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.
I'm in WA state and as far as LTC goes, nurses are still needed and used to their full capabilities. NA's are still doing traditional nursing assistand duties like ADLs, vitals and simple things.....no major wound care, passing meds, insulin injections etc. The day that changes in LTC, will be a sad day indeed.
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.
Then you are not only unclear on what professional nurses ought to have learned in school as a basis for growth in practice, you are blind to how that growth benefits patients.
All you see is tasks; of course any fool can learn any task. We have lay people running complex algorithms doing home hemodialysis; we have parents running their children's ventilators. That makes them good at those tasks, but it doesn't give them the knowledge to then go take a job in the HD unit or the PICU.
No, you do not have the same jobs to do. Your MA friends have psychomotor proficiency, and I'm not denying that some of them may have the native talent and intellectual curiosity to have learned a great deal more than their peers. But "what you're missing here" is a profound sense of the difference between the knowing how to do a task (what you and so many other newbies think are "skills") and the vast spectrum of knowledge to recognize the implications, the possibilities, the potential complications. You lack the appreciation for what has been eloquently described as the nurse's duty to be vigilant (excellent article on this reprinted in the JNLCP for fall 2013, AANLCP | American Assocation of Nurse Life Care Planners), seeing nothing but the checklist of tasks (including the odd "outlandish OTW treatment") that you see many levels of providers performing.
I came late to this discussion, and there are so many points to be seen in better light. One that struck me early on and is germane to this particular post is the one of a basic task and assessment: taking blood pressure. Sure, any reasonably competent CNA can take a blood pressure; so can an MA, an LPN, an RN, and EMT, a vet tech, or a physician.
However, ask how many of those are proficient at doing so without an automatic cuff, and the numbers go down quite markedly. This is in part because a number of those folks do not know the physiology behind systolic and diastolic pressure measurement, and they slap those dinamapps on in the wrong position, don't know why (or even that) they get inaccurate readings in atrial fib and other conditions. They wouldn't know the implications of the different sounds they'd hear if they used a properly-applied manual cuff and a stethoscope. They wouldn't get that changes in those sounds could have great significance in some people. No, all they do is "take the BP," write down a few numbers, and move along to the next arm on the floor.
And that, jonnyvirgo, is only an iota of what you are missing.
Where I live in Florida. We have MAs in the ER. They r weeding them out. They don't want them anymore because of the cost. So they are bringing in paramedics because they only get PAID $$$12 AN HOUR
Yes it is confusing. We hear that BSN should be the entry point into nursing but I have read on another forum as well that there is starting to be an increased use of "techs" in the hospital setting. I suspect we are returning to the model of the RN having 15 patients and then the techs do most of the "hands on" work.
The admins have the upper hand - not sure there is much we can do about it.
And this is what baffles me about all the people here who go on and on about how we need to increase the entry to practice and BSN only and all that.
Once, just once, I'd like to see the whole "increasing use of UAP for tasks formerly performed by nurses" issue addressed by the BSN only crowd. If LPNs and ADNs are phased out, employers won't replace them with BSN RNs out of the goodness of their hearts. More and more new tech positions will be created to save $$$.
Abandoning the different levels of nursing will lead to the expansion of medical assistants, or something similar, into hospitals. Nursing needs multiple tiers of nurses.
And this is what baffles me about all the people here who go on and on about how we need to increase the entry to practice and BSN only and all that.
Once, just once, I'd like to see the whole "increasing use of UAP for tasks formerly performed by nurses" issue addressed by the BSN only crowd.
OK, here ya go. There is nothing wrong with having a team of good UAPs working with nurses. That does not mean that there will be only UAPs at patient bedsides, or that UAPs replace an adequate number of RNs in the mix. One or two UAPs to two or three RNs can deliver fabulous care.
I grant you that adequate staffing has and may always be difficult to pry out of management. But if my choice is RNs or LPNs, I will always take RNs, and if RNs with better education or RNs with less, I will always take the ones with more. Given that scenario, perhaps the people who scoff about including leadership concepts in undergraduate education might want to rethink their opposition. Leadership can mean knowing techniques for working an effective care team, too, if that's what there's going to be. And to reiterate, I am not advocating for replacing nurses with UAPs one-for-one. Expanding UAPs does not mean fewer nurses. But it might mean fewer LPNs to get the most bang for your nursing buck.
...CNA's legally (by the State) delegated to monitor/administer insulin based on glucose parameters, administering potassium supplements, narcs and psychotropics, and PRN's. All for a simple online certification course (nine hours).
This subject is so important to the future of nursing. We can all turn a blind eye and hope it goes away (or, "adjust" as nurses are expected to do as good little "team players"), or we can stay on top of the issues. This is scary stuff.
OK, here ya go. There is nothing wrong with having a team of good UAPs working with nurses. That does not mean that there will be only UAPs at patient bedsides, or that UAPs replace an adequate number of RNs in the mix. One or two UAPs to two or three RNs can deliver fabulous care.
