For a few years now Life Services Network has conducted a survey of RNs and LPNs trying to gauge the nursing profession’s feelings on authorizing a new class of health care professional to administer medication. (see campaign website here) This category of health care worker, sometimes called medication technician or unlicensed assistive personnel (UAP) would administer medications to nursing home residents during med pass, but would do so under the direct delegation, supervision and control of a nurse. The survey, understandably, reflects deep feelings and division among nurses on this issue. (note: the survey referenced here is focused on nurses working in Illinois nursing homes). Roughly one third of nurses surveyed are in favor of creating and authorizing this new class of worker, but over one half are strongly against it.  There are also interesting breakdowns according to which nurses (master’s prepared, RN or LPN) support such a measure, which appear deeply ambivalent and which strongly oppose med techs, but this post is not the occassion to go into the meaning of these divisions).  

There are many compelling arguments on both sides of this issue: increased med-errors because of undertraining vs. more time for nurses to do ‘nursing work’ if they do not have the grind of med-pass, etc.).  One avenue avenue I have not seen much considered in this debate is the economics of malpractice liability.  Nurses in LTC are, for better or worse, general practitioners.  They are responsible for having master competence in everything from direct patient care to family counseling to documentation.  Generalizing skills increases the risk of error, oversight and gaps in one’s knowledge.  This risk increases the insurance needed to cover for nursing error.  One benefit of medication technicians is that a highly-specialized worker – – one who is expected to master competency in a few, interrelated tasks – – generally shows a decreased risk for error in those tasks.  Decreased risk means lower costs to guard against liability.

Is there room for an insurance argument in the med tech debate?  There should be.  And, I would be interested to see the argument framed in terms of liability economics.

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