You think the "Nursing Glut" is bad now?

[Guttercat]

I tend to keep my finger on the pulse of new(er) trends.

This subject is something I've alluded to before, yet now I am even more convinced it may become reality.

My state--a west coast state--recently (last year) redefined the scope of practice for MA's to include much of what RN's are responsible for, based on a new tiered level of education and certifications. Colleges have jumped on the bandwagon to develop intense MA programs to fill the need.

At one time, MA's were relegated mostly to Dr.'s offices (which used to be the domain of RN's). That may not be the case much longer, if the trending continues.

I was just speaking with a fellow student from a math class, who is pursuing her MA. One of our college's nursing program professors is apparently steering potential nursing candidates (friends of hers) away from the nursing program on the QT. She stated, "Now that the scope of practice for MA's has been legally expanded, the hospital is looking to integrate MA's to fill the floors, instead of the more costly RN's."

Just sayin'. Research on your own, and draw your own conclusions.

[Howardhughes, ASN, BSN, RN]

MA..as in Medical Assistent, a person with 6 months training.its a sign of thing to come...do more with less educated people and spread the responsibility around to un LICENSED persons...harder to sue a MA the that old MD NP or RN. I saw this coming in 2004...A TRUE STORY: My dad in Calif noticed a odd "scab" at the left Rad of his neck in 2004. I was finishing up RN school and as we all know time is compressed...I encouraged him to have it cked out...in in CLT NC. He did..doc took a sample for biopisy. a week went by and no one called him so he called the MD office and wanted to talk to a RN..was told they dont have RN's MA..who are as quilified. He stated his name to the MA...she stated it was ok. $ weeks go by and the "scab" gets bigger and his face starts to swell on that side. Upon return to hospital/ checking chain of events the MA has mis labeled my dads biopsy...she had read the report of another Richard Miller that was seen that day...NO ID cross ck, No SSN. My dad Died 7 weeks later from MM, I did not peruse legal as I was too busy finishing school ... the lawyers wanted to sue the MD/Ins co as the MA had no Professional standing in court. My wife is ret 22 USN CDR Masters...she states we have dumbed down the industry to fill billets...In the few years Ive been a RN I can say for sure many Grads don't have a sold foundation of AP/systems or pharmacology. I haven't talked about this ever before outside my family. So... yes the future of the RN is changing...to the determent of the Patient.

[anotherone, BSN, RN]

Almost anyone can learn to put in ngs, ivs, labs etc. anyone. that is the least of what I bring to a pt. I think of my job and the lives I have saved by assessing pts and reporting abnormalities because of my knowledge of disease processes and pathophysiology. That

should be key to any nursing job. on a similar note why does a surgeon need medical school and

then at least 5 years of residency and maybe a fellowship. Can't they just teach anyone where to cut.? Do people really have nursing jobs where a thorough understanding of pathophysiology and even pharmacology is not needed?

[libran1984, ASN, RN]

I think some people are suffering from a lack of education/intelligence. Quite simply, medical assistants do not have the education and training nurses have. To respond to your example of passing meds, in nursing school, before I ever administered my first med in student clinical, I had learned the five rights of medication administration. I was taught to understand the reason the medication was ordered and why it was indicated for the particular patient, the method of action, contraindications to giving, expected effects, side effects, adverse reactions and action to take, patient assessment prior to giving and after giving, i.e. vital signs, labs. The process of giving medications safely requires education; one is not just throwing meds at patients. One is using the nursing process throughout.

I just noticed your post #21. Are you really suggesting that medical assistants should give IV meds? My RN training taught me to assess allergies, compatibility, concentration, rate, use, dose and dilution, along with everything I mentioned in my first paragraph, including IV assessment. Again, using the nursing process in order to give the medication safely.

I ask you, what quality of care do you really want people to receive? What do you want for yourself and your own family?

I thank you for bringing this topic up...

While I cannot speak for all medical assistant programs, I do know the one's I've sat in on or been part of, these MA's DO learn the 5 rights of medication administration. This is not unique to nursing.

In regards to the other comment regarding IVP medications; in my LPN and even my RN training, I was never taught to memorize compatibilities of IVP drugs. Instead, I was always taught to look at the computer and verify drug to drug interactions. Thus, I do so, with every drug I intend to combine I have a check to verify. I think verification on a computer is totally within an MA's ability.

