You think the "Nursing Glut" is bad now?

[Guttercat]

I tend to keep my finger on the pulse of new(er) trends.

This subject is something I've alluded to before, yet now I am even more convinced it may become reality.

My state--a west coast state--recently (last year) redefined the scope of practice for MA's to include much of what RN's are responsible for, based on a new tiered level of education and certifications. Colleges have jumped on the bandwagon to develop intense MA programs to fill the need.

At one time, MA's were relegated mostly to Dr.'s offices (which used to be the domain of RN's). That may not be the case much longer, if the trending continues.

I was just speaking with a fellow student from a math class, who is pursuing her MA. One of our college's nursing program professors is apparently steering potential nursing candidates (friends of hers) away from the nursing program on the QT. She stated, "Now that the scope of practice for MA's has been legally expanded, the hospital is looking to integrate MA's to fill the floors, instead of the more costly RN's."

Just sayin'. Research on your own, and draw your own conclusions.

[traumaRUs, MSN, APRN]

Let's keep this civil guys.....per our terms of service while we encourage lively debate we do not allow name calling or divisive posting.

[elijahvegas, ASN, RN, EMT-P]

as someone posted earlier, I fail to see what an rn knows, that an ma can't learn with some experience. Most of everything we learn as medical professionals is through experience. We can have it beat into our heads from school all day long but until we see it, its just a book concept to us. At a clinic I worked at, the mas were taught on the job how to start ivs, take vitals, and do a physical assessment, as well as pass And draw up meds. These were skills I already had as a medic, but many of the ma titled workers there (as well as x ray techs, who perform these duties as well) obtained within a few weeks of training. Maybe a hospital setting is different..haven't been in one outside of clinicals. But tell me what I'm missing here? Other than having to do the occasional outlandish off the wall treatment once in a while, I really couldn't tell you how profound knowledge of pathophysiology or pharmacodynamics has helped me perform better than any of my coworkers despite my broader knowledgebase. At the end of the day we all had the same job to do.

[Nurse Leigh]

as someone posted earlier, I fail to see what an rn knows, that an ma can't learn with some experience. Most of everything we learn as medical professionals is through experience. We can have it beat into our heads from school all day long but until we see it, its just a book concept to us. At a clinic I worked at, the mas were taught on the job how to start ivs, take vitals, and do a physical assessment, as well as pass And draw up meds. These were skills I already had as a medic, but many of the ma titled workers there (as well as x ray techs, who perform these duties as well) obtained within a few weeks of training. Maybe a hospital setting is different..haven't been in one outside of clinicals. But tell me what I'm missing here? Other than having to do the occasional outlandish off the wall treatment once in a while, I really couldn't tell you how profound knowledge of pathophysiology or pharmacodynamics has helped me perform better than any of my coworkers despite my broader knowledgebase. At the end of the day we all had the same job to do.

Not trying to sound snarky, but if you feel this way about the education of a nurse, why are you in school to become one? Truly, I am curious.

[elijahvegas, ASN, RN, EMT-P]

Not trying to sound snarky, but if you feel this way about the education of a nurse, why are you in school to become one? Truly, I am curious.

Its not snark. And I'm not offended by the question regardless, since I've been asked the very same thing by my friends and family after having started the program.

The answer is, I wasn't (and still not) sure all of the functions of a nurse. I'm trying to get out of my paramedic mindset, where everything was pretty objective.

This is what's happening--this is what you do--this is why. So believe me I fully grasp the importance of understanding physiology and duty interactions and whatnot.

The thing is, we were essentially completely autonomous. Within our scope and protocols we have actual choices of what to give, when to give, how to dilute and titrate at our discretion, things of that nature. From what Ive been experiencing so far, little of nursing deals with medicine (I'm finally beginning to understand when people say docs/pas are taught under a medicine model vs nurses/nps are taught under a nursing model) and nurses don't have very much autonomy. Everything we do is pretty much doctor ordered. We just follow through and I guess make sure that the the proverbial turd not hit the fan ? All the while making sure our patients are comfortable and well tended to

This seems to me to be something that most levels of healthcare providers are capable of. And if I were wrong, then rns wouldn't so easily be phased out by professionals with supposed far less education and capabilities.

My (ill received) 2 cents haha

[libran1984, ASN, RN]

Its not snark.....

