Views from the American Assisted Living Nurses Association (AALNA).

One of the newest professional organizations in long-term care, the American Assisted Living Nurses Association (AALNA), is exploring the developing role of professional nursing, as assisted living becomes more and more healthcare-oriented. Sandra Flores, RN-C, of the AALNA Board of Directors, addressed the medication management issue in a recent interview.

How commonly are RNs involved in assisted living, particular medication management?

Flores: Much more commonly than ever before. Approximately 70% of assisted living facilities now have nurse involvement to varying degrees in the management of meds.

What is the nurse's role in making sure assisted living residents receive their medications safety and effectively?

Flores: I think nursing's greatest impact is in resident advocacy. It is typically the nurses who go to bat against the doctors to say, "This med routine is not working; let's come up with something new." Nurses also monitor and, if necessary, train staff, particularly when unlicensed staff are passing meds. Many seniors are now in HMOs, and face the challenges of the restrictive conditions imposed by some of these health plans; often you'll see the nurse advocating for these residents.

What challenge are unique to assisted living?

Flores: Probably the widespread practice--which is state-specific--of unlicensed caregivers assisting with the meds.

Not all states allow this, but many do. In California, for example, staff need no prequalifications, education or preparation whatsoever. In essence you are hiring people off the street and training them to pass meds.

Assisted living nurses can find themselves walking the tightrope between various government agencies. Again, to use California as an example, the Department of Social Services says that an unlicensed caregiver can pass medications, but the Board of Registered Nursing says that only a nurse should pull, pour and pass a med. Nurses have to satisfy multiple board requirements.

How do nurse overcome these challenge?

Flores: The nurse will reach out to a variety of healthcare practitioners--consultant pharmacists, physicians, psychiatrists--in getting the most effective medication routine possible. RNs are particularly important to the consultant pharmacist in monitoring the residents and giving feedback. I think it's this whole team approach that's making assisted living work so well.

How is the assisted living nurse's role in medication management changing?

Flores: It's changing phenomenally because resident acuity is increasing. This results in part from later placements, but also because seniors are falling in love with what we're doing and don't want to leave us. In years past we would have moved them and their complicated medication routines on to skilled nursing. Now they're staying right here with us.

This again brings up the importance of dealing with people like the consultant pharmacist.

What specific training or attributes do assisted living nurses have?

Flores: Some of these nurses come to assisted living with a geriatric nursing background, but there are other training programs. For example, AALNA just initiated a training program in various locations.

Manynurses coming to assisted living are finding, frankly, the nirvana of nursing care. They're rediscovering the reason that many of us went to nursing school in the first place. Working in assisted living is a holistic approach to nursing. We are making sure that residents are socially well adjusted, and that their psychosocial and physical needs are met. The dynamics of interacting with the residents and the ability that the nurse has to enhance the quality of life for that resident are just fabulous.

The focus on resident independence and residents' dictation of their care plans are to some degree unique to assisted living. We want to make sure that we promote this idea and keep it. In other words, don't destroy the social model just because we brought the nurses in.