Michigan and Pennsylvania are in the process of establishing new certified medication aide roles to help nursing homes struggling to address workflow and staffing challenges.

The CMA role is a specialization path for certified nursing assistants, and a possible higher rung on a career ladder. CMAs focus on assisting registered nurses and licensed practical nurses by administering routine medications to residents.

“Under the supervision of a nurse, trained medication aides now would be able to administer certain medications to nursing facility residents, following a controlled procedure,” explained Melissa Samuel, president and CEO of the Health Care Association of Michigan. “This will improve resident safety as medication aides will be able to focus solely on passing medication, allowing nurses to spend more time assessing residents.”

If the bills legalizing the CMA role are passed into law, Michigan and Pennsylvania would join 32 other states that already permit nursing assistants to specialize in this position.

The measures in each state have received bipartisan support from lawmakers and have been endorsed by nursing home associations.

Michigan’s relevant bills have passed both houses of the legislature and are waiting for the governor’s signature. The Pennsylvania bill is still being considered by the state senate. 

Impact on skilled nursing facilities

Under the new rules, nurses would still be responsible for initial doses of medication, medications taken as-needed, IVs and controlled substances. But by taking on more routine administrations, CMAs would free nurses from tasks that can be time-consuming.

Freeing up nurses in this way is not only beneficial for those nurses — residents stand to gain from more consistent, error-free care, according to Samuel.

“Currently, nurses can be pulled away from administering medication for several reasons, including tending to other resident needs, communicating with physicians, interacting with family members, supervising staff, and more,” Samuel noted. “However, medication aides would be solely dedicated to administering medications. Experience in other states shows med pass errors decrease with the use of medication aides.”

Introducing the CMA role also promises opportunities for CNAs already within the care sector. 

“One of the most important points of this type of legislation is that it would really enhance the career ladder in nursing home care,” explained Zach Shamberg, president and CEO of the Pennsylvania Health Care Association. “A nurse aide would have the opportunity to increase his or her skills and training on the path to becoming an LPN or an RN.”

“If we can provide that real career ladder to ensure that prospective workers see a pathway and they know that they can begin as a CNA and rise up in long-term care — we think that’s very valuable,” said Shamberg.

As the population continues to age and nursing homes face ongoing staff shortages and retention issues, making CNA jobs more appealing is a major focus for industry leaders. The PHCA, which partnered with Republican state senators to advance the bipartisan CMA legislation, hopes that the new role will help address these problems. 

“We’ve got to be competitive not just with other parts of the healthcare continuum, but with other service industries in Pennsylvania,” Shamberg noted. “We think this is a really strong way to do that.”

Getting CMAs off the ground

While the staffing and care needs of each nursing home are unique, CMAs could find a home in hundreds across Michigan and Pennsylvania if the required legislation passes. 

“We’d love to have one or two CMAs in every home across the state,” Shamberg noted. “Our members who operate in states where the CMA position is allowed are telling us that this is really exciting for them and this will be a really exciting development for Pennsylvania.”

To work as a CMA, a CNA would have to pass training programs and be recertified periodically. These programs, however, will be far more accessible to busy care professionals than advancing to the status of LPN. 

The Pennsylvania bill, for example, would require 40 hours of educational and clinical training, as well as recertification every two years. 

Possible snags

The potential for CMAs to help the care sector is not without complications, though. 

The proposed role would be added to the Michigan and Pennsylvania workforces at the same time as possible state and federal mandates requiring certain ratios of staff to residents. Pennsylvania, for example, began requiring a certain number of RNs, LPNs and CNAs per resident in July 2023. 

CMAs are not currently included in these required ratios. It’s possible, then, that facilities would not be incentivized to divert resources into the position that could otherwise be used to directly match a legal quota.

Still, care organizations remain optimistic about the legislation. 

“We’ve worked closely with the department of health, the department of human services, and the department of education to say that this is a valuable position, it’s an innovative position in Pennsylvania and it should be counted in our staffing ratios,” said Shamberg. 

“That is an ongoing conversation and I’m confident given the conversations we’ve had as well as the [staffing] crisis that is facing us that there is an opportunity to include this position in the staffing rules and regulations.”