What could (or would) I do if I didn’t have to pass meds all day? LSN has heard this question from nurses worried about their jobs and worried that they would have nothing to do all day if medication aides came to pass in Illinois. However, the nursing shortage statistics documented in another folder on this website, make it highly unlikely that nurses would be let go in senior living and long-term care settings in Illinois. And LSN’s Nurse Leadership Committee believes that if medication aides were allowed in these environments, nurses working with the elderly could go back to being the kind of nurses they really wanted to be when they went to nursing school.

In a survey of over 800 nurses working at LSN long-term care and senior living member organizations in the Fall of 2006, the following items were listed as the top benefits to nurse delegation of medication administration:

1. Having more time for nurse problem solving and monitoring residents - 39.5%
2. More time for nurses to spend with residents - 36.1%
3. Additional career growth opportunities for unlicensed assistive personnel (UAPs) - 31.5%

Indeed, LSN maintains that there would be many benefits to medication aides in Illinois for the nurse - a nurse performing more than tasks. In other words, performing all the roles for which she went to nursing school to begin with, such as assessing, collaborating, managing, supervising, role modeling, documenting, educating, and functioning as an agent of change. Let’s look at a day in the life of a staff nurse freed from the task of passing routine oral medications:

Upon coming on to the unit at the start of the day shift, the nurse can’t wait to make rounds with the outgoing night shift nurse. She has been concerned about several residents who have been sleeping a lot during the day, so she would like to discuss their sleeping habits at night with the resident and the night nurse. There would be no need to be rushing around getting a shift report at the desk on the fly, because neither the incoming nor outgoing nurses would be worried about starting the med pass.

After reviewing staff on duty and making sure that they are all ready for their permanent assignment for the day, the nurse could start prioritizing her day with some of the following kinds of activities:

• Communicating with CNAs regarding anything unusual with the residents that are their responsibility and discussing mutual expectations with them.
• Continuing to pass non-routine medications, such as prns, IMs, G-tube meds, etc.
• Ensuring competency of staff on tasks that have been delegated such as med pass, use of lifts and vital signs.
• Supervising CNA staff and identifying on-the-spot training opportunities.
• Spending some time with the new CNA and her mentoring "buddy" to see how the new staff member is acclimating to the environment.
• Encouraging and role-modeling person-directed core values, including the development of meaningful relationships with residents.
• Making rounds and assessing residents, checking for med reactions and critically thinking through changes in condition, analyzing what can be handled by her, what requires referral to physicians or other colleagues, or determining who might need to be transferred to the hospital.
• Collaborating with other department staff about resident needs and preferences.
• Calling families at times other than when something goes wrong, discussing their family member’s current status and encouraging them to come to care plan meetings or family nights.
• Attending the care plan meeting for the three scheduled residents on the unit along with the residents and their permanent CNAs.
• Consulting with the MDS Coordinator on residents whose ARD is coming up, and communicating existing strengths and needs as well as ADL performance and restorative potential on the shift she is responsible for.
• Updating care plans in between quarterly care plan review dates as residents change and/or their approaches don’t seem to be working.
• Working with physicians on medication reduction efforts in compliance with the new federal pharmacy regulations.
• Overseeing unit restorative, fall prevention, and continence, skin and hydration programs.
• Thoroughly recording and investigating accidents and incidents.
• Documenting occurrences and happenings in the residents’ lives - clinically, emotionally, etc. - in the nurses’ notes as they happen, and not trying to do a meaningless, repetitive monthly summary when memories are often faulty.
• Observing mealtimes in the dining room and determining who might benefit from an eating restorative and having lunch with different residents several times a week.
• Attending committee meetings where her voice can be heard in improving processes and systems.
• Focusing on being an agent of change, raising the bar of service delivery and being a champion for relationship-based care in her organization.

Towards the end of the shift, the nurse can check in with each of the staff members and go over what has happened during the day and any unusual occurrences that can then be reported to the nurse coming on the next shift. Again, because neither nurse needs to rush to pass pills, rounds can take place along with communication about what happened during the day. Continuity of care would almost be guaranteed.

Can you just imagine having the time to do all these things well??? Being able to do the things nurses are educated to do? Wouldn’t resident care and service delivery be improved? Would not nursing be the joy and the challenge we signed up for?

Click here to read testimonials from nurses who have worked with medication aides in other states.