Should RNs do endoscopies and anaesthetics?

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Did you see the recent Grattan Institute report which recommends that registered nurses take over screening for bowel cancer and administering low grade anaesthetics in order to save public hospitals $430 million a year.

Under the plan up to 17,000 nurse assistants would be employed to take over feeding and bathing patients, turning them in their beds and stocking medications. These nurse assistants would receive their training on the job [doesn’t that sound like the old hospital-based training?] and would be paid 30 percent less than a registered nurse.

Emma, a former registered nurse, is not impressed with this proposal. Read her opinion and then tell us what you think.

As a former registered nurse, I’ve often thought that health departments would prefer to hire people off the street and pay them below the award wage to do the job of enrolled and registered nurses. It didn’t take long to figure out that non-health staff in the hospitals I worked in often resented how much of the health budget was taken up by our wages.

Well it seems my fears could become a reality in the not-too-distant future, according to advice from the Grattan Institute that public hospitals could save $430 million annually if lower qualified medical professionals provided basic care. In a direct quote:

“Nursing assistants could free up nurses’ time, while specialist nurses could free up doctors’ time by taking low-risk procedures from their more qualified colleagues.”

So basically, nursing assistants would be trained on the job, paid around $49K and would perform all basic living and hygiene tasks. “Specialist” registered nurses would perform bowel screening and administer light anaesthetics for this screening and be paid around $86K.

Some questions/concerns I have:

• There is potential for an increase in litigation for hospitals if a patient dies or becomes seriously injured with less qualified staff performing these procedures.

• Registered and enrolled nurses not being able to build a rapport with their patients and becoming excessively task-oriented.

• I’m concerned about the training that RNs and AINs will receive under these changes and how adequate it will be.

• Are $49K and $86K appropriate wages for AINs and RNs in their new roles, given they will have so much responsibility?

• I would be very naïve if I thought the Grattan Institute had our best interests at heart here; clearly this is a cost-saving measure and down the track this will mean less ENs and RNs being trained and hired. This is a blow for the many graduates and experienced nurses out there who can’t find a job currently.

• If the government wants to save money, why not train/utilise more nurse practitioners? They have a beneficial role o/s and take a lot of pressure off medical officers and health systems.

• Yet more professional responsibility will be placed on the shoulders of RNs; do we really need this given we already have so (?too) much? How will this affect professional indemnity?

Obviously most wards, if not all these days, employ AINs to assist in basic hygiene cares and RNs perform many invasive procedures. In another quote:

“It doesn’t take 15 years of training to provide light sedation for a stable patient having a simple procedure or a three-year degree to help someone bathe or eat – but that’s where we are now.”

That’s a fair point sure, but he doesn’t seem to comprehend that a stable patient can become unstable very quickly or that a perforated bowel is very different to a cardiac arrest in terms of the skills required to manage those events. Or that most often, we’re showering patients with severe dementia or brain injuries or that performing basic cares means we get to know the people we care for and can therefore do a better job.

What do others think? Am I overthinking this?

Let us know in comments below what you think or email us at nurseuncut@nswnma.asn.au.

Nursing Professor Christine Duffield argues that replacing registered nurses is not the answer to rising health costs.

The Australian Nursing and Midwifery Federation also argues that this report is not the solution.

Don’t forget to enter our International Nurse/Midwives’ Week contest to win a ‘Janet King’ DVD!

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