Outgoing Nurses Nursing Profession In Transition As Rns Move Out Of Hospital Settings And Travel To Patients’ Homes

Tiena Lynes, a nurse with the Visiting Nurses Association, prefers caring for patients in their homes instead of hospitals.

“In home care, you can work with the whole patient,” says the 20-year nursing veteran. The setting is more natural and allows nurses to provide more holistic care. Also, she says, homes provide a less stressful environment than a hospital and allow more flexibility and creativity in care.

In recent years, the focus of nursing has shifted from hospitals to rehabilitation and extended-care centers as well as home health care. More and more registered nurses are moving away from hospitals, being replaced with certified and non-certified nursing assistants.

Today marks the beginning of National Nurses Week and provides an opportunity to take stock of where nursing as a profession has been and where it is headed.

“As our role moves from the patient’s bedside to more diverse locations, we are committed to doing what we do best - care for the whole patient,” says Meg Jones, a certified registered nurse at Sacred Heart Medical Center. “In spite of the changes and challenges nurses are facing today, we still love what we do and are fighting to keep patient care as our No. 1 priority.”

Changes in the hospital health care system have largely come about due to shrinking budgets and greater emphasis on the bottom line. Jones would prefer to endure smaller budgets rather than have her hospital close and not be there to provide needed services.

“I struggle with budget cuts at my place of employment, just like everyone else does,” says Jones. “Yes, I’m frustrated by fewer and fewer nurses in direct bed-side patient care. I worry about just how far I can stretch my abilities.”

Cherrie Mikel, a nurse practitioner who used to work as an RN at Sacred Heart, sees some benefits and drawbacks of the new organizational structure in hospitals. The emphasis on cost accountability was needed, she says. “When I first started, we didn’t care if we racked up thousands of dollars in 24 hours for a patient in intensive care.”

Mikel does worry that some of the hospital patient care formerly administered by RNs is now in the hands of assistants who have little or no training. “I have concerns when nurses are replaced with unskilled people,” says Mikel.

Instead, RNs now typically function as team leaders, responsible for leading a group of less-skilled workers.

She agrees nurses don’t need to perform small tasks, such as fetching ice water for a patient, but says hands-on work should be done by nurses to ensure proper treatment.

Mikel says the quality of care patients now receive in hospitals has deteriorated compared to 10 years ago.

“I think they (patients) need to be concerned,” says Mikel. “I would be concerned if it was my family member.”

Nurses are necessary to provide the art of care, says Lynes, and taking them away only exacerbates the hospitals’ impersonal atmosphere.

“Reducing the number of nurses can only negatively impact the patient,” says Lynes. “There’s such a huge body of knowledge that nurses have. A technician may not have all of that information to put two and two together.”

Merry Armstrong, an assistant professor at the Intercollegiate Center for Nursing Education, also does not approve of the practice of replacing nurses with other workers. “I don’t think they (nurses) can be replaced by anyone,” says Armstrong, who also works as a nurse at Sacred Heart during the summer. “As a consumer advocate, I would urge people to be aware of that. I think it’s a dangerous trend.”

Nurse practitioners are expected to be in greater demand in the future. Nurse practitioners are RNs with advanced degrees and certification who practice independently and can make diagnoses and prescribe medications.

Mikel, who made the journey from hospital nurse to nurse practitioner three years ago, was frustrated with the limitations she faced at the hospital and liked the idea of working with people in the community. She gained a taste of the autonomy and environment she craved while working at the Visiting Nurses Association, which sends nurses to people’s homes.

“I like working with the patients … giving them the skills they need to impact their health,” says Mikel.

Lynes sees nurses increasingly moving away from hospital care and into long-term care and home care. The benefit of home care, besides being a friendlier environment, is that patients have more say in their care and ultimately choose what care they will receive. In hospitals, patients are told what to do, says Lynes. At home, they are told what they should do.

“We’re there to teach the patients,” says Lynes. “They’re the bosses.”

Despite nursing’s recent changes, Armstrong would still recommend the profession she loves. “I’ve never been sorry. I love my work.”

She sees many nursing students who have a genuine wish to help people. Those who just want a job, she says, will never make it.