The 'De-Skilling' Of Nursing

The reality of technicians and other professionals taking over aspects of the nurse's role is a valid threat that should not be handled lightly. If there's even one jobless nurse in society who desperately wants to secure employment, then the 'de-skilling' of nursing is certainly a problem. The nursing profession must stop giving up skills to other members of the healthcare team. This article attempts to explain how the nursing profession is being 'de-skilled.' Nurses Announcements Archive Article

What should be our greatest concern for the future of nursing?

We must fear the day if (or when) registered nurses (RNs) and licensed practical nurses (LPNs) will be less needed in healthcare due to systematic de-skilling of the nursing profession. Even though patients are becoming sicker and more complex in today's healthcare system, other professionals and paraprofessionals have started to perform tasks and assume roles that had once been within the strict realm of licensed nursing personnel.

The de-skilling of the nursing profession has been taking place for quite some time. For example, we have phlebotomists and phlebotomy technicians to draw blood in certain healthcare settings.

Medication aides regularly administer medications in many nursing homes, group homes, and assisted living facilities, even though the task of medication administration had once been a duty that was strictly performed by licensed nursing staff.

Some hospitals have policies that allow patient care assistants to insert and remove indwelling urinary catheters and discontinue peripheral IV catheters.

Some rehabilitation facilities and specialty hospitals have assembled wound care teams that consist of physical therapists and occupational therapists who perform all the dressing changes and handle all the complex wound care cases.

Many back office medical assistants now perform advanced skills in doctors' offices under the supervision of the physicians who employ them.

Pharmacy technicians now mix medications in hospitals on a regular basis, but RNs were once able to mix drugs in piggybacks for IV administration.

Rehab techs now ambulate patients post operatively when licensed nursing staff used to be the ones to ambulate 'early and often.'

More examples of de-skilling in the nursing profession exist. For instance, many healthcare facilities employ lay people to do the staffing and scheduling for nursing staff. These schedulers are given the fancy titles of 'staffing coordinator' or 'director of staffing,' and have been given responsibility for an administrative aspect that nursing management or supervisory staff strictly performed once upon a time. In addition, some emergency departments are considering hiring paramedics to lessen the need for ER nurses.

The writing is on the wall.

The nursing profession must stop surrendering our valuable skills to other healthcare workers now. Nurses need to fully embrace their skill sets and constantly be on the lookout for other disciplines who are attempting to remove yet another skill away from our roles. If even one unemployed nurse exists who needs a job, then de-skilling is a problem because non-nursing staff are displacing licensed nurses. If this systematic de-skilling does not stop anytime soon, the future of nursing might be in trouble.

It of course varies by state, but in NY for instance nursing assistants are not regulated and or issued a license by the same body that does so for professional nurses. CNAs are just that, they have been issued a certificate that indicates the fullfilling of certain educational and other requirements, but they do not have a professional license.

As for using the term "nurse", again it would vary by state but in NY any graduate of an accredited program is allowed to call themselves a "nurse" (graduate) and once properly licensed a RN or LPN.

They are regulated and issued a "certificate" here in Arizona by the Board of Nursing.

LPNs generally are not considered "professionally licensed" either, they are licensed but not professionally. This is why the term Registered Professional Nurse is coming into play, to differentiate it from Licensed Practical Nurse. I know there are some states that officially recognize the professional title, I though NY was one of them?

Honestly I do not care about an all inclusive nursing organization because ANA already exists. I just do not understand the rationale for wanting to join RNs with LPNs while excluding CNAs.

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As for the whole RN and LPN competing for the same job thing, this does happen. But there are far more RNs taking former LPN positions than the other way around. The tight job market has resulted in many RNs pushing a med cart in LTC. They are doing LPN level work for LPN level pay. When was the last time you heard of a LPN pushing a RN out of a hospital job?

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Specializes in ER, ICU, Neuro, Ortho, Med/Surg, Travele.

Welcome to the new Nursing. We had let for profit and nursing organizations devalue nursing for years. While RT and PT can bill separately, we continue to be listed under bed and board. Yet, we have to carry because we are professionals. We have let the ANA make decisions for us, which has done more harm than good for nurses across the board.

Computerized charting has taken us away from the bedside, customer service has us acting like waitress instead of professionals and administrators think that we are a dime a dozen. Yes you can replaces us but you can't replace our experience.

I have worked all over this country. I have worked in the NE, out west and in the south. I have worked Union and Non Union and For Profit and Non Profit. There is a huge difference across the board. The one thing that does stay the same, is that unless nurse come together under one banner, we will fall by the wayside.

We need to come together, LPN, LVN, RN, BSN and so forth. If we don't stand together, then we have on one to blame but ourselves.

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Specializes in ER, ICU, Neuro, Ortho, Med/Surg, Travele.

The ANA does nothing for the bedside nurse. It is a political organization that is worthless.

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Well just because I want it doesn't mean all the other LPN/LVN want it too. Though to be honest getting out of dissatisfaction with the LVN role is a lot easier for us. Just become an RN. So in some ways we don't find our heads banging on the wall so much or if we do we are reassured of a path out of it if we want.

