Great editorial in the StarTribune from Eileen Weber about nursing homes trying to save money by changing the law on requiring registered nurses to provide care and conduct assessments instead of less qualified licensed practical nurses. Eileen Weber is a nurse attorney serving on the board of directors of the Fourth District Minnesota Nurses Association. She lives in Washington County.
Weber begins with a history lesson. She discusses the nurses’ strike 25 years ago. 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.
South Carolina’s Board of Nursing has Advisory Opinons that mandate that RNs should conduct assessments although LPNs may collect necessary data like blood sugar levels, vital signs, and oxygn saturation, and RNs should provide direct care for treatment of pressure ulcers.