The 'De-Skilling' Of Nursing - page 21

by TheCommuter, BSN, RN Senior Moderator | 34,198 Views | 240 Comments

What should be our greatest concern for the future of nursing? We must fear the day if (or when) registered nurses (RNs) and licensed practical nurses (LPNs) will be less needed in healthcare due to systematic de-skilling of the... Read More


  1. 1
    Quote from Asystole RN
    Nursing was largely unregulated and unformalized until Nightingale popularized and standardized the occupation in the mid to late 19th century. Towards the end of the 19th century formal programs that gave nurses Diplomas were developed. There is debate as to actual time line of when the advent of the baccalaureate level of education for nursing came to be since some programs offered a nursing program that granted a BS coupled with a Diploma in nursing. Either way, the advent of the BSN degree occurred in the late 19th or early 20th centuries. The MSN degree was developed in the 1940's.

    Following WWII, in order to compensate for the shortage of nurses programs began offering an Associates Degree in Nursing.

    BSN nursing predates ADN nursing, meaning that BSN nursing was invented prior to the advent of ADN nursing.
    Thank you......I see now what you meant. It was the first "advanced degree". The first ASN/ADN program was developed in 1952, by Mildred Montag. I beleive that this decision is what has led to the most contentious struggle within nursing.
    lindarn likes this.
  2. 4
    Quote from Asystole RN
    ...BSN nursing predates ADN nursing, meaning that BSN nursing was invented prior to the advent of ADN nursing.
    You keep mentioning how BSN nursing predates ASN nursing. Do you think that somehow makes it better? Being a prostitute/criminal predates BSN nursing. Things evolve and being the old way doesn't necessarily mean being the better way. As far as ASN vs. BSN, I'm not saying one is better than the other; though one may be better for each individual nurse than the other based on their goals. I just think it is interesting how you keep bringing it up.

    I plan to get my BS eventually (and maybe even a Master's one day), just not in nursing!
    mc3, Esme12, Szasz_is_Right, and 1 other like this.
  3. 0
    Quote from tnmarie
    You keep mentioning how BSN nursing predates ASN nursing. Do you think that somehow makes it better? Being a prostitute/criminal predates BSN nursing. Things evolve and being the old way doesn't necessarily mean being the better way. As far as ASN vs. BSN, I'm not saying one is better than the other; though one may be better for each individual nurse than the other based on their goals. I just think it is interesting how you keep bringing it up.

    I plan to get my BS eventually (and maybe even a Master's one day), just not in nursing!
    Maybe you should read the previous posts to qualify the current conversation before posting.

    See the above posting by Esme12 for example.

    I was responding to clarify the timeline of the history of nursing education.
  4. 3
    Has anyone noticed that this discussion of degrees is dividing the nursing profession? Just who benefits from the in-fighting? Hospitals do in the long run. Nursing, in general, will never be able to bill for patient care. Our skills are part of the cost of the room, but if a hospital can increase its room charges it naturally collects more money. Only private paying patients actually pay the billed rates. If insurance is involved only a percentage of the billed rate is actually collected. In order to collect more money hospitals have to be able to justify the higher room charge. What better way to increase your fees than to have nurses with more initials after their name.

    Why is it more important to have BSN's at the bedside? Not all BSN programs are the same across this country. They not even the same in the same state. Here, in my area, BSN's graduate without ANY actual hands on experience in clinical settings. I have seen posters say that requiring BSN will cut down on "fly by night" nursing programs. In this state it takes no less than 4 years to set up a program for ASN and even then if your graduates do not score well enough on the NCLEX after 2 years - your program is dead.

    People are different and not everyone wants to spend 4 years in college. Some excel in academia some excel in doing. Nursing's strength comes from the variety of its members. We cannot all be "in charge" nor can we all be Directors or supervisors. A BSN does not mean that you are automatically better at delegating than an ASN. There is a certain amount of real-world experience necessary for one to be proficient in that area.

    If hospitals could they would, by virtue of technology, use more tech-level personal to do more work and would lower the number of nurses, whether ADN/ASN or BSN. So while we argue about entry-level degrees Hospital Administrators are calculating the cost-benefit analysis of fewer nurses supervising more tech level workers with more advanced equipment versus having more nurses of various degree levels involved in hands on care. The real victim in this scenario is the patient.
    mc3, tnmarie, and lindarn like this.
  5. 4
    Why don't we hear the same complaints from PTs, OTs, Pharmacists, etc? Who all make more money than we do, and have far more respect than nurses do. Spare me the, "nurses were once again voted the most trusted careers for the tenth year in a row,", blah blah blah. We are voted the most trusted because we are doormats who don't stick up for ourselves, or our fellow nurses.

    The market is flooded with nurses, new grads, etc, and new schools are springing up almost daily. No one can get a job, and the small amount of respect the strength that we enjoyed in the years of true nursing shortages, has long gone away.

