The 'De-Skilling' Of Nursing

The reality of technicians and other professionals taking over aspects of the nurse's role is a valid threat that should not be handled lightly. If there's even one jobless nurse in society who desperately wants to secure employment, then the 'de-skilling' of nursing is certainly a problem. The nursing profession must stop giving up skills to other members of the healthcare team. This article attempts to explain how the nursing profession is being 'de-skilled.' Nurses Announcements Archive Article

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.

i totally agree. PT doing wound care is really foreign to me. And for some reason I feel like with the concentration their schooling is directed towards, wouldn't wound care be out of their scope of practice? Of course they could incorporate it, but the thought their primary goal was to help rehabilitate the patient?

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Splitting hairs. :bugeyes:We can debate this further on at the next professional nursing organization meeting...oh wait. :clown:Just kidding.
I can't tell if you're being serious or facetious. Do you really think saying there's a difference between CNAs and LPNs is "splitting hairs"?
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I can't tell if you're being serious or facetious. Do you really think saying there's a difference between CNAs and LPNs is "splitting hairs"?

The "just kidding" was not a clue as to my intentions?

I 100% believe that you are practically a nurse.

:D

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I could not agree more with the part I bolded. Nursing is far too complicated to be able to provide a truly adequate and quality hands-on experience within nursing education. I believe that nursing would do well to copy the physicianmodel of education where there is a theory part of the education and then a formal residency portion. Leaving residency up to the individual hospital to determine the length and quality provides formixed results.
Wouldn't forcing applicants for a RN program to have been first a CNA, then a LPN be the best way to ensure all RNs begin practice with hands on experience under their belt?
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Specializes in Hospice / Ambulatory Clinic.

Just a question that no one seems to answer. If for some reason the phase out of LPN's ADN's and diploma RN's was successful who would work at the nursing homes? or home health? Medication Aides? Long Term Care Technicians? Home Health Assistants? The problem with bringing the education level up is lower level nursing still needs to be done but nobody will want to do it if they are trained to do SO much more.

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i totally agree. PT doing wound care is really foreign to me. And for some reason I feel like with the concentration their schooling is directed towards, wouldn't wound care be out of their scope of practice? Of course they could incorporate it, but the thought their primary goal was to help rehabilitate the patient?

Highly depends upon the various state laws and how they define, or lack thereof, what medical tasks licensed and unlicensed personnel can or cannot perform. Many of the allied professions have somewhat open SOPs.

The tasks being performed as described by the OP occur, and may be common in a particular state, but are definitely not the national norm. Here in AZ RTs can place PICC lines but this is something that is definitely not normal.

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Actually Asystole, the MSN model seems to be similar to the physician model of education. Most MSN programs do the theory prior to the practicum. Usually, the practicum is done last in the MSN program. Generally, this practicum is a real world experience.

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Just a question that no one seems to answer. If for some reason the phase out of LPN's ADN's and diploma RN's was successful who would work at the nursing homes? or home health? Medication Aides? Long Term Care Technicians? Home Health Assistants? The problem with bringing the education level up is lower level nursing still needs to be done but nobody will want to do it if they are trained to do SO much more.
Trust me, LTC facilities would loooove to replace LPNs with medication aides and techs if they legally could. This is the problem with raising the entry point to nursing to the BSN level. You wind up with the former practical nurse jobs being filled with grossly underqulified UAP. Or overqualified BSNs who will also likely be underpaid and will leave the job at the first opportunity.
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Been an ER patient a few times, was a medic, now a nursing student. I may be kind of biased, but I don't see a problem with having assisting staff as long as they are not displacing the staff. When I was going through medic school we gobbled up IVs and EKGs med admin(some things we could administer), ETTs, and defibs in the ER. But there was only one of us one at a given time and the nurses used us as assistants. We did not replace them. Same for the unit I'm on now. Even with the nursing students on we don't replace the nurses.

During my last ER visit I had a tech come in and do an EKG and transport me to xray, but it was the nurse was the one who did everything else.

So as long as they are not being completely replaced and still are able to perform those tasks numerous times per day I don't really see a problem with a little help. I think it becomes a problem when they flood you with help and take away a good part of your job, often because it is cheaper.

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Just a question that no one seems to answer. If for some reason the phase out of LPN's ADN's and diploma RN's was successful who would work at the nursing homes? or home health? Medication Aides? Long Term Care Technicians? Home Health Assistants? The problem with bringing the education level up is lower level nursing still needs to be done but nobody will want to do it if they are trained to do SO much more.

Lower level nursing? Are you implying that the work performed by LPNs is somehow below the level of work performed by RNs? :eek:

I think the idea is that BSN nurses would fill the home health, SNF, and other sub acute positions.

Although, just as LPNs often are overlooked by RNs, the sub acute healthcare scene is often overlooked by acute care. Since acute care RNs dominate the national political nursing scene they do not readily address non acute care issues.

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Wouldn't forcing applicants for a RN program to have been first a CNA, then a LPN be the best way to ensure all RNs begin practice with hands on experience under their belt?

Works in France and other EU countries where time spent as a nursing assistant is required before entry into a "BSN" program or as part of it. However as often pointed out to me the "us" versus "them" when it comes to content between BSN programs.

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Wouldn't forcing applicants for a RN program to have been first a CNA, then a LPN be the best way to ensure all RNs begin practice with hands on experience under their belt?

No. Although experiences at those levels may introduce the student to healthcare and even provide some help to future RNs, CNA and LPN experience is not RN experience. An LPN needs an LPN residency and a RN needs a RN residency.

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