Friday, October 05, 2012


Are nursing an endangered species?

Healthcare is changing. In my ER we are going to PAs as  the main providers. They will be seeing all the patients except those who are critical. This will mean less doctors needed.  Now mind you, this is a decision by our doctor group to do this.  They cover 3 hospitals and its hard to find enough doctors to staff them.  These doctors are saying that the majority of our patients don't really need to be seen by a doctor.

Is this the future of medicine? I mean think about it. Overall, isn't the vast majority of medicine routine?  Couldn't most of the patients in the healthcare system be managed by PAs or NPs?  Most of it is not rocket science. I've always thought that eventually medicine will go to exactly this model. Cost will dictate the change.

Could this same thing happen to nurses? Lets face it, some of what nurses do is not rocket science either. The tasks I mean.  A lesser trained person could easily manage them.  Where the value of nursing comes in is to manage and coordinate the whole picture, to monitor the patient and catch changes,  The value of nursing is our holistic approach.  We are the ones who see all aspects of the patient as a person and address it.  We have the knowledge to know how things should look and can recognize when something is wrong.   We are the person who stands between the patient and all of those specialists focusing on their own unique area. We coordinate the care and keep the patient safe.  We're the ones there at 3 am when the patient goes down the toilet.

WIth the emphasis on costs, do nurses need to care for individual patients? Would it be more cost effective to have 2-3 nurses overseeing a unit and other people doing the tasks? Will hospital managements start to think about cutting the more expensive nurses and replacing some of them with those who cost less, leaving nurses to supervise?  With the inevitability of NPs and PAs providing the majority of primary care, will nursing go the same route, being replaced by perhaps paramedics, EMTs?

Why do I bring this up? Because I see a rapidly changing health care system in which interest groups (doctors, management) are changing the way things are done. They recognize things have to be different. And then there are the nurses.

For a long time, nurses were in the drivers seat with the nursing shortage. We got what we wanted. They wanted to make us happy to keep us. That has all changed.  There will be another nursing shortage but it will be different. Nurses are being asked to do more with less.  We already are.

The nursing profession seems to be in a state of shock right now. Things are changing rapidly.  Corporations control medicine.  Yet we as a group are not stepping up to be a voice in this new environment.  We complain and whine about what is happening (I'm really good at that), wanting it to go back to where it used to be.  It isn't going to.  Unless we step up to the plate and deal with the reality of this health care environment and advocate for our very important place in it, nurses will be replaced. We are a costly part of the system in an environment that emphasizes cost. If we don't take control of our profession and prove our worth, take our rightful place, we will be gone.


Renee Maynes said...

I think you're right in that eventually RN's will supervise and coordinate the care of a great number of patients while the actual hands on, non complex care will be done by unlicensed assistive personnel. And definitely think PAs and NPs can handle many ER visits and be considered appropriate level of care.

Anonymous said...

The great race to the bottom, to the least possible care, least possible cost and least possible wages are what this era will be known. The masses will determine the Walmart of medicine while the Gucci people have what ever they need. We will return to the 1600's, I hope there will be enough grog to go around.

Anonymous said...

Smartazz comment #1: Isn't "have 2-3 nurses overseeing a unit and other people doing the tasks" the current nursing home model? And even the general public thinks that system doesn't work well for patients. Soooo, lobby the public and get them on your side.

Smartazz comment #2: Pennsylvania will never permit unlicensed healthcare workers. Penna is always looking for creative ways to make more people need licenses to do anything, whatsoever. lol

Serious comment: Nursing no doubt is getting gobsmacked by the increasing demands on and decreased respect for nurses. But, nursing dug itself into that hole by refusing to clearly delineate the occupation of Nursing from Mamma doing her Mamma thing. When women in other occupations were seizing power and demanding changes, decades ago, nursing was still giving the store away. Nursing still is treating the job like a relationship, not an occupation. I could see that as clear as day when I started nursing school. If you are a college-grad, highly trained professional, please walk that walk. I could not believe nursing schools are still harping on that Florence Nightingale stuff as a role model, and "mothering" patients, and Extreme Altruism. Flo has been dead since 1910. C'mon, bury that broad.

I am not saying be callous. But do stop being such servants and subordinate help-mates PDQ, because if you don't, your profession will continue to be seen as Mamma and HelpMate. And everyone knows how Mamma gets dumped on in most families.

Demand safety-first for nurses. Demand protection against violent or abusive patients. Demand, do not ask. Coal miners, chemical plant workers, garment factory workers, etc: None of them ever got better working conditions by being putting up with it and being nice.

aliyaa said...

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