The Ohio Medication Aide Dilemma Solved by Asking, “Why?”  

The medication aide discipline (MA-C) was initiated in Ohio circa 2009. It is a skilled certification provided by the Ohio Board of Nursing for administering medications in long-term care. However, the utilization of medication aides is only gaining traction of late. LTC facilities in Ohio have stubbornly resisted the use of medication aides. Recently, the severe shortage of nurses in LTC has created desperation resulting in the use of the few medication aides that Ohio has. So, our first “why” question is answered out of the gate. Unfortunately, for the most part in LTC, desperation is the mother of positive change. Second only to desperation is reactionary change, while the prevention of bad things is mere pretense.

Here is a “why” question we can start with: Why would the medical establishment in Ohio create the MA-C discipline to begin with? Well, obviously, a dire need must have been perceived. Why? If we examine the title, it would seem that nurses in LTC need help passing medications. Why? Apparently, passing medications consumes too much time for nurses in LTC. If these reasons seem reasonable and valid, why all of the resistance towards medication aides?

As the story goes, the primary reason for the resistance follows: LPNs are threatened by medication aides because LPNs believe they are intended to replace LPNs. Hence, due to the shortage of LPNs, and the consequent desperation of DONs (director of nursing), the DONs capitulate to the fears of the LPNs. Please note the following: the severe nurse shortage has empowered what LPNs are left. DONs can’t afford to lose any nurses; therefore, they are likely to capitulate to the fears of LPNs, especially the ones who pick up extra shifts. So, we have answered another “why” question regarding the real reason LPNs are resistant to MA-Cs; they don’t want to lose power/control and a heightened level of job security beyond what is normal. In addition, even though LPNs howl and cry about all the hours they work, in many cases, they don’t want to lose the bonuses they get for picking up shifts.

As far as real job security being a valid concern instead of control/power and bonuses being the real concern, let’s ask the “why” question on job security: Why do LPNs feel like they would be replaceable? The answer follows: “If someone is passing most of the pills, as an LPN, what would be left for me to do? Hence, if there isn’t anything for me to do, my job is in jeopardy!”

Get it? We have seen this movie before. STNAs (Ohio state-tested nurse aides) perform roughly 10% of what they are formally trained to do―if that. Why would we think LPNs are any different? But the next question follows: Why is this the reality? The answer follows: Pills. It is now commonplace that LPNs are working a 1/30 patient ratio (even in skilled facilities) in LTC and this is primarily driven by the volume of medications that need to be administered. Another commonality is the lack of teamwork between STNAs and LPNs that would lighten the load. So, how are the other care necessities like wound care, prevention, and a host of other treatments being completed? That’s the dirty little secret; OTM (other than medication therapy) falls between the cracks, or really, the canyon. Furthermore, it has become more and more the norm that LPNs clock out on time regardless of contemporary nurse-to-patient ratios. That math doesn’t add up. Nurses staying long past their shift was commonplace when the ratios were half of what they are now.

So, what is the answer? The answer should be driven by a goal to put LTC residents first. It is high time that DONs look in the mirror and ask themselves whether they are going to do that or not. A capitulation to LPNs who have control, self-esteem, and co-dependent issues must stop for the sake of what we are called to do as nurses.

There is really no dilemma here. The proper use of medication aides will merely stop staff shortages and lead to an unmeasurable increase in care quality. Yes, the proper use of medication aides will mean less power and control for LPNs, but the use is not going to put them out of a job. For the most part, LPNs are not worried about being unemployed, they are worried about higher care standards for less pay. Excessive pill-passing is their cover for preventing a necessity to work for their own self-actualization and the benefit of higher quality care.

It is way past time for that to stop, and instead, ask why and how interpersonal sensitivities and low self-esteem among nurses became more important than resident care.

Paul M. Dohse, STNA, MA-C, LPN