Are nurses being replaced?

tyvin, BSN, RN · Jun 9, 2011

I saw this happening over 10 years ago when I started a job in a rather nice LTC facility. I was hired as a charge and during orientation they introduced me to the med aids and the facilities policy regarding them. At that time they could only pass oral meds (though now I know it's different depending on your state etc...).

Frankly I was shocked. My first question was are these med techs working under my license? Hmm I got strange answers to the effect that it would be under the DONs. I just couldn't get over the fact that some one other then a licensed nurse was allowed to pass the meds. It really threw me for a loop back then but I have gotten use to it now. I now realize these people are schooled and trained correctly. It was my own paranoia that blocked me from seeing how valuable they can be working with nurses.

I do not blame these people for wanting a career and for wanting to enjoy the autonomy that such positions create. We must face the fact that it is cheaper to hire them. That's why as licensed nurses we must create the future need for our services.

I see nursing leadership roles defining nursing patterns and opportunities that will put us in the forefront of the new emerging health care agenda.

We cannot stand idly by and let "others" define what will happen to nursing. Let's brainstorm and come forth to future nursing's position for the future.

Good luck to us all.

netglow, ASN, RN · Jun 9, 2011

Yup they are being replaced. The motivation is money honey.

No employer, even in healthcare, makes a single move unless there is financial gain anticipated. Nursing is a large cash drain on healthcare. The economy has caused a lot of folks to become purely speculative (I used this term for a reason) in business. Healthcare used to be sacred ground where ethics prevented such a risky approach. Healthcare corporations (which is everybody) have taken a huge leap and have been able to drastically change operations to save/make money and have been able to avoid getting burned. They've adopted a stock market-like speculative approach to patient's lives. EMR allows them too look good (everybody knows which checkboxes must be checked in order for the numbers to look good). I think the heavy influx of foreign nurses in the 90's produced a very strong infrastructure for greedy companies to get nurses basically by ordering them online. This took a while, but is very lucrative for the suppliers!!! They want their money! Also should one "unit" be a bad one, it can be trashed easily and replaced with another without consequence. BTW, I know someone whose neighbor is in this business.

It's like going to the dollar store to get stuff. You know you are not getting the best product, but you walked into that store knowing you'd be able to get a lot of product with the outward appearance (BSN) of the better product, not the quality but an excellent price. The financial gain overrules the risk in the eyes of administration. Corporations mess with your life daily. The more powerful they get, the more risk they take. Actually there is almost no risk, as the larger they get the more lobby power they command. Government will not/cannot prevent them from doing as they wish.

Here is an example googled easily on the internet. It's a well known case, and this stuff still happens in one reincarnation or another, I wonder if healthcare is going down this road:

http://www.wfu.edu/~palmitar/Law&Valuation/Papers/1999/Leggett-pinto.html

Research Time Warner, Proctor and Gamble, etc. Very enlightening if you weren't already aware, you should be.

RNperdiem, RN · Jun 9, 2011

It depends on where you work.

In doctors' offices, MAs now run the show. Nurses way outnumbered by MA staff there.

I have not seen much replacing nurses in the hospital where I work yet.

gymnut · Jun 9, 2011

It's getting like that here too.

When I was younger and went to the doctors office I was always seen by a nurse first and then the doctor. Now it's all MAs. When I visited my grandparents in LTC it was mostly nurses and now it's 1 charge, the rest LPNs and CNAs. There is only one nursing home in my area that is RN only.

My next door neighbor is an OR nurse and she said that hospitals have been replacing them with surg techs (well for the scrub role at least). It's all about money in the end. She makes over $40/hr so why have her scrub when you can get a tech for $16/hr?

I see it as good and bad. It's bad for all the people who went on to become an RN and slowly see their jobs dwindling but it's good for people who want to enter the medical field but have no desire to become a nurse, PA or doctor.

