Are nurses being replaced?

[BC Roberts]

I have noticed that more often than not, I here that new grad nurses are looking for work and can not find a job. I am concerned that the nursing shortage that continues to be discussed so frequently is a projection of the future and not of the present. I have worked in several areas of nursing, including LTC, home healthcare and hospital med/surg. I have noticed a trend and am curious if others nurses in other states have seen this as well? I see more and more that unlicensed staff are able to do more tasks that traditionally nurses were only allowed to do, with patient to nurse ratio increasing. For example, in clinics, assisted living and LTC, medical assistants and medication aides both certified and not, are allowed to pass medications (even insulin! in some cases). Medication aides replace nurses in LTC and assisted living. In hospitals, patient care techs are allowed to place NG tubes, foley catheters, draw blood from PICC lines and do wound care. In the state where I live, the Nurse Practice Act states that tasks that require assessment can not be delegated. So my questions are these: If there are many more nurses now looking for jobs, than why are they being replaced by less skilled unlicensed workers? Why is this OK with Boards of Nursing if their stated goal is to protect the public. Aren't more skilled licensed individuals better? Why are individual hospitals allowed to designate unlicensed individuals with tasks that historically have required assessment when performing either before or after?

[gymnut]

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.

You speak the absolute truth!

I am a tech and we are chronically short staffed. Myself and the other techs are always getting called on our days off or being asked to work 4 hours extra and have day shift come in 4 hours early to create a pseudo night shift. It's to the point our nurses who were techs prior to becoming a nurse get pulled from their RN duties in order to work as techs when we can't find anyone.

We have several open positions for both full and part time and recently one of my friends applied there. She has 5 years experience working in a nursing home and recently started nursing school. The hospital told her that she didn't have the experience they were looking for. The only difference between what she did at LTC and what I do is draw blood and they train you on the job for that! So FINALLY they hired a person and this person has ZERO experience and is currently in her 6th week of training full time and still doing a horrible job (forgetting to get vitals on people, forgetting to enter or tell nurses about vitals, not emptying hats, bulbs, canisters and even forgetting to pass waters!).

So it's obvious what happened there. Management knows the experienced ones will expect more money in their paychecks but, Joe Schmoe off the street will be happy with the two shiny nickles you throw at him every two weeks.

[Asystole RN]

Myth #1 The Board of Nursing is there to protect the public and uphold nursing

-In reality each member of the Board of Nursing is a political appointee, they are chosen by hand because they support the Governor's position upon health care, not because they support nursing or have the public's best interest in mind. In the 80's the California Registered Board of Nursing attempted to create a bridge program with the California Medical Board that would allow a layman to go from secretary to RN to MD within a hospital without ever stepping a foot in a classroom or requiring a single A&P lector.

The members of the Boards of Nursing are political hacks....they are no longer nurses.

(BTW mother was a Pres. of said Board )

Under the guise of the "nursing shortage" some Boards have started including "Med Techs" and other non-licensed personel to start to take over some of the more traditional nursing jobs, this is something that all professional nurses must fight against, become politically active and join professional organizations!

P.S. Remember that LPN/LVNs were created in the same spirit as these unlicensed personel to replace RNs back in the day :sofahider

[BC Roberts]

Just to clarify -one point I want to make is this. Nurses go to school to be prepared for critical thinking and the skills that are required for procedures that nurses can do. Yes some of these tasks can be delegated. However, who should decide what can be delegated and what can not. The Nurse Practice Act in every state is supposed to clarify that, but is often vague and open to interpretation. So, when I see unlicensed staff allowed to perform procedures that historically nurses have done because it requires assessment, then it makes me wonder how long will nurses really be needed, especially when medical facilities make a decision about what unlicensed staff can and can not do. The Board of Nursing most likely is unaware- probably out of choice even though it is widespread practice in my state. So, yes it may be cost effective to have unlicensed persons do these procedures but I went to school to become a nurse not a business major. I think my focus should be, good patient care and safety and not the almighty dollar!!!!!!

[tokmom, BSN, RN]

Not in my organization. CNA can't even do accuchecks! Forget foley's etc...

[xtxrn, ASN, RN]

Med aides were a response to the nursing shortage (at least in TX). There weren't enough nurses to cover the shifts- so they had to do something. It doesn't take a 2 or 4 year education to follow a prescription label :) The med aides I worked with were very astute and took their jobs seriously. If there had been enough licensed staff, they wouldn't have come about. For a 140 bed facility there were 2 RNs (1 M-F, 1 W/E sup for the mandatory 8 hrs in 24 hours), and the DON, ADON, and me (MDS). Five RNs for 140 bed facility- that's it. There were a max of 5 LVNs on days and evenings, and 3 on nights (Med aides only on the medium-level care unit, not on Medicare).

[Katie82, RN]

The new grad job market is driven by the hospital's desire to offer 6 - 9 month "fellowships" to new grads. THis is both time consuming and costly for a hospital, and they usually end up hiring new grads in groups of 6 or less. My daughter got hired in a group of 4 after being out of school for a year. She recently finished the fellowship program and the hospital just hired 4 more new grads. Meanwhile, this hospital had 70+ openings for RN positions. Someone has to figure out a more efficient way to make the transition.

[xtxrn, ASN, RN]

The new grad job market is driven by the hospital's desire to offer 6 - 9 month "fellowships" to new grads. THis is both time consuming and costly for a hospital, and they usually end up hiring new grads in groups of 6 or less. My daughter got hired in a group of 4 after being out of school for a year. She recently finished the fellowship program and the hospital just hired 4 more new grads. Meanwhile, this hospital had 70+ openings for RN positions. Someone has to figure out a more efficient way to make the transition.

They used to give us a week or two of orientation, and then turn us loose !!

[OCNRN63, RN]

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.

This is the sort of mentality that will kill the nursing profession.

[lindarn]

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.

But doctors control their profession, and will never let lower educated individuals drive them out of business. That is the power of the AMA as opposed to the worthless ANA.

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

[DoGoodThenGo]

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.

Actually from what one remembers reading in dept of Labor and other predicted numbers of where employment will be in healthcare, greatest increase isn't in nursing but various techs and aides.

Which stands to reason; techs and aides require less education, are paid less and can be trained quickly to perform a specific task or simple range of duties. Oh and don't forget they also get to wear scrubs and tell people they have a career in "nursing" or the exciting field of healthcare.

[DoGoodThenGo]

But doctors control their profession, and will never let lower educated individuals drive them out of business. That is the power of the AMA as opposed to the worthless ANA.

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Somewhere in the PACNW

There you have it in a nut shell.

Not to be a wet blanket and or rain on anyone's parade, but very little if anything happens to the medical profession without doctor's say so.

When first AP nurses were allowed to write scripts there was quite allot of noise from doctors, but once things were tailored to their liking and or groud was ceded they really didn't want to hold onto anyway things settle down.

Physicans know how to frame an argumemt to patients/general public that will usually have the later choosing the former if given a choice.

In many areas just who is a professional nurse and what she/he does is becoming so muddled that is no wonder techs have been able to slip in with ease. It also explains why you are hearing allot more nurses talk about returning to whites (with or without caps), as it seems that is the only weapon left to them to put an end to title creep and being rendered invisable.

Mark my words, if things continue along these lines the profession will come to resemble just what the ANA proposed all those years ago; one or two RNs will plan,manage and evaluate whilst most of the care will be done by aides and techs. While this may sit fine with many think about the otherside of that fence; the need for fewer nurses.