Who Should Give Medications in Nursing Homes?

A proposal to expand the range of employees in long-term care facilities who can legally administer certain medicines to patients is running into opposition from some registered nurses.

The change is designed to lighten the heavy workloads often carried by nurses — or at least to possibly free up some of their time so they can use it on more challenging professional tasks, according to some lawmakers.

At issue is a measure to let a new class of nursing assistants give patients medications like commonplace pain relievers, topical creams and a limited number of prescription drugs. Lawmakers, including Gov. Phil Bredesen, OK’d that plan last year — but the Tennessee Board of Nursing shot it down.

The measure, which was up for debate Tuesday, will be heard again next week in a legislative sub-committee.

The nursing board — in what some lawmakers saw as open defiance of the legislature and the governor — adopted rules recently indicating that registered nurses be the only ones to decide which lower level workers will give medications to whom.

Lawmakers who passed the measure last year said the specific intent was for licensed practical nurses, who are a step below registered nurses, to also delegate that duty to certified medication aides.

Two Republicans introduced bills this year that would require both registered nurses and licensed practical nurses to delegate their medicine-giving authority. They would oversee the certified medication aides who could administer the drugs once they’d completed 75 hours of training.

Individuals can apply to become a certified medication aide only after working for at least year as a nursing assistant, which includes helping patients with tasks like getting out of bed, eating or using the bathroom.

There is a long list of medications the aides would not be allowed to give, leaving only oral drugs such as Tylonol, Advil, vitamins, laxatives, blood pressure and allergy medications or topical creams like Neosporin.

Sen. Diane Black, a registered nurse from Gallatin, led her bill to passage 27-1 last month in the Senate. Sen. Beverly Marrero, D-Memphis, was the only member to vote against it.

But the House bill is still in committee.

Sponsored by Rep. Debra Young Maggart of Hendersonville, House Bill 3368 was on hold last week in the Professional Occupations subcommittee after Rep. JoAnne Favors, D-Chattanooga, and Democratic Caucus Chairman Mike Turner, D-Old Hickory expressed opposition.

Turner asked Maggart to hit the brakes for a week to give members more time to figure out their vote. Although Favors indicated there’s little likelihood she’ll be changing her mind anytime soon.

“If we pass this, we can come back in a couple years and call it the Euthanasia Bill,” Favors said during last week’s committee meeting.

The new class of nursing assistants, created by a state law approved last year, lacks the medical training necessary to understand if a patient is having an adverse reaction to a medication, she said. And requiring an additional 75 hours of training will not prevent the increased potential for deadly medicine mix-ups that the proposed legislation may inadvertently encourage, said Favors.

“It really is the dumbing-down of administering drugs, and that should not happen,” she told TNReport.

Favors opposed last year’s legislation. Despite her efforts to derail it in 2009, the measure passed by comfortable bipartisan margins in the House and Senate.

But the Tennessee Board of Nursing, which was charged with writing the rules to implement the new law, agreed with her and decided the plan wasn’t a good idea.

At the Jan. 21 board meeting, members voted on rules to keep registered nurses in charge of deciding who will give out medications to patients — essentially erasing any new authority licensed practical nurses, LPNs, would have to assign the new aides to  issue the pills or rub on medical ointments.

“We did not arbitrarily go against the will of the legislature,” said Cheryle Stegbauer who has chaired the nursing board since 2004. After listening to hours of archived legislative committee meetings discussing the measure, she said members of the board believed lawmakers were referring to registered nurses, not LPNs.

“I don’t think the board really saw that they had a mandate. If we thought we had a legislative mandate to open it to LPNs as well as RNs, we would have. We would have complied, but I don’t think that’s our understanding,” she told a committee of lawmakers Tuesday. “If you talk about intent of the legislature, you can look at the tapes and a lot of things said were not exactly what happened in the law.”

She said the board will keep an eye on the bill if it moves through the legislature and continue to do what it believes is safest for the public — but doesn’t plan to try to stop the bill.

The Tennessee Nurses Association is backing the board’s rule-making decision.

“We’re trying to make this as safe as possible for our frail and elderly who can’t advocate for themselves,” said Sharon Adkins, association executive director. “LPNs are trained to give medications. And let me tell you, their training is more than 75 hours.”

AARP Tennessee, which represents retired persons, hasn’t taken a side in the bill debate.

“We see it really as a stop gap. What we really need to see in Tennessee nursing homes is more staff,” said Karin Miller, the state’s AARP spokeswoman. “The state overall is facing a nursing shortage that is expected to get worse in coming years, and that issue is only exacerbated in some of our long-term care institutions.”

Tennessee nursing homes have the second largest shortage of registered nurses in the U.S., according to a 2009 report titled “Quality of Care and Litigation in Tennessee Nursing Homes,” commissioned by AARP.

Tennessee was also one of the 10 worst states for time RNs spend with each patient, which averaged 30 minutes a day, compared to 36 minutes nationally.

According to the study, Tennessee licensed practical nurses ranked above the national average. The LPNs logged in an average of 54 minutes per patient each day, compared to the national average of 48 minutes.