Actually I wonder if doctors feel that way about PAs? I know I see more of them than I do doctors on our floor.

mariposabella · Jun 9, 2011

Well thats definitely not good news and not want I want to hear. Im so sick of hearing of hearing about greed in this country. How the heck is an MA going to replace a nurse??? That just ****** me off. BIG difference between the two.

eriksoln, BSN, RN · Jun 9, 2011

I've made many a comment before about med techs being used. I believe the practice was most popular in TX and FLA, where they used nursing homes as the testing grounds. Then, with the results being mixed, the practice was picked up by a few hospitals. Now, administration across the country are crunching the numbers to see if it will benefit them long term.

Its no secret that hospitals and other facilities know the exact number of lawsuits their insurance will cover without going up. If said number (X) = (Y) pt. falls + (Z) med errors causing harm and the resulting lawsuits equal or are less than X..............then they will move forward and do it. All the while, they will point the finger at the nurses, saying we are too costly and that we priced ourselves out of the marker (and believe me, the general public falls for this stuff).

Its not as if lowering the quality of care by means of cheapening the standards for the workforce is new. Its been happening the past couple decades, right under the RN's eyes but hardly anyone bats an eye about it. When they economy was good, most hospitals ran a tight ship, expecting everyone from housekeeping on up to be safe for medical care work. Not now. Housekeeping, transports, CNA's............just about every ancillary staff position has seen the standards for filling said position nose dive. Min. wage and no benefits only gets you a certain class of worker..........so there was no choice.

Housekeeping:

Then - Better trained on the effects of infection control. NEVER had to be told to wear a gown in an ISO room or while cleaning a vacated ISO room. Special procedures for cleaning ISO rooms were in place (and actually followed). Understood pt. flow and why certain rooms needed done before others, had the time management skills to get w/e room was most necessary at the time cleaned. Knew enough about pt. diets to not give the NPO pt. water or the diabetic graham crackers.

Now - Most are your everyday run of the mill Hotel housekeepers. Start on one end of the unit, go into each room, get the min. amt. done so you can check it off your list...........and leave. The only time they are even slightly interested in "pt. flow" is when they are finding out who is a probable D/C (so they wont clean the room, one less to worry about), otherwise, they just start on one end and work down the hall..........don't waste your time telling them the other room down the hall needs done first ("I'll get there"). Can't understand the difference between NPO and Cardiac Health diet, so they simply tell the patients "Sorry, not my job to fetch snacks, your aid will be in sometime today to attend to that."

Transports:

Then - Most transports used to be CNAs, or were at least trained like one, and were hospital workers. They could get the ambulatory/min. assist patients into the wheelchairs themselves. Understood simple common sense ideas such as: If the pt. is on oxygen in the room, the will probably need it while being transported.

Now - Outsourced job position 90% of the time. W/E company gets used does not provide any training with pt. handling or safety other than "Don't touch anything, get the aid/nurse to do it". Won't touch a patient for transportation who isn't already in the wheelchair/cart for them already. Has to have detailed "Transport Tickets" to know what to do with a patient, and doesn't divert from said ticket at all. If the ticket says no oxygen, n/m they are turning blue and screaming at you that they are actually oxygen dependent. The ticket says no oxygen, so you get none.

These two examples were cost cutting measures by hospitals that raised profits for CEOs and "the board" but put pt. safety at risk. Again though, if Y+Z

The worst cost cutting measure, the one that seems to go unnoticed, involves Pt. Care Techs and/or Aides. Not that long ago, there was a big push for aides to become certified. The idea was that they would then act with a sense of accountability AND deliver safer/well educated care. Why the abd. pillow was so important for a post hip repair pt. was understood by them.................why you don't press the buttons on a heparin gtt. didn't have to be explained to them time and time again.............when to get the nurse because of an abnormal vital sign was not a mental cramp.

