Glazer, G. (February 28, 2002). NursingWorld | OJIN: Legislative Column: "Medication Administration Interventions That Must Be Performed By A Registered Nurse" Online Journal of Issues in Nursing. Available http://www.nursingworld.org/ojin/tpclg/leg_12.htm

Keywords: medication administration, medication aides, medication technicians

This column summarizes the findings of an OJIN survey asking readers to identify which nursing interventions related to administration of medications and blood products must be performed by a registered nurse and which nursing interventions can be safely delegated. Ten interventions were identified by at least 75% of the respondents as interventions that must be performed by a RN.

Sixteen states (Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Nebraska, North Carolina, North Dakota, Oklahoma, Oregon, Texas, Virginia, Wisconsin) and the District of Columbia currently legislate medication assistants (medication aides, qualified medication technicians, nurse apprentices or nursing technicians) which were created over 20 years ago. Nursing students in Iowa, Nevada and Washington may also engage in medication administration in instances specified by law. Whereas, this scope of practice has primarily been limited to long term care facilities, developmentally disabled, group homes, and family homes, expansion of their practice to other settings has been attempted. States differ in the initial training and ongoing supervision of medication assistants, the types and routes of various medications that may be given by medication assistants, and oversight. Since there is no national consensus on which nursing interventions related to administration of medication and blood products must be performed by a registered nurse, and which nursing interventions can be safely delegated, a national survey was conducted from September 7, 2001 to November 5, 2001 to identify which medication administration interventions should be performed by a RN regardless of setting or type of medication. The purpose of this column is to share the results of our online survey.

The survey was completed by 740 respondents; 686 (93%) were registered nurses and the rest were other health care professionals, LPNs, nurse’s aides, and consumers. The majority of the nurses were staff nurses (N=286) and most respondents worked in the hospital (N=388). Although there was diversity of opinion on every type of medication administration intervention, there was widespread agreement that a number of medication administration interventions must be performed by a RN. Table 1 identified medication administration interventions (McCloskey & Bulechek, 2000) that must be performed only by a RN regardless of setting or type of medication rated by the majority of respondents. For the following 10 interventions, three quarters or more (> 75%) of the respondents specified these interventions must be performed by a RN regardless of setting or type of medication: blood products administration, chemotherapy management, conscious sedation, medication administration: epidural, medication administration: interpleural, medication administration: ventricular reservoir, analgesic administration: intraspinal, medication administration: intravenous and medication administration: intraosseous. On the other hand, for 7 nursing interventions related to the administration of medication, at least 63% identified the intervention as delegatable, dependent upon the setting or type of medication. Table 2 depicts these types of medication administration that may sometimes be performed by someone other than a RN: medication administration: skin, ear, inhalation, rectal, vaginal, eye, and oral.

Numerous written comments advocated for the importance of context and essential role of the RN in assessment and evaluation of patient status. One example is the comment from the respondent who wrote:

Medication administration should never be just a process of ‘passing’ medications. While it is true that anyone can give a medication (task), it is important to remember that this is not what registered healthcare professionals should be doing. Rather, nurses should be . . . assessing if the medication’s correct for this persons diagnosis, is the dose appropriate for the patient, what is the reaction to the medication, is there a side effect or adverse drug reaction, etc. (cognitive thought process).

Another respondent identified other contextual variables, including whether the outcome of the intervention is predictable and if the patient is in an urgent or emergent state. She states,

The tendency to delegate simply based on a ‘list’ of tasks is frightening because there is no evaluation of the requirements of the patient or the knowledge and skill of the intervenor.

The difficulty of the question addressed in this survey is noted by the following respondent:

I couldn’t find the factor that I think should determine ‘who administers’ and that is the condition and cognition of the person receiving the medication.

This survey provides preliminary data that some national consensus exists on which nursing interventions related to administration of medication and blood products must be performed by a registered nurse, and which nursing interventions can be safely delegated. Respondents providing written comments agreed that whereas preparation and administration tasks of the total administration task might be delegated in some instances, the registered nurse must maintain responsibility for the assessment and evaluation of medication effectiveness. Validation of these finding by future research is warranted prior to making policy recommendations.

One of our students, our future, wrote,

Students are eager and loud voices. Today’s nursing issues are very important to us, they will become our problems tomorrow when we find ourselves in practice.

We owe it to the profession and the public to identify medication administration tasks that must be performed by a RN versus those that can be safely delegated. If we do not do this, others will be happy to do it for us. And we have no assurance that this will be in the best interest of nurses or the public.

Medication administration interventions rated by at least 50% of the respondents, as essential to always be performed by a RN.

*regardless of setting or type of medication.

TABLE 2

Medication administration interventions that may sometimes be performed by someone other than a RN* rated by at least 50% of respondents.

*dependent upon the setting or type of medication.

THE AUTHOR

Greer Glazer, PhD, RN, FAAN

Director, Parent Child Nursing
College of Nursing
Kent State University
Kent, OH 44202
Email Address: GGlazer@kent.edu

REFERENCE

Letter to the Editor by Ann Amburn (March 10, 2004)