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.

Sorry about your wife. I am surprise that nurse did that because most vns do not stay they are usually there for the treatment and other stuff and leave . I am appalled by what the nurse did to you and your wife. However, nursing is more than looking and having a feeling...I am glad you want to learn. I hope you continue down this path to become a R.N or LPN. As a CNA you should NEVER teach anyone anything. "When a patient is having breathing difficulties, who better to work with them until the RN arrives, coaching them to take slow deep breaths and urging the patient to try to relax, the CNA who is there." This exactly what irks me as a RN ...Do you see why we need to organize and start taking back our skills?

I'm not sure if I'll go one to get my LPN because the hospitals are phasing them out here in Florida (at least where I live). Because of my age, 58, I haven't made up my mind yet. I think you miss understood my comment about"coaching" a patient having breathing problems. I have been in the situation where my wife has gone into respiratory distress and by the time staff got there, I was able to talk her through slow breathing techniques. Not teaching, working gently and calmly with the patient. Those are skill I have learned because of my own asthma and working with respiratory staff. Once more qualified staff get there, let them take over unless I'm asked to continue with assisting the patient. No more, no less. I think my background has given me skills that other CNAs. I've had the opportunity to learn skills outside of schooling that most have not but in a critical situation ( for lack of a better term) doing what you can after calling for assistance makes more sense to me.

Specializes in Peds/outpatient FP,derm,allergy/private duty.
I don't understand what you mean by this. Education should determine how a nurse can practice. Since a BSN nurse has more schooling, he should have a wider scope of practice and probably it's own licensure. With an enhanced license of its own, the BSN nurse would be in a better position to demand more money. Without something like this it ju,st seems like education for the sake of education. Why have extra training if it doesn't result in more privileges and money?

It would depend on what the identified differences are in a BSN program vs an ADN program. Many of them, as has been said, focus on leadership, community health, health care policy, etc. so maybe I don't understand what you mean by "scope of practice"?

Specializes in Hospice / Ambulatory Clinic.
I don't understand what you mean by this. Education should determine how a nurse can practice. Since a BSN nurse has more schooling, he should have a wider scope of practice and probably it's own licensure. With an enhanced license of its own, the BSN nurse would be in a better position to demand more money. Without something like this it just seems like education for the sake of education. Why have extra training if it doesn't result in more privileges and money?

I think she's referring to the things that are inherent to all nurses. Common sense/critical thinking, compassion, being able to see the big picture. If you took a cross section of nurses and placed them at a level that all the nurses SOP covered you'd probably get the same results.

That's what most of the LPN vs RN's miss. I can do MY job as well as an RN can. I'm not saying that I can do her job but if she were to do mine it would be about the same.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
The BSN nurse predates all other forms of nursing except the Diploma nurse. Many hospitals are actively attempting to increase the ratio of BSN nurses on the floor.

The level of academic achievement of a nurse however has nothing to do with their clinical practice however.

I am curious......what makes you say the BSN nurse predates all other forms of nursing except the diploma nurse. What are you saying that ADN programs don't produce nurses? I am unclear......If this is true.....what you are saying is that my ASN program was a figment of my imagination.

I do however agree that the academic achievement of the nurse in no way influences their clinical expertise and practice at the bedside.

Specializes in Hospice / Ambulatory Clinic.
I am curious......what makes you say the BSN nurse predates all other forms of nursing except the diploma nurse. What are you saying that ADN programs don't produce nurses? I am unclear......If this is true.....what you are saying is that my ASN program was a figment of my imagination.

I do however agree that the academic achievement of the nurse in no way influences their clinical expertise and practice at the bedside.

I believe that BSN programs were developed before ADN programs were that originally there were BSN programs and diploma programs. I know my old college developed the first BSN program in the state and that was back in the 40's. Not sure when associate degrees themselves came about.

I don't understand what you mean by this. Education should determine how a nurse can practice. Since a BSN nurse has more schooling, he should have a wider scope of practice and probably it's own licensure. With an enhanced license of its own, the BSN nurse would be in a better position to demand more money. Without something like this it just seems like education for the sake of education. Why have extra training if it doesn't result in more privileges and money?

There are various forms of education. The education you received as a LPN/LVN is what is known as vocational training, not collegiate education. Hence the V in LVN.

RN education is comprised of two elements, the clinical vocational training and the liberal collegiate education. ADNs mostly receive vocational training with some collegiate education while BSN nurses roughly receive the same vocational training with more collegiate education.

What constitutes collegiate education is determined by, and certified by, various credentialing organizations that have developed the collegiate educational model. Depending upon the mix of various classes within the educational program will determine if your degree is a science or an art. In fact, the first nursing program at Columbia in the 1890's gave nurses a BA and a Diploma in nursing, only later was the degree combined into the BSN by Yale.

One can have a BSN without ever being a nurse, one can be a nurse without ever having a collegiate education.

I am curious......what makes you say the BSN nurse predates all other forms of nursing except the diploma nurse. What are you saying that ADN programs don't produce nurses? I am unclear......If this is true.....what you are saying is that my ASN program was a figment of my imagination.

I do however agree that the academic achievement of the nurse in no way influences their clinical expertise and practice at the bedside.

