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.

[BrandonLPN, LPN]

Asystole RN, for someone who obviously is well educated, you're surprisingly ignorant of the role of the LPN and of the legal definition of the word 'nurse'.

[Asystole RN]

The ANA is NOT all inclusive. That's the point. They should call themselves the ARNA or something. Their current title for their organization is disingenuous and misleading. Of course, it's a free country and they could call themselves the Bolivian Clown League if they wanted to. And CNAs can't join a nurses association because they are not nurses. Now, if it was the American Healthcare Worker's association or something.....

Maybe they do not see you as a nurse... :kiss

To be fair, the organization predates LPNs. Why don't you start your own all inclusive association?

[Asystole RN]

Asystole RN, for someone who obviously is well educated, you're surprisingly ignorant of the role of the LPN and of the legal definition of the word 'nurse'.

There is no federal law that protects the title of nurse, in those states that do a CNA, MA, or plumber can use the title.

I personally do not care about the title nurse.

For the record, I would LOVE a joint RN/LPN organization. When are you going to start one so I can join? :loveya:

[BrandonLPN, LPN]

Ok, this has drifted more than a little off topic....

I think the real de-skilling of nursing occurred when "task oriented" became a dirty word. There's nothing wrong with assigning a single nurse to do a single task for a large group of patients. Sometimes this is more efficient. It doesn't preclude said nurse from using critical thinking skills or from seeing the big picture. I honestly think it's more a matter of ego. Many nurses would bristle at the idea of being assigned to be a "med nurse" or a "wound nurse". We need to get over ourselves and just get the work done.

[Asystole RN]

Ok, this has drifted more than a little off topic....

I think the real de-skilling of nursing occurred when "task oriented" became a dirty word. There's nothing wrong with assigning a single nurse to do a single task for a large group of patients. Sometimes this is more efficient. It doesn't preclude said nurse from using critical thinking skills or from seeing the big picture. I honestly think it's more a matter of ego. Many nurses would bristle at the idea of being assigned to be a "med nurse" or a "wound nurse". We need to get over ourselves and just get the work done.

I agree with you.

The ideal would be a one-to-one nurse patient ratio but in realty nursing is far too complex for a super-generalist. We need specialists who are fantastic at a particular field of nursing.

I would rather have 10 specialists who are masters at what they do then a single generalist who can perform all 10 things adequately.

See Brandon, we can get along. :hug:

[kellieskorner]

I am an RN in Australia.Having a strong union is the only way to go.We have some of the best benefits in the world as well as high wages, low pt/Staff ratio.6 weeks paid holidays,paid CE money and great working benefits.We mix our drugs,do our own ABGs.We don't rely too much on pt or rt.In ICU and the wards everything is done by the nurses.Including the ventilators settings, auctioning, ,ABG's,In recovery room.Nurses insert LMA's and have a lot more responsibiltys/scope of Practice than Nurses do in the USA.I'm licensed in the USA.I would highly recommend American Nurses to come work in Australia for one year.All nurses in Australia have Bachelor degrees but an ADN from the USA is licensed here as an RN.Scary days lay ahead for nursing in the USA if unions aren't able to be your voice.Absolutely silly to give our profession away so easily.

[tothepointeLVN, LVN]

Are you guys still hiding the mattresses over there?

[DoGoodThenGo]

I am an RN in Australia.Having a strong union is the only way to go.We have some of the best benefits in the world as well as high wages, low pt/Staff ratio.6 weeks paid holidays,paid CE money and great working benefits.We mix our drugs,do our own ABGs.We don't rely too much on pt or rt.In ICU and the wards everything is done by the nurses.Including the ventilators settings, auctioning, ,ABG's,In recovery room.Nurses insert LMA's and have a lot more responsibiltys/scope of Practice than Nurses do in the USA.I'm licensed in the USA.I would highly recommend American Nurses to come work in Australia for one year.All nurses in Australia have Bachelor degrees but an ADN from the USA is licensed here as an RN.Scary days lay ahead for nursing in the USA if unions aren't able to be your voice.Absolutely silly to give our profession away so easily.

To be fair it wasn't just nurses "giving" away anything which has caused certain previously exercised functions such a mixing various drugs and or performing certain proceedures/treatments.

Rather the very litigious culture of the USA and various levels of skill proficiency of nurses would lead to errors which in turn lead to adverse outcomes which lead to lawsuits. Hospitals, their insurers and various regulating bodies researched and or otherwise looked into matters and decided certain things were best taken away from nursing staff and placed elsewhere.

For instance, and one forgets exactly when or who did the study but nearly a majority or clear majority of RNs a studied area made huge errors related to reconstitution of meds. It therefore came to pass that facilities began transferring the responsibility of such meds to the pharmacy and they arrive on the floor ready for administration.

[passionflower, BSN, MSN, RN]

I always wondered why nurses don't liberate themselves and bill for our own services. Other professions do this why not us?

[luv2]

My point is that R.N, ADN and LPN/LVN need to join forces together collaborate and stand as one. It does not matter if there are extra credentials behind your title we need to unite. I know the light has been turned on because we are having this discussion. I know we can mobilize in all 50 states. It will not be an easy task, but together we can come together. The leadership behind the American Nurses Association is not really standing for us as NURSES in D.C nor in any elections. How many times does an elected official make a comment about nurses? In the hospitals how many nurses are on the board? Other professions are telling us what we as NURSES need to do in order to complete our job? Where are our nurses? There are nurses who have worked for many years.....they know what it takes and how to get the job done. Why are they not speaking up for us. We need to get the notion of I AM LOOKING OUT FOR ME ....forget everyone else. It is imperative for us to have the motto e pluribus unum. If we truly want to advance as a profession.

[Asystole RN]

I always wondered why nurses don't liberate themselves and bill for our own services. Other professions do this why not us?

Inpatient billing is covered by DRGs, outpatients can and are billed for specific specialized care given.

[kellieskorner]

Errors happen but rarely happen here in Australia.We are mandated to have two nurses check and give medications.We have to calculate drugs, doses, volumes and we have drug books that are for the individual drug as to constitution, compatibility, and every thing we need to know.Two nurses for S8, and we inject cardiac medications,mix potassium infusions, scope of practice and safety measures sometimes checked 4 times.Takes longer but makes you think and not just hang what pharmacy gives you.Almost gave a lethal dose one time in the US that I checked prior to hanging from pharmacy.Found an error.Nursing around the world is at risk of under skilled people getting the jobs just to save money.Cna and LPN should not be devalued as they are our eyes/ears at times, but I do agree they do not have the critical thinking or assessment skills.CNA or MA should not be telling patients they are anybody's nurse.This is a hot subject and I mean no offense.The same issues are everywhere