The 'De-Skilling' Of Nursing - page 23

by TheCommuter 33,748 Views | 240 Comments Senior Moderator

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. 2
    Quote from eCCU
    I hope they got slapped with enough lawsuits to last them a long long time....that's just plain ignorance on both the pharmacist for tolerating this and the hospital for not providing enough qualified staff!
    According to the law, however, they did have qualified staff.

    Have you ever watched behind the desk at your local pharmacy? The techs pull the scripts out of the bins, fill them, then the pharmacist rechecks them. I've watched the pharmacist open the bottle, look at the pills, look at the script, then sign off. I've even caught an error at my local pharmacy for a refill. The pills looked different than what I received before, although the label was correct. Ends up that the tech and the pharmacist both missed the error. Still not sure what was in the bottle.

    When I've had to pick up a med from pharmacy, I've watched the same process. Tech gets the order, gets the med, labels it, takes it over to the pharmacist, and he/she signs off on the label. I've caught two pharmacy errors in the past week. One was an order for an oral med, and they sent up an IV med. The other was the wrong solution for the med in an IVPB. The order called for D5W, but they mixed it with 0.45%.

    Always check your labels!
    tnmarie and turnforthenurseRN like this.
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    And don't forget HCAHPS. This idea of "customer service" over my professional judgement is also leading to the deskilling of nursing, IMO.
    SoldierNurse22, noyesno, tnmarie, and 2 others like this.
  3. 1
    Quote from eCCU
    The only thing that pharmacy techs do in my hospital is restock pyxis and bring up meds. We have a pharmacist in the I.V room whose job is to mix medications and others who accepts orders, process them and the tech brings the meds to the nursing station or pyxis.

    Techs mixing sterile I.V drugs? ....where the heck is this?
    Here is one..........
    $8.25 Million Settlement Reached After Premature Infant Died From Fatal Overdose of Medication
    According to reports by the Chicago Daily Law Bulletin, the infant was born three months premature, weighing less than 2 pounds. Nevertheless, during his stay at Lutheran General Hospital in Park Ridge, Illinois, he made “terrific progress through the 40 days of his life...and there was every reason to believe he was going to survive.”


    A pharmacy technician working for the hospital prepared a prescription of sodium chloride to be given to the baby boy. Because of the technician’s negligence, the dose was more than 60 times the amount of sodium chloride that the physician ordered, and the child died of an overdose. The boy died in the arms of his mother who had suffered two prior miscarriages, reported the Chicago Daily Law Bulletin.


    Following an immediate investigation into the infant’s death, the hospital changed its policy to ensure that each staff member double-checks intravenous bags so the label matches what’s in the bag. Nevertheless, because of the pharmacy technician’s carelessness, Lutheran General Hospital was liable for the child’s death.
    Pharmacy technicians are an integral part of hospital health-system pharmacies. The National Association of Boards of Pharmacy defines pharmacy technician as a board-registered employee who may dispense medications, handle clinical conflict resolution, prepare IV admixtures, and prepackage and repackage medications under the supervision of a licensed pharmacist.1

