February 9, 2000
MEDICATION ADMINISTRATION IN NURSING HOMES
By: Helga Niesz, Principal Analyst
You asked what states allow people who are not licensed as registered nurses or licensed practical nurses, such as nurses' aides, to administer medications in nursing homes.
At least nine states (Indiana, Iowa, Kansas, Maryland, Minnesota, Nebraska, Rhode Island, South Dakota, and Texas) allow nurses' aides or other unlicensed personnel who receive extra training to administer medicines in nursing homes under the supervision of a doctor, nurse, or other health professional. They are often called “medication aides,” “medication technicians,” or “unlicensed assistive personnel.” In a number of states, including Connecticut, such activities are allowed in state mental retardation or mental health facilities, but not in nursing homes serving the elderly. Others allow unlicensed personnel to assist less frail elderly people with self-administering their medicines in assisted living facilities or residential care homes, but not in nursing homes.
REQUIREMENTS IN OTHER STATES
We found no central source that had comprehensive information on these laws. We searched a national statutory database under certain key phrases to find this information. We must caution that this list may not be complete because states use different terms for these functions and some may allow this only through regulations, rather than specifically in statute.
Following are brief summaries of who can become a nursing home medication aide and how much training is needed in the nine states identified by our search. Relevant statutes, regulations, and other materials describing these programs are enclosed.
Indiana has allowed medication aides in nursing homes since 1977. They have to be certified nurses' aides and must take an additional 40 hours of classroom instruction and 20 hours of practical experience (I.C. § 16-28-1-11).
Iowa allows medication aides in nursing homes, but requires them to be certified nurses' aides first. They must undergo 50 hours of training and then engage in administering medication under the supervision of a nurse (Iowa Code § 135C.34).
Medication aides are allowed in nursing homes, which come under the definition of “adult care homes”. They must first be certified nurses' aides and undergo 60 hours of instruction, 15 of which must be clinical instruction. They must complete 10 hours of medication aide continuing education every two years (Kansas Stat. §§ 65-1, 121, 65-1124)
Maryland allows certified “medicine aides” to administer medication in nursing homes under the supervision of a nurse. They have to be geriatric nursing assistants (nurses' aides), have one year work experience, and complete additional training. Proposed regulations would redefine the scope of medicine aides' responsibilities (MD Code, Health Occupations, § 8-205, 8-6A-01, 8-6A-16).
Minnesota regulations allow the director of nursing services in a nursing home to delegate medication administration to unlicensed personnel. These people have to complete a nursing assistant training program and a standardized medication administration training program for unlicensed personnel in nursing homes, offered through a postsecondary educational institution (Minn. Rule § 4658.1360).
The Nebraska Medication Aide Act, passed in 1998, allows people who are not nurses to receive 40 hours of training and administer medications in a nursing home under the supervision of a physician, nurse, or other licensed health care professionals. It also allows them to engage in these activities in assisted living facilities and other settings (Neb. Rev. Stat. § 71-620 et seq., Neb. Admin. R. and Regs., Title 172, Ch. 96)
Rhode Island regulations have allowed unlicensed personnel to act as medication technicians in nursing homes since 1979. They must complete 45 hours of instruction at a higher education institution. They do not have to be nurses' aides if all they do is administer medications (R.I. Code R. § 23.7).
South Dakota's Nurse Practice Act allows nurses in nursing homes and other settings to delegate some of their nursing tasks to “unlicensed assistive personnel (UAP).” Administering medication is one of these tasks. The regulations require the nurse to supervise the UAP and specify the tasks that may be delegated. The regulations also set standards for approval of medication administration programs, which must provide 16 hours of classroom instruction and four hours of clinical or laboratory instruction as well as a series of tests (S.D. Codified Laws, §§ 20:48:04.01:10 et seq.).
Since 1979, Texas has allowed medication aides to work in nursing homes. They must first be certified nurses' aides and complete 140 hours of additional instruction. These include 100 hours of classroom instruction, 30 hours of a skills demonstration laboratory, and 10 hours of clinical experience (Texas Code § 242.606 et seq.)
REQUIREMENTS IN CONNECTICUT
In Connecticut nursing homes, only registered nurses and licensed practical nurses can administer medication and they must do so under the supervision of a physician. Nurses' aides (who are “certified” but receive only brief training) and other unlicensed people cannot administer medication in nursing homes. However, people who are not registered or licensed practical nurses can receive training to become “medication technicians” and administer medications under the supervision of a registered nurse in facilities run by the Department of Children and Families, the Department of Mental Retardation, and the Department of Mental Health and Addiction Services. Recent legislation (PA 99-80) also requires training of unlicensed personnel to administer medication to elderly people in residential care homes (who must be ambulatory and generally less frail than those in nursing homes). It requires the Department of Public Health to adopt regulations by July 1, 2000. The regulations must establish ongoing training requirements, among other items.