Why hire RN's when other disciplines can do the job

[Marisette]

Has anyone noticed that pharmacist at major drug chains administer flu, pneumonia, and other vaccines at large pharmaceutical chains. The medical assistant at my doctors office calls in medications for me because they don't hire RN's. In the hospitals we have nursing aids, & patient care technicians assist with patient care. I know the value of RN's doing the many functions, but I ask myself when did personnel or professionals from other disciplines start performing what was once mostly performed by RN's.

Could this be part of the reason new grads. can't find employment, or frankly many nurses in different markets. Why bother hiring RN's ? I Know that nurses do more than administer medications, call in medications and perform other physical labor, but sometimes I ask myself if the push for more anxillary health care help is slowly replacing the need for RN's. I recall getting injections from RN's at the large pharmaceutical chains years ago, but now the pharmacist administers. They hire nurse practioners for the outpatient clinics at the large phamaceutical chains or drug stores, but they are advanced degree Registered Nurses. Does anyone value a nurse with a simple RN behind her name anymore?

[R*Star*RN, BSN, RN]

It's interesting what the public knows. First of all I have seen MAs, CNAs and even Vet techs called "nurses" which I do find offensive, though it is usually by the office staff or receptionist and not anyone with an actual liscense behind their name.

I am always told "wow you are too young to be a nurse" and "I bet you were in school for YEARS!" and "you must be so intelligent to be where you are now". So that tells me that the public does think that nurses are well educated (most of them don't know there is a 2 year option) and intelligent.

The hospital in town is primary care. They are just transitioning back to CNAs on some floors now. However when I emptied the trash or changed the linens or helped patients to the bathroom they would always say "oh, that isn't your job. don't you have an assistant for that?".

I took pride in being able to do those little things for the patient, because some key assessments are made during this time. IE how they ambulate to the bathroom, what does their skin look like, what junk food is in their garbage that they shouldn't be eating. Besides just the assessment part of it, I felt as if I was actually physically HELPING someone which was the main reason I became a nurse in the first place.

Perhaps the public's knowledge of nurses and what they do varies in areas of the country, as does the ability to read and percentage that have a high school education or other degree.

I don't think we can stop the "elevation" of nursing. Look at all the others. . .physical therapists, occupational therapists, speech therapists. They all need advanced degrees to practice. However if they are going to require it for one profession they should accross the board -- xray techs, sonographers, respiratory therapy, etc should all be expected to have "advanced" degrees in that case.

ok that was kind of long and rambling.

[SDALPN]

kenyacka, well said!! Your statement about the different professions having different responsibilities and each one being equally important says it all!

Each area of nursing (and all other medical areas) all have different responsibilities and scopes of practice. Its important to know where the scope of practice starts and ends. Then all medical personnel can be used for their ability and education level. A pharmacist may not want to give an injection any more than a nurse wants to feed a patient (just an example). But if its within the scope of practice, I don't see a problem with hiring/using that person for the assigned task.

The med tech certification has me more worried than a Pharmacist giving an injection. The Pharmacist knows the risks and side effects of the med. The med tech knows they are working under the license of the nurse who is supervising. I'd much rather have a Pharmacist give me an injection than a med tech.

Nurses give neb treatments all the time. Why hire RT's if a nurse can do some of their tasks? Why hire a nurse to give a neb tx if an RT can give it? Some things are going to overlap.

[dscrn]

The corporate machine won't stop until everyone that's making more than $50,000 a year is down to $12 an hour.

The field of nursing needs to quit trying to "elevate" the profession by pushing B.S.N.'s. This will only increase cuts of R.N.'s to other types like M.A.'s and CNA's.

The money would be better spent on ad campaign smearing hospitals for replacing R.N.'s with M.A.'s CNA's, etc.

The public has high regard for nurses, and the public doesn't understand what's happening. They think all these other people are nurses too.

They need to understand that their healthcare is being delivered by people making not much better than Starbucks.[/quo

Bedside nursing-and all the skills therein-have gone the way.//In school, years back-assesment BY NURSES, NOT OTHER STAFF-was what nursing care was based on. Today, everythin in healthcare that matters is what is entered on the computer...actually TEACHING patients about their condition doesn;t matter-as long as it's "documented". A very sad state of affairs...

[tothepointeLVN, LVN]

When did RT start becoming the norm. Aren't RT's a spinoff of a nursing task. Taking a very small part of our job and specializing and expanding upon it.

dscrn,

I still do ALOT of patient/family education. One of my favorite parts of the job. When I worked in a clinic that was ALL I did aside from vaccines.

[workingharder]

Nothing in life or medicine is static.

I seem to recall several years ago when Nurse Practitioners started showing up on the scene. Many doctors waged a political and media battle against it. The claim was that NPs were not educated or knowledgeable enough for diagnosing or prescribing treatment. Well, the public didn't care. They saw it as a way to save money, also they weren't concerned about anyone's turf battles within medicine. Nurses weren't exactly rushing in to support the physicians either, because they saw it as a way to expand their scope of practice and gain some "inside the hospital" respect and prestige. Now that NPs are widely accepted I can't recall where patient care has deteriorated because of it.

As to pharmacists giving flu vaccines, really I don't care. They have oodles of knowledge of physiology and probably more than a little knowledge of the fluids they're pumping into my arm.

Alas, you will never get the public behind you in a turf war. As I said, they don't care. They want adequate service at something resembling a reasonable price. They have no idea what the difference is between an LVN, an ADN, or a BSN. All they know is that someone is sticking a needle in their arm or a foley in their...place. For the majority of them, the world is divided into Doctors and Nurses (including the techs and therapists). For most people, if you're not one, you're the other.