Nursing was largely unregulated and unformalized until Nightingale popularized and standardized the occupation in the mid to late 19th century. Towards the end of the 19th century formal programs that gave nurses Diplomas were developed. There is debate as to actual time line of when the advent of the baccalaureate level of education for nursing came to be since some programs offered a nursing program that granted a BS coupled with a Diploma in nursing. Either way, the advent of the BSN degree occurred in the late 19th or early 20th centuries. The MSN degree was developed in the 1940's.

Following WWII, in order to compensate for the shortage of nurses programs began offering an Associates Degree in Nursing.

BSN nursing predates ADN nursing, meaning that BSN nursing was invented prior to the advent of ADN nursing.

Just for info - the proud history of LPN's (taken from Wikipedia):

The first formal training program for practical nurses was developed at the Young Women's Christian Association (YWCA) in New York City in 1892. The following year this became the Ballard School of Practical Nursing (after Lucinda Ballard, an early benefactor) and was a three-month-long course of study concerned with the care of infants, children and the elderly and disabled. The curriculum included instruction in cooking and nutrition as well as basic science and nursing. The school closed in 1949 after the YWCA was reorganized. Other early practical nursing education program include the Thompson Practical Nursing School, established in 1907 in Brattleboro, Vermont (still in operation today) and the Household Nursing School (later the Shepard-Gill School of Practical Nursing), established in 1918 in Boston. In 1930, there were still just 11 schools of practical nursing, but between 1948 and 1954, 260 more opened. The Association of Practical Nurse Schools (APNS) as founded in 1942, and the next year the name of the organization was changed to the National Association was changed to National Association for Practical Nurse Education and Service (NAPNAS), and the first planned curriculum for practical nurses as developed.[4]

mc3 :nurse:

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Nursing was largely unregulated and unformalized until Nightingale popularized and standardized the occupation in the mid to late 19th century. Towards the end of the 19th century formal programs that gave nurses Diplomas were developed. There is debate as to actual time line of when the advent of the baccalaureate level of education for nursing came to be since some programs offered a nursing program that granted a BS coupled with a Diploma in nursing. Either way, the advent of the BSN degree occurred in the late 19th or early 20th centuries. The MSN degree was developed in the 1940's.

Following WWII, in order to compensate for the shortage of nurses programs began offering an Associates Degree in Nursing.

BSN nursing predates ADN nursing, meaning that BSN nursing was invented prior to the advent of ADN nursing.

Thank you......I see now what you meant. It was the first "advanced degree". The first ASN/ADN program was developed in 1952, by Mildred Montag. I beleive that this decision is what has led to the most contentious struggle within nursing.

Specializes in geriatrics, hospice, private duty.

...BSN nursing predates ADN nursing, meaning that BSN nursing was invented prior to the advent of ADN nursing.

You keep mentioning how BSN nursing predates ASN nursing. Do you think that somehow makes it better? Being a prostitute/criminal predates BSN nursing. Things evolve and being the old way doesn't necessarily mean being the better way. As far as ASN vs. BSN, I'm not saying one is better than the other; though one may be better for each individual nurse than the other based on their goals. I just think it is interesting how you keep bringing it up.

I plan to get my BS eventually (and maybe even a Master's one day), just not in nursing!

You keep mentioning how BSN nursing predates ASN nursing. Do you think that somehow makes it better? Being a prostitute/criminal predates BSN nursing. Things evolve and being the old way doesn't necessarily mean being the better way. As far as ASN vs. BSN, I'm not saying one is better than the other; though one may be better for each individual nurse than the other based on their goals. I just think it is interesting how you keep bringing it up.

I plan to get my BS eventually (and maybe even a Master's one day), just not in nursing!

Maybe you should read the previous posts to qualify the current conversation before posting.

See the above posting by Esme12 for example.

I was responding to clarify the timeline of the history of nursing education.

Specializes in ER - trauma/cardiac/burns. IV start spec.

Has anyone noticed that this discussion of degrees is dividing the nursing profession? Just who benefits from the in-fighting? Hospitals do in the long run. Nursing, in general, will never be able to bill for patient care. Our skills are part of the cost of the room, but if a hospital can increase its room charges it naturally collects more money. Only private paying patients actually pay the billed rates. If insurance is involved only a percentage of the billed rate is actually collected. In order to collect more money hospitals have to be able to justify the higher room charge. What better way to increase your fees than to have nurses with more initials after their name.

Why is it more important to have BSN's at the bedside? Not all BSN programs are the same across this country. They not even the same in the same state. Here, in my area, BSN's graduate without ANY actual hands on experience in clinical settings. I have seen posters say that requiring BSN will cut down on "fly by night" nursing programs. In this state it takes no less than 4 years to set up a program for ASN and even then if your graduates do not score well enough on the NCLEX after 2 years - your program is dead.

People are different and not everyone wants to spend 4 years in college. Some excel in academia some excel in doing. Nursing's strength comes from the variety of its members. We cannot all be "in charge" nor can we all be Directors or supervisors. A BSN does not mean that you are automatically better at delegating than an ASN. There is a certain amount of real-world experience necessary for one to be proficient in that area.

If hospitals could they would, by virtue of technology, use more tech-level personal to do more work and would lower the number of nurses, whether ADN/ASN or BSN. So while we argue about entry-level degrees Hospital Administrators are calculating the cost-benefit analysis of fewer nurses supervising more tech level workers with more advanced equipment versus having more nurses of various degree levels involved in hands on care. The real victim in this scenario is the patient.