Jeez, either some of us haven't been around long enough to know what 'the good old days' were, or some of us are so 'long in the tooth' we don't want to remember! I do know that the impact of working experiences depends greatly on geographic areas and institutional restrictions. My experience with team nursing was always most positive whether in hospital, LTC or Home Health Care. The areas and institutions in which I worked understood the scope of practice of the RN, LPN and aide and utilized those positions accordingly. The LPN used to be viewed and utilized as an Assistant to the RN. Every one knew what everyone else was responsible for...the RN supervised her aides and LPNs. She knew that her LPN could provide all the basic cares that an aide could plus all the skilled cares for which the LPN had been specifically trained. So I (and thousands upon thousands like me), received training in nursing school to do a great many things that, at that time, an aide could not do but an RN could. As my clinical experience grew so did my responsibilities; I was given more on the job training, took courses of all kinds, gained entry into the speciality areas where I could ultilze these skills...in different States and large teaching hospitals. All of my skilled training was provided by most excellent RNs who understood the absolute value of well trained LPNs. We worked along side of the RN and the aide. We filled in when the RN could not; we filled in when the aide could not; while the LPN passed meds, the RN might be giving a bed bath to help out an aide who was a bit behind; when the RN was imprisioned behind the desk and up to her kiester in paper, the LPN would make out care plans
for new admits or update old ones; as LPNs we admitted and discharged; we took phone orders, we contacted the doctors when needed-these things were not done without the RNs knowledge, but the RN knew she could continue her job, initial our work and sleep well at night. The LPN could take her training into a LTC setting and demonstrate excellent skilled supervisory abilities often, as in my ten year experience, without an RN overseer. Speaking for myself and the LPNs I worked with at the time, we didn't blink an eye when the IVs needed inserting and the NG tubes had to be placed. At the beginning of my post I used the word, "was"...I don't work in institutional settings anymore. Looking over my resume I see that I accomplished wonderful things as a nurse. I see that it has been faithfully updated with many CEU credits; it shows my Professional and community services to date; it does not, however, show any type of 'in-house' or agency experience since 1995. That is because my skills are no longer wanted or needed. I continue to practice nursing, but not with you guys. I am an advocate of Team Nursing, but I liked it better when it was a Partnership. I cannot tell you how much I miss the 'good old days'...God, we worked so well together and had such great times, all of us. Remember how we'd all pull together for our patient's best? Remember how we'd work so hard together-we aides, LPNs and RNs, and then find a bit of relaxation and release together when our shifts were over? I'm not in a position to pack up and find the place where nursing personnel work with each other, where my scope of practice hasn't been blurred by insurance regulations, institutional requirements and an American Nurses Association who tells me I am 'limited'. I can put up with a lot because I'm older now and have gotten used to it. However, I am reminded of the words of a wise old man..he said, "Our world is being destroyed by the very same 'do'gooders' who are trying to save it".
Sorry for the long post--but it's my one day off.