.....My (ill received) 2 cents haha

I'd also like to point out the grave difference (at least in my area of the midwest) in pay. I'm not sure about Jonnyvirgo and his neck of the woods, but the LPNs and Medics I work with in the ED are started around $14/hr base. The RNs start off without experience at $22 and some change/hr base.

Today, I taught an RN how to draw an ABG. I showed her the method and I demonstrated. The next room, luckily, also had an ABG to be drawn. Before we went in, she told me how she would perform the Allen's test and how she would palpate the artery and the angle to draw. She missed the first time on the R wrist. However, she did get it on the L wrist!!!! I was so excited for her!!!

However, the petty part of me inwardly groaned thinking about how much more money she was making.

[GundeRN]

I do think experience can count for a lot. I work with some very knowledgeable LPN's and will ask them for their opinion on things even if I have more education, but you cannot deem the education pointless. Yes I have forgotten a lot of what I have learned but there is one thing that a nursing education can do whether you forget or not. It weeds out the people who can't learn. Sure there are some people who could learn on the job to be excellent nurses, but there are many more who are just not smart enough to ever grasp these things. Nursing programs stop these people before they can go on to hurt someone.

I went to school with someone who failed three times. Knowing her, I am glad that she wasn't offered a 6mo course to do my job.

[elijahvegas, ASN, RN, EMT-P]

I do think experience can count for a lot. I work with some very knowledgeable LPN's and will ask them for their opinion on things even if I have more education, but you cannot deem the education pointless. Yes I have forgotten a lot of what I have learned but there is one thing that a nursing education can do whether you forget or not. It weeds out the people who can't learn. Sure there are some people who could learn on the job to be excellent nurses, but there are many more who are just not smart enough to ever grasp these things. Nursing programs stop these people before they can go on to hurt someone.

I went to school with someone who failed three times. Knowing her, I am glad that she wasn't offered a 6mo course to do my job.

That's something that actually annoys me about nursing curriculum. It seems like its designed to weed out professionals that would otherwise be quite great at their jobs. Its beginning to seem more like a title than an actually rank based on skill. I haven't learned anything new yet, I've just been forced to look at healthcare from a different perspective. My lpn classmates say what they're learning in class is what they've already been taught but more in-depth, yet when I ask how, she really can't explain or differentiate.

We are taught basics that's buried in a curriculum that's all fluff and excess, rarely used in the real world. Strip all the chapters on legal, ethics, safety, and review after review of a&p which was a prerequisite, and in its bare-bones you're left with an ma, cna, lpn, or what have you.

[vera4130]

Its not snark. And I'm not offended by the question regardless, since I've been asked the very same thing by my friends and family after having started the program.

The answer is, I wasn't (and still not) sure all of the functions of a nurse. I'm trying to get out of my paramedic mindset, where everything was pretty objective.

This is what's happening--this is what you do--this is why. So believe me I fully grasp the importance of understanding physiology and duty interactions and whatnot.

The thing is, we were essentially completely autonomous. Within our scope and protocols we have actual choices of what to give, when to give, how to dilute and titrate at our discretion, things of that nature. From what Ive been experiencing so far, little of nursing deals with medicine (I'm finally beginning to understand when people say docs/pas are taught under a medicine model vs nurses/nps are taught under a nursing model) and nurses don't have very much autonomy. Everything we do is pretty much doctor ordered. We just follow through and I guess make sure that the the proverbial turd not hit the fan ? All the while making sure our patients are comfortable and well tended to

This seems to me to be something that most levels of healthcare providers are capable of. And if I were wrong, then rns wouldn't so easily be phased out by professionals with supposed far less education and capabilities.

My (ill received) 2 cents haha

You aren't sure of all the functions of a nurse but think MAs can do all the same stuff?

I'm an ICU nurse and I have had patients on as many as 9 gtts while also getting blood products, completely unstable and on CRRT. I frequently call the doctors and ask for orders, sometimes they just ask me what I want. I also need to be able to recognize bad orders. I've refused orders before because they were inappropriate.

There are bad nurses, just like there are bad CNAs, EMTs, and MDs. But saying MAs can be trained to do everything is an overstatement. I don't know what kind of program you're in but mine was hard - and I had a prior science degree. We learned a lot, and were expected to know a ton of patho and pharm.

