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.

Why don't we hear the same complaints from PTs, OTs, Pharmacists, etc? Who all make more money than we do, and have far more respect than nurses do. Spare me the, "nurses were once again voted the most trusted careers for the tenth year in a row,", blah blah blah. We are voted the most trusted because we are doormats who don't stick up for ourselves, or our fellow nurses.

The market is flooded with nurses, new grads, etc, and new schools are springing up almost daily. No one can get a job, and the small amount of respect the strength that we enjoyed in the years of true nursing shortages, has long gone away.

Our low levels of education make us easy to replace with lower educated individuals, as our professional practice is being sold to the highest bidder.

We will never be able to claim the same professional image as other health care professions, due to our low levels of education. Especially when PTs now have a Doctorate as entry into practice, and OTs have a Masters. PT ASSISTANTS, have an Associates degree as entry into practice. RECREATIONAL THERAPISTS have a Bachelors degree as entry into practice! What does that say about nursing, who still have people entering with as little as an Associates degree, or not even that much for LPN/LVNs.

Spare me the sob stories about individuals who would never be able to make it through a four year BSN program for what ever the excuse du jour that they claim. Not everyone can and/or, should be admitted to a program, that is life. PTs and OTs will freely tell you that the main reason that they went to a higher level of education, was to claim their piece of the health care pie, increase their pay, and keep themselves in demand, with fewer people entering the career.

We do not control our profession to prevent ourselves from being replaced by de- skilling. We are allowing it to happen. Teachers fight to keep their profession from being overrun by lesser educated individuals. Why are we not emulating other successful professionals who are keeping their professional from being deskilled?

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

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Specializes in Oncology.

I just want to say that I have really enjoyed reading this thread. It has given me a lot to think about, and I've enjoyed all of the viewpoints. I may add some of my own later, but for now I am still thinking about them.

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Specializes in Med/Surg, Academics.
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 I might write a post on the different educational requirements of ADNs, BSNs, and RN-to-BSN programs. The educational requirements for the degree in each program are different, but not enough to change the scope of practice for licensure's sake.

BSNs do have more education, but I would argue it's not for education's sake. Any amount of education is dependent on how the student applies it in the real world. Even if it doesn't mean a wider scope or more money, it is intended to enhance an RN's practice, if applied appropriately.

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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.

The only divisiveness I have found in nursing discussing this issue is on AN, not exactly something mind-boggling.

The BSN standard has nothing to do with individual professionalism nor clinical proficiency. The BSN standard is about professionalizing the occupation. A profession is something that is defined and studied with certain criteria that must be met for an occupation to be deemed a profession. The lack of an educational standard is something holding nursing at the level of "developing profession."

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I don't care if we're called a "profession" or not. I do care that as long as we can be easily replaced by someone with a 2 year degree, we're not going to get the respect from facility management that is demanded by someone that is less easily replaced. We're going to go without breaks, be expected to work off the clock, get worse and worse ratios, etc. as long as there's a flooding stream of people ready to replace us every 2 years.

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I have to agree 100%. I'm a hospice nurse and frequent facilities with one if any licensed nursing staff and I shutter. I realize it's a money thing but why would you put a family member, or anyone, in a place where there's staff that wouldn't even recognize an allergic reaction, hyper/hypo glycemia ...the list goes on and on... they have compassion and patients best interest at heart but when that patients well being is in your hands education, education, education

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When I first graduated we had a lot of patients who were admitted to have gallbladder xrays and ivps. At some point they figured that the patient could keep himself npo after midnight. It doesn't take too much sense to take an iv site out and apply pressure so it don't bleed. Most diabetics are educated to do their own blood sugars so I don't see why aides cannot be so educated.

In the meantime lab results come back quickly and need to be addressed. Patients conditions are much more complex now. A lot of the patients we get would not have survived to get so sick back in the day. Just because nurses don't clean floors, draw all labs, put kcl in if fluids etc doesn't mean we don't have anything to do. A lot of the things we no longer do (mix iv fluids as an example) are more safely done now and are no longer done by nurses because of many tragic mistakes in the past.

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Specializes in Oncology; medical specialty website.
My original statement was facetious, now you get it? :D

I'm not sure what game it is you think you're playing, but I find it tiresome.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
A lot of the things we no longer do (mix iv fluids as an example) are more safely done now and are no longer done by nurses because of many tragic mistakes in the past.
To be totally fair, many pharmacy technicians have made mistakes while mixing medications that had tragic results. A handful of dialysis technicians have made mistakes that have led to patient demise.

Is it really a good idea to surrender certain nursing skills to people who tend to have less training? Is this practice going to stop tragic mistakes? I think not.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
To be totally fair, many pharmacy technicians have made mistakes while mixing medications that had tragic results. A handful of dialysis technicians have made mistakes that have led to patient demise.

Is it really a good idea to surrender certain nursing skills to people who tend to have less training? Is this practice going to stop tragic mistakes? I think not.

I can't like this enough!!!!!!!

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Specializes in CCU, CVICU, Cath Lab, MICU, Endoscopy..
To be totally fair, many pharmacy technicians have made mistakes while mixing medications that had tragic results. A handful of dialysis technicians have made mistakes that have led to patient demise.

Is it really a good idea to surrender certain nursing skills to people who tend to have less training? Is this practice going to stop tragic mistakes? I think not.

The only thing that pharmacy techs do in my hospital is restock pyxis and bring up meds. We have a pharmacist in the I.V room whose job is to mix medications and others who accepts orders, process them and the tech brings the meds to the nursing station or pyxis. :up:

Techs mixing sterile I.V drugs? ....where the heck is this?:roflmao:

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Techs mixing sterile I.V drugs? ....where the heck is this?:roflmao:

Cropp was the supervising pharmacist at Rainbow Babies & Children's Hospital on Feb. 26, 2006, when a pharmacy technician prepared a chemotherapy treatment for Emily.

The solution was 23 percent salt when the formula called for a saline base of 1 percent. Emily slipped into a coma after receiving the treatment and died on March 1.

As supervising pharmacist, Cropp had the duty to inspect and approve all work prepared by technicians before the drugs were administered to patients.

Cropp initially was charged with reckless homicide but agreed to plead no-contest in May to involuntary manslaughter. The State Pharmacy Board revoked his pharmacist license in April 2007.

Former pharmacist Eric Cropp gets 6 months in jail in Emily Jerry's death from wrong chemotherapy solution | cleveland.com

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