    The Pharmacy Technician’s Role

    The pharmacy technician’s role is evolving and varies widely between the retail industry and hospital health systems, as well as from state to state. Job descriptions and responsibilities have changed considerably over the past few decades. The impetus behind many of these changes is actually the desire to redefine the role of the pharmacist. Some states are looking to broaden the pharmacy technician’s role, allowing more control and responsibility for duties traditionally performed by pharmacists, such as clarifying prescriptions, reviewing orders for unacceptable abbreviations, and entering orders.
    http://www.uspharmacist.com/content/d/feature/c/31431/
    Wise Woman RN likes this.
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    Well...what can i say we are spoiled where we work, and the more i read about all these the more am glad i work where i do!!!!
    We have a different clinical pharmacists assigned to each ICUs since they are quite busy. These pharmacist are to confirm physician orders and make sure they get to the pharmacist downstairs at the pharmacy. The clinical pharmacist also has to round with the physicians and other team members during rounds and is a great resource for everyone they are also rarely rotated as they have already developed a rapport with the team.
    Again sorry but pharmacy techs don't fill meds my hospital! They might at other places just not here. Even specifically even asked this to her and she was like nope especially not iv!!
    STAT meds like levo, amio, heparin, narcotics needed stat she literally goes to the pharmacy to pick them up and brings it to the nurse! Plus the facility has policies any mixed iv by the nurse as a stat should be replaced ASAP with one mixed by the pharmacist under sterile condition....again spoiled n loving it;-)
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    I bet this dangerous errors do not scan their manufacturer barcodes to link up with their MAR and IV pumps...trying to save up the costs
  6. 2
    Quote from VICEDRN
    Despite the endless and ever growing pile of studies that show that when there are more Bsn nurses in a unit, the less patient t mortality there is?I honestly can't believe that there are still corners of the nursing universe that haven't accepted this as a basic fact of life.And for brandonlpn, yes, the doctors care. They read those studies and now, they want to know why all the nurses aren't bsn and how crazy it is that we accept anything less for our profession. True.
    Can you please site some of these studies? I've done a quick search myself and the primary studies I have found are more related to staffing ratios and nursing care environments than the education of the nurses on the units. The only study I found that considered education level of nursing staff was from JONA:

    "Results: Controlling for patient acuity, hours of nursing care, and staff mix, units with more experienced nurses had lower medication errors and lower patient fall rates. These adverse occurrence rates on units with more baccalaureate-prepared nurses were not significantly better."

    Source: Nurse Experience and Education: Effect on Quality of Care : Journal of Nursing Administration
    BrandonLPN and nursel56 like this.
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    I've never met a doctor in my life who gave a **** whether they were talking to a ADN RN or a BSN RN. And I'm willing to bet the vast majority of nurses here would agree...
    Last edit by Esme12 on Nov 6, '12 : Reason: TOS/profanity
  8. 3
    Quote from VICEDRN
    Despite the endless and ever growing pile of studies that show that when there are more Bsn nurses in a unit, the less patient t mortality there is?I honestly can't believe that there are still corners of the nursing universe that haven't accepted this as a basic fact of life.And for brandonlpn, yes, the doctors care. They read those studies and now, they want to know why all the nurses aren't bsn and how crazy it is that we accept anything less for our profession. True.
    There is no endless or ever growing pile of studies on BSN nurses and patient mortality. There has been only one study by Linda Aiken so it's far from being a basic fact of life. It's another example where if something gets repeated enough times, it starts to become accepted as the truth.
    tnmarie, BrandonLPN, and nursel56 like this.
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    Quote from tnmarie
    Can you please site some of these studies? I've done a quick search myself and the primary studies I have found are more related to staffing ratios and nursing care environments than the education of the nurses on the units. The only study I found that considered education level of nursing staff was from JONA:

    "Results: Controlling for patient acuity, hours of nursing care, and staff mix, units with more experienced nurses had lower medication errors and lower patient fall rates. These adverse occurrence rates on units with more baccalaureate-prepared nurses were not significantly better."

    Source: Nurse Experience and Education: Effect on Quality of Care : Journal of Nursing Administration
    That's an interesting result because one of the findings of the so-called "landmark" study by Linda Aiken in 2003 used a model that included the finding that experience is of little importance. Instead of questioning the model they reported in their conclusions that we might be over-emphasizing the importance of experience.
    tnmarie and RN34TX like this.
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    Perhaps facilities and units staffed with a greater proportion of BSN-educated nurses result in better outcomes because RNs with BSN degrees are typically less likely to end up in settings with horrid nurse/patient ratios (LTC, acute rehab, prisons) and more likely to work in settings with lower nurse/patient ratios (acute care hospitals).
    tnmarie and BrandonLPN like this.


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