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.

[nurseladybug12]

libran1984, are you a LPN or MA? I'm going to be blunt and offensive in my comment, sorry. I went to school with a lot of idiots taking prereq math, chemistry, and anatomy and phys who were repeating these classes for failing, some were repeating them for the third time, still hoping to apply to nursing school. I thought to myself , oh god if they cant even pass a basic algebra class or anatomy and phys, or take the time to study for these classes in order to pass or get some extra tutoring to make it happen, I pray they do not ever become a nurse. When classmates of mine failed nursing school exams in the first semester and would argue for points in the exam reviews and sound like complete morons because they lack critical thinking skills, I thought good riddance when I finally noticed these same people never came back to class again because they had to drop out because they couldnt hack it. Nursing programs are competitive and weed people out who are not dedicated and who dont show some form of intelligence needed to do the job. Nursing school is intense and life consuming and if you dont have the dedication to study, make hard sacrifices, and deal with writing careplans, which require critical thinking, at all hours of the night just before you have to wake up at 5 am for clinicals, then you just are not cut out for it because real nursing is much harder than all of this. I dont know what MA school entails but MAs dont know what nursing school entails either and I hate when people- PCAs CNAs LPNs who have not been through the rigors of nursing school presume to think they can do our job. Yes anyone can learn the hands on nursing skills, but do you have the brains to make it to and through nursing school, and pass the boards to be licensed to take responsibility for the lives of pts when crap hits the fan? It's insulting after all of my hard work and dedication to hear this.

[Chisca, RN]

One third of the nurses in the US are over 50. There is going to be a huge shortage as these nurses leave the workforce and there aren't enough replacements.

http://bhpr.hrsa.gov/healthworkforce1/reports/nursingworkforce/nursingworkforcefullreport.pdf

[libran1984, ASN, RN]

libran1984, are you a LPN or MA? I'm going to be blunt and offensive in my comment, sorry. I went to school with a lot of idiots taking prereq math, chemistry, and anatomy and phys who were repeating these classes for failing, some were repeating them for the third time, still hoping to apply to nursing school. I thought to myself , oh god if they cant even pass a basic algebra class or anatomy and phys, or take the time to study for these classes in order to pass or get some extra tutoring to make it happen, I pray they do not ever become a nurse. When classmates of mine failed nursing school exams in the first semester and would argue for points in the exam reviews and sound like complete morons because they lack critical thinking skills, I thought good riddance when I finally noticed these same people never came back to class again because they had to drop out because they couldnt hack it. Nursing programs are competitive and weed people out who are not dedicated and who dont show some form of intelligence needed to do the job. Nursing school is intense and life consuming and if you dont have the dedication to study, make hard sacrifices, and deal with writing careplans, which require critical thinking, at all hours of the night just before you have to wake up at 5 am for clinicals, then you just are not cut out for it because real nursing is much harder than all of this. I dont know what MA school entails but MAs dont know what nursing school entails either and I hate when people- PCAs CNAs LPNs who have not been through the rigors of nursing school presume to think they can do our job. Yes anyone can learn the hands on nursing skills, but do you have the brains to make it to and through nursing school, and pass the boards to be licensed to take responsibility for the lives of pts when crap hits the fan? It's insulting after all of my hard work and dedication to hear this.

HAHA!! You are right on so many levels. This was not offensive or rude at all.

I literally just said the same thing to my friends. I'm finishing up the last and only new class for my LPN to RN. We were having a study group and a friend was complaining of a QMA that works with her and she was having trouble expressing her frustration with this QMA, so I said, "you mean you're tired of them thinking that they're the nurse?" And she said, "EXACTLY!"

I really do get it. I also think quite often, "thank god person will never get into the nursing program". I often also think of my own peers, "How did they get into the nursing program?"

Yet, I believe that if someone, like an MA, is passionate about a field of interest, they could become an invaluable resource and through proper training, become equally as competent as any nurse without the formalized education.

I think that critical thinking skills come from experience rather than text books and lectures. Those only highlight the most important and critical worries. Yet, where is the thinking part of this critical if it is merely just a memorized fact to pass a test.

