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Certified medication assistants.

The April, 2007 issue of Capitol Update's article on "Legislating Assistive Personnel to Administer Medications" identified states in which legislation is currently pending to authorize assistive personnel to administer medications, while noting those known states in which the practice is currently permitted through statute or regulations. Thanks in part, to responses from constituent member associations, the list has been updated. The resulting list now at eighteen states includes: Arkansas, Colorado, Connecticut, Indiana, Iowa, Minnesota, Montana, Nebraska, New Mexico, New York, North Dakota, Oklahoma, Oregon, Rhode Island, South Dakota, Washington, Virginia and West Virginia.

Indiana authorizes medication administration by qualified medication aides in nursing homes and mental health facilities, while Montana permits the practice only in assisted living facilities. By comparison, New York State permits assistive personnel to administer medications, once certified, in group homes and other select Mental Health designations for many years. The New York law authorizing this practice dates back to 1938, when institutionalization was the norm and there were far fewer medications. More recently, the New York State Nurses Association (NYSNA) was unsuccessful in stopping the expansion of medication administration by non nurses in day care settings. Regulations are still under negotiation and NYSNA has been at the table in an attempt to influence.

Colorado, Iowa and Oklahoma each provide for additional training of certified nurses aides to classify them as medication aides. In Colorado, the medication aides may perform in nursing homes after they complete training that is equivalent to the first semester of LPN education. Medication aides in Iowa may perform in long term care and residential facilities. What appears to be unique in Oklahoma is that certified medication technicians (CMTs) may also administer insulin by injection, an administration route generally restricted to nurses in most states. Minnesota has had a long standing practice of permitting the use of medication technicians in long term care and assisted living. Both Minnesota and Washington State permit the administration of medications by school personnel (with some exceptions) in the absence of a nurse and if requested/ authorized by parents.

At the time of this printing, this is the most comprehensive summary. If there is a statute and/or regulations authorizing this practice in your state and you do not see the state listed, please contact Janet Haebler, MSN, RN, Associate Director, ANA State Government Affairs at

Janet Haebler, MSN, RN

Editor note:

NNA worked closely with the Nevada State Board of Nursing (NSBN) during this past legislative session. On the proposed AB 187 Certified Medication Aide (CMA) Bill the NSBN board remained neutral since CMA would be under their regulatory process. NNA and SEIU both strongly opposed this bill. See the "Legislative Update 2007" for additional information

I asked Debra Scott, NSBN executive director, if she would comment on the above information from the ANA Government Affairs. Betty Razor

Dear Betty

It is always difficult to comment on a general issue, rather than to comment on proposed legislation. When AB187 came out, we believed that the NSBN could work with the language and safely regulate medication aides, but the Board believes more research needs to be done regarding the safety of medication aides in medical settings. Had the bill passed, we intended to do our own research to assess how this would work. Almost all of the research has been done in nonmedical settings, such as assisted living.

If legislation allowed the utilization of medication aides in long-term care settings, we would promulgate regulations regarding the amount and type of training and testing CNAs would have to undergo to qualify as CMAs. The CMAs would work under the direction of a licensed nurse and the nurse would be delegating the task of medication administration to the CMA.

I know there will continue to be interest in the state to allow certified medication aides in long-term healthcare settings. We know that 47 states have medication aides in some form, and in 21 of those states, it is the nursing boards which regulate the aides. The NSBN is willing to continue to discuss the use of medication aides and we look forward to more research about the level of safety for patients. In anticipating future discussion, we have placed the issue of medication aides on our CNA Advisory Committee agenda as a regular agenda item. We invite anyone who is interested to come to those meetings to give us any information which might be useful.

Above all, the NSBN believes that medication administration must be delegated by an RN in any medical facility--long term care included. Delegation requires the RN to assess the level of skill of the delegatee, the difficulty of the task being delegated, the status of the patient receiving the medication, and the ongoing supervision of the delegatee. The RN always maintains accountability for the delegation of the task.

Thanks for asking, Debra
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Title Annotation:Legislative Updates
Author:Haebler, Janet
Publication:Nevada RNformation
Geographic Code:1USA
Date:Aug 1, 2007
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