Under who's license?

Nursing Students CNA/MA

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Hello everyone. Please I need info.

I am a Certified Medication Aide and a CNA, I work in a Type B Al/Memory Care in Texas.

I have been told now 3 times by an LVN that I work under her license. I have been RN delegated to do BS and insulin. I have my med aide certification, cna certification, certified EKG tech. I worked in a Trauma 2 hospital, drew blood, started foleys, took out IV's, drew cultures, checked BP, BS, ect. Point is I am very knowledgeable in most aspects of the nursing field. I know s/s of good/bad bs/vitals, I may not know what every drug is for but I follow the MAR exactly. I am just trying to figure out if I am working under my certification for meds and my DON license for insulin? Or am I working under the LVN license? I do follow policy and procedures well. So if you know the correct answer please post for me. I would greatly appreciate if.

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You are not working under the nurse's license, but you are working under the nurse(s). Their responsibility, legally, is to monitor you and be 100 % sure you're competent to complete the tasks delegated to you.

Not knowing what medications are for can create huge issues, as can blindly following the MAR.

Is there a specific issue you're having?

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Specifically just that. I do not blindly follow it, I check all info and if something seems amiss I ask the nurse. As for not know all medications, the nurses do not either. I do know the antibiotics, heart, blood thinners, and the ones that in fact could kill if not checked properly. Just tired of hearing that I work under the LVN's license. So I am listening.

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As for not know all medications, the nurses do not either.

That doesn't make it right... if that's true.

Everybody looks up meds-- even doctors and pharmacists. Look up your meds. If you want to handle them, then do it responsibly.

As for "working under" someone's license, the nurse is ultimately responsible in that any issues must be reported to them. They have to handle it. I sure as heck don't want to clean up somebody's mess because they screwed up meds.

Have you looked through this?

Licensing Standards for Medication Aides Handbook

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When those who say you are working under their license, what they basically mean is that they are ultimately responsible for your work. Here is a real life example of something I encountered.

A resident came to our facility with a small pressure ulcer on her coccyx. Naturally she was a turn 2Q. It was my first night with this patient, (plus I was a brand new nurse) and the CNA was diligently turning the patient Q2. That night, administration showed up out of the blue to check turn patients. (Family complaint had been made about worsening pressure ulcer on someone.) They pulled the covers completely back on my patient and saw that she, while turned, was not completely off-loaded from the pressure ulcer.

While it is a task I delegated to the CNA, it is ultimately my responsibility that it gets done and done correctly. I didn't think to pull the covers back. I should have done it at the beginning of the shift to make sure the pt was off-loaded as I had yet to have any rapport with this CNA to know her work/knowledge base. If that had continued under my care and her pressure ulcer got worse, that is neglect. That is a big deal for nurses.

Being brand new, and kissing butt asking questions on proper turning technique for this particular patient, I was let off with education and an informal warning. However, that night a different nurse was suspended for the same thing. Even though she delegated the task to the CNA, it was ultimately HER responsibility.

Let's say the nurse got fired. (Not unheard of in this facility) but I'm sorry, when you give us 40 patients, we can't go behind every CNA and check their work. She's the one who will have to explain in her next job interview how she let a pressure ulcer get worse EVEN THOUGH THE TASK WAS DELEGATED TO A CNA. If the family goes after the nursing facility, she is the one who will have to sit in on the deposition being interrogated on how she let a pressure ulcer worsen.

That is what is meant when nurses say that. Maybe for some it's a power trip, but I've never looked at it that way. The fact of the matter is, nurses have more responsibility than CNAs. If you are passing meds to my patients, I have more responsibility than you do to make sure it's done properly. Because I am delegating it to you. If you give BP meds, it's my responsibility to know the BP parameters and s/s if hypotension and to assess the pt before and after. You do the task of giving the med. I do the critical thinking. If I let you give a med to a pt when I assessed it wasn't appropriate to give and should have been held, I am responsible. Not you. I went to nursing school to learn assessment and nursing judgement. I obtained a license stating I am competent to provide such care. You have a certificate to perform tasks. Invaluable, crucial and highly appreciated functions of the healthcare team. But not the most responsible of the healthcare team.

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Very well said, Orion81.

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