The 'De-Skilling' Of Nursing - page 6
by TheCommuter 33,615 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
- 0Aug 26, '12 by Asystole RNQuote from Cold StethoscopeOne only needs to research the Magnet certification to find out what it is supposed to do.What problems are magnet status supposed to solve? Are those problems being solved through a hospital's attainment of magnet status? Are patient outcomes better? Are nurses' working conditions better?
Magnet status: What is is, what it is not, and what it could be
Working Conditions for Nurses: Does Magnet Status Make a Difference?
The quest for Magnet certification and any implementations of policy are entirely the doing of hospital administration. It is silly and very strange to blame the ANCC for poor staffing and poor policy decisions by the administration. No one forces a hospital to seek or obtain a Magnet certification.
- 2Aug 26, '12 by DoGoodThenGoQuote from lindarnIf anytime in the fifty or so years since the ANA put out it's infamous white paper the profession as whole or in enough states embraced some of the ideas put forth, mainly elevating the RN to BSN for entry and creating another class of nurses below (LPN, technical nurse, whatever) things might have turned out differently. Canada is a perfect example. RN/BSN nurses have their own scope of practice, and LPNs (two year nursing programs) do their own thing and everyone seems to get along with nobody stepping on anyone's toes. IIRC the type of nurse assigned to a patient is determined by several factors including acuity.I have been saying for years, that nursing needs to go to a BSN as entry into practice, and grandfather in the ADNs and Diploma nurses.
LPN/LVN needs to go to an Associates Degree and entry into practice. Physical Therapy Assistants have a two year associates degree as entry into practice, and they never do anything that comes close to endangering a patient like LNPs do.
The BSN need to be re vamped. Some of the fluff can be done away with, classes like, "How To Run a Business", "Legal Aspects of Nursing and Patient Care", "Employment Law", need to be included.
These type of classes are included in the class work of PTs OTs, etc. Nurses are too naive in these areas, and that is why they are pushed around like they are. If you do not know the law, you can be too easily intimidated by managers, etc. Ignorance is not bliss in the work place.
A higher level of education will make us less likely to be replaced by lesser educated individuals. A two year associates degree is looked as more easlily replaced by a MED tech or nurses aide, with a minimum educational level.
Unionizing will give you the support to be able to go out to the public and educated them as to what is going on in the hospital. Let them know that the hospital is trying to replace college educated RNs with not much more than HS dropouts. The public doesn't complain because they do not know who is taking care of them, how many patients your are assigned to, etc. If something goes wrong, they throw the nurse under the bus and blame the nurses instead of the managers who are assigning too many patients to each nurses.
Think outside the box!
JMHO and my NY $0.02.
Lindarn, RN, BSN, CCRN
Somewhere in the PACNW
But no, as with so much in the nursing profession hospitals/healthcare systems called the shots. It was they who by and large determined LPNs weren't fit for the "sicker" patients modern hospitals must cope with, so they were phased out. Now you have quite allot of RNs who quite honesty aren't interested in the real down and dirty parts of bedside care, so hospitals bring in techs, assistants and so forth to ease that burden. Now it seems that isn't working out for various reasons at many facilities so aides are being phased out as well. This leaves RNs (increasingly BSN nurses) doing primary care in ways that wasn't what they had planned.
- 1Aug 26, '12 by Asystole RNQuote from luv2If only there was a large national association for registered nurses that also had chapters in all 50 states...I see LPN's and RN's seem to be on the same page so when and how we are going to organize? All nurses .com is a great platform however we need to be serious about taking back what is our skills ..............We need to start to organize and have a solid platform to stand on to appeal all LPN's and RN's on a whole........
I honestly do not think LPNs and RNs can really coexist in a unified nursing body since the goals of the two are pretty conflicting and then the CNAs, techs and the like would also feel left out...
- 3Aug 26, '12 by DoGoodThenGoQuote from MijourneyMuch of the nurse educator problems in many areas of the USA at least revolves around money. Master and higher degree holding RNs simply can earn more today in hospital or other capacities with often less aggravation than teaching.Great article! Many good points. It's not clear to me that nursing is necessarily being de-skilled. It's just that we need to continually update our skill sets. As other posters have pointed out, what nurses do today, physicians use to do. In many cases, nurses have invaded other discipline's territory as it were and become the bain of that other discipline's existence.
Health care facilities are in the money making business, for-profit or not, and if they deem their reimbursement levels to be too low to pay wages and benefits for licensed workers then unfortunately caregivers and our patients suffer. I do agree with some of the assessments that point out that nurses may need to make an effort to become independent practitioners while providing care at the bedside. I think those of us with graduate nursing degrees can make that case as long as the scope of practice supports it.