    Our low levels of education make us easy to replace with lower educated individuals, as our professional practice is being sold to the highest bidder.
    We will never be able to claim the same professional image as other health care professions, due to our low levels of education. Especially when PTs now have a Doctorate as entry into practice, and OTs have a Masters. PT ASSISTANTS, have an Associates degree as entry into practice. RECREATIONAL THERAPISTS have a Bachelors degree as entry into practice! What does that say about nursing, who still have people entering with as little as an Associates degree, or not even that much for LPN/LVNs.

    Spare me the sob stories about individuals who would never be able to make it through a four year BSN program for what ever the excuse du jour that they claim. Not everyone can and/or, should be admitted to a program, that is life. PTs and OTs will freely tell you that the main reason that they went to a higher level of education, was to claim their piece of the health care pie, increase their pay, and keep themselves in demand, with fewer people entering the career.
    We do not control our profession to prevent ourselves from being replaced by de- skilling. We are allowing it to happen. Teachers fight to keep their profession from being overrun by lesser educated individuals. Why are we not emulating other successful professionals who are keeping their professional from being deskilled?

    JMHO and my NY $0.02.
    Lindarn, RN, BSN, CCRN
    Somewhere in the PACNW
    Last edit by lindarn on Aug 31, '12
    VICEDRN, mc3, TheCommuter, and 1 other like this.
  6. 2
    I just want to say that I have really enjoyed reading this thread. It has given me a lot to think about, and I've enjoyed all of the viewpoints. I may add some of my own later, but for now I am still thinking about them.
    lindarn and TheCommuter like this.
  7. 1
    Quote from BrandonLPN
    I don't understand what you mean by this. Education should determine how a nurse can practice. Since a BSN nurse has more schooling, he should have a wider scope of practice and probably it's own licensure. With an enhanced license of its own, the BSN nurse would be in a better position to demand more money. Without something like this it just seems like education for the sake of education. Why have extra training if it doesn't result in more privileges and money?
    I think I might write a post on the different educational requirements of ADNs, BSNs, and RN-to-BSN programs. The educational requirements for the degree in each program are different, but not enough to change the scope of practice for licensure's sake.

    BSNs do have more education, but I would argue it's not for education's sake. Any amount of education is dependent on how the student applies it in the real world. Even if it doesn't mean a wider scope or more money, it is intended to enhance an RN's practice, if applied appropriately.
    lindarn likes this.
  8. 1
    Quote from Dragonnurse1
    Has anyone noticed that this discussion of degrees is dividing the nursing profession? Just who benefits from the in-fighting? Hospitals do in the long run. Nursing, in general, will never be able to bill for patient care. Our skills are part of the cost of the room, but if a hospital can increase its room charges it naturally collects more money. Only private paying patients actually pay the billed rates. If insurance is involved only a percentage of the billed rate is actually collected. In order to collect more money hospitals have to be able to justify the higher room charge. What better way to increase your fees than to have nurses with more initials after their name.

    Why is it more important to have BSN's at the bedside? Not all BSN programs are the same across this country. They not even the same in the same state. Here, in my area, BSN's graduate without ANY actual hands on experience in clinical settings. I have seen posters say that requiring BSN will cut down on "fly by night" nursing programs. In this state it takes no less than 4 years to set up a program for ASN and even then if your graduates do not score well enough on the NCLEX after 2 years - your program is dead.

    People are different and not everyone wants to spend 4 years in college. Some excel in academia some excel in doing. Nursing's strength comes from the variety of its members. We cannot all be "in charge" nor can we all be Directors or supervisors. A BSN does not mean that you are automatically better at delegating than an ASN. There is a certain amount of real-world experience necessary for one to be proficient in that area.

    If hospitals could they would, by virtue of technology, use more tech-level personal to do more work and would lower the number of nurses, whether ADN/ASN or BSN. So while we argue about entry-level degrees Hospital Administrators are calculating the cost-benefit analysis of fewer nurses supervising more tech level workers with more advanced equipment versus having more nurses of various degree levels involved in hands on care. The real victim in this scenario is the patient.
    The only divisiveness I have found in nursing discussing this issue is on AN, not exactly something mind-boggling.

    The BSN standard has nothing to do with individual professionalism nor clinical proficiency. The BSN standard is about professionalizing the occupation. A profession is something that is defined and studied with certain criteria that must be met for an occupation to be deemed a profession. The lack of an educational standard is something holding nursing at the level of "developing profession."
    lindarn likes this.
  9. 3
    I don't care if we're called a "profession" or not. I do care that as long as we can be easily replaced by someone with a 2 year degree, we're not going to get the respect from facility management that is demanded by someone that is less easily replaced. We're going to go without breaks, be expected to work off the clock, get worse and worse ratios, etc. as long as there's a flooding stream of people ready to replace us every 2 years.
    Rose_Queen, lindarn, and TheCommuter like this.
  10. 2
    I have to agree 100%. I'm a hospice nurse and frequent facilities with one if any licensed nursing staff and I shutter. I realize it's a money thing but why would you put a family member, or anyone, in a place where there's staff that wouldn't even recognize an allergic reaction, hyper/hypo glycemia ...the list goes on and on... they have compassion and patients best interest at heart but when that patients well being is in your hands education, education, education
    mc3 and lindarn like this.


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