The three red rules at every hospital I know of are: Pt name. Pt DoB, and Pt allergies. I'm sure an MA could verify name, dob, and allergies before administering a med. If a pt is allergic to ACE inhibitors, the MA had similar pharmacology classes as ourselves, they know (as is stated in my local MA education) how to identify ACE inhibitors like knowing to question a med if it ends in -pril, or if the computer x-nays the med prior to administration.

With regards to side effects, this goes back to my original statement, MAs (often) have similar pharmacological training as us. They know tetracyclines cause photosensitivity and antibiotics may cause diarrhea, or macrolides cause a copper taste in the mouth, or ACE inhibitors may cause a cough.... What other side effects are you thinking of that couldn't be learned on the job?

Most nurses I see enter the ER straight from school don't understand side effects themselves. It is learned through time. I honestly won't even get into all the silly things I've witnessed from new grads. Honestly, I'm sure I was just like that more than once in my own experience. The real thing comes from asking questions to verify your certainty about a task, order, or job.

[anotherone, BSN, RN]

If anything Inthink nursing school should focus a lot more on patho and pharmacology. Bed making, fluff nursing theory, WASTE of time. the longer i go as a nurse the more I understand why many instructors said not to worry about skills so much. And the more I resent the implication and demands that RNs waste their time on stupid tasks a robot can do. It is the dumbing down of the profession. But in reality not THAT long ago only a MD could place an IV or take a blood pressure...... who knows. why even have rns if an ma can do the job? why have an MD if a pa or np could do it.......

[libran1984, ASN, RN]

I want nurses at the bedside, not someone who got a certification/license at the bottom of a Cracker Jack box.

From the posts I read about several ADN programs, you'd thing that some people might think that nurse is probably from a Crack Jack box that cost $40,000.

[libran1984, ASN, RN]

If anything Inthink nursing school should focus a lot more on patho and pharmacology. Bed making, fluff nursing theory, WASTE of time. the longer i go as a nurse the more I understand why many instructors said not to worry about skills so much. And the more I resent the implication and demands that RNs waste their time on stupid tasks a robot can do. It is the dumbing down of the profession. But in reality not THAT long ago only a MD could place an IV or take a blood pressure...... who knows. why even have rns if an ma can do the job? why have an MD if a pa or np could do it.......

I almost agree... its education inflation.

Yes, I do grasp the ignorance behind this. Yet another way to think of this is, do you want to take the advice of an NP with 10 years experience in his/her specialty or a new grad MD/DO?

[anotherone, BSN, RN]

I almost agree... its education inflation.

Yes, I do grasp the ignorance behind this. Yet another way to think of this is, do you want to take the advice of an NP with 10 years experience in his/her specialty or a new grad MD/DO?

My last post was filled with sarcasm. I rather have the new md/do if they are seeing me as an out pts/he is already an attending and if inpatient the attending still rounds.

[Esme12, ASN, BSN, RN]

As an LPN making barely $13/hr while my RNs made $22+/hr and so little distinction between our job descriptions... yes.....

I made, perhaps, $1/h more than an MA in the hospital setting, and I'm appraised by my peers for my utilization of the nursing process, which confabulates me.... I'm just doing common sense things to make sure my pt is safe and i'm not going to kill them. I've learned SOOOO much from the "am I going to kill them" question. Because, in the ER, that is a serious question when you have an unstable pt. Who want to tip someone over the edge. I know MA's that I swear had more knowledge than myself coming out of LPN school. I knew paramedics who I swear I had more knowledge than coming out of school, I knew other paramedics who I thought should have been doctors because they talked so far over my head.

I think, if people are so concerned about money, then go for the lesser paid professionals.

Here is my theory...

If an MA were to be precepted by an RN for a new job for 12-16 weeks (as is normal where i work) then learn proper protocol and basic meds and usual assessments skills, then the MA could progress along the Novice to Expert scale. Upon reaching competent or expert, they too, can train the next MA to be as efficiently trained as the original RN.

They could do all this for half the price of an RN, in theory.

From the way most ED's I've visited or worked in, you'd think most ECFs were ran by CMAs b/c no one in the ED seems to respect the ECF nurses. If respect is so low, then why even have nurses (LPNs/RNs).. let them be CMAs throughout so at least maybe morning med pass might more rounded out.

