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Medication aides in nursing homes: A push to save money or improve patient care?

May 21, 2009
by JRosenfeld
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A bill in the Tennessee Legislature would create a new 'medication aide' position in nursing homes. The bill would allow medication aides to administer medication under the supervision of licensed nurses as opposed to a registered nurse—a more advanced position. Applicants for the new position would need a high school diploma, one year experience as a nurses aide in a nursing home, and passage of a standardized exam.

An improvement to patient care or simply cutting corners?

Proponents of the bill claim the creation of a new group of medication aides will free up more experienced nurses to work directly with patients as opposed to dispensing routine medications. According to bill sponsor, Debra Young Maggart (R-Hendersonville, Tennessee), the bill could eventually reduce medication errors caused by over-extended nurses. The secondary benefit to some would be an inherent cost savings by hiring lesser credentialed employees.

The bill’s opponents worry that the credentialing requirements are insufficient for a job where a slight error could cost a life. Not surprisingly, some of the bills most vocal opponents are nurses groups who are quick to point out that there are thousands of drugs available in the United States and medication aides with limited training are simply unable to have a mastery of all of them.

Medication errors continue to climb each year. By some accounts, 1.5 million people are injured on an annual basis due to medication errors. In a study completed by The Institute of Medicine, 800,000 of the injuries occurred in the long-term care setting.

The Tennessee bill is currently in subcommittee. If passed, Tennessee would join the majority of other states that allow medication aides to dispense medication in nursing homes and long-term care facilities. Read more about this proposed nursing home legislation here.

I tend to think nurses aides can be a good idea in settings where common medications are dispensed on a regular basis. The argument that a medication aide should have a mastery of every medication available is ridiculous! Is it really fair (or necessary) to expect them to be intimately familiar with medications that would rarely be dispensed in a long-term care setting?


Preventing Medication Errors, Annals of Long-Term Care by Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD

Jonathan Rosenfeld is a lawyer who represents people injured in nursing homes and long-term care facilities. Visit his personal blog at


Jonathan Rosenfeld...



I am a DON at an assisted living. We use medication aides (or QMAPS) to pass medications at the facility. I am the only nurse here and can spend my time with tending to client needs that require more skill and assessment. I am thankful to have them.

In NE we could not live without our Med Aides. We have used them for years. The article worries about Med Aides not having enough education....well haven't surgeons cut off the wrong leg? Haven't patients died in the recovery room because the RN was not paying attention? My experience is that Med Aides take this job serious and feel honored to being doing a position that has honor when they can not afford to go to school to become a LPN or RN. Good for TN for finally "getting it".

Here in New Hampshire, we have used MNA's for several years. They are not alowed to administer medications to "non stable residents". Our fqcility uses an MNA to enhance the role of a nurse, not replace a nurse. Unfortunatley, there are times due to call outs when we use an MNA instead of a nurse. Research here in New Hampshire has shown that MNAs make less med errors than licensed nurses. Our state board of nursing has not disciplined any MNAs for med errors since 2002, when the program began. I have seen the tests that the MNA student must take to pass their course and the state exam - I am sure there are many nurses out there who could not pass the test - it is hard! I was initially opposed to using MNAs, but now find them a valuable resource. Thanks.

AT our facility med techs are utilized as the nurses have an abundance of paper work that needs to be compketed. While there is supposed to be supervision of the tech, most of our nurses wander off the the coffee shop etc and still do not accomplish the intended paper work. WHen there is an emergency on the unit, the tech stands there dumbfounded and unable to respond. Valuable time is wasted in tracking the nurse. No one benefits from this situation and our residents suffer the brunt of this. While cost for techs is is not a good situation.

I am a Nursing Home Administrator and I have found Medication Aids to be better at administering medication than Licensed personnel. This is their primary job and they become very proficient and skilled in this task. Licensed Nurses are too busy being utilized in many different areas and unfortunately can't focus as closely.

As a long time nursing home adminstrator I have for many years advocated bar coding for medication administration in long term care, where the patient armband, the nurse administering the medication and the medication bingo card would all be bar coded. This will tremedously reduce medication errors as the computer will monitor the accuracy as well as the contraindication of the medication being administered. If this system is implimented then medication administration for chronic patients will be almost ministerial and therefore could be administered by properly trained medication aides. Other positive aspects of this proposal would be relieving overworked nurses to deal with the more complicated patients, thus,minimizing other nursing errors as well as stabilizing nursing home costs in these critical times.

Med techs passing meds in an assisted living is a far cry from passing to sub acute patients on a rehab floor. While it is true that anyone who can read can hand out medications, one needs to be a licensed person to assess the patient's reaction positive or negative to the medications given. We should hire more nurses or hand out fewer medications both of which would greatly improve the care and the quality of life for most residents.

In Wiscosnin they are allowed with some restrictions. When you have another RN on a wing the routine meds are something they can easily handle. The stress is on the other nurse who must handle insulins and specific meds on the wing. But, they know the residents and their meds and are better than hiring an agency nurse when you cannot fill a shift.

It is not a viable long term or short term solution. One needs to be more than a high school grad with one yr. of experience and pass a state test. What happens if that med tech has a problem she has never encountered before? Then what? What about the Nurse Practice Acts in these states and coverage of non licensed help. I have worked hard to obtain my license I would be very uncomfortable being responsible for someone else giving medication they don't know nor do they understand on my watch.

We use med aides in our facility and it is very beneficial. They free up the nurse for other things and help out on the floor inbetween med passes. This helps the other CNAs. It is a win win situation. If your nurses don't use their time wisely then why blame the med aide? Thanks from ND