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?

[BuckyBadgerRN, ASN, RN]

To the OP....you make it sound as if only RN's are nurses. LPN's are nurses too. And stating "RN behind her name" makes it sound as if only women are nurses. Men are nurses too.

In my state, ONLY a registered nurse can legally call themselves a NURSE. Sucked when I had worked so hard to get my LPN license and learn I wasn't a NURSE in the legal sense of the word, LOL! But now I can call myself a nurse =)

The OP may live in a state where RN's are the only NURSES legally recognized....

[JSBoston]

I've had many years of the opposite problem! Let's only staff an entire floor with one cna because the nurses can wash people up, do q2hr turns on all of the patients, take out linen bags and garbage and clean the nurses station along with admissions, families, critical vitals, meds etc. I will always help wash a pt up, do turns etc, but putting one patient on the bedpan 12 TIMES (lasix and uti being treated lol) by myself in one shift is too freaking much along with all of the other turns and bed pans. I'm finally at a job where I feel like a NURSE- I still do a lot of basic cares which is fine and good assessment opportunities, but it's just a tiny bit less.

My husband used to get mad when I would tell him how I'd be late for meds because I was washing 6 patients up and giving showers... he'd say "WHY would they do that to you! It's like having my boss come in and clean the toilets!!!" But then again, he thinks I should just pass meds to patients on perfect white linen

[sweetnurse63, BSN, RN]

Maybe one day it will get to that point.

Point is, I don't care if my doctor is titled Dr., or Grand Pubah, the EDUCATION is what matters. Titles are made up. You can't "make up" education. It's the knowledge that makes a nurse a nurse, not the word.

If this is the case, than every nursing student should be able to legally practice and call themselves nurses right after school is complete. There would be no need to take the NCLEX=PN or RN to be a lcensed nurse. For example if some one is going to build me a house from the ground up, I would want to see a license or certification for building not just going on the experience that the contractor has. A license legally binds you to your profession, this is just my opinion.

[MinnieMomRN]

I agree to an extent, but there's a flip-side, and it's this: I would love to do total care for my patients. BUT, that is simply not possible with the current staffing ratio. We need the LPN's, CNAs and MAs. We need them to do what is in their scope of practice, so we can do the tasks that are within ours. But no. Management max's us out so that I am running ragged for my entire shift and left feeling like if I have left everyone breathing and with a pulse, and with the minimum care completed; that's good nursing. Frankly, NO. And it's not safe either...

Additionally, at my hospital they have discontinued sitters (Management: Pull a CNA off their assignment of 14+ patients if needed) and, we are in the process of discontinuing Transport (The RN can transport the patient). Really???!! Who is watching my other patients while I'm off the floor?? I know we work as a team, and my fellow nurses will do what they can, but they have a full patient load of their own which they can barely keep up safely. Oh, and let's not forget the nurse's 'customer satisfaction after discharge' follow-up calls during down-time. What?! You don't have down-time??? We need to look at your time management...

We are told we need to save $. Do more with less. Work smarter, not harder. Pardon me for not drinking the Kool-aide, but it's pretty hard to swallow when I look at our recently renovated hospital with flat screen TV's in each room. Management is sending a message that they think nursing should be the first thrown on the healthcare grenade. I am at the end of my rope.

[muesli]

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.

This is an interesting point. For example, on the medsurg floor where I work, RTs are trained and allowed to do certain tasks (deep suctioning, neb treatments, ABGs) which RNs are not allowed to do per policy. This may differ in the ICU. It's interesting that some tasks that were formerly under the nursing scope of practice have now been transferred, at least in my facility, to a different specialty.

1. This is great for the RTs, and since they do these things more often, their expertise is appreciated when they come and help my patient out with these tasks. I rely on their specialized area of knowledge a lot.

2. This may be convenient for me, but I do not believe it is beneficial in the long run. I want to know how to do these things. The same holds true for phlebotomy and placing IVs, which is discouraged among day and evening nurses because "it takes up too much of our time" and we have phlebotomists and IV RNs for that - how often has a patient had to wait TOO LONG while you're sitting nervously rapping your fingers waiting for an IV RN to come to place an IV because a patient needs blood or a medication urgently, or for a phlebotomist to draw blood cultures for a patient actively febrile, or for a RT to come draw ABGs on a patient who appears to be in respiratory distress. I hate that the norms in my job hold me back from administering quick care to my patients because I'm not allowed to train in certain tasks, even though legally it may be within my scope of practice. (Thankfully I have phlebotomy skills from when I was a PCA, ironically, I was trained as a less qualified employee but not as a nurse.)

[muesli]

We are told we need to save $. Do more with less. Work smarter, not harder. Pardon me for not drinking the Kool-aide, but it's pretty hard to swallow when I look at our recently renovated hospital with flat screen TV's in each room. Management is sending a message that they think nursing should be the first thrown on the grenade. I am at the end of my rope.

Ten bucks says that those flat screen TVs were initiated because of the new rules for Medicare reimbursement being tied to patient satisfaction... I think we're going to see a lot more of annoying "patient satisfaction" improvement measures and less (or at the sacrifice of) safe care measures. Just an aside.

