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No one is "dunning" the regulators. If we can't have an open and honest discussion among our peers, then we might as well get in the branding line. Just because they are "regulators" doesn't make them right about any of this. Personally, I want to be consulted before I am told I "have" to do something that I feel is not safe.
Nursing isn't stagnant, it is fluid, it requires thought, debate, critical thinking, creativity and sometimes hard words said with respect, but said none-the-less.
It is easy to say it us up to the individual nurse to decide what to teach, but that is not true. Ultimately, it is up to Mainecare and the "regulators" because they decide what they will pay for and what they will allow. We, as nurses, have to protect the patient and the profession. The more you teach others, the more they will be allowed to do. When does it stop? Do you want your family taken care of by a nurse, or by UAP's who know how to do a task but don't know what to look for, how it all comes together, and how to avoid the unpredictable.
I have tremendous respect for the CRMA's that I teach and that work for me. I support them completely. They are competent and capable, but they are not licensed and I will not jeopardize the client, the CRMA or myself by expecting too much from them.
As we quote regulations, keep in mind the Assisted Living regs and the BON regs that say we cannot delegate assessment. Giving heparin requires assessment.
Kathleen
----- Original Message -----
From: Djgam100@aol.com
To: Dgrass@gwi.net ; voodoosgirl@midmaine.com ; Beas-crma@lists.state.me.us
Sent: Monday, December 13, 2004 10:26 PM
Subject: Re: beas-crma Fw: sub-cutaneous injections
Hi all.
Kathleen,
I have read the regs and chapter 6 of the BON regs. I find it peculiar that although the regs specifically state Insulin and Bee Sting Kits that a number of instructors refer to epi pens as an injection that CRMA's can give. Epi pens are not stated in the regs., only Bee Sting Kits.
7.1.2 No injectable medications may be administered by an unlicensed person, with the exception of bee sting kits and insulin.
7.1.3 Before using a bee sting kit, unlicensed persons must be trained by a registered professional nurse in regard to safe and proper use. Documentation of training shall be included in the employee record.
note that there is no mention of epi pens in this reg, but nurses teach CRMA's to administer them.
7.16 Whenever a Registered Nurse teaches or provides in-service training to unlicensed personnel on medical issues, treatments and/or medical equipment not specifically outlined in these Regulations, there must be documentation in the employee file.
The above regulation implies to me that the RN can provide in service training to unlicensed persons that is not stated specifically in these regulations inclusive of the administration of other SC injections. Going along with the BON chapter 6, if the resident/client/consumer is stable on the medication and the CRMA(s) have proven competency in administering SC insulin why should they not be allowed to administer other medications SC? Levonox is available in pre filled syringes to take the guess work out of the amount to be administered and is probably safer than administering Insulin. An SC injection is an SC injection regardless of what the medication is. If the CRMA is taught to do one, I see no difference in another just because it is a different medication being injected.
I also understand that if, as RN's we are not comfortable with teaching the CRMA to do this, we do not have to. We as RN's , when working in Home Health, teach family members to do more complicated procedures and administer more dangerous meds and these family members, for the most part, have not training whatsoever previous to our instruction. I think that CRMA's, with the new Standardized Curriculum are better able to give an SC injection than ever before.
We need to give the CRMA's the credit they deserve for the knowledge that we have imparted on them throughout our teaching and use our own judgement in what we teach them after they are trained as CRMA's.
I also feel that instead of dunning the regulators that we should work with them in a constructive manner as opposed to always throwing dig at them. It never ceases to amaze me that we cannot ever seem to ask questions or reply to questions from others without dunning the regulators for trying to keep the services provided under them safe and affordable.
Don
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