Unlicensed personnel administering medications

[boquiabierta]

I recently moved to a new state that has very different scope of practice laws than the state where I come from. I was trained as an RN to take my responsibility of administering medications extremely seriously. The five (seven) rights of medication administration and all that; making sure I was aware of indications, contraindications, potential side effects and complications of every single med I ever gave. We learn this stuff in school and I for one have always taken it very seriously.

My new state allows unlicensed personnel like medical assistants to dispense meds, including injections. I am so uncomfortable with this practice and was wondering if it's common. I know medical assistants go through training and I have to assume that the training is adequate. But I can't believe that the training is truly equivalent to what we go through as nurses to enable us to safely administer medications. It seems like a huge liability issue, not to mention potentially unsafe if the MA is unaware of some medication contraindication or something.

Thoughts?

[boquiabierta]

While it's not unusual for MA's to be allowed to give medications, I don't know of any states where they are allowed to administer medications, it's important to note those are two very different things.

The scope of an MA is generally limited to assisting with self administration or assisting with administration by personnel licensed to administer.

Can you clarify what you mean by the difference between give and administer? In my state the MAs both give meds (i.e. hand pts oral medications) and administer them (injections).

[Have Nurse, ADN, RN]

We too have T.M.A.s (Trained Medical Assistants) to give orals, eye drops, ear meds and topicals. But nebs and insulins, no. The nurse has to do those due to assessments of lungs and also doing blood glucose. Injectables are invasive so we don't allow that duty to fall on the T.M.A.s.

[Ddestiny, BSN, RN]

Before I went to nursing school I was a Certified Medication Aide (basically a CNA plus additional hours of learning about medications, how to administer them, etc) at a couple different LTC facilities. We could give POs, eye drops, ear drops, suppositories, topicals and inhalers/nebs. In my state we could not give injections but I remember in the workbook from which we did some of our CMA homework, there was a section for insulin injections so some states must allow it.

At the time I felt fairly comfortable with it but after going to nursing school and learning how much I really *didn't* know....also, we weren't allowed any room for critical thinking and we could not hold any medications unless we were told that the patient was NPO. So, for example, when one of my residents was having nausea/vomiting/diarrhea for a couple days, I technically wasn't supposed to hold her Lasix so I got a bit of a finger wagged at me for doing so even when it was agreed that it was probably the right thing to do. In one of my facilities it was Assisted Living so we only had a nurse available during office hours. The CMAs were the leaders of the shift. If there was an incident or fall we had to call someone over from another building.

I think there are some great CMAs and some that really don't really appreciate the weight they carry and their ability to influence others' lives and health. It probably is equivalent to any other field where the employee is very busy, under strict time constraints and expected to fulfill a very important but repetitious job. It is a lot of responsibility for literally $0.50 more per hour. It scares me that some people don't take appropriate precautions, or may not have been fully educated about them in the first place. I can't give insulin in a hospital setting without having another RN dual-sign with me -- why is it only one CMA or one LPN/RN in LTC appropriate?

Bottom line, I can appreciate some concern about having unlicensed personnel administering medications. I don't equate it exactly the same as having family members administer meds because you're giving it to *so many* with so many different circumstances, and honestly have less room to use any kind of critical thinking. I feel like having a nurse administer meds acts as a "check and balance" for the providers that order since they can make sure there aren't interactions, duplications, odd dosing, etc but you can't expect that from a CMA and they often work in areas where they don't have their own pharmacies available 24/7 to answer questions. I don't consider it to be an ideal situation.

[slauren]

I live in Florida. When I worked in LTC/rehab, only the nurses gave the medications. I once interviewed for a job at an assisted living facility and the techs administered medications. I was curious about that myself and they explained that assisted living is still offering the residents independence, it's just someone to make sure they take the right medications at the right times. For the facility, there was only one nurse (position I interviewed for) and it was checking on the residents and being available to help, I believe also managing doctor appointments. I didn't take the position, I now work at a hospital, they are no longer accepting LPNs, therefore, only the nurses give medications there.

[verene, MSN]

I was a medication aide in an ALF before nursing school. So basically a CNA with additional training in how to pass medications (or rather supervise self-administered medications). It was for PO meds only and I could provide minimal assistance for things like eye-drops. Diabetic residents who could test their own CBGs and draw up and administer their own insulin I could watch to record that it had been done. At the time it made me a little nervous but thought it was fine especially since I had the same crew of residents with the same medications every shift. It was a stable population with very few medication changes.

After going to nursing school and taking pharmacology classes I really began to see the lack of knowledge I'd held while in this role. In retrospect I'm rather uncomfortable with what I was allowed to do.

[ivyleaf]

In our clinics, Medical assistants used to be able to give all injections (except insulin, we dont keep that in stock) including rocephin, depo, testo, b12 and all vaccines. they have recently changed the rules so that MAs can now only give vaccines (and nebs, which i didnt mention before).

[beachynurse, ASN, BSN]

I have a Certified NUrsing Assistant as an assistant, and she is able to pass out meds. When she is hired we do medication safety training, and will review it on an annual basis. It is a task that can be delegated, as the nurse is supposed to go over any medication orders that come in. I have done this for 14 years and there hasn't been an issue with medications.

[BostonFNP, APRN]

In this state they just recently passed a law that allows for me to delegate, to my (certified) medical assistant, vaccines when I am present in the building. It's a huge help to workflow, but there have also been a few (thankfully) minor incidents.

[ruby_jane, BSN, RN]

Just make sure that if the tasks are being delegated under your license, that you're comfortable that the unlicensed staff can do the job, and is willing to do the job.

[2BS Nurse, BSN]

MAs have a broad scope of practice in my state. They are working under the Drs. license, so they can pretty much do anything delegated by the provider (other than starting IVs, inserting urinary catheters and phone triage). That is why in outpatient settings, you typically see RNs in the phone room. MAs are a cost savings for health care facilities and this seems to take precedence over safety.

[Amethya]

It depends where and what state you are in. I'm a CMA from Texas and we were trained on medications and administering medications. It also depends of the school we went to, mine drilled it on us the 7 rights and such, but mainly RNs, NP and MDs are responsible for us.

[sswinner]

NYC.. Its all up to the doc. I have some that give dexa shots, some that start I.V's, and others all they can do is vitals and venipuncture.

Though I wonder why M.A's are called unlicensed. We are licensed. **Though we dont have to be** if i recall correctly.