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.

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.

What has the ANA done or not done that you are displeased with? Are you displeased with the actions the delegates voted on or the governance structure itself?

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

Many nurses may not want to take on the responsibility of independent billing when they learn what they may face. Independent billing still would entail adding to our skill and knowledge set as I pointed out earlier in a post. To bill for services, you would have to know about clinical code sets and reimbursement; you would have to make sure that you are performing evidence-based practice to prevent being overly scrutinized by third party auditors; you would need to know a third party payer's policies, and I can tell you Medicare/Medicaid is very complex; you would need to be willing to talk with third party payers and auditors when they deny your services; your documention would need to be stepped up several notches in order to meet the criteria for payment from third party payers and demonstrate quality care; your rates would skyrocket; you would become even more exposed to litigation. Is this something you think the average RN or LPN at the bedside could deal with or afford? Would the current scope of practice for LPN/LVNs and RNs warrant these additional headaches? I realize the scope of practice varies from state to state.

I stand by my mantra that standardization is one way to address the conflicts that nurses face. Yes, let's grandfather whoever needs to be grandfathered, but we need unification through standardization.

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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

If you allowed LPN's to join the NNOC or ANA, you would add thousands of voices to the cause...unions have split the two apart. Why? We are nurses, you know!

Just saying..........

mc3

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CNA

:no:

There is no "Aide" in Licensed Practical Nurse. One assists the nurse, the other is a Nurse!!!

:banghead:

mc3

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Welcome to the new Nursing. We had let for profit and nursing organizations devalue nursing for years. While RT and PT can bill separately, we continue to be listed under bed and board. Yet, we have to carry malpractice insurance because we are professionals. We have let the ANA make decisions for us, which has done more harm than good for nurses across the board.

Computerized charting has taken us away from the bedside, customer service has us acting like waitress instead of professionals and administrators think that we are a dime a dozen. Yes you can replaces us but you can't replace our experience.

I have worked all over this country. I have worked in the NE, out west and in the south. I have worked Union and Non Union and For Profit and Non Profit. There is a huge difference across the board. The one thing that does stay the same, is that unless nurse come together under one banner, we will fall by the wayside.

We need to come together, LPN, LVN, RN, BSN and so forth. If we don't stand together, then we have on one to blame but ourselves.

Absolutely! We're only hurting ourselves and look at what's happened.............

mc3

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I get the desire for standardization, but there's benefits of having a multi tiered system. I actually think there is some merit to the idea of *forcing* nursing to be a career taken on a step by step basis. A requirement to get into a LPN program is having worked for a year first as a CNA. A requirement to get into a RN program is having worked for a year as a LPN. Thus no new RN could possibly step into a RN job without already having solid nursing experience. Nursing schools do such a pi** poor job of preparing nurses for the real world, some real world experience could only help.

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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?

Could you explain to me why LPN's shouldn't be included. Honestly, are our goals different? Do we both not want to take care of and help patients? Then all nurses would be working together on these issues. One powerful voice. Sorry, but your remarks remind me of a Jr. High School clique (i.e. why don't you go hang around with the other kids that are more like you....)

mc3

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There is no "Aide" in Licensed Practical Nurse. One assists the nurse, the other is a Nurse!!!

:banghead:

mc3

Splitting hairs.

:bugeyes:

We can debate this further on at the next professional nursing organization meeting...oh wait.

:clown:

Just kidding.

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Could you explain to me why LPN's shouldn't be included. Honestly, are our goals different? Do we both not want to take care of and help patients? Then all nurses would be working together on these issues. One powerful voice. Sorry, but your remarks remind me of a Jr. High School clique (i.e. why don't you go hang around with the other kids that are more like you....)

mc3

I think LPNs should be allowed to join ANA, I also think CNAs should be able to too.

I do not believe this will ever happen though because, although similar, our occupations are too different with the main difference being in educational preparedness. The current trend in registered nursing is to eliminate the ADN and Diploma nurses in favor of the BSN nurse, just think of what the opinion on LPNs is.

Considering that LPNs have been around how long now and they have not formed a national nursing organization themselves, I do not think there is much interest.

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I get the desire for standardization, but there's benefits of having a multi tiered system. I actually think there is some merit to the idea of *forcing* nursing to be a career taken on a step by step basis. A requirement to get into a LPN program is having worked for a year first as a CNA. A requirement to get into a RN program is having worked for a year as a LPN. Thus no new RN could possibly step into a RN job without already having solid nursing experience. Nursing schools do such a pi** poor job of preparing nurses for the real world, some real world experience could only help.

Brandon, I agree with you that nursing school typically does not provide real world experience. However, at least in my state to my knowledge, one is not required to have prior nursing experience to become a nurse-particularly at the ADN, BSN, or MSN levels. In fact, as I write, there are people entering the nursing profession that have no intention of "wiping butt" beyond their schooling. They seek to go into administration or specialize in non-physical contact areas.

It's all about getting that buck for many people who enter nursing. Even though most bedside nurses do not feel they're getting well-compensated, nursing does provide a decent wage and some measure of security depending on where you work and who is in top management.

To mitigate any problems with your step by step recommendation, nursing could go back to the days of old when nurses worked as "techs" in between semesters (back then it was a source of free help; I would not recommend no pay today) or nursing internship programs could be established.

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

In the ER that I worked in Pharmacy did not mix our drugs we, the nurses, did. I cannot tell you how many times I mixed dopamine, dobutamine, bi-carb, nitro drips, antibiotics, drips for diabetics, caffeine drips, and so many others that I do not remember them all. We pushed meds for rapid intubations, mixed anti-venom drips and gave meds for cardioversions. All this in the ER but the one I was most afraid of was levophed. My first overdose I had to push methylene blue with only a drug book to tell me how. No one in the hospital had experience with that one. I guess that is one reason I really liked my ER, we nurses really did everything except suture and that was because the hospital would not let us not because it was beyond our scope per the state nursing board.

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To mitigate any problems with your step by step recommendation, nursing could go back to the days of old when nurses worked as "techs" in between semesters (back then it was a source of free help; I would not recommend no pay today) or nursing internship programs could be established.

I could not agree more with the part I bolded. Nursing is far too complicated to be able to provide a truly adequate and quality hands-on experience within nursing education. I believe that nursing would do well to copy the physician model of education where there is a theory part of the education and then a formal residency portion.

Leaving residency up to the individual hospital to determine the length and quality provides for mixed results.

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