Below is an article I read with some dismay. I find it untenable that the general population does not even understand what a nurse does and what a nurse is held legally accountable for.
In today’s economy, we frequently hear of cost cutting, or streamlining budgets. Nursing is really not an area where it is cost effective to cut costs. You really do get what you pay for.
I love working with LPNs, and I love working with my team. However, I frequently find myself in the role of teacher with my peers. I see, quite distinctly, the differences in education as it pertains to patient care. I also see the lack of understanding for legality and civil rights issues.
I think this article points out some of the potential problems to be faced if LPNs are allowed to do the work of RNs. Please do not think I am anti-LPNs because I am not. I really am trying to be an advocate for my fellow nurses who would then be put in a dangerous position if the legal system ever were to become involved.
Registered nurses (and subsequently patients) are threatened by cost-cutting.
By EILEEN WEBER
Last update: October 18, 2009 – 5:18 PM
Twenty-five years ago, Twin Cities registered nurses made history with the nation’s largest strike. Over 6,000 RNs stayed out for six weeks, without a strike fund, against a coalition of most Twin Cities-area hospitals.
Many of these highly trained professionals used food shelves and borrowed money to survive. They went on strike for numerous reasons, including respect for seniority when laying off staff instead of cutting the most experienced nurses first.
The strike highlighted the worrisome new hospital practice of sending patients home “quicker and sicker” in order to avoid losing money. Medicare’s new Diagnosis Related Group program reimbursed hospitals for the expected stay of patients with certain diagnoses, instead of paying for the actual stay. This threatened revenue if patients stayed longer than their DRG called for.
Similar to private managed care, the policy implicitly encouraged hospitals to send patients home when their time was up, not when they were ready. Concerns that people too sick to go home would end up right back in the hospital were well-founded.Payers now want to save money by reducing the expensive inefficiency of rapid rehospitalization. Nurses then and now say, “Duh.” When it comes to the big picture of meeting health care needs, cutting corners rarely cuts costs.
Registered nurses, whom the law calls “professional nurses,” won the seniority battle, keeping more wisdom at the bedside. They now face a new corner-cutting threat to their professionalism. The Minnesota Board of Nursing, charged with licensing all levels of nurses, seeing that they meet state educational requirements and protecting the public from unsafe care, is under pressure to allow less-educated licensed practical nurses (LPNs) to do what RNs do now. The chair of the subcommittee drafting the board’s proposal is himself an LPN.
Only legislators may define nursing practice, but instead of taking this issue to them, the board is putting a new spin on the law to appease those who would benefit if organizations that deliver health care can get an RN at an LPN price.
Vulnerable populations, especially in rural communities with fewer resources, are often the canary in the mine of health care corner-cutting. If LPNs do more than the job they are educated for, the effects will be suffered by patients who are least likely to understand what’s missing, who are not inclined to complain, and who are found where LPNs usually work: in home and institutional long-term care.
If there’s anyplace that needs an RN’s better-trained ability to assess what is going wrong in a person with multiple problems, to decide what is needed, to connect that patient with the right problem-solver and to judge if the solution is working, it’s exactly where corner-cutters would like to replace RNs with less-expensive caregivers.
The differences among the rungs of the nursing career ladder all come down to education. Certified nursing assistants (CNAs) take a basic technical course, are the backbone of basic nursing care and have the aching backs to prove it. They report to RNs and LPNs. LPNs have more education than CNAs, can give some medications if trained to do so, and know more of what problems to look for. They report to an RN. RNs have college degrees, more in-depth education in the science, specialties and basic law of health care, ethics and care management. When they can’t independently solve a problem, they call on doctors or advanced practice nurses. Advanced practice nurses, like nurse practitioners, are RNs who get at least master’s degrees to specialize in areas like pediatrics, midwifery, geriatrics and more.
Additional education brings additional independence, accountability and pay. The answer to someone on the nursing ladder who wants to do more has always been to go back to school.
Instead of cutting corners to get around this safeguard of quality care, the Board of Nursing should be pressuring the Legislature and nursing schools to do what is necessary to produce more of all the kinds of nurses needed to assure excellent care of a growing, aging, diverse population with increasing acute and chronic health care needs.
Eileen Weber is a nurse attorney serving on the board of directors of the Fourth District Minnesota Nurses Association. She lives in Washington County.
October 27, 2009
Seeking RN expertise at LPN prices | StarTribune.com
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