Replacement of nurses with unlicensed assistive personnel: the erosion of professional nursing and what we can do.

I n 1994, 38% of hospi ta l s su rveyed ind ica t ed plans for future workforce cuts. Twenty-seven percen t of these hospi ta l s i nd ica t ed they are t a rge t ing nurses, compared wi th only 19% in 1993.1 Professional nurs ing staff cuts are not just a resul t of dec reased need or inc reased efficiency: 50% of the nurses whose jobs are e l imina ted are be ing rep laced wi th un l i censed ass is t ive personnel (UAP). 2 Many nurses respond to this news wi th sad accep tance as a new necess i ty beyond their control. Nurs ing labor ' s expense and ease of e l imina t ion are wide ly assumed. Fee l ing powerless , many are reduced to only hoping they will be personal ly spared. However, these are reverbera t ing revolut ionary changes tha t mus t be ac t ively confronted. Job erosion is d a m a g i n g our profession, and qua l i ty pa t i en t care is de ter iora t ing . There are a t ta inable , del iberate act ions ind iv idua l nurses can take tha t toge ther create a po ten t professional chal lenge.