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.

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.

They can here in Arizona, but they have not.

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Lower level nursing? Are you implying that the work performed by LPNs is somehow below the level of work performed by RNs
Of course it is. No one ever said LPNs and RNs are the same.we DO provide a lower, less acute level of care. Doesn't mean we're not really nurses, or that our role isn't needed.
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Of course it is. No one ever said LPNs and RNs are the same.we DO provide a lower, less acute level of care. Doesn't mean we're not really nurses, or that our role isn't needed.

I am confused by Aystole RN's comment too.

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They can here in Arizona, but they have not.
Thats because federal law still mandates that a facility licensed as a nursing home MUST have a licensed nurse on site 24/7. Get rid of that law, and I'm sure many SNF's would revert to an assisted living model where NO nurse is present on off shifts and the med tech (or whoever) can just call the nurse "on call" if he needs to.
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Specializes in CCU, CVICU, Cath Lab, MICU, Endoscopy..

Hmmm...interesting although i fail to see why requiring entry level Nurse to have a BSN should not be a requirement. Besides you work with physicians that have been to school for minimum 12yrs just college education most have done research or participated in several, pharmacists in my hospital are all doctorate levels, even PT now is asking for a masters degree. Yet Nursing wants to be respected by their colleagues with minimal education no research, no scholarly articles. I say please give me a break!...i prefer my meds especially i.v to be mixed by a pharmacist for infection control issues unless its a STAT required drug. I like my CNA to check my patients call lights and assist in ADLs we have classes for CNAs and educate them to recognize subtle things. I also want my wound care consult to change dressings as i ordered and collaborate with me. As for RRT yes i know the vent settings and how to change them but when i am busy titrating drugs or stuck in patients room for a procedure our enroute to CT, MRI or whatever procedure then i appreciate them giving treatments. BTW only Nurses and Physicians can put in orders in my hospital and charge. After all you never see a cardiologist doing am endoscopy. What Nurses to recognize is that they have the power to command higher salaries, but you can't do that without proving you are on the same level of education as the people commanding the high pay. Til them we can complain til we drop!....and yes i started as a CNA went to Nursing school and almost done with my MSN and i definitely can see the difference in how i have evolved as a professional.

jm2c...

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Of course it is. No one ever said LPNs and RNs are the same.we DO provide a lower, less acute level of care. Doesn't mean we're not really nurses, or that our role isn't needed.

I will remember that you said this the next time there is a LPN v. RN thread where LPNs are claiming they do the same things RNs do and that the only difference are some fluff classes. :eek:

I do not see LPNs as a lesser nurse. I see LPNs as an entirely separate, but related, occupation that has it's own unique features and it's own unique role within healthcare.

Just as I see sub-acute healthcare, it is not a lesser form of healthcare when compared to acute care but rather a separate, but related, form of care that has its own unique features and it's own unique role within healthcare.

I do not believe that LPNs should be relegated to a lower acuity level of care either, I think that they can fulfill a unique roll within all the levels of care.

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Thats because federal law still mandates that a facility licensed as a nursing home MUST have a licensed nurse on site 24/7. Get rid of that law, and I'm sure many SNF's would revert to an assisted living model where NO nurse is present on off shifts and the med tech (or whoever) can just call the nurse "on call" if he needs to.

I am unaware of any federal law that states that a nurse has to be on site, I know of laws that state a nurse has to be on call or available at all times however. Please feel free to correct me if I am wrong. And if this is a Medicare directive then that definitely does not apply to the non Medicare facilities, I know of several here in Arizona alone.

There are several facilities in Arizona that utilize medication aides, they are utilized along with LPNs and RNs on the floor.

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So often the argument for requiring the entry to nursing to be the BSN is that it will get us more respect from the doctors and pharmacists and other professionals. Why is that so important to people. Why do you care? Besides, we all know most doctors don't give a rat's a** whether you're a ADN or a BSN.

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So often the argument for requiring the entry to nursing to be the BSN is that it will get us more respect from the doctors and pharmacists and other professionals. Why is that so important to people. Why do you care? Besides, we all know most doctors don't give a rat's a** whether you're a ADN or a BSN.

It is about the professionalization of the occupation.

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I will remember that you said this the next time there is a LPN v. RN thread where LPNs are claiming they do the same things RNs do and that the only difference are some fluff classes. :eek:
I've never said that. I HAVE said that when both RNs and LPNs work as floor nurses in LTC they do essentially the same job. I stand by that. I've also said that it's silly to say that LPNs "don't assess" when we do, every shift of every day. I've also went on record here as saying that a LPN should not take a pt assignment in acute care. In that setting we should be doing the "tasky" stuff like getting vitals, meds, dressings, etc. thus freeing the RN to, y'know, actually be a team leader and stuff like all that extra training prepared you for.
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The "just kidding" was not a clue as to my intentions?

I 100% believe that you are practically a nurse.

:D

I am not sure what you are saying to BrandonLPN, but the words "I 100% believe that you are practically a nurse" do not leave a nice impression. Nor does saying that "just kidding" was not a clue as to your intentions in regard to his asking "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?"

I couldn't tell if you were being serious or facetious either. I am reading BrandonLPN's concerns as being sincere. I am not reading your comments the same way.

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It is about the professionalization of the occupation.
How does my existing (or ADNs) prevent you from being a professional? So we have a multi tiered nursing model that includes LPNs and ADNs. So what? If BSNs want to be viewed as professionals why don't we make the BSN an exclusively management position? You'll still need someone to delegate the bedside tasks to. Or would you rather delegate them to an army of unlicensed personel?
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