Paul's Passing Thoughts

By Paul Dohse, STNA/MA-C

Medication Aides are coming to Ohio, and though most nurses disdain the program, there is no stopping it now, especially in assisted living facilities. Unfortunately, an Ohio MA-C (Medication Aide-Certified), is often confused with a certification of completion (they do not receive certification) in developmental disability group homes. That certification entails about 16 hours of in-class training and no clinicals. Neither does it require a state test.

The MA-C certification is through the Ohio Board of Nursing. It is a nursing certification. It qualifies an individual to administer medications in long term care including skilled nursing facilities, with some restrictions. However, regarding skilled nursing and nursing homes, the MA-C must also have an STNA (State Tested Nurse Aide) certification through the Ohio Department of Health. Resident Assistants (RA) must have at least one-year full time experience in the last 5 years in assisted living facilities in order to qualify for certification.

Medication Aides have changed the face of healthcare in many states for a long time: Ohio is very late to the party, in part, because Ohio has stringent healthcare regulations that surpass the majority of states.

But the slow, uphill rollout of MA-C in Ohio has other causes. In Ohio, nurses have a strange dysfunctional relationship with passing medications. The task is a merciless tyrant that excels in the tyranny of the urgent, yet nurses object to being saved from the unhealthy co-dependent relationship. I have devoted the rest of my life to serving nurses, at least until I become one, and my experience as a MA-C, especially in assisted living, has shown me the amazing potential of MA-Cs to enable nurses to deliver higher quality care and to do more of what they have been trained to do. On one point alone, nurses having more time to interact with concerned families can serve to elevate the census of that facility expeditiously.

Look, I hesitate to share this because nurses are my heroes, and as an STNA, I have worked with very few bad ones, but it is clear that medication passes are a nurse’s worst enemy whether they admit it or not. I have watched it for years, but the past year has been the most interesting. Why? Because as an STNA with a MA-C certification, I have watched nurses struggle with med passes, and in the beginning, suggested that I could help, which resulted in being attacked and demeaned for the suggestion. It was never any skin off my back, I enjoy being an aide, so I quietly and joyfully cleaned up the pitchers of water off the floor dropped in their panic, said nothing when they poured water into a medicine cup, didn’t pass judgment when too much of the plastic spoon was in the resident’s mouth, and offered to do their treatment orders when their eMAR was all red. As an older, male STNA, I always enjoyed overhearing nurses talk about their bad relationships with boyfriends; it always made me think of their med passes as well.

Do I think med passes are the number one cause of the rampant pressure ulcer epidemic in long term care facilities? Yes. Clearly, med passes rob time from attention to wound treatments and making sure aides do what they need to do to prevent them. Nurses who do too much are also directly related to the nurse aide shortage. Having little time to involve aides in the care of residents diminishes the value of being an aide in the minds of the aides. When aides refer to themselves as “certified butt-wipers,” you can be sure that severe staff shortages are coming.

I have been an aide for a long time in the heaviest of skilled nursing facilities. How many times has a nurse wanted to do a report with me while saying things like, “These are my diabetics, and these are the people who need to get their trays first, and I need vitals on these people by this time,” ect., ect? Once, one time, and frankly, I wondered what the hell was going on. Aide work is the hardest work out there. If you want to erase participants, detract from its value while making your own job harder. Yeah, do that, brilliant.

With all this said, and Ohio facilities finally seeing the light after the necessary amount of suffering, the first MA-Cs are burdened with a huge responsibility. All eyes are on us. As far as I can tell, and after asking people who are in a position to know, there are probably less than 20 experienced MA-Cs in Ohio. The future of the program and its benefits will be judged by our performance. We have two jobs: to be the best MA-Cs we can be, and to convince the sceptics because we believe the program will result in higher quality healthcare.

However, a much larger consideration looms. Medication errors kill more people annually than traffic accidents. And like traffic accidents, it only takes a moment of non-focus or distraction to change someone’s life forever or end it. As medication aides, we live by the “Six Rights,” the right resident, the right drug, the right dose, the right route, the right time, and the right documentation. And we are not passing over the counter drugs, we are administering very powerful medications. Last week, I found myself passing meds on a unit that I was much less familiar with than the unit I am usually assigned to. Not being totally familiar with the residents on that unit, I applied the two-check system for identifying the right resident. The residents were not in their rooms, so I focused on the full names for one check. I was unaware that two residents on that unit have the same last name. My inquiry revealed different first names, which also revealed the fact that I was standing before a resident with the wrong cup of meds. I returned to the med cart stunned. It took me about 15 minutes to collect myself.

This brings me to a suggestion that is a carryover from a creed I always practiced as an STNA: ALWAYS take the resident’s concerns seriously…always. I delight in a resident who is on top of the medications prescribed to them. If you have a healthy fear for what we do, you will welcome this seventh check. In fact, I insist that there are really seven checks with the seventh one being, “ALWAYS listen to the resident.” You can call it “Paul’s seven rights” and that will suit me just fine. Again, if you have the healthy fear, you will be humble enough to listen. Besides, according to my firsthand knowledge, listening to residents has prevented drug errors.

Though MA-Cs are not nurses, they are an extension of the nurse aide calling to aide nurses. Nevertheless, it must be pointed out that Ohio STNAs are not fully used to benefit nurses to begin with. Be sure of this: the nurse aide identity crisis in Ohio has led to severe shortages of both. Lack of value regarding aides, and burnout regarding nurses. MA-Cs are an important hinge that will swing both ways and cure both shortages. Healthcare facilities are beginning to figure that out.

The first qualification of a MA-C is a healthy fear of our task at hand. Secondly, education, but the first qualification will determine how much we excel in the application of what we learn.

A healthy fear and enough humbleness to listen are our greatest assets.