What is your opinion on CNA's being med certified?

[nursedora]

I just read a post by a new Nurse who admitted to making a medication error, and as I was replying to her post I was wondering about something and I'd like to get opinions from others.

In my area, there are several state run facilities for the mentally and physically retarded, either as a large institution or as an ICF house in the community. In thees places, CNA's are medication certified, they go threw a 3 or 4 week crash course on administering medications. I'm not saying CNA's can't do a great job, they can. What I'm concerned with, we as LPN's or RN's have spent a year or longer learning dosage formula's, different names, side effects, differing nursing interventions etc. of medication administration. In addition to this, we have to take continuing education courses. As far as I know, all a CNA has to do is once a year show proficientcy in administering one medication in front of a staff nurse. They are only allowed to administer PO medications, so a licensed Nurse has to be available for IM, SQ, and for feeding tube care, med administration, and so on.

Do other states, counties or area's allow CNA's to administer medications. And what is your opinion on this?

[mariedoreen]

... but they did not learn any drug calculations, how to check dosages, use body surface area dosage, or what to do if there is an accidental overdose, or the steps to take if meds were given to the wrong patient. I do NOT feel this class was enough! During clinicals I asked many Med Techs what they were giving, how, and why. No one could tell me why! I hope nothing ever reacts for an ADR, or no one will be able to tell the ER what happened!

Is that because these are usually standing med orders that have been checked by a nurse already before becoming the distribution-responsibility of the CNA? Or does that not matter because in theory that checking should be done at the time of distribution?

[mariedoreen]

This Nurse I Worked With Said When She Was A Cna The Nurse Would But All Meds In Souffle Cups And Hand Them To Her To Pass Out According To What Name Was Written On Cup.....she Said She Never Thought About What A Dangerous Game She Was Playing Until She Became A Nurse Herself...needless To Say She Always Gave Out Her Own Meds...i Don't Know If This Was Condoned By Facility And/or State As This Was Many Years Ago...but Anytime You Are Asked To Do Something That Will Endanger Your License Say No No No I Promise You That You Can Get Another Job In A Heartbeat

Just a friendly side note... I've seen your posts before and they are always SO hard for me to read because of all the caps. I usually end up skipping to the next one. For some reason it really hurts my brain, lol.

[Hellllllo Nurse, BSN, RN]

Oops! CMAs are not CNAs. Certified Medical Assistants (CMA) do NOT work under the auspices or license of a RN/LPN, nursing assistants do. Too many letters, not enough spelling out. CMAs are used in ambulatory care settings (read: office and clinics) and DO in fact give many medications under the direction of a MD/PA/NP.

I am vaguely familiar with med techs; the assisted care facilities in this area train their own and are not under the Board of Nursing, altho NA certification is. They are limited as to what meds they can pass out and where they can be employed.

Duckie, your point is well taken!

There are TWO difference workers who are called CMAs.

This thread is about Certified Medication Aides, who work under nurses' licenses, not Certified Medical Assistants, who don't.

[Hellllllo Nurse, BSN, RN]

In some states, CNAs are now inserting foleys, and doing sterile dressing changes. There was a thread on this not too long ago.

[caroladybelle, BSN, RN]

In some states, CNAs are now inserting foleys, and doing sterile dressing changes. There was a thread on this not too long ago.

Yes, and I still say that they should only be permitted to do what they can be held legally accountable for.

[Nitengale326]

In Virginia, Med Techs could only pass po meds in Assisted Living Facilities or in group homes. But I know of occasions when Insulins and other subQ's had to be given by the MT's because the LPN had called off or was late ... again. Fortunately in those instances... the tech, I would trust with my life... the nurse.... I'm not so sure....

In the hospital we have Pt. Care techs in the ER that can do almost everything the nurses do including start IVs!!! Too scary for me!!!

[FROGGYLEGS, LPN]

I have 60 residents on two halls and 3 CNAs. I am fortunate to have 3 good CNAs at the moment. I do trust them, but I feel like I can only trust another person so much when it comes to my license.

The thing I hate is that the CNAs seem to be accountable for nothing. Having a CNA to do med pass would lighten my load tremendously, but trusting that they would do everything appropriately, 100% is too much to ask. I'm not saying that there are not CNAs that carry out this task, but only that I wouldn't want to be responsible for what goes wrong. I think giving meds requires a good degree of knowledge on the subject and a lot of judgement. If I would be accountable for their med passing; I would not allow it. I'd go work somewhere else.

I know that everyone has made small mistakes or will during med pass. If it is you that made the mistake you can use it as a learning experience and be more conscientious about that in the future. Someone else's mistakes that you are accountable for are a lot harder to swallow.

[Marie_LPN, RN, LPN, RN]

The only way i was allowed to start IVs was after training as an extern and taking the IV training. I put Foleys in all the time.

[SmilingBluEyes]

As an RN you would still be held accountable for CMA/CNA mistakes in med passes, if you are incharge. Rather do it myself, given THAT load of liability.

[FROGGYLEGS, LPN]

This is how I would imagine the scenario to play out at the LTC centers I've worked at:

The CNA has X amount of work to do. The CNA accepts the offer of going to CMA class. The CNA returns to work and it given the same work assingment in addition to the med passes. If the center does promise that the CNA will have a lighter assignment to compensate for the added responsibility, I predict that promise will eventually be broken. For reference consult with the Restorative Aides, Weight Aides, and Shower Aides that live this every day.

In the meantime, the nurse has a X amount of hours freed by the CNA giving meds. Those hours will not be free-time. The nurse will spend those hours checking behind the CNA and assisting with med pass. The rest of the time will be spent in a futile attempt to catch up on some of the other miscellaneous assignments.

The DON will then pop up and expect to be congratulated for having helped the nurse out so much. She will then decide that the nurse has too much free time and scurry away to find more assingnments. The DON comes up with a list of things that will perfectly fill in the void left by the loss of med pass; she will then multiply that list by 1.5. The amended list will be what the nurse gets.

In conclusion, nobody wins as per the usual.

Perhaps it could work at a better managed center. I don't think so at mine. Even if it could, I wouldn't be willing to assume the risk.

[Dixiedi]

I don't have a problem with CNAs passing meds and not knowing how to calculate a dose. They are standing orders and theoretically would have been double checked by the nursing staff prior to asking the CNA to hand it to the pt.

It is just those few PO meds that require a specific nursing judgement each time it is given.

But then... the nurse should know which pts are on such meds and check them BEFORE the CNA gets to them and can intervene when needed. - That would be in a perfect world... I don't live in one.

[fairyprincess2003]

I think it is a very sticky situation.

There have been a few times when I have pulled out a med, or drew up something and stopped myself in my tracks...like wait a minute this cant be right, or hmm his/her stats were this or that let me recheck that BP, or call the Dr. I really don't think CNA's have this. I am not saying they don't have the capability, but not the education. I was a CNA before getting my nursing degree, and there is NO way I could have done this. Looking back, I might have been 100% sure I could handle passing meds and think to myself "im not stupid, I can do that" But it is not about that. It is not the CNA's fault either. They would miss things and not even knew they did.

I don't have a problem with CNAs passing meds and not knowing how to calculate a dose. They are standing orders and theoretically would have been double checked by the nursing staff prior to asking the CNA to hand it to the pt.

It is just those few PO meds that require a specific nursing judgement each time it is given.

But then... the nurse should know which pts are on such meds and check them BEFORE the CNA gets to them and can intervene when needed. - That would be in a perfect world... I don't live in one.