No worries, Nurseladybug12. No one will be taking over nursing except for the BSNs (j/k j/k - another topic another time lol). We have secured our position, I believe.

I do get saddened by the distribution of nursing tasks. It seems there are forever more and more specialists that are taking away our duties. Lol, and here I am saying an MA could do our job for us. Sadly, I do think, in all honesty, most of the time a well-trained MA could do our job for us. Thankfully laws and legalities will not allow that to happen.

[LadyFree28, BSN, LPN, RN]

libran1984 are you a LPN or MA? I'm going to be blunt and offensive in my comment, sorry. I went to school with a lot of idiots taking prereq math, chemistry, and anatomy and phys who were repeating these classes for failing, some were repeating them for the third time, still hoping to apply to nursing school. I thought to myself , oh god if they cant even pass a basic algebra class or anatomy and phys, or take the time to study for these classes in order to pass or get some extra tutoring to make it happen, I pray they do not ever become a nurse. When classmates of mine failed nursing school exams in the first semester and would argue for points in the exam reviews and sound like complete morons because they lack critical thinking skills, I thought good riddance when I finally noticed these same people never came back to class again because they had to drop out because they couldnt hack it. Nursing programs are competitive and weed people out who are not dedicated and who dont show some form of intelligence needed to do the job. Nursing school is intense and life consuming and if you dont have the dedication to study, make hard sacrifices, and deal with writing careplans, which require critical thinking, at all hours of the night just before you have to wake up at 5 am for clinicals, then you just are not cut out for it because real nursing is much harder than all of this. I dont know what MA school entails but MAs dont know what nursing school entails either and I hate when people- PCAs CNAs LPNs who have not been through the rigors of nursing school presume to think they can do our job. Yes anyone can learn the hands on nursing skills, but do you have the brains to make it to and through nursing school, and pass the boards to be licensed to take responsibility for the lives of pts when crap hits the fan? It's insulting after all of my hard work and dedication to hear this.[/quote']

I just want to point out that LPNs learn about nursing theory and critical thinking skills...Practical nursing school is just as rigorous as a RN program.

I've been a Benner Fan since 2004-when I learned about novice to expert in PN school; when I went through my BSN program, I did a paper on a transition to practice model using the theory. I would LOVE to meet her...I think she is spot ON in her theory; her theory on clinical practice has allowed me not to burnout and to enjoy my clinical practice.

FWIW, working in this business for 13 years and have been in a "task position" to LPN to RN; one CAN NOT compare the skill set and scope in each; although I will say my LPN background helped me tremendously during my BSN program; however, the BSN did sharpen my critical thinking, learning more in depth about hospital economics (although I had extensive knowledge of those economics working as a contractor though CMS) nursing economics, policy preparedness (on a beginning scale for bachelors) that added, at least for me, added depth in terms of making informed decisions for my career and help me contribute to continuing this profession-carrying the torch for the ones who will be retiring and need us at the bedside and to educate and empower; I couldn't to that as a skilled tech after 5 years (proficient)-I saw the writing on the wall that I needed to do more for my patients; as a LPN after 7 years (considered expert per Benner) and I wanted to do MORE, although my scope is broad in my state, I wanted MORE flexibility; as a RN and now learning my first leadership experience, I can see where my past experiences and my new knowledge can help create an effective practice; it's NOT about the tasks; it's about knowing what I expect when one has to call the MD and advocate for the patient with one look at the patient or when you get new rest results; or creating teachable moments to unlicensed personnel when communicating to people who have emotional and mental health issues, as well as patients with Alzheimer's and Dementia; or residual effects from a stroke or TBI. I've seen "expert" CNAs have actual concern for a pt who is having a change in mentation, but because I utilize the nursing process, I am able to advise on how to handle those behaviors by having safety checks because it's not pathological, but psychological...that's the difference in being a proficient-expert nurse vs, proficient-expert "task worker." There will ALWAYS be a REASON behind the "tasks"; seeing the forest beyond the trees...I'm able to do it as a RN; I had to collaborate as a LPN to make sure it was effective, and I knew I had to do more as a tech, but did not have the information of the nursing process to do so...and CNA/MA, etc, do not have the hours entailed to go into depth..,they have to return to school, as many have done, such as myself.