So if adding additional education and clinical hours equals an upgrade in license for a LVN/LPN moving up shouldn't a RN moving from ADN to BSN be offered the same reward in addition to a pretty thing to hang on the wall? Don't RT's have a two tiered system with RCP and RRT ?

And should RN's and LVN's be competing for the same jobs if we have two different SOP. Don't you think that working together would clarify that issue. Or is it because you as an RN don't have a desire to play nice and would prefer that skills be given to UAP rather than to an LVN because you feel we are competing somehow.

RTs do have a two tier system but from what I understand the RTs are actively moving to manditory RRTs. I have honestly not looked into it but I hear the RTs at work talking about it.

When I moved from an ASN RN to a BSN RN I did get a pretty thing to hang on the wall, in fact I am looking at it now. :specs:

Honestly I do not care if RNs and LPNs are joined together, in fact I think they should be allowed into ANA, I think ANA would be a good influence. I also believe that CNAs should also be allowed. CNAs are as much a vital part of the nursing team and LPNs are IMHO.

On the overall topic I do not agree that nursing skills are being dumbed down or taken away, I think that nursing is specializing and each nurse is becoming an expert in a single area to the detriment of general nursing skills. Look at how far nursing has come in the world of vascular access, I work with a nurse that remembers when only physicians inserted IVs.

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Honestly I do not care about an all inclusive nursing organization because ANA already exists. I just do not understand the rationale for wanting to join RNs with LPNs while excluding CNAs.
The ANA is NOT all inclusive. That's the point. They should call themselves the ARNA or something. Their current title for their organization is disingenuous and misleading. Of course, it's a free country and they could call themselves the Bolivian Clown League if they wanted to. And CNAs can't join a nurses association because they are not nurses. Now, if it was the American Healthcare Worker's association or something.....
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They are regulated and issued a "certificate" here in Arizona by the Board of Nursing.

LPNs generally are not considered "professionally licensed" either, they are licensed but not professionally. This is why the term Registered Professional Nurse is coming into play, to differentiate it from Licensed Practical Nurse. I know there are some states that officially recognize the professional title, I though NY was one of them?

Honestly I do not care about an all inclusive nursing organization because ANA already exists. I just do not understand the rationale for wanting to join RNs with LPNs while excluding CNAs.

You're correct, had to go look it up. In NYS it tis "Registered Professional Nurse". T'was the fact both are under the NYS's Office of the Professions that threw me. Apologies for giving out incorrect information.

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Meh only by RN's who seem to have a misconception that extra year of school dramatically changes the way a nurse practices. Face it RN's feel threatened on all sides and instead of working collaboratively they lash out or make grandiose statements

Some here actually think that only having a single year be the difference is far too little. Look at all the four year degree entry level talk.

Dislike it if you want but in reality there is a big rift. How many MAs have you encountered that call themselves a nurse? Most of the MAs I encounter introduce themselves as a nurse.

Who cares honestly? To me the term "nurse" is a vague and often misused title that has lost nearly all of its prestige. I do not care if MAs, CNAs, or LPNs use the term. I identify myself as a registered nurse and I have never suffered a mistake in professional identity.

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Specializes in Hospice / Ambulatory Clinic.

We need to come together, LPN, LVN, RN, BSN and so forth. If we don't stand together, then we have on one to blame but ourselves.

Agree.

To Asytole RN they only thing you achieve by being divisive is ensuring your own demise. You have that kind of attitude nobodies going to run to your defense.

Personally I've only ever worked outside a hospital in areas where LVN's are desired so I can't compare or contrast but I'm not seeking a hospital position either because why would I want to have to deal with the LVN vs RN fight every single day. I don't think unemployed RN's working for LVN pay is pushing me out of anything. My division stopped hiring them because it wasn't worth their while since they didn't stay for long and a new grad RN couldn't offer anything skill wise than an LVN couldn't for that position.

When I was working ambulatory care they were actually phasing the RN's out of the clinic with the manager trying to find case manager positions for them. When it came down to it the RN's couldn't justify what made them worth the extra $$$.

The two above situations were within the last year. But yet again the argument always comes down to RN vs LVN or SOP vs SOP *yawn* This is why we get nowhere.

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Welcome to the new Nursing. We had let for profit and nursing organizations devalue nursing for years. While RT and PT can bill separately, we continue to be listed under bed and board. Yet, we have to carry malpractice insurance because we are professionals. We have let the ANA make decisions for us, which has done more harm than good for nurses across the board.

RTs, PT/OT and the like are specialists that have billed for specific therapies. Nurses who perform specialized treatments/procedures can also bill separately. My department does. :)

You should start your own nursing organization that makes the correct decisions then, I would join it :o

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The ANA does nothing for the bedside nurse. It is a political organization that is worthless.

I like their Code of Ethics.

Know of any better nursing organizations that does help bedside nursing?

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Specializes in Hospice / Ambulatory Clinic.

Dislike it if you want but in reality there is a big rift. How many MAs have you encountered that call themselves a nurse? Most of the MAs I encounter introduce themselves as a nurse.

An MA has no license and I do and a legal right to call myself a nurse in my state. Whether you think I should or not is irrelevant. Honestly I'm not going to get anyway discussing anything with you because your firm in you (somewhat misguided) opinion and no correspondence shall be entered into. I'll just put you on my list of first to be thrown under the proverbial bus.

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