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?

[kids]

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 previously 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.

Pharmacists are doctors, it wasn't all that long ago that only doctors were permitted to give injections and start IVs (among other things).

Many of these places might be "contracting" out work typically done by registered nurses because registered nurses might be hard to come by.

My concern with companies that abide by this practice could be unsafe. Let us assume that a pharmacist administers a shot and the client has a bad reaction to it. Will the pharmacist have the training to recognize and react to the situation?:uhoh21:

Well considering their entire area of education and expertise is medications, their indications, mechanism of action and adverse reactions...I think it's a safe bet they do. Really, think about it, what 'special' training do nurses have to recognize and react an adverse medication reaction? Pharmacology.

It is the education that makes a nurse. But a medical assistant doesn't have the education a nurse has. Thats why we have titles.

It depends on the State or area, some places Medical Assistant is an associate degree program and they spend more time in school than an LPN.

I think money would be better spent lobbying for legislation that makes some procedures as RN ONLY procedures. For example it would be illegal for a Pharmacist to push immunizations at a pharmacy. If it becomes an RN ONLY procedure then you would have to hire an RN. Prevents firing of RNs to be replaced by MA/CNA.

I mean realistically with enough experience in the field an LVN can learn what an RN does. The only thing preventing the LVN from taking the RN position is scope of practice. Scope of Practice puts down what are the procedures that an LVN or RN can Legally do. The Law is the biggest difference.

Forget the smear campaign, lets just buy some legislators to vote in favor of RN ONLY procedures. Yes I said BUY LEGISLATORS. It is the way our government works.

How does banning a Pharmacist from giving immunizations and making it an RN only task prevent replacing RNs with CNAs & MAs? Blocking Pharmacists from giving flu shots won't result in more jobs for nurses, it's far more likely to result in drug stores discontinuing the service. The demand for flu shots and their low cost at drug stores just isn't that high, it wouldn't support the cost of having a nurse on duty all day (and what would s/he do in between time?). Drug stores would have to limit the hours and increase the cost, the end result would be fewer people using the service, 90% of the 1-2 flu shots given daily at the Walgreens in my town are uninsured.

[nursel56]

I think money would be better spent lobbying for legislation that makes some procedures as RN ONLY procedures. For example it would be illegal for a Pharmacist to push immunizations at a pharmacy. If it becomes an RN ONLY procedure then you would have to hire an RN. Prevents firing of RNs to be replaced by MA/CNA.

I mean realistically with enough experience in the field an LVN can learn what an RN does. The only thing preventing the LVN from taking the RN position is scope of practice. Scope of Practice puts down what are the procedures that an LVN or RN can Legally do. The Law is the biggest difference.

Forget the smear campaign, lets just buy some legislators to vote in favor of RN ONLY procedures. Yes I said BUY LEGISLATORS. It is the way our government works.

What will you offer as your rationale to arbitrarily narrow current scope of practice if the legislator wants to know what he or she is voting to do? Trying to prevent expansion of "scope" is different from taking away from it.

[kalevra, BSN, RN]

How does banning a Pharmacist from giving immunizations and making it an RN only task prevent replacing RNs with CNAs & MAs? Blocking Pharmacists from giving flu shots won't result in more jobs for nurses, it's far more likely to result in drug stores discontinuing the service. The demand for flu shots and their low cost at drug stores just isn't that high, it wouldn't support the cost of having a nurse on duty all day (and what would s/he do in between time?). Drug stores would have to limit the hours and increase the cost, the end result would be fewer people using the service, 90% of the 1-2 flu shots given daily at the Walgreens in my town are uninsured.

The idea was making some procedures RN only tasks by law. The general concept was if legislators passed bills making some tasks require an RN then the institution would have to hire an RN to perform such tasks. I am not necessarily saying it has to be in the pharmacy. I am more interested in making more positions in the hospital setting. I use the term task as a broad phrase and not just some form of manual procedure. The pharmacy scenario was a quick example.

Out in California a law was passed limiting the patient load for an RN in a hospital setting. This created mandatory slots that must be filled but only by an RN/LVN. MAs or CNAs could not fill these slots which prevents any future loss of jobs to anyone else except to another RN/LVN.

Its the same general idea I am bringing to the table with making some tasks RN only. Management would not like the idea because now they would have to pay for an RN/LVN when in the past a CNA or MA would do. Hospitals would have to adjust how they bill patients, but I guarantee the hospital would still be in business.

[tothepointeLVN, LVN]

It depends on the State or area, some places Medical Assistant is an associate degree program and they spend more time in school than an LPN.

Time spent is not synonymous with knowledge received. Despite what MA's with associates try and convince you otherwise. Some MA's spend more time in school than an accelerated BSN.

[Guest717236]

I have said it more than a dozen times here and other forums.

We (Nurses) are being dumb-ed down for the sake of cost-cutting

measures. We are too expensive. They would rather hire a CNA than

an RN because it's cheaper. Don't need the professional nurse these

days, Right? How do they accomplish this?

They start by taking away the things that the professional nurse is

capable of doing like medical shorthand. "Can't use THOSE abbreviations

any more..."

By not allowing us to mix medications. The pharmacy needs to mix all

IV medications and doses, YOU can't be trusted to do it any more. It's

all about patient SAFETY..."

All IV medications have to be on a pump. We now use guardrails to

program all those medications. "You're no longer required to calculate

drip rates. We'll do it for you..."

