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?

[MiaLyse, APRN]

In my area, there are several state run facilities for the mentally and physically retarded>>

We have homes for the mentally ill here throughout the county. The "staff", not CNA's or CMA's but just regular people never trained in any areas of care, dispense meds to the residents living in these homes. The company sends them to medication training, they take a test every 2 yrs. and are considered med certified and can pass medications in DMR run homes.

Here's a description from their site:

The Medication Administration Program's training program is specific to DMH/DMR registered MAP programs only. MAP trainers may only train those individuals who will be administering medications in registered DMH/DMR adult settings. >>

16 hr. trainings are all that are required. Every 2 yrs. following your initial MAP certification you simply have to go to a review that lasts maybe 3 hrs and have a nurse watch you give a med and chart it. And, the individuals they train are not specifically trained in patient care, meaning not CNA's.

Is this what you are speaking of?

Kelly

[obeyacts2]

In my area, there are several state run facilities for the mentally and physically retarded>>

We have homes for the mentally ill here throughout the county. The "staff", not CNA's or CMA's but just regular people never trained in any areas of care, dispense meds to the residents living in these homes.

Is this what you are speaking of?

Kelly

EXACTLY!!!!! Here, to work in homes for the developmentally disabled, CNA training is not required, nor is med certification class. One of the first jobs I ever had as a caregiver was in one of these places. My training to pass meds was "From now on you will pass meds (dinner time) when you are working. Here are the cards with meds blisterpacked, client name is at top. Here is the chart: intial on the line when you give the med" Period. The meds we gave were "maintenance" lots of anti seizure drugs, for example. The meds I had the hardest time learning to give: birth control pills :chuckle I had the hardest time trying to figure out how to open the package :rotfl:

Laura

[GEO]

CNA'S are care givers. They do not pass meds. CMA'S are certified medication aides. While there are private, for profit facilities who do make money, there are also facilities who are non profit. The cost of LTC is very expensive, be it private pay or DHS. For some facilities the door staying open is dependent on the old budget. There are facilities who DO care about the quality that is delivered to the elderly that are living in their faciltiy. And some of these non profit facilites are having a hard time keeping their door open with the costs of care. The role of the CMA is directly under the LPN/RN license. As for the DON, well the buck stops right with her license. I have worked with very, very GOOD CNA'S & CMA'S. Do they have the knowledge of the LN'S, NO WAY. However their job is very important, many of these CMA'S are working towards going to school. I have observed many facilties send anyone to CMA class. It behoves any DON to look closely at the particular staff member who wants to go to medication aide training. They must be a person who is attentive to details and who is not afraid to ask questions and take direct supervision well. Just anyone wont do... I do see the BON getting more involved in this area. Making more decisons about what the cma can and can not do. It wasnt that many years ago there did not even have to be an LPN/RN on duty but for the day shift and 3 evening shifts. That left 10 shifts a week without any licensed staff on. This has changed in the last 10 years. Things are changing for the better, and it gets better with more Licensed staff. I predict there will be a day that the CMA goes the way of the dinasoar....I just hope we will have the LN'S to fill the gap. LTC is a tough place to work. Just as challenging as Acute care in many aspects. The elderly are frail, and are coming into the facilities sicker.

I Did not mean to write a book, however, many CNAS and CMAS are very special, intelligent folks. The best for the residents is their goal. Passing medications in an ideal situation would be RNS/LPNS. How many health care settings are ideal? But many of the elderly have been cared for at home by family members who are trying to care for families, work full time and have absolutely no health care training. For now, until things change, their is a definite place in the picture for CMAS. This part of the Team just has to be supervised and educated by the LN who is working with them. Their education , just as ours, just begins with the Certification/License.

I am sure several will disagree with this. That is what makes this discussion board so interesting. OPINIONS BEING VOICED........makes folks think. I will turn it over to the next interested person.........geo

[lady_jezebel]

I believe that meds should only be administered by professionals with specialized training, just as those who prescribe need to have the appropriate background & license (for accountability). You can't safely give a Rx without understanding patho, pharmacology, how to monitor/recognize side-effects, and how to respond quickly to side-effects.

[happystudent, RN]

I worked for DMR years ago and I passed meds to the residents. All meds were routine except for the occasional antibiotic.

I do agree, however, that more training needed to be given. I remember staff members forgetting to give medications or giving them at wrong times.

It was a mess........anyway, these people never got written up or fired. We dont have "licenses" to lose. So it wasn't a "big deal"

If I knew then what I know now about med admins. I would never have taken the job.

Its scarey, the people they would hire to give meds....