Then hospitals realized "Hmmmm, our idea for better care is working a little too good. These CNA's are going to want paid. We can't become dependent on them." So, back to the old style of hiring/training aides. Now, any Molly/Matt off the street who proclaims "I wanna help people" is allowed to fill the position. [Drum roll] And the best part is, they are trained by other off the street aides who have no clue. The blind leading the blind. Most aides today could not tell you how to properly sit up a post OP pt., how to help someone complaining of pain while the nurse is getting their meds............couldn't tell you much more than..........well, how to punch in and punch out on the time clock.

The choice of "wage cost over pt. safety/satisfaction" is glaring here, but................administration points the finger at its nurses, the general public falls for it and the issue never gets addressed. There was a thread talking about how "unliked" nurses have become with the general public not too long ago. It focused on a thread in which there were a lot of negative comments concerning nurses. I wonder what those posters would think if they were more educated on issues like this?

steelcityrn, RN · Jun 9, 2011

Insurance companies are not going to pay for acute care without a licensed professional taking care of them. There may be virtual nurses used in the future, but I do not believe they will ever be used for the total care of a patient in an acute care setting.

eriksoln, BSN, RN · Jun 9, 2011

Insurance companies are not going to pay for acute care without a licensed professional taking care of them. There may be virtual nurses used in the future, but I do not believe they will ever be used for the total care of a patient in an acute care setting.

I was kinda thinking that too after I posted.

"How would med techs go over in the ICU and ED?".

Hmmmm..........food for thought. Time to get outta M/S and into ED/ICU/Step-down.

AnnemRN · Jun 9, 2011

All you have to do is go to the career/employment section of local hospital websites, clinics etc. to see MA's & tech job openings far outnumber nursing positions.

eriksoln, BSN, RN · Jun 9, 2011

All you have to do is go to the career/employment section of local hospital websites, clinics etc. to see MA's & tech job openings far outnumber nursing positions.

I wonder about this though. I for one have known for a long time MANY positions are posted, but very few are truly "open". In other words: There are a great many positions posted that admin. have no plans on filling any time soon.

My current facility has a chronic/dire shortage of Aides. There are probably close to 20 Aid positions posted (to the public, not internal) that never get filled. I personally know of 2 experienced aides who applied for multiple positions and were not even called for an interview. I've talked to other nurses who also know people who've applied, with the same results. I've also talked to people in the public who've applied to the hospital (various positions, some for aid, some for others) who also don't even get a phone call or interview.

I used to travel nurse and I'd go through my company's listings to decide where I'd be going next. Often, my recruiter would tell me "We think this job is a bait and switch. They have not hired anyone for over a year for it, but keep posting it."

I think admin. likes to post jobs they don't plan on filling to give the current workers the impression that "help is on the way" or "it's not admin.'s fault we are so short staffed, they are trying to hire." The reality is, they are fine and happy running the facilities dangerously short staffed.

HouTx, BSN, MSN, EdD · Jun 9, 2011

The key to this issue is for nurses to become more engaged with their state's BON - where scopes of practice are defined. In Texas, we currently have one of the most proscriptive nurse practice acts in the country. In fact, I believe we are still the only state that has a legally defined "nurse patient duty" that cannot be superceded by anyone, including physicians.

Our Texas nurse practice act requires us (RNs) to consider any clinician "unlicensed assistive personnel" if he/she is acting outside his/her designated scope of practice. So, for instanced, EMTs are not allowed to perform high level tasks in a hospital because they are only licensed as first responders. I have never encountered a Med Tech or MA in an acute care setting. MAny hospitals still train their own aides because the CNA curriculum is based on a LTC model that is not applicable to acute care.

I agree that dwindling reimbursement will continue to have an impact on staffing. Many facilities are unable to afford an 'all RN' or 'all licensed' care team any longer. Based on my own experience, it seems that RNs today are not very comfortable with skills needed to work with unlicensed staff. As nurses, we need to accept this reality and work to establish staffing models that support quality without increasing cost. This may mean 'giving up' tasks that can be safely delegated.