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?

[kalevra, BSN, RN]

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.

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

Under Hospital-Related Mortality:

"Greater RN staffing was consistently associated with a

reduction in the adjusted odds ratio of hospital related mortality (Table 1). An increase by 1 RN FTE per patient day was

associated with a 9% reduction in odds of death in ICUs."

"...an increase by 1 RN FTE per patient day would save 5 lives per 1000 hospitalized patients in ICUs, 5 lives per 1000 medical patients, and 6 per 1000 surgical patients (Table 1)."

Under Adverse Patient Effect:

"Higher RN staffing was associated with lower odds of several patient adverse events (Table 1)."

"An increase by 1 RN FTE per patient day was associated with a 60% lower odds of respiratory failure in ICUs".

"increase by 1 RN FTE per patient day in ICUs would avoid 7 cases of hospital-acquired pneumonia, 7 cases of respiratory failure, 6 cases of unplanned extubation, and 2 cases of cardiac arrest per 1000 hospitalized patients."

The Discussion uses the term nurse, however they are specifically researching RN outcomes in regards to patient mortality and adverse effects. Reading the raw data from shows that the studies focus is on RNs and not other allied health workers. Therefore the term nurse used in the study refers to the licensed RNs which the study investigated. I did not read LVN,CNA,MA,CPT in the study, so if I missed something reading the data please inform me.

I have not seen any primary articles regarding patient outcomes regarding LVN,CNA,MA. Based on this article alone I would make the conclusion that an RN caring for a patient has has less mortality than other health workers such as an LVN/CNA/MA. I do not include MD/PA/APN/ because their scope of practice has more control and autonomy over patient care as compared to an RN/LVN/CNA/MA.

Keep in mind if anyone has other articles saying otherwise regarding other healthcare workers please feel free to send a link. I would love to read them.

[nursel56]

Kalevra -

Your main argument is that you want to make a number of unspecified tasks "RN only" to manipulate the job market by creating an artificial demand. You feel that research studying staffing ratios provides ample evidence to do this. I'm not going to dispute what that study review purports to show aka the "lies, damn lies and statistics" argument although a cursory reading through it reveals some definite problems.

Assuming the link you provided was appropriate to prove your point, other issues will emerge.

Above all, association is not causation. The conclusion of the review itself acknowledges this when it is stated:

"patient and hospital characteristics, including a hospital's committment to quality of medical care likely contributed to actual causal pathway"

In other words, maybe these outcomes can be explained by how crappy the patient's doctor may or may not be. That is only one of a multitude of variables that haven't been ruled out. It certainly is nowhere near proving your point, which is that you want to make it illegal for other disciplines to perform those tasks with no study of those hypothetical tasks actually showing a danger to patients if an LVN or other ancillary staff performs that unspecified task.

In your effort to improve the situation for RNs (and we haven't even touched the ADN-BSN better outcome argument) you will harm the job prospects for other people by reducing their skill set when there is no evidence that performing the unspecified task poses a danger to patients.

-- I just want to clarify that I'm only talking about those things that someone is trained to do and has done for a long enough time to allow patterns to emerge, removing that skill for economic reasons alone. I'm not talking about those things that someone can master the mechanics of but is not fully trained and tested on. I know decisions are made on theoretical risk as well.

[nurseprnRN, BSN, RN]

"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"

as a matter of fact, the nurse practice act and the ana standards and scope of practice do exactly that. anyone who doesn't believe me probably hasn't read theirs.

and i take issue with the person who says " i do not include md/pa/apn/ because their scope of practice has more control and autonomy over patient care as compared to an rn/lvn/cna/ma" for the same reason. and, of course, because tasks do not equal professional competence. ::headbanging::

comparing a pa to an rn is apples and oranges. don't believe me? go look it up-- and be sure you're not dazzled by the fact that pas "can do..." various tasks that you don't see rns doing where you work. i'll bet you dollars to donuts that i can find a setting/specialty where rns "can do..." it to-- and (and this is critically important) we, rns, have greater autonomy for our plans of care (i.e., not dependent on a medical plan of care) both within the hospital as hospital employees and outside of it as independent practitioners than any pa, who must, perforce, practice under the physician supervision/standing "orders" in all actions.

[kalevra, BSN, RN]

[/b]purports to show aka the "lies, damn lies and statistics" argument[/b]

--

study review purports to show aka the "lies, damn lies and statistics" argument

this conversation is obviously not going to go anywhere as you are already closed off to the idea that research has shown. i am willing to look for more resources but since you are not willing to discuss the issue based on research finding i think this will be our last conversation

[tothepointeLVN, LVN]

The Discussion uses the term nurse, however they are specifically researching RN outcomes in regards to patient mortality and adverse effects. Reading the raw data from shows that the studies focus is on RNs and not other allied health workers. Therefore the term nurse used in the study refers to the licensed RNs which the study investigated. I did not read LVN,CNA,MA,CPT in the study, so if I missed something reading the data please inform me.

I have not seen any primary articles regarding patient outcomes regarding LVN,CNA,MA. Based on this article alone I would make the conclusion that an RN caring for a patient has has less mortality than other health workers such as an LVN/CNA/MA. I do not include MD/PA/APN/ because their scope of practice has more control and autonomy over patient care as compared to an RN/LVN/CNA/MA.

