I just posted an article under news on this subject

Wow.  Dangerous, if you ask me.  A 60-hour course does not begin to approach necessary competency for medication administration.  Remember that a nurse retains responsibility for all tasks he or she delegates - that means if an unlicensed person administers a medication incorrectly, under the wrong parameters, inappropriately - even if the tech doesn't realize that they've made an error, the nurse is responsible for the medication error and is hanging out in the wind.  60 hours is nowhere near enough time to teach adequate pharmacology, anatomy, physiology, assessment, and clinical judgement enough to know when to give a med, when to hold a med, or sometimes even when to ask.

Setting aside the liability issue, a few points come immediately to mind - 1) We are all supposed to be patient advocates first.  That means we do what is in the best interest of the patient, all the time.  Can you honestly tell me that you would feel competent to administer medications after a 60 hour certification course and a CNA certificate?  Because I wouldn't.  No way.  I've pushed medications prehospital that RN's cannot push in a hospital setting - but I wouldn't perform a med pass until I had been signed off, tested, and confident as a second-year RN student.  The difference is that as a medic I had two years of training, including training in specific prehospital meds, when to give them and when not to, and what they can do - and even then, it was limited.  I learned a whole lot more about the meds I had been giving in the field, and their long-term effects, half-lives, and indications and contraindications in Nursing school than I even did in Medic school.  It's a different scope of practice.  Not selling anybody's current profession short by any means - I'm a fierce advocate for CNAs, EMTs, and techs - just pointing out that each profession has a role and a scope of practice - and this seems way, WAY outside.

2) This proviso - " MACs may not administer any medication which requires nursing assessment or judgment prior to administration, evaluation, or follow-up," in the definition of the scope of practice, nullifies the usefulness of the position.  What medications do we give that DON'T require nursing assessment prior to administration?  Or that DON'T require nursing evaluation or follow-up?  Cause if you ain't assessing, evaluating, and following up your medication administrations - I don't want you as my nurse or my family's nurse!

3) I don't know about "cloning new nurses" to ease the nursing shortage.  What I do know is that you don't fix a problem, like a nursing shortage, by lowering standards.  That's a bad idea for our profession, and for our patients.

I absolutely agree 100% with cd, tdage and shan.  And I'm going out on a limb here and going to hurt some professional and personal feelings.  I'm not comfortable either with LPN/LVN's passing  meds.  Ultimately, it's the RN license on the line.

Ted: great post.

I have emailed several people about this topic . I sure hope we get some disucssion going on this.

Medication administration is an awesome responsibility & would be VERY dangerous for a UAP without the proper supervision. As an LPN, I still don't feel completely comfortable passing meds in LTC.  So many residents with so many varied diagnosises, diets, & sensitivities.  I don't have the time to pass the meds myself, though.  All the meds are reviewed by the pharmacy consultants monthly.  Also, they are checked in & approved by a nurse before being placed in the med carts.  I like to discuss any new meds with my med aids before administration & provide any necessary information.  Afterall, it is my license as well as their certification & my resident's safety on the line.  I suppose I'm fortunate to have med aids that take their responsibility very seriously.  At my facility during the last state inspection there were more errors in the nurses' MARs than in the med aids MARs most consisting of failure to initial routine meds & none resultin in injury.  I'm very proud of my med aids.  They are my eyes & ears on the floor.

As an LPN I have given meds both IV and po without one med error in 30yrs. I have had to bail out several RN's who were tripping over their ego......

I remember when I worked in a Retire and Care Center, they had two people that help with Medication assistance, that were CNA's, the RN Supervisor would make her rounds, to see if the medicationss were given at a certain time, and to check on the CNA / Medtech on the assistive living portion of the facility, on the SNF, the LVN or the RN passed medications.The facility kept it on a downlow, and only these two people were qualified to assist the residents with medications, or whom they trusted.

As an RN that works in a hospital we give our own meds. We do not even use LPN's on the acute care floors. We do however have LPN's on our Skilled Nursing Facility (SNF). I would not feel comfortable letting someone else give my meds for me. When assessing patients I like to know what kind of meds they are on. I with you guys, that  CNA's should not be passing meds. It is a very scary thing.

RNDude: the situation with paramedics is different. They have intensive medical training. I would feel comfortable with a paramedic giving meds, no problem! It's the med techs that have little to no training that I am worried about.

And RN dude i agree with you too! paramedic giving meds is a great idea as well!

Well, here in Va. they use Med techs on a regular basis (less pay, more scarey)  In fact. in alot of nursing homes, med tech are replacing the LPNs. I worked at an Assisted Living facility and was replaced by a Med tech. It scares me to death to think about this. They get a short class on passing of meds, but like someone said, they have no knowledge of adverse side effects. reasons for giving or not giving meds, when a MD should be notified or numerous other concerns that should be considered for patient safety.( Giving insullin is especially frightening). As far as Lpns giving meds, that is a big part of our nursing education. I  currently work with a RN who has never given an injection, in school or out.    I also interviewed for a position in a LTC where I would be Charge Nurse over a CNA giving meds. I DON'T THINK SO! I'm not putting my license on the line for somebody else and if I have to go behind them and check everything, I might as well be doing it myself. I refused the postion. I have worked as LPN in LTC where the passing of medications is a time consuming and difficult job. I couldn't imagine a CNA or Med tech doing it and what about the consequences. I was constantly double checking everything. Too much chance of mistakes being made with so much going on and so many distractions.  It's all about the money. But it should be all about the patient's safety.  In LTC anything and everything can happen and usually does.

I teach new employee orientation for our healthcare system. CNAs are not allowed to dispense meds at any of our facilities, including long term care or assisted living. I have heard horror stories from CNAs who have been required to do so elsewhere and the sigh of relief when they find out won't be responsible for passing medications.

We have to stop using the nursing shortage as our excuse to place assistive personnel in roles beyond their comfort level , training or scope of practice. If the nursing shortage is the problem... EVERY nurse has a responsibility to make nursing a more attractive profession. WE can start this by speaking positively about nursing to everyone, especially our assistive personnel. CNAs tell me how frequently nurses try to talk them out of going into nursing.   

I also believe that LPNs are an indispensible part of the healthcare team.  We couldn't survive in Florida without them.