[BuckyBadgerRN, ASN, RN]

Ten bucks says that those flat screen TVs were initiated because of the new rules for Medicare reimbursement being tied to patient satisfaction... I think we're going to see a lot more of annoying "patient satisfaction" improvement measures and less (or at the sacrifice of) safe care measures. Just an aside.

OMG, that whole Medicare pt satisfaction thing is over the top!!! I have a friend who is an RN on a busy cardiac floor. Per their new policy, EVERY SINGLE HOUR they need to go in the pt's room, ask if they need anything and assure them "I have the time". They have a script they have to stick to and "I have the time" is part of it. It needs to be documented every hour that they've done this. Three missed and you are FIRED. I asked what about at 2am when they are sleeping? There's an answer for that too: at the START of each shift, you advise the patient that you'll be doing this hourly check and since she works pms, the patient can opt out of this check if they are sleeping and the pt must sign off that they ok'd no checks while sleeping. Otherwise, you wake them up!!!

[Kooky Korky, BSN, RN]

I recognize that nurses are far more than the task they deliver,but when in school I was thought you asses and educate patients while in the process of delivering care. Why should pharmacist administer medications, when RN's can't dispense medications? And Yes I'm aware the LPN's are nurses. I believe many of the task previosly done by LPN's are more often delegated to less trained assitive personnel, also. I know men in nursing and would love to see more, but frankly when I use, she, I refer to most of the nurses in healthcare.

It would be good to assess and educate, but I think you should leave off the asses. Uh, donkeys, that is.

[Kooky Korky, BSN, RN]

OMG, that whole Medicare pt satisfaction thing is over the top!!! I have a friend who is an RN on a busy cardiac floor. Per their new policy, EVERY SINGLE HOUR they need to go in the pt's room, ask if they need anything and assure them "I have the time". They have a script they have to stick to and "I have the time" is part of it. It needs to be documented every hour that they've done this. Three missed and you are FIRED. I asked what about at 2am when they are sleeping? There's an answer for that too: at the START of each shift, you advise the patient that you'll be doing this hourly check and since she works pms, the patient can opt out of this check if they are sleeping and the pt must sign off that they ok'd no checks while sleeping. Otherwise, you wake them up!!!

Many moons ago when I was a new nurse, we were expected to do hourly rounds on pts with IV's on Med-Surg and q 2 hr. on those without IV's. We did not have a script.

I wonder how all of this came about and what we plan to do about it. It is so completely ridiculous. We all have to stand up against this madness.

[Kooky Korky, BSN, RN]

OMG, that whole Medicare pt satisfaction thing is over the top!!! I have a friend who is an RN on a busy cardiac floor. Per their new policy, EVERY SINGLE HOUR they need to go in the pt's room, ask if they need anything and assure them "I have the time". They have a script they have to stick to and "I have the time" is part of it. It needs to be documented every hour that they've done this. Three missed and you are FIRED. I asked what about at 2am when they are sleeping? There's an answer for that too: at the START of each shift, you advise the patient that you'll be doing this hourly check and since she works pms, the patient can opt out of this check if they are sleeping and the pt must sign off that they ok'd no checks while sleeping. Otherwise, you wake them up!!!

What about night shift?

[BuckyBadgerRN, ASN, RN]

What about night shift?

You wake them up (if sleeping) when you come on, tell them AGAIN (remember, they are being told 3x per day that an hourly offer will be made to get them anything they need, because you "have the time") and ask them if they'd like to be woken if sleeping or not. RIDICULOUS I tell you =(

[anniv91106]

This is an interesting point. For example, on the medsurg floor where I work, RTs are trained and allowed to do certain tasks (deep suctioning, neb treatments, ABGs) which RNs are not allowed to do per policy. This may differ in the ICU. It's interesting that some tasks that were formerly under the nursing scope of practice have now been transferred, at least in my facility, to a different specialty.

1. This is great for the RTs, and since they do these things more often, their expertise is appreciated when they come and help my patient out with these tasks. I rely on their specialized area of knowledge a lot.

2. This may be convenient for me, but I do not believe it is beneficial in the long run. I want to know how to do these things. The same holds true for phlebotomy and placing IVs, which is discouraged among day and evening nurses because "it takes up too much of our time" and we have phlebotomists and IV RNs for that - how often has a patient had to wait TOO LONG while you're sitting nervously rapping your fingers waiting for an IV RN to come to place an IV because a patient needs blood or a medication urgently, or for a phlebotomist to draw blood cultures for a patient actively febrile, or for a RT to come draw ABGs on a patient who appears to be in respiratory distress. I hate that the norms in my job hold me back from administering quick care to my patients because I'm not allowed to train in certain tasks, even though legally it may be within my scope of practice. (Thankfully I have phlebotomy skills from when I was a PCA, ironically, I was trained as a less qualified employee but not as a nurse.)

But how many patients can you safely care for, doing all these tasks you advocate? Here enters safe nurse-patient ratios. And too many of us do not consider "in the long run"!