The 'De-Skilling' Of Nursing

[TheCommuter]

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 nursing profession. Even though patients are becoming sicker and more complex in today's healthcare system, other professionals and paraprofessionals have started to perform tasks and assume roles that had once been within the strict realm of licensed nursing personnel.

The de-skilling of the nursing profession has been taking place for quite some time. For example, we have phlebotomists and phlebotomy technicians to draw blood in certain healthcare settings.

Medication aides regularly administer medications in many nursing homes, group homes, and assisted living facilities, even though the task of medication administration had once been a duty that was strictly performed by licensed nursing staff.

Some hospitals have policies that allow patient care assistants to insert and remove indwelling urinary catheters and discontinue peripheral IV catheters.

Some rehabilitation facilities and specialty hospitals have assembled wound care teams that consist of physical therapists and occupational therapists who perform all the dressing changes and handle all the complex wound care cases.

Many back office medical assistants now perform advanced skills in doctors' offices under the supervision of the physicians who employ them.

Pharmacy technicians now mix medications in hospitals on a regular basis, but RNs were once able to mix drugs in piggybacks for IV administration.

Rehab techs now ambulate patients post operatively when licensed nursing staff used to be the ones to ambulate 'early and often.'

More examples of de-skilling in the nursing profession exist. For instance, many healthcare facilities employ lay people to do the staffing and scheduling for nursing staff. These schedulers are given the fancy titles of 'staffing coordinator' or 'director of staffing,' and have been given responsibility for an administrative aspect that nursing management or supervisory staff strictly performed once upon a time. In addition, some emergency departments are considering hiring paramedics to lessen the need for ER nurses.

The writing is on the wall.

The nursing profession must stop surrendering our valuable skills to other healthcare workers now. Nurses need to fully embrace their skill sets and constantly be on the lookout for other disciplines who are attempting to remove yet another skill away from our roles. If even one unemployed nurse exists who needs a job, then de-skilling is a problem because non-nursing staff are displacing licensed nurses. If this systematic de-skilling does not stop anytime soon, the future of nursing might be in trouble.

[luv2]

Lindarn I agree with what you wrote

[animal1953]

I am a new CNA. While I am still looking for my first job, I have aquired skills over the last 10 years while caring for my wife after her stroke. I learned critical skills in observation in the years since the stroke. I can look at her and tell if something is wrong and whether a call to the doctor is in order or a trip to the ER. Done it more times than I wish to count. I was trained to do wound care on her by the wound care doctor and staff after we found out that the visiting nurse was watching TV and trying to get my wife to do her own wound care on the backs of her knees with a mirror on the couch. The nurse was fired by me and dismissed from her agency. As a CNA I know my scope of practice and would never over step those boundries. I feel that most CNAs want to learn. Some are in school to become RNs. I have also had asthma all my life. When a patient is having breathing difficulties, who better to work with them until the RN arrives, coaching them to take slow deep breaths and urging the patient to try to relax, the CNA who is there. And what about the lowly CNA? Can we join the union also to help us? Some things to think about. I'm not there to take your job or do your job, RNs. I'm there to care for our patients and help you out and learn from you.

[luv2]

Sorry about your wife. I am surprise that nurse did that because most vns do not stay they are usually there for the treatment and other stuff and leave . I am appalled by what the nurse did to you and your wife. However, nursing is more than looking and having a feeling...I am glad you want to learn. I hope you continue down this path to become a R.N or LPN. As a CNA you should NEVER teach anyone anything. "When a patient is having breathing difficulties, who better to work with them until the RN arrives, coaching them to take slow deep breaths and urging the patient to try to relax, the CNA who is there." This exactly what irks me as a RN ...Do you see why we need to organize and start taking back our skills?

[luv2]

It is very scary to think this could happen right now ......RN and LPN we need to embrace the technology i.e EMR to have more time for our patients to make sure you know what is going on....Do you recall the med tech who gave pt hep C because he was allowed to give meds ....This is scary and sad

[tothepointeLVN, LVN]

I think the real problem comes from billing. As long as another department gets to charge, and nurses continue to earn no more for the hospital bottom line than the curtains in the room (but cost a lot more than the curtains), hospitals will look to find ways to cut our numbers. Other departments have found ways to ADD to the bottom line. RTs charge for each treatment. PTs charge for each wound treatment or therapy session. But nurses continue to just be bundled in with the room. Until nursing can start BILLING FOR OUR SERVICES, we're going to be considered merely a very expensive piece of furniture in the patient room.

