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.

Specializes in Hospice / Ambulatory Clinic.

Doesn't the UK instead of having RN and enrolled nurses have First Level and Second Level? And bands like band 6 etc.

0 Votes
I have worked in sub-acute care for most of my career, and still do PRN. I would agree that there needs to be multiple levels of care. I predict that the future of nursing will have the BSN nurse finally become the standard of entry to be a registered nurse and LPNs will be left but required to have an associates degree. I would not be surprised if the two forms of nursing completely split into entirely separate professions with differenteducational pathways and different regulating bodies.

I'll agree with this. I went to a

vocational school, and I stand by my abilities as a nurse. But, at that school, I *did* witness some of the stupidest people I've ever met get "babied" through to protect the school's graduation statistics. That's scary. Making the LPN an associates

program makes sense. Thus you would have two year degreed nurses practicing "practical nursing" and four year degreed nurses practicing "professional nursing".

Of course, the pickle is then what happens to the ADN? Do we merge them with the LPN, which practicing ADNs would understandably see as a slap in the face? Or do we grandfather them into the new "professional nurse" role, which kind of seems to defeat the purpose...

0 Votes
I am displeased with the actions of the delegates of the ANA..... because honestly..... at this point I AM thinking what delegates?....they have the name but no action....How many of them are addressing the facts hundreds of new/old graduates RN are being turned away from working everyday as R.N's and LPN /LVN's. How about the fact that many health care facilities prefer to hire 12 cna or techs or care companions as oppose to nurses....How have they address this concern? How about meds being administered via med tech...how have they addressed this? How about ECG being performed by EKG tech or cna.....how about vitals signs being done by cna......and the nurse has to go back and check it again.....how about cultures being done tech or cna .....and we have to take it again because it was done wrong....how about blood being taken by phlebotomist.......How about in some hospital or other health care facilities in the OR there NO RN's just surgical tech.....the scrub nurse is only there when JACHO is visiting.....I could go on and on? ...Where are the regulations? Where is the tone? . These ANA people in my opinion are NOT representing my interest.....When was the last time you went on the ANA website? ..... no offense somethings are outdated and they are on their website. The governance structure does not use its power to advance the nurse. It makes rules and regulation for nurses, but no follow up.It DOES NOT organize us nurses rather it divides because it does not include LPN/LVN. It has not organized us as NURSES to make political stands. Imagine if it was important for who ever was running for office to get a our support as NURSES.....we could take a stand as one united body. However, they have never tapped into their ability to create UNITY.....

You should read their lobbying efforts and find out exactly what action they took. They are not all-powerful and can only lobby for the causes that were voted upon.

You think that nursing is the only profession with problems?

Many of the problems you stated firmly lay with the state legislature, not with ANA or your local chapter. Your local chapter can lobby but I can guarantee you that they are no where near the influence of your local teamsters or AFL-CIO union.

I was on their website about two hours ago.

Just because something is not as powerful or follows your ideology 100% does not make it garbage. I hate ANA's liberal stance but hope that others like me will moderate them.

0 Votes
I'll agree with this. I went to a vocational school, and I stand by my abilities as a nurse. But, at that school, I *did* witness some of the stupidest people I've ever met get "babied" through to protect the school's graduation statistics. That's scary. Making the LPN an associates program makes sense. Of course, the pickle is then what happens to the ADN? Do we merge them with the LPN, which practicing ADNs would understandably see as a slap in the face? Or do we grandfather them into the new "professional nurse" role, which kind of seems to defeat the purpose...

The ADN registered nurses would be grandfathered and merged into the rest of registered nursing. The professionalization of nursing is not something calculated in years or decades, it is something calculated in lifetimes.

Look at Diploma nurses, as those nurses retire their form of nursing is going extinct. (although there are still a couple of programs left in the United States)

0 Votes
Honestly that sounds like a fine idea and similar to something I suggested except mine was phase out the LPN's. Make the ADN then entry level nurse and make the BSN Nurse + with the expectation that having a BSN mean you already had experience and thus could benefit from the added education.