What do you feel that you're actually responsible for anymore that

can't be done by ancillary staff? Assessments? HA! Keep holding onto

that. See how long it will be before THAT is no longer needed.

So sad and so true. But, as Lindarn has pointed out, we will lose the last of our

professional scope if we do not band together and define what nursing is and then

control the profession by enacting legislation or enforcing what exists currently.

With your nursing license, walk into any public school and start teaching. You can bet without the right credentials in your state, you will be shown the door.

And rightfully so, teachers have defined who they are, and the criteria that you must meet to teach, and they enforce it in many areas by unions.

[anotherone, BSN, RN]

why would a pharmacy ever hire a nurse to give a flu shot when the overworked pharmacist can be forced to do that amoung all his/her other tasks? if a nursing student can safely give a im injection so can a pharmacist. it will just continue. there was a time long long ago.... when rn's didn't routinely get bps, listen to lung sounds etc right?

[anotherone, BSN, RN]

Many of these places might be "contracting" out work typically done by registered nurses because registered nurses might be hard to come by.

My concern with companies that abide by this practice could be unsafe. Let us assume that a pharmacist administers a shot and the client has a bad reaction to it. Will the pharmacist have the training to recognize and react to the situation?:uhoh21:

is this sarcasm? i think so but have heard this in a serious tone by others. .. the average pharmacist knows more than the average to above average nurse about any med especially a flu shot.......

[tothepointeLVN, LVN]

why would a pharmacy ever hire a nurse to give a flu shot when the overworked pharmacist can be forced to do that amoung all his/her other tasks?

This and also consumers don't want to have to come in at a certain day/time for a Flu clinic they want it whenever, whereever. The upside is I "think" ( no statistics to prove this ) that this leads to more people getting flu shots. So far as the pharmacist giving flu shots I think that ship has sailed though if pharmacists push back ( since they seem to hate/resent having to do it ) it may fall back in our laps again.

[kalevra, BSN, RN]

What will you offer as your rationale to arbitrarily narrow current scope of practice if the legislator wants to know what he or she is voting to do? Trying to prevent expansion of "scope" is different from taking away from it.

I would not be trying to prevent the expansion the scope of an RN, narrowing of RN scope of practice is the last thing I want to happen. My rationale for increasing RN staffing in hospitals would be based on research done Kane et. al (2007) which states that "an increased RN staffing and lower odds of hospital related mortality and adverse patient events."

http://www.ona.org.3pdns.korax.net/documents/File/pdf/KaneRNStaffingPatientOutcomesMedCare.pdf

Maybe my idea is getting lost here, so let me make it simple. Get legislators to make some tasks RN only or RN required. This would increase the amount of positions that can only be filled by RNs. Research has shown that an increase of RN staffing will decrease patient mortality and adverse events in hospital.

[nursel56]

I would not be trying to prevent the expansion the scope of an RN, narrowing of RN scope of practice is the last thing I want to happen. My rationale for increasing RN staffing in hospitals would be based on research done Kane et. al (2007) which states that "an increased RN staffing and lower odds of hospital related mortality and adverse patient events."

http://www.ona.org.3pdns.korax.net/documents/File/pdf/KaneRNStaffingPatientOutcomesMedCare.pdf

Maybe my idea is getting lost here, so let me make it simple. Get legislators to make some tasks RN only or RN required. This would increase the amount of positions that can only be filled by RNs. Research has shown that an increase of RN staffing will decrease patient mortality and adverse events in hospital.

I wasn't talking about narrowing the scope of an RN. If you buy a legislator and instruct them to come up with some RN only tasks that are currently in the scope of practice of an LVN, you narrow the scope of practice of the LVN, not the RN. Even if it were true that legislators are so easily corrupted, you would need to supply a reason for such a move, or nobody will vote in favor of it. I don't think just using the law as a form of protection to help RNs keep their jobs or increase their pay will work as the elected official must at least sound like he or she is being fair and objective to all his constituents.

The article you referenced talks about improved outcomes measuring nurse to patient ratios. This is not the same as saying that an RN caring for a patient has less mortality than other healthcare workers. It is quite logical that a nurse with fewer patients will probably have fewer adverse outcomes, but even the conclusion states that other factors such as the facility itself affect the final outcome. In California the ratio laws cover both LVNs and RNs. It's almost impossible to separate enough factors to say with certaintly that "RN only" procedures should be instituted because fewer patients will get sicker and/or die.

I'm just trying to see how your ideas would actually work in real life. Every bit of legislation, even if it's based on a bribe has to be justified or it will die on the table. The last thing in the world I want is for nursing jobs to dwindle further!

[whereslilly]

There are places that hire only RN's and LPN's and respect their nurses. I'm thankful to work in such a place.

Yes the MA issue has been beat to death but it needs to be. Something needs to be done. Doctors have no problems calling their MA their "nurse" but would they like it if their NP referred to themselves as the "doctor"? I see no difference. Neither should be allowed!

OOH, Jersey you made my day!!;) Nailed it!!!

[Guest717236]

Where I'm at currently, they told all of the RN's in orientation that the only reason we're there is because they need our license and that if they could get away with it, we wouldn't be there at all. We're too expensive.

We are not as expensive as the lawsuits they will endure if they replace licensed staff RNs and LPNs with unlicensed "nursing" staff.