There are 22,000 nurses and caretakers to manage patients in the 37,850 nursing home beds, according to the Tennessee Health Care Association, which wants the new nursing aides to administer medications.

“Clearly we do not want to reduce the licensed nursing staff. It’s to use nursing staff more efficiently in the building,” said Deborah Heeney, THCA’s government relations director who predicted the nursing board will “fight us to the end.”

“It’s just because the nurses don’t believe anyone else should be able to give medication besides the nurses,” she said.

Maggart says she has the votes to push her bill through the House, but said she may consider officially asking the state attorney general to weigh in.

“There’s a lot of ways to skin a cat. There’s other ways we can go at this if, for some reason, it doesn’t pass,” said Maggart.

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  • http://thisone Lesha

    I am currently in school full time obtaining my LVN degree. I plan on Getting my RN part time while working as an LVN. No way should anyone who has 75 hours of training pass medications. How would they understand the Anatomy and Physiology alone, that occurs when following the patients MAR. As a nurse in training we have to take harsh detailed pharmocologie. We do not continue in the coures should we make under an 85% on any math-type exams. My program takes a YEAR AND A HALF…YES 1.5 years. For ten months of my program I am working two days a week in a hospital as my internship. Medication is life or death…I get (understand) that insurance wishes they could pay less for a med tech…but, they will pay in law suites for the mistakes. It is not worth it, leave the medication to the nurses.

  • http://CHARTER BARBARA LEONARD R.N 30 YEARS

    MY 30 YEARS I HAVE SEEN VERY GOOD MED.TECH GIVE OUT DRUGS. AND ALL I HAVE SEEN ARE THE BEST. HERE IS WHY THIS IS WHAT THEY HAVE STUDIED. THIS IS ALL THEY DO . AND THEY GIVE OUT MEDICATION BETTER THAN A RN, LPN THIS IS TRUE. SO TO DO AWAY WITH M.T WOULD BE A BIG MISTAKE. SO I AGREE WITH THE HEALTH CARE ASSOCIATION LET THE M.T GIVE OUT MEDICATION. NOT L.P.N. HERE IS WHY L.P.N HAVE FORGOT WHAT THEY WAS TAUGHT IN GETTING THEIR L.P.N LICENSE. BECAUSE YOUR M.T HAVE TO GO OVER AND TRAIN L.P.N TO GIVE OUT DRUGS.THIS IS VERY TRUE. MED TECH HAVE TO RE TRAIN LPN ON MED CARTS.

  • http://YAHOO.COM MARTHA KENNEDY

    IN WORKING WITH MED TECH I HAVE FOUND OUT THAT MED TECH ARE IN LOTS OF WAYS BETTER IN GIVING OUT MEDICATION THAN LPN OR RN THE REASON IS MOST ALL LPN HAVE FORGOT WHAT THEY WERE TAUGHT IN SCHOOL ABOUT GIVING OUT MEDICATION .WE HAVE TO TRAIN LPN TO GIVE OUT MEDICATION BY OUR MED TECH ON DUTY AND THIS COST OUR COMPANY MONEY. SO YOU NEED TO KEEP ALL OF YOUR MED TECHS KEEP THEM WHERE THEY ARE . MOST ALL LPN MAKE 18.00 TO 19.00 AN HOUR. MED TECHS MAKE 12.00 TO 13.00 AN HOUR. AND MED TECHS ARE VERY TRUSTED ON GIVING OUT MEDICATION I KNOW THIS BECAUSE I SEE THIS EVERDAY AT MY JOB. MOST OF YOUR MED TECH ARE BETTER THAN YOUR LPN .

  • big m

    As a trained and educated LPN…..I know for a fact that the LPN main job at a Nursing Home LTC is to give meds and oversee the Cert Nurse Aides…..if you take the med pass away from the LPN, there is no real need for that job…..the Cert Nurse Aide can report to the RN and cut out all the LPN jobs——thus saving money….that is what this is all about—-money and not the people who are supposed to be taken care of—–a 75 hr training class for a Med Tech is NOT ENOUGH…..if you administer a med—-you better know how to asses your patient before/during/after adminstration and you better know their health history

  • big m

    I think the 2 other posts are from the same person….Barbara Leonard and the Martha Kennedy….the word usage is similiar…..I have nothing against a Med Tech—–but if the training only requires 75 hours, well that is just unreasonable—-you can NOT possibly even begin to understand the Basics of Pharmacology in 75 hrs. PLUS you need to understand Anatomy and Physiology as well as Disease Process….so less than 2 weeks of work hours (80) you expect to accomplish this—and the LTC environment encompasses Geriatric Care….you can’t just assume a headache will be relieved with a 500mg Advil….and the paperwork involved with Medication Adminstration—–how many of the 75hrs are devoted to this……Seems like a Med Tech should be at least 2 trimesters—–8 months which is approx 864 hrs compared to the LPN 1296 hr class (This is Tn LPN course requirements 1296 hrs for LPN).

  • Tina M Ledford

    The RMA,MA, CCMA are also giving Medication out at Assisted Living