When it comes down to it my view point as a nurse is I just want to be utilized appropriately. I would embrace a clearly defined role even if it was a little restricted. Though this embrace for me would be fleeting as I'm actively working on transitioning but still.

As a LPN you advocate the destruction of LPNs?

I am a BSN-RN and even I do not want the complete elimination of LPNs.

You are right though, there needs to be clearly defined roles for all the various forms of nurses.

0 Votes
Specializes in Hospice / Ambulatory Clinic.

If it'll bring peace yes. When it comes down to it its just a bunch of letters especially since LVN/LPN/RPN isn't a consistent title anyways. I advocate for maintain that level of nurse though whether its called practical nurse, enrolled nurse, level 2 nurse etc. And I DO think RN with high levels of education should get some recognition on the level of their license.

Whatever system we have it needs to be clear to the public and others what each level means. How often are we having these THIS vs THAT fights when one side doesn't even know what the other can do.

We ALL should be expected to think critically though thats the only thing really seperates us from the techs since we can make caring a license only thing.

0 Votes

Yes, I don't care *what* I'm called, as long as "nurse" is part of the title. If I had to pick, I prefer "practical nurse" to "vocational nurse" or "enrolled nurse". And please, don't change the title to "technical nurse". The derogatory terms write themselves with that one....

0 Votes

.

You should read their lobbying efforts and find out exactly what action they took. They are not all-powerful and can only lobby for the causes that were voted upon.

You think that nursing is the only profession with problems?

Many of the problems you stated firmly lay with the state legislature, not with ANA or your local chapter. Your local chapter can lobby but I can guarantee you that they are no where near the influence of your local teamsters or AFL-CIO union.

I was on their website about two hours ago.

Just because something is not as powerful or follows your ideology 100% does not make it garbage. I hate ANA's liberal stance but hope that others like me will moderate them.

The AFL-CIO union has a powerful lobbying firm behind them.....The potential for us to replicate AMA is there ...I just think it is about time the ANA become more inclusive ad vocal. In nursing school I learned how when other medical professions worked in the same capacity of MD. The AMA joined forces and defined what is in the scope of practice of MD and other professions . Why does the ANA not copy a chapter of the AMA

0 Votes
Specializes in being a Credible Source.
I love computer charting. I find it faster, safer, and way more efficient. No more lost charts and it is nice to actually be able to READ the nursing notes from the prior shift. Yay to computer charting.
I *could* love computer charting. Unfortunately, the people who picked the software for our facility did not perform due diligence nor seek input from people with germane experience. Hence, they purchased a package which is uniformly horrible and grossly inefficient at everything.
0 Votes
Yes, I don't care *what* I'm called, as long as "nurse" is part of the title. If I had to pick, I prefer "practical nurse" to "vocational nurse" or "enrolled nurse". And please, don't change the title to "technical nurse". The derogatory terms write themselves with that one....

I do not know if technically being a nurse is worse than practically being a nurse. :yeah:

I personally like the title Licensed Nurse Tech or Registered Nurse Tech. I think it sound more prestigious.

0 Votes
.

The AFL-CIO union has a powerful lobbying firm behind them.....The potential for us to replicate AMA is there ...I just think it is about time the ANA become more inclusive ad vocal. In nursing school I learned how when other medical professions worked in the same capacity of MD. The AMA joined forces and defined what is in the scope of practice of MD and other professions . Why does the ANA not copy a chapter of the AMA

Yes the potential is there but nursing arguably a newer profession that is still attempting to define itself. Nursing only really developed as a profession due largely to the efforts of a Italian born British Aristocrat. AMA has a professional base that has been recognized as a profession for hundreds of years.

ANA does work with other organizations including AMA, AARC and the like. I know for a fact that ANA and AMA have worked hand in hand on several bills in California.

0 Votes
I do not know if technically being a nurse is worse than practically being a nurse. :yeah:I personally like the title Licensed Nurse Tech or Registered Nurse Tech. I think it sound more prestigious.
I don't know, I like the PN title. The dictionary defines 'practical' as "likely to succeed or be effective in real circumstances". I like that. And "licensed nurse tech"? Sounds like you're trying to remove the word "nurse" as the root of the title. Again...cold, dead fingers.....
0 Votes