Letter to the Legislative Editor:

I write in response to Dr. Glazer's Legislative Column, "Medication Administration Interventions That Must Be Performed by a Registered Nurse." In the State of Michigan, licensed individuals are able to delegate to sublicensed and unlicenced individuals "who [are] otherwise qualified by education, training and experience" (State of Michigan, 1996). As my health system was acquiring physicians' office practices, it became apparent to us, the RNs practicing in the primary care network, that physicians were willing to delegate many medication administration responsibilities to assistive personnel. Rather than watch all our physicians embrace this more liberal model in the name of efficiency, and perhaps not monitor the situation carefully, the RN's undertook the challenge of "managing" delegation. In the ambulatory care areas, we applied the American Association of Critical Care Nurses (AACN) decision-making model (AACN, 1995) and determined some medication administrations that we would delegate and under what circumstances. We developed written guidelines, training, and competency assessment tools. Now, some medical assistants do administer skin tests (intradermal), common immunizations (subcutaneous and intramuscular) and a few other medications (e.g. B12 injections). I think allowing medical assistants to administer skin tests, immunizations and medications such as B-12 injections is fairly common in ambulatory care settings, particularly community-based settings in Michigan. I share our approach because it differs from the majority opinion expressed in the survey conducted by Dr. Greer Glazer.

Candia Baker Laughlin, MS,RN,C
Director of Patient Care Services, Ambulatory Care Services
University of Michigan Hospitals and Health Centers
Ann Arbor, MI
candial@umich.edu

References:

American Association of Critical Care Nurses. (1995). Delegation: a tool for success in the changing workplace. Aliso Viejo, CA: Author

State of Michigan. (1996). Michigan Public Health Code, 1978 PA 368, as amended, Lansing, MI: Author.

Go to the article.
Reply by author Greer Glazer

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