Imagine if all treatments and med passes were done by CMAs, QMAs, or MAs? You could have a higher certified personnel to patient ratio. What if all nursing homes had a 6 to 1 certified personnel ratio with normal CNA to licensed/certified personnel ratio. How much cheaper would that be? Instead of one nurse looking over 20+ people, you have 1 certified personnel looking over 10? 1 certified personel would be almost as much as 0.5 nurses nurse! The pt would probably see more attention paid to themselves. The pt may not have to wait as long receive treatment for distressing situations... and trust me, that is how LTC nurses often see a situation- is it distressing? So then they call the doctor. Maybe, the MA, with a lower pt to MA ratio, would be able to identify something is seriously wrong. I don't even know any nurses in LTC that listen to all their patients breath sounds every single morning (b/c it is not time efficient despite the dx of CHF). That is why I could never work LTC; too corrupt and unforgiving... or maybe "too forgiving".

I began to ramble, I'm sorry...

Yes, I am willing to allow someone of lesser education to replace my position because they CAN do it as effectively.

Look at the debates.. Diploma and ASNs still vouch that they can perform just as well as a BSN. Its all about experience. Grant the MA the same experience, and they, too, can perform equally as well in the field of desired work (as is my theory).

The RN has more education and more responsibility....hence more money. The ADN, diploma, BSN debate is not in question here..... for all three educations allows one to have the education necessary to pass the NCLEX exam to become a RN....hence the argument...all pass the same exam ...... NO one is really "better than the other".

Not all states have LPN's in cute care anymore. I am sorry that you feel so little about your education that you re willing to hand it over to non- licensed personnel. It saddens me that you think so little of your education and patients that you think you can easily be replaced by non licensed personnel and that they will provide the same level of care as a licensed nurse.

As an ED nurse for 35 years....I disagree that "anyone" can be trained to know the intricacies of patients with multiple co-morbidities, triage them, critically think to know what needs to be done and effectively care for them and react in n emergent situation. You far under estimate your value.

I feel you are angry or hurt, maybe even resentful, at how much the nurse are paid. You are worth more...you should go back to school....but the answer isn't to allow non licensed personnel care for critically injured people...or sick patients. I remember the days of 1RN, 1LPN and 2 aids for 35 surgical patients with NGT and multiple drains, foleys, sump pumps...and it isn't pretty.

I m sad for you......You far underestimate your value. You far underestimate the RN's value, role and education.

[Leonardo Del Toro, RN]

MA..as in Medical Assistent, a person with 6 months training.its a sign of thing to come...do more with less educated people and spread the responsibility around to un LICENSED persons...harder to sue a MA the that old MD NP or RN. I saw this coming in 2004...A TRUE STORY: My dad in Calif noticed a odd "scab" at the left Rad of his neck in 2004. I was finishing up RN school and as we all know time is compressed...I encouraged him to have it cked out...in in CLT NC. He did..doc took a sample for biopisy. a week went by and no one called him so he called the MD office and wanted to talk to a RN..was told they dont have RN's MA..who are as quilified. He stated his name to the MA...she stated it was ok. $ weeks go by and the "scab" gets bigger and his face starts to swell on that side. Upon return to hospital/ checking chain of events the MA has mis labeled my dads biopsy...she had read the report of another Richard Miller that was seen that day...NO ID cross ck, No SSN. My dad Died 7 weeks later from MM, I did not peruse legal as I was too busy finishing school ... the lawyers wanted to sue the MD/Ins co as the MA had no Professional standing in court. My wife is ret 22 USN CDR Masters...she states we have dumbed down the industry to fill billets...In the few years Ive been a RN I can say for sure many Grads don't have a sold foundation of AP/systems or pharmacology. I haven't talked about this ever before outside my family. So... yes the future of the RN is changing...to the determent of the Patient.

Yes, you hit that 16mm gauge neddle right into that juicy vessel and the red blood is racing the tubbing. (my nursing version of hit the nail on the head). I think nurses have a serious self esteam problem sometimes and don't give themselves credit for how much they know. I'ts not just about technical things, but remember how much you've learn in ethics, critical thinking, rights of patients, safety, mental health, social work, elderly, life and death...and the list goes on. There's still a reason why we are nurses! don't forget that and sell yourself cheap...c'mon yall

[netglow, ASN, RN]

But you all forget, the reason for the move to MAs is just that. They don't want thinkers. They just want "staff" to complete the list of tasks given.

I see movement to off floor management centers full of telemetry and live feed images from each patient room. Generalists probably NP/PA hospitalists will be responsible for managing the day to day. MAs will complete tasks given and talk to the camera on the wall as THEY perform assessments and med passes (No thinking, just doing, charting and reporting findings).

