TASK SHIFTING OF NURSES1
Task Shifting of Registered Nurses
Jessica Scharfenberg
MPH 548: Human Resource Management
July 5, 2015
Task Shifting of Registered Nurses
Introduction
The registered nurse is a person who combines the art of caring for individuals with the science of healthcare (Fottler & Fried, 2011). They focus not only on the whole patient, but also the family of the patient they are caring for, all while adhering to the standard nursing process. Nurses utilize a process of assessment, diagnosis, planning, implementation, and evaluation to advocate for the patients under their care (Fottler & Fried, 2011).
There are over three million registered nurses in the United States, who fall into a unique profession (Fottler & Fried, 2011). Currently, a registered nurse is able to complete one of three levels of education before attempting a national test. Registered nurses can complete either a two-year, associate’s degree in nursing program, a three-year diploma program, or a four-year bachelor’s degree in nursing program (Fottler & Fried, 2011). No matter which program a registered nurse completes, is must be an approved nursing program and the nurse must complete the national examination before being eligible to practice.
Scope of Practice Expansion
The registered nurse no longer just cares for the patient, but has also assumed many other tasks from other healthcare providers (Fottler & Fried, 2011). They act as a pharmacist, phlebotomist, physical therapist, respiratory therapist, and medical social worker. Almost all clinical tasks are the responsibility of the nurse at one point in time (Hirsch & Schumacher, 2012).
Nurses are asked to perform rate and dose calculations for medication administration. In rural hospitals, nurses have access to the pharmacy at night when a pharmacist is not on staff. During that time, they often dispense and mix medications in emergency situations. Clinic nurses are often responsible for calculating injection doses for common antibiotic administrations. Similarly, the registered nurse obtains intravenous access for both blood draws and medicine administrations, in which a phlebotomist or laboratory technician is utilized for.
The registered nurse is responsible for acting as the physical therapist also. They assist patients with ambulation and transfers, while teaching exercises to strengthen and aide in recovery. Often times, the first time a patient moves post-operatively it is under the watchful eye of a registered nurse. The nurse also monitors respiratory status, administers nebulized and inhaled medication, and weans patients off oxygen while they act as the respiratory therapist.
Lastly, the registered nurse fills the shoes of the medical social worker. They obtain consents, help find post-hospitalization placement for patients, and identify resources for those in their care. The registered nurse is in the midst of all family dynamics, acting as mediator while offering the shoulder to cry on.
Task Shifting in the United States
As the healthcare workforce continues to see shortages, task shifting has become the answer to fewer employees (Chang, 2009). Task shifting is the redistribution of healthcare tasks to different members of the healthcare team (Evans, 2014). This could be a medical assistant calling patients with laboratory results instead of a physician, or utilizing nurse practitioners and physician assistants instead of medical doctors (Chang, 2009). The shifting of tasks from higher trained medical professionals, to those with lower training there is hope to increase efficiency while decreasing costs (Evans, 2014).
The questions of quality care and safety remain, even after the World Health Organization implemented task shifting guidelines, which call for continues monitoring and evaluation of task shifting practices (Evans, 2014). Although, it has decreased costs and increased healthcare efficiency. Nurses now have increased time with patients, as receptionists now work towards scheduling future appointments and procedures.
However, task shifting may not be the answer to the healthcare worker shortage. Task shifting places less qualified professionals in positions that can endanger patient outcomes and safety (Evans, 2014). Another problem with task shifting is that although one plate of tasks is being emptied, it is being loaded onto another’s plate. This creates a cycle of burnout for healthcare professionals, never really solving the healthcare shortage problem, only adding to it (Hirsch & Schumacher, 2012).
Conclusion
It is a double-edged sword though. While the cost of physician assistants and nurse practitioners is less, a healthcare facility has the opportunity to employee more of them. This will increase the accessibility to care for many people (Chang, 2009). It does not necessarily increase the access to quality care, as physicians are still needed to over-see midlevel practitioners.
From personal experience, my family has received less then top-quality care from mid-level practitioners. When my son was three days old, his bilirubin level was elevated to 19.6. It is presumed that permanent neurological damage occurs with a level over 24. When his level was checked that day, the physician assistant sent us home without concern. Later that night, after the overseeing physician reviewed the chart, he was placed on an emergency bili-blanket to decrease his bilirubin level. Due to this, we fall into the category of patients who have a difficult time accepting the change of task shifting (Evans, 2014).
From a larger perspective, task shifting is the only immediate answer to the current healthcare shortage. The benefits of task shifting include improved skill mix of teams, lower cost for training lower trained healthcare personnel, and more efficient use of the current staff (Affo, Agbogbe, Jennings, Tankoano, & Yebadokpo, (2011). There is an opportunity for this structure of shifting to work, if the healthcare facility enacts the correct monitoring systems and evaluation methods, but only for the short term (Chang, 2009).
References
Affo, J., Agbogbe, M., Jenning, L., Tankoano, A., & Yebadokpo, A. (2011). Task shifting in
maternal and newborn care: A non-inferiority study examining delegation of antenatal
counseling to lay nurse aides supported by job aides. Implementation Science, 6, 2.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024964/
Chang, L. (2009). Task shifting: A solution for the health worker human resource crisis.
Retrieved from
Evans, M. (2014). Expanding the team. Modern Healthcare, 44(38), 16. Retrieved from
http://web.b.ebscohost.com.vproxy.cune.edu/ehost/detail/detail?sid=5bfcc0a4-c831-449e-
af234ad8d9679b68%40sessionmgr113&vid=1&hid=105&bdata=JnNpdGU9ZWhvc3Qtb
Gl2ZQ%3d%3d#db=rzh&AN=2012753256
Fottler, M. & Fried, B. (2011). Fundamentals of human resources in healthcare. Chicago,
Illinois: Health Administration Press
Hirsch, B. & Schumacher, E. (2012). Underpaid or overpaid? Wage analysis for nurses using job
and worker attributes. Southern Economic Journal, 78(4), 1096-1119. Retrieved from
http://web.a.ebscohost.com.vproxy.cune.edu/ehost/pdfviewer/pdfviewer?sid=81a3af11-
0cb5-4c04-898c-e3bf220cb54d%40sessionmgr4001&vid=1&hid=4201