I grant you that adequate staffing has and may always be difficult to pry out of management. But if my choice is RNs or LPNs, I will always take RNs, and if RNs with better education or RNs with less, I will always take the ones with more. Given that scenario, perhaps the people who scoff about including leadership concepts in undergraduate education might want to rethink their opposition. Leadership can mean knowing techniques for working an effective care team, too, if that's what there's going to be. And to reiterate, I am not advocating for replacing nurses with UAPs one-for-one. Expanding UAPs does not mean fewer nurses. But it might mean fewer LPNs to get the most bang for your nursing buck.
OK, I'll admit that, as a LPN, I fixate perhaps too much on the "UAP replacing LPN" angle. I obviously have a horse in that race.
But it can't be denied that, increasingly, techs (or whatever) are taking over the traditional "tasks" of nursing. Today its Glucoscans, catheterization, etc. Tomorrow it'll be meds, dressing changes, etc.
In LTC, "medication aides" are creeping in. After all, any literate adult human can read a MAR and pop a pill.
You say these things are just rote physical movements, but I think the trend over the years of delegating so much of this to UAP is a huge blow to nursing.
I'm guessing the response to this would be "as nursing education increases, so does the role evolve, and delegating all the routine we used to jealously guard is a result" I'll bet some see that as a positive. A vindication of increasing education and professionalism. But I think the increasing levels of delegation cuts out part of the heart of nursing. I think its the wrong road.
One last thought: When you say hospitals might as well use techs over LPNs to getmore bang for their buck, that seems a little offensive. I know it wasn't meant to offend,but the impression that gives me is that you view techs and LPNs as more or less interchangeable, at least in acute care.
I know from experience that hospital RNs view LPNs as glorified techs, especially in those hospitals that essentially utilize their LPNs as techs. As someone who's been a tech and a practical nurse, I know this isn't true. Even if I were to be utilized as a tech in a hospital, doing only tech duties,my ability, education and experience as a LPN would enable me to serve the RN and the patients better than any tech, no matter how smart or diligent. I know 100% that if a RN had me on their team, as opposed to a tech, it would result in better patient outcomes. Any LPN worth his salt will notice abnormal status changes faster than any tech. How can having another nurse (albeit a LPN) on the team to observe and monitor not be a good thing?
So I don't think employers are getting more bang for their buck at all. I think the shift toward techs is an ill conceived quick fix.
Here in Canada there is only the degree route for RNs and a diploma for LPNs. If anything the role of the LPN has expanded in acute care due to the need to utilize healthcare funds. The RN role is becoming more management with more PNs at the bedside.
I would suggest reading this recent thread https://allnurses.com/nursing-issues-patient/couldnt-believe-he-881366.html over in Patient Safety forum. I'd like to see this thread cross-posted over here in General. People need to be aware... ...CNA's legally (by the State) delegated to monitor/administer insulin based on glucose parameters administering potassium supplements, narcs and psychotropics, and PRN's. All for a simple online certification course (nine hours). This subject is so important to the future of nursing. We can all turn a blind eye and hope it goes away (or, "adjust" as nurses are expected to do as good little "team players"), or we can stay on top of the issues. This is scary stuff.[/quote']
I just read this thread. Much of the problems in these "care homes" is that they have a poor system. Their MARS are difficult to read and set anyone (licensed or not) up for error. There is no way to positively ID the resident( wristbands), so since that med aide was "new" he probably just got the identity mistaken. Sadly to say, it happened to me as a RN.
Here in Canada there is only the degree route for RNs and a diploma for LPNs. If anything the role of the LPN has expanded in acute care due to the need to utilize healthcare funds. The RN role is becoming more management with more PNs at the bedside.
Very interesting, Fiona.
I am always curious as to nursing trends of our colleagues and neighbors to the north.
We down south of the border are not (yet) a single payer system--but I am anticipating that this is where we're eventually headed.
I just read this thread. Much of the problems in these "care homes" is that they have a poor system. Their MARS are difficult to read and set anyone (licensed or not) up for error. There is no way to positively ID the resident( wristbands), so since that med aide was "new" he probably just got the identity mistaken. Sadly to say, it happened to me as a RN.
Agree with the "poor system" comment. But, I do not know one seasoned nurse who hasn't made a med error at some point, system notwithstanding. I think we all dread med errors. That said, unlicensed personnel are simply not trained to make complex clinical judgments...especially when complex disease processes are tossed into the mix (like diabetes and renal impairment). It's frightening that a CNA could take a nine hour course, and be "delegated" medication administration and treatments in what amounts to autonomous decisions and practice.
If CNA's/MA's are given these responsibilities in non-acute care settings, how long until they are doing the same in acute care? Am I being overreactive? I think not.
thenursemandy
276 Posts
I'm in WA state and as far as LTC goes, nurses are still needed and used to their full capabilities. NA's are still doing traditional nursing assistand duties like ADLs, vitals and simple things.....no major wound care, passing meds, insulin injections etc. The day that changes in LTC, will be a sad day indeed.