Thats a pretty big stretch there. Especially since the data isn't there. It compares x # of RN's to y # of RN's not RN vs anything else. It fact due to the nature of staffing it would impossible to compare anything else as there aren't any hospitals solely staffed by LVN/CNA/MA's so the data is not available to make a balanced decision.

[tothepointeLVN, LVN]

study review purports to show aka the "lies, damn lies and statistics" argument

this conversation is obviously not going to go anywhere as you are already closed off to the idea that research has shown. i am willing to look for more resources but since you are not willing to discuss the issue based on research finding i think this will be our last conversation

i thought she discussed it quite well unless by discussion you mean "concede to your expertise."

what's always interesting about this discussion is that the rn's seem to want to chip away at the lpn/lvn's rather than working together to create a true nursing monopoly. nursing provided by nurses.

[kalevra, BSN, RN]

"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"

as a matter of fact, the nurse practice act and the ana standards and scope of practice do exactly that. anyone who doesn't believe me probably hasn't read theirs.

and i take issue with the person who says " i do not include md/pa/apn/ because their scope of practice has more control and autonomy over patient care as compared to an rn/lvn/cna/ma" for the same reason. and, of course, because tasks do not equal professional competence. ::headbanging::

comparing a pa to an rn is apples and oranges. don't believe me? go look it up-- and be sure you're not dazzled by the fact that pas "can do..." various tasks that you don't see rns doing where you work. i'll bet you dollars to donuts that i can find a setting/specialty where rns "can do..." it to-- and (and this is critically important) we, rns, have greater autonomy for our plans of care (i.e., not dependent on a medical plan of care) both within the hospital as hospital employees and outside of it as independent practitioners than any pa, who must, perforce, practice under the physician supervision/standing "orders" in all actions.

the thread started off asking the question, "why hire rns when other disciplines can do the job?"

adnrnstudent posted

"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"

i replied by saying rather than a smear campaign, money is better spent on legislation. getting politicians to vote in favor for rns. powerful unions usually have the power to buy a few politicians and get their legislation passed.

i have seen my states nurse practice act and that it outlines in detail what an rn is legally allowed to do. i also understand that legislation can be passed that can change how the nursing (rn) profession operates. in my state there is legislation limiting the number of patients an rn can legally have. it only makes sense that if you want to protect you job from other disciplines then the best way to do it is through legislation. add on to the nurse practice act by getting lawmakers to pass bills in favor of protecting rns from other disciplines that are taking these position. a smear campaign would do nothing but make people mad and you would still have the original problem at hand.

[kalevra, BSN, RN]

and i take issue with the person who says [/size]" i do not include md/pa/apn/ because their scope of practice has more control and autonomy over patient care as compared to an rn/lvn/cna/ma" for the same reason. and, of course, because tasks do not equal professional competence. ::headbanging::

i was thinking along the lines of their ability to prescribe medications. you tend to have a lot of control and autonomy over patients care when you can prescribe medications. my instructor is an fnp and he can prescribe medications for things like htn. my family's pa can prescribed ultram for my dad's back before. i believe both pas and nps are able to prescribe meds in all 50 states. as far as i know i do not know of any rns that are able to prescribe medication, i'm not talking about giving scheduled or prn meds in a hospital setting. i'm talking about writing out an order for meds where the patient takes it to the pharmacy and then picks up medication.

i was not thinking about chest tubes or any kind of invasive procedures. i am not sure if an fnp in my state can put in a chest tube.

[kalevra, BSN, RN]

Thats a pretty big stretch there. Especially since the data isn't there. It compares x # of RN's to y # of RN's not RN vs anything else. It fact due to the nature of staffing it would impossible to compare anything else as there aren't any hospitals solely staffed by LVN/CNA/MA's so the data is not available to make a balanced decision.

At the bottom of the post I wrote:

"Keep in mind if anyone has other articles saying otherwise regarding other healthcare workers please feel free to send a link. I would love to read them."

I kept it open so that people can post what articles they did find so we may discuss it.

[kalevra, BSN, RN]

I thought she discussed it quite well unless by discussion you mean "concede to your expertise."

What's always interesting about this discussion is that the RN's seem to want to chip away at the LPN/LVN's rather than working together to create a true nursing monopoly. Nursing provided by nurses.

I felt that once they wrote "lies, damn lies and statistics" that they would not be responsive to other ideas regarding the issue. They are set in their ways even with data supporting my position. The source that I used was the first one I found on google scholar. I can access CINAHL of more primary articles regarding the matter.

It like trying to get your grandpa to change his opinion on democrats, its just not gonna happen. I spent a lot of time getting no where fast.

[tothepointeLVN, LVN]

At the bottom of the post I wrote:

"Keep in mind if anyone has other articles saying otherwise regarding other healthcare workers please feel free to send a link. I would love to read them."

I kept it open so that people can post what articles they did find so we may discuss it.

And I did point out that data wouldn't exist because the situation does not exist yet. Though one could compare between an all LVN/CNA staffed nursing home and a all RN staffed nursing home as the latter does exist but a hospital where you could compare an all RN staff to a non RN staff not going to happen.

While studies and data are nice if the data only focuses on one thing it doesn't automatically mean the other is not true.

[tothepointeLVN, LVN]

I felt that once they wrote "lies, damn lies and statistics" that they would not be responsive to other ideas regarding the issue. They are set in their ways even with data supporting my position. The source that I used was the first one I found on google scholar. I can access CINAHL of more primary articles regarding the matter.

Why do you have to bring facts into a perfectly good opinion fest