Some nurses feel that the problem of de-skilling is as a result of too much focus on enhancing the educational requirements for nurses. I contend that the fact that our profession is so fragmented is the cause of much of our agony. We have unlicensed nurses, ranging from CNAs to RMAs, as well as licensed nurses, RNs and LPNs. Practically anyone calls him/herself a nurse, but you don't hear much of that with therapy or pharmacy. So, I contend (I know darts will be thrown in my direction) that part of the problem with de-skilling lies with us not accepting that we need to standardize nursing educational requirements. That will partly solve the nurse educator shortage as well as the de-skilling problem. Alright, let me have it!
To me the problem lies where others have hinted or come outright and stated, politics.
Nursing as profession behaves more like a loose confederation of warring tribes than a cohesive unit. Much as it pains me to say so, this is a direct result of a profession made up of females.
Women have then and now have various reasons for becoming nurses, and not all of them had anything to with "helping others". Like it or not nursing has always been viewed as an easy profession to pick up and drop as a woman's life situation warrants. This is one of the reasons historically given for not phasing out two year programs in favour of the BSN. Not everyone has the time or money for a four year college degree and or need to get into the workforce quickly, so the theory goes. If you mandate the BSN you'll be removing an option for much needed employment. Even the current administration is pushing "community college" degrees including nursing for those whom are under, unemployed and or displaced due layoffs and so forth.
Now I ask you when was the last time you heard about a "fast way" to become a physican because someone needs a job quickly?
- 0Aug 26, '12 by toxnurse1I agree. But, this has been in practice for some time! I have been personally affected from the lack of knowlegable staffing. I was given an IM injection into my sciatic nerve. I literally thought I was going to die. But, it happen at a national "doc-in-the-box" chain and they only hire "lay" people to do the job of nurses. Literally, NO nurses are employeed. Talk about be mad, I went to school for a long time to accomplish my goals and have worried hard to obtain my clinical skills, only to go to a HCF, which has "posers" as nurses. The general public does not know to question what someone is doing to them. I am affraid it will get worse!
- 2Aug 26, '12 by BrandonLPNQuote from Asystole RNWhy would aides and techs feel "left out" of a nursing association? They are not nurses. On the other hand, we (LPNs) have every right to feel "left out" of the American NURSES Association.If only there was a large national association for registered nurses that also had chapters in all 50 states...I honestly do not think LPNs and RNs can really coexist in a unified nursing body since the goals of the two are pretty conflicting and then the CNAs, techs and the like would also feel left out...
- 0Aug 26, '12 by tothepointeLVNQuote from MijourneyI agree with you and not in the way you think. I think the standard entry level nurse should be at the associate level scrap the LPN (yes even though I am one) and merge them into the role.. The BSN should equal having extra skills and knowledge not being some hodge podge of entry level and experienced nurses.So, I contend (I know darts will be thrown in my direction) that part of the problem with de-skilling lies with us not accepting that we need to standardize nursing educational requirements. That will partly solve the nurse educator shortage as well as the de-skilling problem. Alright, let me have it!
If you make the entry level nurse a BSN or higher your probably going to exacerbate the deskilling problem as staff becomes more and more expensive and less and less inclined to do hands on care.
So basic nurse = 2 year program which fits in which the educational infrastructure we have now. People in their cry to BSN only always fail to look at the fact that many nursing programs don't have the ability to phase up to that level since they are not at bachelor's degree issuing institutions.
Do the extra 2 years to get a BSN well that should be an extra endorsement to your license. Perhaps an extra exam maybe in a specialty. Make the BSN "mean" something more than a vague concept of moving into management
I think sometime we get caught up on ideals and ignore the practicality. We need to blend what we want with what the system needs otherwise they'll just invent a new title that will replace nurses entirely.
- 0Aug 26, '12 by tothepointeLVNQuote from Asystole RNI think your wrong on that point. The problem is that we have separate nursing bodies/unions that fight against each other. If we were in the same body it might be rough at first but things would be smoothed out and optimized eventually and yes the CNA's would be left out but it would be a nursing body so thats expectedI honestly do not think LPNs and RNs can really coexist in a unified nursing body since the goals of the two are pretty conflicting and then the CNAs, techs and the like would also feel left out...
In my state the LVNs and the RN's have different BON and that causes some problems.
I'm all for nationalized licensing maybe even get rid of the two titles and have a level system of education and licensing but I'm from a country originally that had that kind of system for all levels of education and titles.
But wouldn't in be great if we had a system where career advancement up the clinical ladder wasn't solely tied to your facility.