This really is the key issue. If the hospital can't bill directly for nursing services then they need to figure out a way to provide the services in a cost effective manner. Enter deskilling. If the hospitals COULD bill for nursing services based on the service we actually provide you can guarantee they'd want as many of us in there as possible being cash cows for them. Home health can charge for nursing services correct? Why not inpatient nursing?

[tothepointeLVN, LVN]

I should also add as long as there is a steady stream of people willing to mop up our abandoned skills for less money and NO license then we will also continue to lose them. There is no shortage of people wanting to be medical assistants, medication aide or tech this or tech that all for the thrill of wearing scrubs and being in the medical profession and helping patients and doctors. Supply and demand. They demand a position and the powers that be dole out the skills just enough to keep them happy and barely enough money to make it worth it.

(UAP's don't kill me for that comment I understand the drive really I do but it's a stick with two short ends. I still love you though mwah)

[Music in My Heart]

There is no shortage of people wanting to be medical assistants, medication aide or tech this or tech that all for the thrill of wearing scrubs and being in the medical profession and helping patients and doctors.

Probably more about the dearth of career employment opportunities than the thrill of wearing scrubs.

[tothepointeLVN, LVN]

Probably more about the dearth of career employment opportunities than the thrill of wearing scrubs.

Now perhaps but people were flocking to become MA's and such like even when the economy was great and I see them flounce around the Dr's office twirling their stethescopes etc and playing nurse.

[amoLucia]

Probably more about the dearth of career employment opportunities than the thrill of wearing scrubs.

And the surplus of for-profit educational institutions all willing to provide that magic certificate of being desparately needed in the industry!!!

[DoGoodThenGo]

Said this before a long time ago.

Nurses were quick to ditch caps, whites and all the "pillow-plumping" aspects of the practice along with quite allot of other things in favor of elevating the "Profession" (with a capital "P"). By and large everyone jumped at the chance to write scripts and or move into roles that were formerly reserved for physicans. Well on the way quite allot got dropped and or otherwise shifted to UAPs and others because now a nurse's time was too valuable.

Ever single function/task not strictly mandated to be performed by a license is up for grabs, and everytime there is a "nursing shortage" yet more is chipped away.

Everyone comes to work in their PJ's and patients are for the most part blissfully unaware that by and large there isn't anything the various UAPs and others coming in and out of their rooms do that a nurse cannot. Nor do they know that she or he can do things that the aforementioned cannot. Facilities and others love this little bit of confusion as to "who is a nurse" because what people don't know won't often hurt them. That is unless something goes south. I mean look at all the posts/reports of UAPs and others calling themselves "nurse" when they aren't and worse management or those running a facility backs them up. Twenty or ten years ago that just wouldn't have been tolerated.

Something else one has said before, little by little the ANA and their little white paper are winning. Soon all nurses in most areas will have the BSN and will mainly be responsible for planning, assignment,evaluation, management and so forth of care. The actual implementation will be done by various other personnel who report back to the nurse.

[kitty13]

De-skilling the RN, LPN, and hospitals drive to be magnet. Nurses!! the ANCC is getting money from the gov, making money off each of us, driving the hospitals to believe there will a rosy world if they see the light, all the time we are left to be at the bedside, running night after night, patients that are really sick and need one on one care!

How many times do you wake up and panic wondering did i chart this or that, did i give that med. In-services while i run trying to get my meds passed on time, change my dressing

Lets begin to make a difference, lets stand up and fight for our license and the years of knowledge we have!

[Asystole RN]

De-skilling the RN, LPN, and hospitals drive to be magnet. Nurses!! the ANCC is getting money from the gov, making money off each of us, driving the hospitals to believe there will a rosy world if they see the light, all the time we are left to be at the bedside, running night after night, patients that are really sick and need one on one care!

How many times do you wake up and panic wondering did i chart this or that, did i give that med. In-services while i run trying to get my meds passed on time, change my dressing

Lets begin to make a difference, lets stand up and fight for our license and the years of knowledge we have!

The ANCC is conspiring to ruin nursing? Magnet status is somehow subverting patient care?

I want whatever you're smoking.