What is your opinion of medication management by unlicensed nurses?

By | 2021-05-28T17:21:41-04:00 March 6th, 2015|1 Comment


Dear Nancy,

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 nurse’s supervision and some without. What are your thoughts?


Dear Nancy replies:

Dear Jean,

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).



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One Comment

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    Marie Lord October 23, 2016 at 6:08 pm - Reply

    In my experience a unlicensed person delivering medication to vulnerable seniors is unsafe. It is a way of addressing the cost per hour to the nursing home rather than the safety of the resident, patient or what ever term one wants to put on our aging population.

    Observing as a visitor and retired nurse, I witnessed 2 registered nurses come into a room to do an assessment of a sleeping patient and to obtain a sample for glucose testing. The patient was sleeping at the lower half of the bed, legs hanging over each side of the bed that was in trendelenberg position. Each nurse did the exam that was timed for that hour, neither awakened the patient and promptly exited the room. Said patient was in a cardiac care with multiple heart issues and new heart damage. Next same story but in a nursing home. Patient had a new stroke history of new heart issued and was rocking side to side. Nurse comes into room, announces she is supervisor and listens to bowel sounds. She leaves and returns with maalox. She never awakened the patient , never listened to heart sounds and failed to realize he was having the heart attack that eventually took his life.

    You are going to kill off a lot of people if nursing continues on this tract

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