At the time, I had a vague idea of the types of meds I was admin. I had not idea why that particualr client was recieving it.

[mscsrjhm]

Dear Geo,

I agree with your opinion regarding CMTs in acute care settings. Long term settings have worked out a system for CMTs that is effective. Agreed that persons at home might ineffectively receive meds from caring family.

What we know is not effective are the MILLIONS of persons being given meds by untrained staff, in the mental retardation/ developmental disabilities area, with no direct supervision by LPNs, RNs, or DONs. Just a weekly/bimonthly visit from RN to check on MARS.

This is where I personally saw hundreds-and I mean hundreds- of medication errors, frequent reports to state with no actions taken, and some harm to patients due to this system.

HappyStudent worked it, she/he saw.

No changes in site for this system.

Mschrisco

[mscsrjhm]

Dear HappyStudent,

Definitely a SHE. Sorry- I saw the picture, but didn't see your age. Thought that the picture might be a daughter, now I see it is you. Very pretty. As a mom with three daughters, I give congrats to your MOM.

Have a good day,

Mschrisco

[Angela Mac]

ALFs use med techs and CNAs for med passes. Sure anyone can read a med sheet and pass pills. But it is the lack of assessment that bothers me. The elderly folks in these ALFs have meds that are controlled by their lab values and dietary intake. The pill passers are not educated on adverse reactions, s/s of toxicity, or changes in their VS. Trained nurses are able to note an abnormal apical pulse. I have been noticing, that more skilled patients are entering the assisted living facilities.

[Dixiedi]

ALFs use med techs and CNAs for med passes. Sure anyone can read a med sheet and pass pills. But it is the lack of assessment that bothers me. The elderly folks in these ALFs have meds that are controlled by their lab values and dietary intake. The pill passers are not educated on adverse reactions, s/s of toxicity, or changes in their VS. Trained nurses are able to note an abnormal apical pulse. I have been noticing, that more skilled patients are entering the assisted living facilities.

You make a very good point with the skilled pts in the LTC facilities and that makes med certified CNAs scarey.

In theory, I would think the nurse would be able to assess each of her pts before the meds are passed and tell the CNA to skip this person or that until things are checked out (yea, that's kind of a sloppy way to say it but there are just so many variables). HOWEVER we all know the perfect world does not exsist and while the nurse should be assessing these pts we all know the LTC facility has filled her time with 20 or 30 other responsibilites.

On the other hand, even though as nurses we are told errors can never occur and if they do we are 10% liable for them there is a margin of error that most facilities consider WNL. It's been so many years since I worked in an administrative position in LTC that I simply do not remember the specifics but I do remember that a facility can have X number of errors before they are considered below standard (some errors are never considered "OK" withi the standard.) That in and of itself is scarey but the governing forces do realize that we are all human and error will occur but too many errors is incompetent.

Scarey isn't it.

[evonlpn]

I really don't think that certified nurse's aids should be doing anything with passing out medication. This is just one more step toward replaceing RN's with unlicensed personal. What 's next ?Giving chemo to cancer patients? This opens up Pandora's box.

I personally don't feel CNA's should be allowed to pass medications. As an LPN I had an opportunity to work with a CNA that had worked at a facility previously that trained her to pass meds. She acted like she knew more than me and try to tell me how to care for an Hospice --dying patient. I believe that passing out meds leads them to believe they know everything- :angryfire sorry sister, try again. I'm not comfortable with being responsible for someone coming off the streets, take a couple of weeks in Med. Administration and proceed to think they know more than me and I have the full training. Let them pass meds today.... what wil they be allowed to do tomorrow.

[Dixiedi]

I personally don't feel CNA's should be allowed to pass medications. As an LPN I had an opportunity to work with a CNA that had worked at a facility previously that trained her to pass meds. She acted like she knew more than me and try to tell me how to care for an Hospice --dying patient. I believe that passing out meds leads them to believe they know everything- :angryfire sorry sister, try again. I'm not comfortable with being responsible for someone coming off the streets, take a couple of weeks in Med. Administration and proceed to think they know more than me and I have the full training. Let them pass meds today.... what wil they be allowed to do tomorrow.

LOL, (I agree with you about passing CNAs meds is scarey) but can you imagine that RNs are saying the same thing about LPNs?

The ANA tries very hard to keep our scope of practice at a place that will prevent hospitals from hiring more LPNs and fewer RNs.

Sounds like that same thing to me.

Remember, I agree. You just have to have more than a couple of weeks education. A&P, chemistry and biology, etc are definately needed in order to understand how drugs work and if you don't understand how they work you have no business handing them to a pt.