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.

Nurses, you have made your bed, and are now suffering the results of it.

Nurses need to belong to a powerful national union to protect our best interests. By refusing to organize years ago, we have surrendered our professional identity and practice to hospital administrators,who would like nothing more than to be able to run a hospital with as few nurses as possible. I have heard all of the views against unions, but reality is, with no national union/organization to represent OUR BEST INTERESTS, we will ALWAYS LOSE OUT TO THE INDIVIDUALS WHO DO HOLD THE POWER!!

Nurses, you cannot speak for yourself when it comes to issues like this. You are out gunned, and out spent by the ptb, who have their best interests in mind $$$$$, not yours.

I will say it again, nurses need to join the National Nurses United, and become a force to be reckoned with. Without it, nursing will cease to exist as it is now, in a generation. It is already happening.

Our professional practice is being sold to the highest bidder. When did it become a funcion of PTs and OTs to do dressing changes? They do not learn sterile technique in school, and nurses do. Their professional organizations are being proactive in ensuring that they have billable skills to add $$ to the hospital. Especially since they have gone to a doctorate and masters degree as entry into practice. As long as a nurses professional practice is rolled into the room rate, housekeeping, and complimentary roll of toilet paper, nurses will always be an expense, instead of an asset to the hospital.

Why should RTs charge to do ABGs? I did them in the ICU, and was not able to bill for them. But the RTs did. Again, another instance of RTs making themselves valuable to the hospitals. It is called job security, and nurses have not learned that skill.

WAKE UP NURSES, OR WE WILL NOT BE AROUND FOR MUCH LONGER!!

JMHO AND MY NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

ADNRNStudent reply says it all in one short sentence. We as nurses are allowing others to take away our profession. Hospitals want magnet status. What does it do for hospitals, not a darn thing, stating that outcomes will improve as the level of education is "ELEVATED" Give me a break. Nurses face the same issues all over the US; time behind the computer charting has taken time from our real patient care that used to include passing meds, pt assessments, VS, IV infusions, cath care and insertions. HAIs' are on the rise so hospitals throw in hand sanitizer, gee that still doesn't decrease HAI's! Scrub the hub, half the US wipes the hub of their IV line, i know i have been a traveler. I have watched with disgust, even had one nurse say it doent matter their all on antiobiotics, Hospitals once again spend money on products that are going to decrease HAI, gee, swab cap, has it helped?

Magnet status will require monitoring of clinical data, another job created for what.

The more we give up as Nurses the more likely it is to plan that the next time you are in that hospital bed your medication aide will provide your med/iv infusion, CNAs will assess and provide your care.

Lets think about where we are headed!

PTs doing wound care, can almost get it. RTs doing blood gases, can almost get it. Apparently we now have RTs that are hanging blood.

If I put O2 on a patient, no charge. Once an RT comes into the room and charts the pulse ox off of the pulse ox that I put on along with the O2 amount that I set the O2 at, now there's a charge.

Those who make money will have jobs. Those of us that just cost money, won't.

It's not just that nurses are being let go, but that now, with the task-based nursing aides, the hospital can load more patients on less nurses. The responsibility is still there for the nurse, but the time needed to ensure that tasks are done safely and properly is not. The PTB don't know, or don't care that many of the tasks still require the knowledge and expertise of the nurse to assess underlying causes and implications of the tasks, such as evaluating wound healing, response of the patient to medication changes, disease process, family support, etc. People are dying for lack of nurse assessment and intervention. The CNA's do not have, and are not trained to have, critical thinking skills. They do a task. There is no care for the intangible needs that patients and their families have. We are all warm bodies, there to fulfill the needs of the "staffing grid," without taking into account patient needs and acuity. As far as being "less needed," we are less needed by the corporations and hospitals, but we are far more needed by the patient in the bed, who are now being cared for by staff who do not have the wherewithal to detect serious complications until it is far too late.

We, as nurses, have an obligation to inform and EDUCATE the public as to what is going on, and how it is negatively effecting the care and safety, in the hospital, and also doctors' offices, and clinics. MA, answering the phone and identyfing themselves, as, "doctor so and so's nurse, ", nurses aides referring to themselves as nurses.

Nurses need to take a page from teachers. Teachers are almost 100% unionized. They can speak without fear of repercussion, can and do, organize large gatherings in very public places, to inform the public about changes in the schools that are determental to the students. They miss no opportunity to voice their concerns to the parents.

