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?

[BostonFNP, APRN]

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.

Are there states that license medical assistants? I know there is a national certification and there are some states that require certification to practice but I've never seen a license.

[sswinner]

Are there states that license medical assistants? I know there is a national certification and there are some states that require certification to practice but I've never seen a license.

I double checked. It isn't a license, it is a certification. I will have to make some corrections when I get to work. I think I was confused because my students keep telling me their employers ask for a license number. I'm guessing they were too lazy to change it to certificate number.

[drkshadez]

Different states have different laws. Usually those laws allow some flexibility due to geographic location. Let me explain.

Here in Ohio, Medical Assistance are able to dispense medications and give injections, but only under the direction of a physician. In other words, it is not a task that a registered nurse can delegate. It can only be under direct physician supervision.

Here is why that law is in place. In rural communities or small towns, you have medical assistants working in physician offices, as well as some RNs. Medical assistants help fill the gap to meet client needs and flow efficiently. In a major hospital setting, such as Cleveland or Cincinnati, even though the law is there, hospital administrators are really weary about allowing MAs to dispense medications and give them to patients because of liability to the hospital.

It is a law in place that has "Just because you can, does not mean you should" stigma attached to it. The law is in place to allow certain facilities that are really short handed in health care to help with patient flow. As you migrate into larger urban areas in MAGNET hospitals, for example, they most likely will not allow MAs to dispense and pass meds - not because they cannot do so legally, but because of concerns of liability as mentioned above.

Now, in the state of Ohio, STNAs can actually take courses to be certified in passing certain pills to patiets. They have to be certified to do so through a series of classes. As an STNA you can also become a "Certified Medication Aid." Some people do not even have to be an STNA to become a CMA. RNs can delegate non-invasive medication passes to CMAs (no IVP, for example) - and I believe there are certain stipulations for high alert medications as well.

I would not worry about state laws like this unless your facility utilizes them, then I would read up on the rules and regulations of delegation to said personnel. I know in Ohio, RNs cannot delegate med passes to MAs - only under direct supervision of an MD or DO.

[NurseSpeedy, ADN, LPN, RN]

I worked at an ALF that used med techs for med pass. It's when there's a call out and you as a nurse get stuck on the cart doing that med pass that you have an "oh crud" moment.

You see, med techs get a class on how to do a medication observation. They take the pills listed on the medication observation sheet (the MOR-not MAR) and place them in a cup and hand them to the resident. The resident then takes the medication cup and administers themselves the pills that the tech pulled for them. The tech cannot place the pills in the residents mouth as this would be administering meds, requiring a licensed nurse-at lease where I'm from.

Any new orders the nurse would write on the MOR, and hopefully if there's anything that would give question as to why the resident was getting the medication, possible issues with other meds also ordered, allergies, etc were checked at the tins it was placed on the sheet. Key word-HOPEFULLY.

Fast forward and the resident has been there a few days, weeks, whatever and staffing stinks. Then there's more call outs and it's BAD. Now there's no med tech and the nurse is on the cart for 100 plus residents am med pass. The nurse does not know each one of these residents but is held to the standards of their license which means he/she better know what the heck their placing in that med cup regardless of what a med tech, who does NOT have to know what the meds are for, does for their job. For starters, this medication pass is not getting finished in two hours. Second, holy crap who the heck placed all these orders on this resident with these meds at these times? Oh, wait, they're also allergic to this one supposedly...Why are half these med containers empty/expired but all "given" yesterday? Total scary mess that had me turning in my notice...

So, it may be legal, but if proper safety guidelines aren't followed it could be unsafe.

[LostMyPen,RN, BSN]

I'm in NC in an outpatient hemodialysis setting. Here we have unlicensed personnel administer IVP heparin boluses with on the job training. Of course the RN must check the dose and is held responsible.