I was wondering, what is your opinion of medication management by unlicensed nurses? The aides at my facility seem to be giving medications in the same fashion that a nurse would, some with a nurses supervision and some without. What are your thoughts?
Dear Nancy replies:
Medication administration by unlicensed assistive personnel has become fairly common in assisted living settings, mental health settings, school settings and developmental disabilities settings, as examples. Although nurses generally would prefer they or other licensed personnel, like LPNs, administer medications, there are not enough nurses employed in such settings. As a result, medication aides, UAPs, CNAs or employees with other titles are doing so to make certain those who need their medications are getting them.
The utilization of these individuals should not be done without adequate training. Most states require the UAP to be certified and to successfully pass a medication course for those who give medications to residents of such facilities. In addition, there are limitations placed on the type of medications they can administer. Usually, topical medications, such as ointments, eye drops and specified oral medications are allowed. Injections, feeding tube nourishment and those medications that require an RN to assess whether it should be given or not, are prohibited.
Supervision of the UAPs is also regulated by state law. Some states require an RN to be “readily available” to the UAP while others require direct or indirect supervision. In addition, nurses must follow guidelines in state nurse practice acts concerning delegation of medication administration to UAPs.
Continued competency of UAPs to administer medications is also important. As an example, the UAP may be required to take a refresher medication administration course or be evaluated by an RN or LPN on a specified basis.
Regulatory oversight also exists for UAPs who administer medications. Many times, such oversight is done by the state board of nursing. Other states utilize the state department of health or the department of aging. Regulation is important so that required credentials, continued competency, and if needed, discipline, of the UAP can occur.
An article you might be interested in is Jill Bidden’s “The Safety and Regulation of Medication Aides, 2(2) Journal of Nursing Regulation, (2011) (https://www.ncsbn.org/safety_and_regulation_article.pdf).