\Under new rules proposed by the Wyoming State Board of Nursing, certified nursing assistants (CNAs) with 1,000 hours in practice and a further 125 hours of training (called CNAIIs) could be authorized to give certain medications to patients.

Mary Kay Goetter, executive director for the Wyoming State Board of Nursing, said that these proposed rule changes address concerns brought forward by citizens and legislators who wanted to expand the CNA’s responsibilities to include providing medications to patients. She said the revisions had input from long-term nurses across the state.

In a prepared statement, Goetter stressed that the Wyoming Board of Nursing is responsible for the “protection of the public’s health, welfare and safety through the regulation of nursing, nursing education, nursing practice and disciplinary standards.” She said the rules and regulations of the board of nursing are opened for revision through a legislative rule-making process and public input was welcomed “to meet not only the letter, but the spirit of the law.”

The rules revision awaiting Gov. Dave Freudenthal’s approval has a section related to medication administration. The section reads, in part, that “medication administration may be delegated to a nursing assistant/nurse aide when a predictable outcome is expected in stable patients with common reoccurring health problems.”

There are several classifications of medications that may be delegated for administration, including over-the-counter (OTC) analgesics, antacids, antipyretics, and laxatives.

“We have selected the medications least likely to cause a problem,” Goetter said. “Administering medications is a nursing practice that requires assessment and evaluation of the patient. We want to protect the public so that persons not qualified to pass medications are not doing it. We feel comfortable in what we have offered in the CNAII.”

Several state organizations support the idea of medication aides but oppose the list of medications proposed by the state board of nursing.

Tom Jones, executive director of the Wyoming Health Care Association, said the list of medications should be broader.

“The concern is the list of medications that is not there,” Jones said. “We don’t advocate that medication aides pass out narcotics or psychotropic drugs but a lot of medications people routinely take are not on the list.”

Another organization opposed to the list of proposed medications that a medication aide could dispense is the Quality Healthcare Foundation.

“The problem is the list is too restrictive,” said Quality Healthcare Foundation executive director Dan Lex. “It would not work in nursing homes. With this limitation a nurse would have to come behind (the medication aide) and give more medications. Unless the patient has to be closely monitored and nursing judgment used, the medication aide should be authorized to dispense most medications.”

For a number of years the Wyoming State Training School (recently renamed the Wyoming Life Resource Center) near Lander has used medication aides to give medications and haspecial legislative approval for its medication aides. According to Diane Baird Hudson, superintendent of the school, on average 1,000 doses of medication are given per day. Their medication error rate is less than one half of one percent.

At the Wyoming Life Resource Center, new employees have 30 days of orientation training. Medication aides get an additional 30 hours of training.

“Once they have completed their training, the medication aides watch meds being given, then they are supervised giving meds and, finally, they are allowed to pass medications,” Hudson said.

Approximately 30 of the 50 states authorize CNAs with special training to dispense medications to patients. Community Hospital was contacted regarding the proposed rule changes but declined to comment.

“This (revised rules) is a big step forward toward a compromise to address the need of health professionals,” said Mary Beth Stepans, assistant executive director for the Wyoming Board of Nursing. “It offers an expanded role for the CNA.”

According to Cara Eastwood, Freudenthal’s press secretary, the governor’s counsel will review the rule changes and make a recommendation that the governor will consider before making a decision. The governor has until July 2 to decide whether or not to approve the new rules.

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