[LadyFree28, BSN, LPN, RN]

You aren't sure of all the functions of a nurse but think MAs can do all the same stuff? I'm an ICU nurse and I have had patients on as many as 9 gtts while also getting blood products completely unstable and on CRRT. I frequently call the doctors and ask for orders, sometimes they just ask me what I want. I also need to be able to recognize bad orders. I've refused orders before because they were inappropriate. There are bad nurses, just like there are bad CNAs, EMTs, and MDs. But saying MAs can be trained to do everything is an overstatement. I don't know what kind of program you're in but mine was hard - and I had a prior science degree. We learned a lot, and were expected to know a ton of patho and pharm.[/quote']

^THIS.

That's something that actually annoys me about nursing curriculum. It seems like its designed to weed out professionals that would otherwise be quite great at their jobs. Its beginning to seem more like a title than an actually rank based on skill. I haven't learned anything new yet I've just been forced to look at healthcare from a different perspective. My lpn classmates say what they're learning in class is what they've already been taught but more in-depth, yet when I ask how, she really can't explain or differentiate. We are taught basics that's buried in a curriculum that's all fluff and excess, rarely used in the real world. *Strip all the chapters on legal, ethics, safety,* and review after review of a&p which was a prerequisite, and in its bare-bones you're left with an ma, cna, lpn, or what have you.[/quote']

*That "fluff" you speak of-ETHICS, critical thinking; nursing process? Pharm? Patho? SAFETY???

Those are the MANY KEYS to identifying a bad order. We are essential parts of the healthcare team; I will say it AGAIN. You need the ethics to CHALLENGE orders and learning the nursing process to assess, diagnose, plan and implement and evaluate EVERYTHING SAFELY, including a doctors order, especially if it does not match up to a nurses' assessment. Like vera explained, and what I have experienced as a NURSE, doctors will ask what we want, and that's because of knowing rationales, use of CRITICAL THINKING through the nursing process, and SAFETY.

TASKS are ONE thing...NURSING PROCESS and learning how be empowered with it is a WHOLE 'nother animal-this is coming from a former CNA and LPN...stripping down to tasks will do NOTHING for the patient-NOTHING.

And nurses will NEVER be phased out; what we do is TOO essential to be replaced; even though certain areas are trying to, they will never succeed; again, nursing history has YET to not support my opinion on this matter.

[elijahvegas, ASN, RN, EMT-P]

^THIS.

*That "fluff" you speak of-ETHICS, critical thinking; nursing process? Pharm? Patho? SAFETY???

Those are the MANY KEYS to identifying a bad order. We are essential parts of the healthcare team; I will say it AGAIN. You need the ethics to CHALLENGE orders and learning the nursing process to assess, diagnose, plan and implement and evaluate EVERYTHING SAFELY, including a doctors order, especially if it does not match up to a nurses' assessment. Like vera explained, and what I have experienced as a NURSE, doctors will ask what we want, and that's because of knowing rationales, use of CRITICAL THINKING through the nursing process, and SAFETY.

TASKS are ONE thing...NURSING PROCESS and learning how be empowered with it is a WHOLE 'nother animal-this is coming from a former CNA and LPN...stripping down to tasks will do NOTHING for the patient-NOTHING.

And nurses will NEVER be phased out; what we do is TOO essential to be replaced; even though certain areas are trying to, they will never succeed; again, nursing history has YET to not support my opinion on this matter.

when I said fluff such as ethics and legal and safety, I'm talking a out the questions on exams I get where the right answer is to label a defective bp machine and take itnto an engineer rather than take vitals. Knowing the difference between slander libel and defamation. Stuff like that.

I understand a good nurse is there to recognize bad orders, but do you work in a setting where the doctors make so many orders that its imperative nurses are there to catch them all, lest the whole hospital go up in flames ?

[vera4130]

It's not just catching bad orders. It's also being able to recognize when a patient starts to decompensate before it becomes an emergency, or recognizing that your septic patient hasn't gotten enough fluid (and subsequently getting orders for it), or changing out the dressings for a patient's 18 tunneling wounds. Nursing is much more than tasks.

You know who really wouldn't put up with the MA business? The doctors. Most of our doctors know the value of a good nurse. I can only imagine the kind of hell they would raise to find out it would be MAs calling them at 3 AM.

[jadelpn, LPN, EMT-B]

Here's the thing. When an MA can sit for their own license and I don't need to be delegating to UAP's whom I am responsible for, then have at it. Otherwise, I would prefer to do my own thing, as ultimately, I am responsible.