As much as big business can try, nursing CAN NOT be replaced; and that's why our business has been so cyclical...what's happening has happened before as Esme stated on team nursing; I know nurses who did that model 20-30 years ago; one was my research instructor that helped instill changes at one of my local hospitals doing EBP. That's how she decided to contribute to nursing; her view was to make them LISTEN, she had to "back it up."

My instructor told us-I will paraphrase her wordy soliloquy-WE nurses must take the wheel NOW...any way we can; from bedside to leadership; we know know what works, and what doesn't.

[loveoverpride]

One third of the nurses in the US are over 50. There is going to be a huge shortage as these nurses leave the workforce and there aren't enough replacements.

http://bhpr.hrsa.gov/healthworkforce1/reports/nursingworkforce/nursingworkforcefullreport.pdf

Well then it's back to hitting the books again tonight for this little nursing student...I refuse & will NEVER ever let a patient suffer & not be able to receive the right kind of care, that they deserve; just because some bonehead bigwigs want to keep making cuts & unsafe changes. This coming from a person who is in fact a certified MA & a current Nursing Student (going for my LPN right now, & then God-willing a little further down the line RN.)

I can tell you for a FACT that going to school to be an MA (I didn't attend a 6-month program, I did a full yr.) However, even in that full year, I PROMISE you that it didn't even begin to scratch the surface in regards to what an actual Nurse has to know.

Yes, anyone (like a monkey/puppet) can just pump out meds, and stick an arm with a needle or two, and maybe even hang an IV bag. HOWEVER Nurses are trained to do so much more then that. Nurses are not only trained for the physical actions of performing tasks, but to know the "Why" and the Reason behind the specific task they are performing, & furthermore the reason why they are performing the specific task for the specific pt in question. There is a reason why we have our own license, there is a reason why a Nurse can be sued for Malpractice (rare, but can happen), there is a reason why NURSES have to know many things on the same level that a Doctor does.

MA's aren't trained to be pt advocates (Nurses are!) MA's are Doctor advocates! Biggest difference right there! An MA will listen to the Doctor's order's without batting an eye each & every time!! (Lord, I cringe to think of how many future pt's who have a potassium level of 3.5, will be given a diuretic at the hands of an MA from the orders of a Dr.) Where is the objectivity?

If the MA is working for a Doctor (obviously under his license) who is looking out for the pt? An MA can't tell a Doctor "No" (well they can, but they will be saying it while a chart is being thrown at them, or maybe a computer now w/ the recent changes, while they are walking out the door.) A Nurse can voice a concern to a Doctor & has every right to say that they don't feel comfortable administering (let's say the above diuretic like I mentioned) to a particular pt, because that Nurse's training, knowledge, experience, license, and advocacy of the Pt gives them the right, and the privilege to do so.

I wonder if Pt's have any idea, what the difference between what an MA and an actual Nurse is? Especially because I have seen with my own eyes, MA's basically infer that they were "the nurse" and I've never ONCE seen an MA correct a pt when that pt called them "Nurse." Part of the reason why I'm going to school to become a Nurse is because, I want to earn that right, privilege and title.

I'm starting to think that maybe Nurses need to get together, ALL of us Nurses & future Nurses (RN's and LPN's will have to stand strong & unite on this one, for the love of our profession & our future pt's) and maybe start having "walks" and "demonstrations" and start passing out flyers informing people (who are not in the medical field) exactly what the differences are, and that an MA is NOT licensed, they are under a Dr's license (who isn't physically supervising them most of the time) & that there is NO objectivity or advocacy for the Pt with an MA. Let the Pt know what's really going on, and what is happening to the Nurses! (the real one's not the fake wannabe MA's) The way I see it, is that 1 of 2 things are going to happen: 1-Pt's will start demanding things to go back to the way it was (LPN's & RN's being treated fairly, working together in harmony, being allowed to spend more time & actually care for a PT, and most importantly living out what Florence Nightingale's vision was and staying true to our oath!) or 2- It's inevitable that eventually an MA will screw up to the point that it just can't be covered up (the future Nurse in me can't help but feel bad for the poor future pt who will be the 1 to really suffer) & Doctor's will grow tired of being sued over it and will hopefully take they're heads out of the sand.

