilized in my state, yet. I refuse to allow anyone to pass meds under my license. When the day comes that I am ever told I have to do that, that day I will stop practicing nursing.

Specializes in RN: L&D, LPN: Med/Surg, CNA: MedSurg/LTC.
As a nursing professional who visits people living in facilities that practice this method of med delivery I will say that it is a sub-optimal system. People DO NOT get PRN meds, they do not get assessed regularly by a nurse. This is why, if you think an elderly dementia patient needs occas tylenol for OA, that med must be given ATC in scheduled doses...or they just simply won't ever get it.

That is a very general statement. Please don't judge all CMA's based off your experience. There are good and bad people in all professions.

Specializes in Gen Surg, Peds, family med, geriatrics.

Thank you all for your replies.

First off sirI, you're right....I did mean "Administer".....don't ask me why I used "dispense" instead. Mea culpa. :specs:

I went for a second interview yesterday and spoke with the nurse in charge of all the residences in my province. I asked her point blank about the technicians and my liability. She said that the process that they use is first of all approved by the local health department, who in this province oversees all clinics, offices and senior residences.

The medication is packed daily at the pharmacy and delivered a couple of times a day. Only the nurse can open and put away meds from that package. The medications arrive in sealed plastic envelopes with the medications the resident takes. If for example at 10 AM the resident takes Norvasc, Metformin and Lipitor, then the envelope will contain those three pills. The resident's name, medication, date and time will be written. The med sheet contains the name of the resident, the time the med is given, name, dose, what the med looks like and use. The med sheet also has a picture of the resident and a larger plastic envelope that the techs place the meds for that particular time into. The meds are only taken out again when the tech is in front of the resident...then the envelope is opened and the meds given to the resident.

The techs also have to receive training prior to being allowed to administer the meds and that includes several weeks of having the RN inspect the meds before they are given. I asked about liability if there is a serious adverse event or error and was told that the "under the license" is more for the government to know that there is someone qualified overseeing the whole thing. If the tech makes an error, it does not reflect on my license.

Seems pretty fool-proof. The job looks phenomenal but before I make the decision, I'm going to check with the local health department and my provincial nursing order.

Thanks again for all your replies.

Laura

Specializes in PICU, NICU, L&D, Public Health, Hospice.

"Originally Posted by tewdles

As a nursing professional who visits people living in facilities that practice this method of med delivery I will say that it is a sub-optimal system. People DO NOT get PRN meds, they do not get assessed regularly by a nurse. This is why, if you think an elderly dementia patient needs occas tylenol for OA, that med must be given ATC in scheduled doses...or they just simply won't ever get it.

That is a very general statement. Please don't judge all CMA's based off your experience. There are good and bad people in all professions.

Ok...point taken, although I am not sure where I made a judgement about CMAs?!? Rather, I was commenting on a practice...which I believe is sub-optimal.

I'm in CO, and before I finished the LPN program (almost done w/ RN..yay!) I was a QMAP, qualified medication administration personnel. Which is a really long name to say the in ALF or in private settings, I could administer medication. Of course, we had extended training and doctor's orders for EVERYTHING, even Tylenol. I was not making any judgements about whether they could, or should have any of the medication. These were stable patients who needed some reminding. I did not work under anyone's license per se.

At anytime a mistake could happen, just like anyone else, but it was a great system for this type of setting.

Specializes in Psych, EMS.

I always thought Med Techs were a great addition to healthcare..they get specialty training and take care of most of the PO's, very efficient in LTC, lets the nurses focus on assessments such. But I had no idea they practice under the nurse's license. They should have their own licenses. I would not feel comfortable with that.

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

The only person that practices "under" your license is you. If a UAP is trained by a facility/agency to do a job and has been deemed proficient and they screw up unless you have active knowledge that they were doing something wrong it will not fall on you. You would only be responsible, for example, if you went on a home visit to administer meds and handed them over to the health aide that was giving a bath and said "here give these meds when you are done" while you walked out the door. If a tech I work with does a procedure within their scope of practice and after having been adequately trained and tested and does it wrong with ensuing complications it is not my responsibility and my license would absolutely not be in jeopardy. Would the family try to sue me...probably but my license would not be in peril only my bank account. If YOU are the person who did the training and taught the UAP incorrectly then yes you would be responsible but you would lose your license based on your actions (bad teaching) only. You can only lose your license based on what you do not based on the actions of others. You may however find yourself on the ugly end of a protracted legal battle regarding the actions of those you supervise. The onus is on you to make sure those people are adequately trained and competent in practice.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

I think that there are specifically trained persons who are not nurses who can administer medications. For me, the problem is that there is the implication that those persons must be supervised by a nurse and the patients must be assessed to insure that their pharmacologic plan is appropriate and working, but the nurses have too many other duties assigned to do all of them well.

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
I would never let anyone pass meds under my license.

This is a triple Ditto from me.:twocents::up:

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