NP/PAs will supervise and will report back to a MD in a glassed-in central area within the management center (He's eating cheetos and watching SportsCenter and plotting fantasy football). He's there in case he's needed... better not bug him...

I don't see RNs in this mix, once it's all established.

[libran1984, ASN, RN]

The RN has more education and more responsibility....hence more money. The ADN, diploma, BSN debate is not in question here..... for all three educations allows one to have the education necessary to pass the NCLEX exam to become a RN....hence the argument...all pass the same exam ...... NO one is really "better than the other".

Not all states have LPN's in cute care anymore. I am sorry that you feel so little about your education that you re willing to hand it over to non- licensed personnel. It saddens me that you think so little of your education and patients that you think you can easily be replaced by non licensed personnel and that they will provide the same level of care as a licensed nurse.

As an ED nurse for 35 years....I disagree that "anyone" can be trained to know the intricacies of patients with multiple co-morbidities, triage them, critically think to know what needs to be done and effectively care for them and react in n emergent situation. You far under estimate your value.

I feel you are angry or hurt, maybe even resentful, at how much the nurse are paid. You are worth more...you should go back to school....but the answer isn't to allow non licensed personnel care for critically injured people...or sick patients. I remember the days of 1RN, 1LPN and 2 aids for 35 surgical patients with NGT and multiple drains, foleys, sump pumps...and it isn't pretty.

I m sad for you......You far underestimate your value. You far underestimate the RN's value, role and education.

You may be right, but I can't help but think, given 1-2 years of the same experiences as myself, someone such as an MA with his/her current education curriculum could become equally as qualified or better.

I truly believe in a bare bones novice to expert theory. Bare bones of it.

In reality, I see daily how much more nurses know and do than MAs in today's environment, but given the opportunity, could the MAs learn to thrive in a nurse's role? Could they learn through job experience how to perform nursing tasks and even make assessments? Lots of people learn more on the job than they ever did in school... couldn't that be applicable to an acute care MA? The foundations like 5 rights, pharmacology, and basic patient care seem to already be there... We can go into the pathophys and etiology of it all; that might differ between an MA and a nurse and provoke "critical thinking" required for certain tasks. Yet, while I've never been in an MA program, who am I to say they don't study pathophys with their education/curriculum? What if they did or actually do!?

I remember seeing and doing some of the most ridiculous mistakes from new nurses (LPN, RN, BSN), some of which I have done myself (although I won't list them here for sheer embarrassment)...

4mg Zofran IVP followed by a GI cocktail. Pt vomits GI cocktail. MD informed. Md asks, "Did you think to let the zofran work before you administered the GI cocktail?" Lesson learned and never once repeated. Lots of new grad LPNs, RNs, and BSNs have made this mistake. LOTS!! But it is a learning experience. I imagine an MA probably making a similar mistake and learning from it.

Pt discharged from ED without full infusion of antibiotics. Seen the new RNs do this plenty of times only to have the pt called back to have the infusion continued.

EKG not performed until after Xray, IV, and what not due to suspected asthma attack only to realize it wasn't an asthma attack but an MI. I'm sure that nurse will never make a mistake like that again.

Phenergan 25mg/1mL given over 3 minutes undiluted into a saline lock without maintenance fluids running behind it. Note: the pig tail/adapter holds total of 2mL . Then rapidly flushed with saline flush.

Larger sized Xfr tubes (NG/OG/Foley) are better for sucking up clots as opposed to the more easily placed 14fr tubes.

Always have an IV and a bag of saline handy when administering any form of Nitro.

These are things I have seen people learn on the job. They didn't seem to learn them in school the first time around, so perhaps having seen it in real life was better and perhaps these people will never forget! We learn from our mistakes. We should only hope our mistakes do not result in harm. With appropriate on the job training, I think we can make a successful apprenticeship for MAs as our peers!

::EDIT:: Correction- An MA friend said she did learn pathophys and etiology in her accredited associate degree MA program; but this may not be accurate for all MA programs.

[Howardhughes, ASN, BSN, RN]

I had a chance to work in a Psych facility a few years ago where Meds were passed by MA/NA....Psychotropics..... BP meds..... Folks had no idea what EPS was ...TD...hell they used 0700 BP values to pass Beta blockers that had just been increased...no you can keep the MA/NA in roles their education will support their skills..Humm I guess all that assessment stuff is overrated...because you have someone with 90 days training giving powerful meds to folks who may or may not have the cognition to ask for help...Folks we are dumbing down health care to cut costs. I want the best trained MEDICAL DOCTOR to review and treat me