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.

[tothepointeLVN, LVN]

I prefer vocational to practical but maybe thats because I hate the little pretend nurse insult. Something harder to do with the LVN title. Plus V seem hard and cold while p is soft and warm and fuzzy.

LOL

[BrandonLPN, LPN]

I prefer vocational to practical but maybe thats because I hate the little pretend nurse insult. Something harder to do with the LVN title. Plus V seem hard and cold while p is soft and warm and fuzzy.LOL

Hmmmm, "Little Vapid Nurse", "Less Valued Nurse".... You're right it is harder.....

[tothepointeLVN, LVN]

I AM vapid so thats true.

[Cold Stethoscope]

To many hospital administrators, nurses are just error-prone machines with emotional issues. Eventually it will all be iNurses.

Need a new skill? Download a new app.

[duskyjewel]

It's kinda sad to see that some of you think that CNAs are a part of the problem and not a part of the team present to assist nurses. At my hospital, many nurses are more than happy to pass off "basic nursing skills" to the CNAs because they have "more important nurse stuff to do". Yes, some of them actually think this way, and have no problem saying so. Some of them try to have minimum physical contact with the patients as possible because they don't feel like dealing with the patients. And then you have the nurses on the opposite end of the spectrum, who'll do whatever it takes to get the job done and provide efficient patient care no matter what the task is. I think that most of this "deskilling" is being driven by nurses in higher positions with multiple degrees who no longer work at the bedside, and have "better things to do" than to assist patients with ambulation, insert catheters, and obtain vital signs. Blame these types nurses for the deskilling of the nursing profession, not the CNAs that are right next to you working their butts off, and often trying to attain a higher education at the same time too. These antibedside nurses are so preoccupied with trying to gain the same respect and recognition as physicians, that they start to believe that they are above and beyond giving basic nursing care.

Oh man, as I was reading these comments, I was hoping someone was going to say this! Working in the hospital, I met plenty of nurses who wanted absolutely nothing to do with CNA work. Clearly, my job developed for a reason. I worked with some great nurses who were always ready to help turn a patient, give a bath, etc. But I also worked with a whole lot that I am pretty sure had not done peri care themselves in multiple years, and would waste ten minutes looking for one of us to get a patient on a commode instead of doing it themselves while they were already in the room. Nurses asked for a lot of the "de-skilling" that is going on, and well, now they are getting it! Personally, witchy as this sounds, I'm kinda like, "Oh boo hoo, the poor nurses."

[aquarius04]

Oh man, as I was reading these comments, I was hoping someone was going to say this! Working in the hospital, I met plenty of nurses who wanted absolutely nothing to do with CNA work. Clearly, my job developed for a reason. I worked with some great nurses who were always ready to help turn a patient, give a bath, etc. But I also worked with a whole lot that I am pretty sure had not done peri care themselves in multiple years, and would waste ten minutes looking for one of us to get a patient on a commode instead of doing it themselves while they were already in the room. Nurses asked for a lot of the "de-skilling" that is going on, and well, now they are getting it! Personally, witchy as this sounds, I'm kinda like, "Oh boo hoo, the poor nurses."

As a PCA I have come across nurses like that who would spend more time hunting me down when the task could have already been completed. And I also worked with nurses that have knocked out some of my job before I even knew it needed to be done. I really think all of us as nurses need to come together and stand together as a profession, because we are a very valuable part of healthcare. And also nurses who don't think they should do peri care need to go back to fundamentals of nursing.

[Szasz_is_Right]

I think that most of this "deskilling" is being driven by nurses in higher positions with multiple degrees who no longer work at the bedside, and have "better things to do" than to assist patients with ambulation, insert catheters, and obtain vital signs. Blame these types nurses for the deskilling of the nursing profession, not the CNAs that are right next to you working their butts off, and often trying to attain a higher education at the same time too. These antibedside nurses are so preoccupied with trying to gain the same respect and recognition as physicians, that they start to believe that they are above and beyond giving basic nursing care.

I wish I could give you 1000 "likes" for this statement. These types are busy collecting pieces of paper (degrees) because while they like the idea of being called a nurse, they really see it as "much too icky" for them to do themselves. Therefore, they are very eager to "escape" the bedside role and do not care about improving conditions for bedside nurses. They just want to get away from it and keep climbing the ladder.

[neurorn6]

After reading most of the responses on this thread, I have developed a few thoughts. As nurses, no matter what our education level, ADN, Diploma or BSN. We take the same boards. There is no difference, we are all the same. Scared too Death. It's organizations like the ANA that keeps pushing us to fight amonst ourselves. I have had the pleasures of working with some of the finest nurses you can possible imagine and guess what, they are LPN's. As nurses we are professionals, no matter what our education, and as such we need to band together to improve our profession. I dislike the ANA, while their code of ethics governing nursing is a valuable tool, the organization as a whole does nothing for our profession. If every nurse, from LPN to MSW joined a national nursing union, then as a whole, we would be better able to advance our profession. While I often precept student nurses and new graduates, one thing is clear. Our profession is at a dangerous turning point. Students and new grads are not taught critical things skills or hands on skills. They aren't taught to CYA, they are taught not to think for themselves. As a whole, we need to stop bitchin amonst ourselves and start looking out for each other. We need to come together before it is too late.

[lindarn]

For the millionth time-

EVERY NURSE IN AMERICA NEEDS TO JOIN THE NNOC, AND THE NATIONAL NURSES UNITED!!

They are the ONLY NURSE ORGANIZATION, to do ANYTHING FOR NURSES AND THE NURSING PROFESSION!!

We ALL have to stand with them to protect our profession and professional prectice, and advance the profession before it is too late!

\

We need a national voice, and the ANA and our State Nurses Associations are, as we say in Brooklyn, as useful as tits on a bull!!

We need a national voice to protect what we STILL HAVE LEFT that is shrinking on a regular basis, and to advocate for us at the National level!!

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

[mc3, ASN, RN]

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

I 100% believe that you are practically a nurse.

Kind of vicious, wasn't it?

mc3

[BrandonLPN, LPN]

Kind of vicious, wasn't it?mc3

Actually, I thought it was kind of funny. I'd be a bit of a DB if I could dish the insults but couldn't take them, wouldn't I?

[mc3, ASN, RN]

I dunno...I didn't see you putting anyone down...........just sayin'.....

mc3