Why this is admirable, lets face it folks- no one ever died because they could not do long division or diagram a sentence. But how many patients are experiencing poor outcomes because of deliberate short staffing, that hospitals take no responsibilty for.

Why are peoples' lives being put at risk and we sit around and do nothing but complain to each other, but not to the people who can force change- the patients who we care for and who DO care about dangerous staffing and poor outcomes.

It will not change unless we organize under a strong unbrella of an organization who has OUR best interests at heart, and our patients.

Think about calling the NNOC, and get a unionizing campaign started. This is for your and your patients. You cannot defend your patients is you fear losing your job and getting blackballed!

JMHO and my NY $0.02.

Lindarn, BSN, CCRN

Somewhere in the PACNW

How long until the task-specific unlicensed techs become a majority and decide they have no further need of US? Throw together a couple medication aides, a wound tech and a "data collection specialist" and it's all over.

Specializes in Oncology; medical specialty website.

No nurse was able to save a patient's life without the help of a teacher.

I agree with the fact that nurses are being de-skilled right out of the hospital, but minimizing the impact teachers have had on our lives is just petty.

I'm a member of NNOC. They don't represent nurses in my area, but I am ever-hopeful.

I don't think most patients care about short staffing. As long as someone shows up with their Cokes and sandwiches, a lot of them could give a rip if the person on the other side of the bed is an RN, LPN, UAP, RMA or M-O-U-S-E.

I have an ethics situation I'd like to ask about. Where is the best place to post and have questions asked? It's been too long since I was here last.

Specializes in Psychiatric, geriatric, medical.

The missing component is critical thinking.

My response was not meant in any way to denigrate teachers. I was just pointing out that because teachers have a strong union, they have prevented the de skilling of the teaching profession, unlike nurses, and because they have a strong union, they can and have, made it their business to go public anything that inpacts their jobs and their ability to teach. Which, by the way, is the reason that teachers did unionize years ago, to protect their academic freedom. What is the difference in protecting your academic freedom to teach, and protecing a nurses ability to protect his/her, ability, to care for their patients with proper staffing? And being able to whistle blow insafe practices in a hospital or nursing home withour fear of retaliation?

Is a teachers' ability of academic freedom more important than a nurses ability to save a patients life due to being forced to take an unsafe assignment of too many patients? I think not. That does not mean that I do not respect teachers and their contribution to society. I do believe that my need to advocate for a patient's life is more important than a teacher having the academic freedom to teach their students a subject that is not popular with their PTB.

I did not mean to minimize the impact of teachers, and I have no idea how you read that into my response. That is what I meant with my statement.

Patients don't care about short staffing becaus WE lead them to believe that everything is hunkydory with the staffing, and your ability to care for too many patients.

But everything is not OK. Bedside nursing is a nightmare, and the name of the game is to get out of bedside nursing as fast as you can after graduation. Why is that? I don't hear PTs,OTs, even RTs, running away from their practice as fast as they can. Bedside nursing, and how it is being practiced around the country is unsafe for anyone, and most nurses cannot be the patient advocate that they are required to be by the Nurse Practice Act because they fear for their jobs.

Why do we allow it? Because we have no strong organization to watch our backs, and advocate for us. And we allow it. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

Specializes in being a Credible Source.
Also, obstetrics was once within the strict realm of nursing (midwifery).
As was anesthesia.

I'd prefer to see the 'skills' be emphasized and have technology utilized to reduce the time spent on documentation.

"EMR" is getting a bad rap due to selection of lousy systems and resistance of many nurses to its adoption. If done well, EMR could free up nurses to spend more time 'nursing' and less time 'charting.'

There is also an incredibly large variation in the skill, judgment, knowledge, wisdom, and maturity of nurses which promotes, I think, the taking away of skilled work from the generalist nurses and handing it over to "specialists."

As a Registered Nurse, I agree with what you wrote. I see it all the time cna/ pca are doing the skill aspect of our job. Which in my opinion is very dangerous. I am not trying to offend anyone, but the knowledge and skills that a R.N or LPN know is more than a pca or cna. It is offensive when I see the cna working as R.N because it is cost effective to hire them as oppose to R.N or LPN. It is about time stand up a unite especially in this upcoming elections and have our voice heard regardless of our race, religion, or political background. We need to have the same of power in D.C as the AMA. I could remember reading articles years ago of how jobs where being taken over by other medical professions. The medical doctors in the U.S banned together and made the voice heard. They set the tone on their profession. It is about time nurse really unite and stop getting trampled and passed aside.