One Nurse's View on Patient Care

By Beth Smith

Do you want an 18-year-old with only a year of experience and less than two weeks of education administering medication to you in a nursing home or assisted care living facility? Or do you want this same untrained and uneducated person providing this level of care to your family member?

If your answer is no, then your action is needed to get your state representative to vote against HB 1607, which the House Health and Human Resources Committee will consider today.

Proposed by the association representing nursing homes and sponsored by state Sen. Diane Black and Rep. Debra Maggart, HB 1607 would allow certified medication aides, who would be registered with the Board of Nursing, have a year’s experience working in a nursing home or assisted care living facility, and 75 hours of training, to administer medications to individuals in nursing homes and assisted care living facilities.

Proponents of the bill say that it will give nurses more time to do other nursing jobs, but what is more important than providing nursing care? They also argue that the amendment only allows for routine medications to be administered; however, those “routine” medications include heart drugs, blood pressure medicines, diabetes drugs and antibiotics, just to name a few. The average nursing home patient receives eight different medications.

Nurses argue that this is a patient safety issue. It takes knowledge and education to understand how drugs affect the body and is more difficult when multiple medications are given.

It takes skill and experience to be able to identify drug interactions and side effects, especially in an elderly patient with chronic illness.

Medication administration offers the nurse an opportunity to “lay hands on” the patient. This is one of the most substantive times a nurse spends with a patient and provides time to observe the patient, discuss any health care concerns with them and determine necessary treatment if there are any changes in the patient’s health. Giving the nurse less time to deal with the patient and delegating this authority to a medication aide will force registered nurses into even more administrative roles, such as reviewing charts and overseeing staff, instead of having registered nurses providing patient care.

Tennessee’s nursing homes already do not meet national safety and quality standards – 111 of the 319 nursing homes in the state received the lowest rating of one star according to the Center for Medicaid Services, and only 22 have received CMS’s highest score of five stars. To check the quality of nursing homes in your area, please visit www.cms.gov. Nursing home patients deserve improvement in their level of care. This bill takes several steps backward and will further decrease the quality of care our most vulnerable citizens receive.

Individuals in nursing homes and assisted care facilities are our most frail and vulnerable citizens, often unable to advocate for themselves. The addition of another layer of uneducated and undertrained health personnel between the patient and licensed health care provider will only create further confusion and further distance between those most qualified to give care and those most in need of the care.

Please call and e-mail your representatives and voice your opposition to HB1607. We must ensure that properly educated, trained and licensed individuals are providing this care.

The reason they are called nursing homes is because these patients need nursing care.

Let’s ensure our most vulnerable citizens are given a voice in the legislature and that their needs are put first and not at the bottom lines of nursing homes and assisted care living facilities.

Beth Smith, a registered nurse who holds a doctorate, has been in nursing practice and health education for more than 30 years in the Tri-Cities area. She has served as a member of the nursing faculty at East Tennessee State University and Milligan College. She is involved in clinical health care research.