The 'De-Skilling' Of Nursing

[Good Morning, Gil]

I don't want to mix my own drugs. With all of the paperwork/charting on top of the nursing care, I wouldn't have time, and am glad pharmacy does this. We don't have any CNA's, and we draw all our own labs in my ICU (which is typical in ICU's), so I guess this article really isn't applicable in that setting.

But, I can see how it is applicable almost everywhere else. I see what you're saying, but I still think nurses are valuable, and the skills that are being taken away from us are not rocket science. Anyone can d/c a peripheral IV or urinary catheter, though I do think that only nurses should be inserting foley catheters.

I do also think that only RN's and LPNs should be allowed to administer medication. I don't think a medication tech has the knowledge base to administer them safely. A lot goes into administering meds, knowing the side effects, their use, when to hold them, and especially in the poly-pharmacy world that is geriatrics, it is unsafe. This can only be taught in nursing school since one pharmacology course does not cover this; you need to understand human physiology to know why certain meds need to be given and others held.

[TheCommuter, BSN, RN]

Although the typical shift of the bedside nurse is already busy enough, and even though the skills that have already been removed from nursing are not the most complicated, this issue is problematic.

Why should we be concerned? If there's even one unemployed nurse in society who desperately wants to work, then the de-skilling of nursing has become out of control. We need to stop blowing this issue off for the sake of the unemployed new grads and jobless experienced nurses who would kill to be working.

Jobs that could be performed by licensed nurses (RNs and LPNs) are being done by others. This means that one nurse out there is jobless while some technician, medication aide, therapist, or phlebotomist out there gains a job.

[ocankhe]

Nursing has been de-skilling for many decades... respiratory therapy , nutrion, PT & OT were once part of the RNs role. On the other hand nurses have added skills that were once the performed by MDs only. The question is balance, I don't mind loosing skills if I am gaining (for lack of better term) more advanced skills and commensurate compensation for those skills.

[SHGR, MSN, RN, CNS]

Great article (as usual)! The physical therapists doing wound care is concerning to me. I understand having techs do some skills, and medication aides, from a cost perspective; phlebotomy makes sense, in that way; but now that PT's have to have a doctorate, how does that at all make sense since we have WOCNs that do wonderful work? The first time I saw this, it was a PT that came in to my (back in my med surg days) primary patient's room every day to do this pulse lavage treatment that was pretty new at the time. It just seemed like a way for their department to generate revenue. Didn't benefit the patient. Maybe because "nursing services" come just, you know, bundled in the room payment.

[TheCommuter, BSN, RN]

. . .but now that PT's have to have a doctorate, how does that at all make sense since we have WOCNs that do wonderful work? The first time I saw this, it was a PT that came in to my (back in my med surg days) primary patient's room every day to do this pulse lavage treatment that was pretty new at the time. It just seemed like a way for their department to generate revenue. Didn't benefit the patient. Maybe because "nursing services" come just, you know, bundled in the room payment.

Yes. My place of employment (an acute rehabilitation hospital) has a wound care team that consists of physical therapists and occupational therapists who can bill and charge for every dressing change, ACE wrap, wound vac application, and every type of simple and complicated wound care treatment possible.

From a monetary perspective, the PTs/OTs generally earn higher salaries and can bill for wound care services when a certified wound care nurse could accomplish the same tasks in a more cost-effective manner. Just another nursing job being displaced...

[Despareux]

What I went to school for is different from how I get to actually practice at my work. I feel like I'm handing out meds and doing treatments more so than the things that would actually increase my patient's wellness. It is cost-effective to have 2 CNAs for 1 nurse, but it's not helping the patient gain much in the way of long-term wellness.

[adnrnstudent, ASN, RN]

Nursing is making their own bed. The efforts to "elevate" the profession are what's downsizing it.

[TheCommuter, BSN, RN]

Nursing has been de-skilling for many decades... respiratory therapy , nutrion, PT & OT were once part of the RNs role.

Also, obstetrics was once within the strict realm of nursing (midwifery). Even though nurse midwives still exist, obstetrics and childbirth have been taken over by physicians due to a widespread smear campaign against the nurse midwifery profession during the last century.

On the other hand nurses have added skills that were once the performed by MDs only. The question is balance, I don't mind loosing skills if I am gaining (for lack of better term) more advanced skills and commensurate compensation for those skills.

I'll agree that nurses are gaining a handful of more advanced skills. However, we are also gaining more accountability without the corresponding authority. We are also entering an era of stagnating and/or deflating nursing wages.

[wooh, BSN, RN]

Nursing has been de-skilling for many decades... respiratory therapy , nutrion, PT & OT were once part of the RNs role. On the other hand nurses have added skills that were once the performed by MDs only. The question is balance, I don't mind loosing skills if I am gaining (for lack of better term) more advanced skills and commensurate compensation for those skills.

I think the balance is what's important. I just found out that repairing central lines has gone from being a surgeon's job to a nursing job. Which is great! Turning over less-skilled functions is fine as long as at the same time we're taking on more-skilled functions.

I think the real problem comes from billing. As long as another department gets to charge, and nurses continue to earn no more for the hospital bottom line than the curtains in the room (but cost a lot more than the curtains), hospitals will look to find ways to cut our numbers. Other departments have found ways to ADD to the bottom line. RTs charge for each treatment. PTs charge for each wound treatment or therapy session. But nurses continue to just be bundled in with the room. Until nursing can start BILLING FOR OUR SERVICES, we're going to be considered merely a very expensive piece of furniture in the patient room.

[GeneralJinjur]

Until nursing can start BILLING FOR OUR SERVICES, we're going to be considered merely a very expensive piece of furniture in the patient room.

Too bad we couldn't bill for each call light answered.

[Esme12, ASN, BSN, RN]

I have said on many occasions.....we are going to educate ourselves out of the bedside if we keep insisting that "isn't a nursing duty". I have worked in ICUs that I draw all labs and EKGS and I have worked in ICUs that those tasks were done by someone else.

When I started nursing in the ICU we did it all. We mixed our meds, did our own labs, mixed our own gtts and "Hyperal" We had to be very specially trained to be there and our patients needed very specialized care. We may not have had all the "fancy equipment" but we had vents, balloon pumps, temp pacers, and gambros. Our MI's had all the arrhythmias because we didn't intervene. Inferiors had Brady's and heart blocks...your anteriors Vtach/Vfib. If they developed a murmor......we called the MD......they weren't going to do well.

We trialed the new meds....hung IV nitro, TPA, IV bretylium....... for the first time. I have seen and cared for the first "artificial heart" LVADS that turned into the portable LVADs ........I have practiced through medical history. Our calculations were by hand. I remember the first computers installed, the first printer for lab results....that was a great day. I am highly trained, very well educated.....at the bedside not with degrees.....I am extremely specialized the MD's depended on me. It was the nurse at the bedside that did all these things.

Now, If they can find someone else to bathe, assess a patient from a TV monitor in a remote location, read my strips, change me dressings, watch my balloon pump, run my gambro or ECCMO...... fix my drips or pass my meds...... what will they need me for?

That will be a sad day.