[Art_Vandelay]

This will only serve to accelerate a trend that has been going on a long time in nursing - to de-skill and deprofessionalize our profession, due to concerns by TPTB of $$$. Nursing 'tasks" are broken down and then given, piece by piece, to poorly-paid non-professionals. Once these vital parts of the nursing role are porificed out to unlicensed personnel, we have lost these pieces of nursing forever. I believe the ACA will only make this trend much worse.

If you wish to see what the constraints of government-funded healthcare has done to the profession of nursing, one only has to look to the typical nursing home (i.e., the ones where Medicaid is the main source of reimbursement, not private pay).

As far as nursing homes, I attribute the horrible staffing to the "for profit" nature of the company, not government reimbursements.

With that being said, the hiring of MAs in lieu RNs is another example of the decline of healthcare in this country. The goals now are money, standard protocol, avoidance of lawsuits, and how quickly the provider can see/medicate the patient, not actually to get to know him and collaborate as a team.

Not that I am against MAs, it's just American healthcare priorities are extremely twisted and misguided.

[Stephalump]

My best friend is heading to PA school and decided to get her required health care experience through working as an MA. She has a Master's degree in another field, so she's far from a traditional MA student, and I think it gave her an interesting perspective.

I have to say, I was mortified weekly by the tales of her peers, professors, and overall education. Kids who barely made it out of high school, couldn't cut it in college, could barely read or write, much less think critically whatsoever. Homework consisted of things like writing vocabulary words and looking at the warning labels on bottles of Tylenol.

The professors, while experienced MAs, came before the times of MA college programs, so not only were they not trained to teach, they didn't even GO to college. They were running a classroom, teaching things like patho and pharm, and knew close to nothing. Which means the students came out knowing even less. They spent more time learning how to file in alphabetical order and answer phones than skills, because skills vary so much from specialty to specialty, and the physician could have them do almost ANYthing.

Her biggest complaint now that she's working is the knowledge gap. She isn't qualified to educate the patient on anything, but the physicians aren't really into it either (shocking, I know)...so who should do it?

I think MAs serve a purpose, and I know for a fact there are great ones out there. It's also a great career path for those who want a good job but maybe aren't truly college bound.

But it terrifies me that they can take the place of a nurse. There is no comparison, except we both wear scrubs and know how to give injections. I hope these new "intense" tiered programs provide sufficient education.

But I have to ask...

Why would anyone put in the same amount of work in a program just to get paid less?

[HHN2472]

I deal with MA's on a daily basis when calling Drs offices. Today in fact (which is the only reason I am responding to this post), I spoke with one about a pt on Levaquin... Her response was... What's that again? A pain med? She has worked there over a year. Not worried yet. That isn't even the dumbest thing I have heard from them. I am not belittling them, but seriously? I'm not saying that most aren't intelligent, but I speak with many of them throughout the day and it is like talking to any random Joe. Very frustrating. Statistics are rarely wrong and 75% of my convos with them end in frustration or me thinking "*****? Did you even read a Pharmacology book?"

[Marisette, BSN, RN]

I saw this coming for awhile. I posted about this awhile back. I now see employment ads for technicians in the G.I lab and Cardiac Cath. lab. Now you can argue that they don't perform at the levels of the RN's scope of practice. Still employers will hire lower wage earners that can perform the "technical" part of the work and hire less RN's to perform assessment or medication administration. But bottom line, the nurse still bears the responsibility for supervising the technical employees, and is still responsible for the bulk of the work. Personally, I find my work load is easier when I work with other RN's, more than the assist of technicians, or MA's. I have to question the need for all this nursing education when many RN's are not able to find employment, even if advanced education effects the quality of care delivered to the patient. We will have BSN graduates still unable to find employment and if you look at this site, you will find that that's not so uncommon.

[Eru Ilúvatar]

I have been following this thread and all the answers and I am horrified of some people saying that a MA can replace the role of a RN from a knowledge perspective.

It may be true that mostly anyone can perform mechanical tasks with a certain proficiency, but degrading a RN or LPN role to mere completion of tasks is insulting.