Let me end with this concerning, "The officials need to be going to Dr offices unannounced/undercover and ask the person assisting the Dr what their title is. Wrong answers must be enforced!" Who are these "officials"? And why would they enforce a wrong answer? I can't get the officials I know about to stop that kid down the street from driving 40 thru a 25 mph residential neighborhood.

[cacentralvalley]

I don't think comparing salaries would be the answer, I find it insulting. But back to the point.

Where's the fine line? We (not nurses but consumers) shop for low prices and want costs kept low. Businesses need to watch the bottom line, customers want prices kept to a minimum. For people without insurance and can't use welfare provided insurance its more cost effective to get a flu shot for $30 at CVS than paying for a $100 doctor visit plus the cost of the flu shot to go and get your flu shot from your doctor.

I do think in offices they should use correct titles, my doctor has a nurse and an MA and refers to them as 'the nurse' and 'the assistant'. As in, 'the nurse will be in to give you your shot' and 'I'll give my assistant your prescription so pick it up at the front desk'.

Me personally, I see the unions fighting for higher pay more than anything else (not just nursing unions but education and others as well), to increase salary there needs to be smaller paychecks somewhere.

I know I might get ripped for showing the business part but it is part of the reality; at least mine (I have a pretty small paycheck and am a single mother). The reason I do take offense to the salary dig (about Starbucks emplyees) is because when I worked as a full time teacher, taught a night class once a week, and was finishing my Masters degree; I worked weekends at Target for minimum wage. I needed the money and I worked for it, I was proud to work to support my family no matter what the job was.

[Munch]

I guess it depends on what state you are living in, if you have a licensed nurse shortage or overage etc. Actually the hospital I used to work at only hired nurses with four year degrees, they wouldn't even call you for an interview if you have a two year degree. The Patient care associates(not to put down the work they do because they DO work VERY hard and make a difference, especially to the patients..the nurses at times are VERY busy and don't have time to chit chat..and at the hospital I work at now if a nurse has nothing to do the Charge nurse will FIND something for you to do..but the patient care team not only do they take care of the patient, but they sit and chat with them..I remember when I was hospitalized for 10 days the Patient care associates would always come to sit and chat). However, they cannot administer meds, discharge patients, or even hang bags of fluids. What they can do is vital signs, change the beds, bring patients water, pillows..whatever they can to keep them comfortable...they also answer call bells and try to take care of the patients need and if they can't they find someone who is able to. Those are just a few examples. They are very hard workers but in my personal opinions they cannot replace Licensed nurses(whether the nurses have 2 year or 4 degrees).

[SDALPN]

HIPAA requires that a statement be given about privacy rights to each patient. Could a law be made to give each patient a statement about the level of education of each of the "titles" of employees working at a location? That way the patient would be informed of who (as in title) will be taking care of them and what their education is. That would clarify quite a bit. And make Dr's answer to the patients that question why a medical assistant is there instead of a nurse. (Not knocking MA's) And for the few curious patients that take it a step further...the curious could look up more info online about what our titles really mean.

I'm sure some people will never care or bother to read something like that. But they are the type that will remain ignorant. For the rest, they will be more informed.

[SunSurfRN]

To OP...allowing the assistive personnel to provide care seems like it will diminish the role of RNs. However, a medical assistant can't become and NP and essentially act as a primary care provider, or Psyche NP, or Neonatal etc etc. The future of RNs is bright if they move to masters level, and there is still a shortage in nursing - masters prepared nurses at the bedside. Since the primary care doctor shortage will only get worse, it is likely that NPs will help provide care for people. If one stays as an RN, it is dependent on where they are I think. If someone is an RN in an emergent care setting, its tough to picture the MA or CNA having the subjective systems and physiology perspective to competently assess someone quickly.

[xtxrn, ASN, RN]

New nurses without the skills needed by hospital nursing are also very expensive for employers. Thank nursing school's mindset of "someone else will do it" for that one.

[Healing Soul]

I worked as cna for many years and was the first to correct patients who assumed I was a nurse. However, I was also the type of CNA who only wanted to do non nursing tasks. For example, dress, feed, change incontinent patients and would try to steer clear of vitals and finger sticks because I wanted nothing to do with it. I have seen some CNA's handle situations better than nurses and I have wittnessed CNA's being called nurses but I saw very few overstep or practice outside of their scope. Once in a while, nursing students would shadow a nurse to learn stuff. A CNA is engaged in nursing however;is not a licensed nurse, but I viewed it as just a job, and frankly it is much more than that and your heart needs to be in it and you need to be somewhat interested in nursing. Be greatful when you have a CNA who has passion for nursing and looks up to you and your chosen profession.

[DogWmn]

Good point! I'm sorry if my post was also insensitive to LPNs, although that wasn't my intent. I confess not to know a lot about LPNs because I don't work with many.

I consider this a real tragedy, I hope you do find out about us, we have a lot to offer and depending on what state your are in you'd be surprised as to what our scope of practice is. AND many of the RN's on this forum started their nursing careers as LPN's.

I've read through this entire thread, I'd much prefer a pharmD giving me a shot vs a med tech. Like others I'm appalled that there are now "medication technicians", here in GA they are heavily utilized at ALF's.

But back to the point at hand, why hire RN's...because they cost a lot of $$$ and the noobs coming out of school require mega orientation time that is costly. I graduated from nursing school in 1972 and since then the scope of practice for nurses both LPN/LVN's and RN's have changed significantly and as we as nurses take on more and more something has to be passed down the line.