The RN title entails a minimum of knowledge for entry in the profession, it means there are things that not need to be taught to a licensed professional. It also expresses a certain level of independence and autonomy to make decisions for the patient's sake.

If patient care were to become a task oriented only process then why not get rid of MDs alltogether, after all any unlicensed individual can be teach to look up symptoms using Google and make a diagnosis no? Why do we need licensed professionals safegarding the patients wellbeing if we can replace them all with lower paid individuals, which many may be smart but lack the same preparation and oversight as a licensed professional does. ( Do please note the sarcastic tone in this remark) Also while at it lets get rid of all licensed professionals, Accountants (CPA) , Physicians (MD) , Stockbrokers , Psycologist , etc , we can replace them all with anyone who can perform a bunch of task lined up in a paper cant they?

Again is not about being able to perform a task, is about having the theoretical knowledge in your head so if a situation that is not described in a paper or a book comes to you , you have the capacity to use your learned knowledge and come out with a solution.

Please dont give in the propaganda of Corporations that only advocate for their profit, and never for the good of a profession or a patient ( and yes they are patients not costumers, we dont sell cars or tvs, we take care of people and nurse them into wellness)

My 2 cents...

Bryan

[elijahvegas, ASN, RN, EMT-P]

You might be able to train an MA to pass meds, but will they understand how that medication works within the body, what effects it may have on the patient's other diseases, or what medication interactions may occur? You can teach just about anyone a skill, that doesn't mean they understand what they are doing or why. That is a HUGE reason why this is a terrible idea!

statements like these as of late have really been beginning to irk me. Im all in favor of knowledge of pharmacology an pathophysiology, but you're not a low/mid level provider to act autonomously. CNAs MAs LPNs even RNs dont pass or prescribe meds based on their own findings. They assess, and pass it on to the all-knowing all-seeing docs from above that then tell us what to give. They know better, and if thats whats ordered, thats what we give. The knowledge only comes in handy if we're looking to make sure the doc hasn't overlooked something or made an error, which happens to just about anyone and everyone in healthcare at some point in time. Sure you could save a life, and sure it could cost a life, but the bottom line is, we're not nearly as autonomous as we'd like to think. We're merely extensions of the doc, being at all the places they cant be to free up time for them to Dx and Rx

[SoldierNurse22, BSN, RN]

statements like these as of late have really been beginning to irk me. Im all in favor of knowledge of pharmacology an pathophysiology, but you're not a low/mid level provider to act autonomously. CNAs MAs LPNs even RNs dont pass or prescribe meds based on their own findings. They assess, and pass it on to the all-knowing all-seeing docs from above that then tell us what to give. They know better, and if thats whats ordered, thats what we give. The knowledge only comes in handy if we're looking to make sure the doc hasn't overlooked something or made an error, which happens to just about anyone and everyone in healthcare at some point in time. Sure you could save a life, and sure it could cost a life, but the bottom line is, we're not nearly as autonomous as we'd like to think. We're merely extensions of the doc, being at all the places they cant be to free up time for them to Dx and Rx

Wrong, wrong and more wrong. Your work is tightly connected with that of the medical care of the patient, but nursing care of a patient is inherently different than the medical care of that same patient. If you're merely an "extension of the doc", then how is it you can get sued for giving a medication that is contraindicated and the doc isn't implicated in the error?

No, we don't prescribe. We don't write the "orders", we don't make the big decisions that people see. We're the ones who catch the errors, who make suggestions and collaborate with colleagues (physicians and other providers), hopefully for the good of the patient. How can we do that? Because we are educated and subsequently, we develop the ability to critically think by integrating our critical thinking abilities, bedside skills and knowledge of the patient, pharmacology, anatomy/physiology and pathophysiology.

A very wise instructor once told us that patients don't get admitted to the hospital to see doctors. They get admitted for the skilled nursing care. After all, if you simply needed a gallbladder out and the doc was all you wanted, you'd get the surgery done and go home, right? Who needs dressing changes, vitals monitoring, assistance with pain management, etc? And while the doctor and nurse collaborate on many of the issues patients face post-procedure or during treatment while in a hospital, it is ultimately up to the nurse to assess, evaluate, advocate and carry through on behalf of the patient.