Am I Nursey Enough For You?
We nurses are sometimes our own worst enemies. Far too often, lay people demonstrate misunderstanding and disrespect for nurses. Why shouldn't they, when they learned at least some of it from us?In the US, the definition of a nurse is a simple one. A registered nurse is a person who has passed the appropriate NCLEX exam and who holds a valid license in his or her state. The same is true for a licensed practical nurse. That's pretty straight forward, isn't it?
As it turns out, the definitions are a bit too straight forward for some, meaning they don't allow the lay public to discern exactly how nursey a particular practitioner might be. This deficiency has inspired some nurses to take it upon themselves to establish various nursiness scales and encourage others to abide by them when evaluating those who may--or may not--be their peers.
For instance, ICU and ED nurses typically outrank med/surg, OB, and psych nurses. Flight nurses and those who work in neuro or cardiac ORs are usually located somewhere near the top of the heap, while others who give vaccinations at community clinics, educate new diabetics, or work in school health rooms come out near the bottom.
The problem with this kind of thinking is that it fosters division and disrespect among people who ought to be linking arms and presenting a united front when non-nurses demonstrate how poorly much of the general public understands the nursing profession--and who belongs in it.
In an age when medical assistants, nursing assistants, med techs, and even office personnel might wrongfully refer to themselves as nurses, we who genuinely have earned the title should insist on truth in labeling. We need to educate consumers and get after those who exploit their confusion. As nursey as these assistive personnel may appear, they have no right to appropriate the title.
Not much to argue about there. But, along with exclusive limitation, truth in labeling has an inclusive aspect as well. And that is not nearly as popular within our ranks.
The initial showdown takes place between hospital nurses and everyone else. Acute care nurses take pride in what they do, and they should, so long as they don't--even mentally--let their workplaces give them an excuse to snub other nurses.
Among the non-hospital nurses, another dust-up occurs between those who provide patient care and those who don't. Do you work with residents, visit people in their homes, give kids their ADHD meds and inhalers? Okay, you're a notch or two down from the hospital folks, but at least you're still a hands-on nurse.
What if you're a case manager, an insurance reviewer, or an IT person? Sorry, you don't seem very nursey at all.
Advanced practice nurses might as well be animals of a different species, along with those involved in upper management or teaching.
And so it goes.
Why do we treat each other this way? How can we blame the public for having a distorted image of nursing when some of us capitalize on this very misinformation--"Why yes, thank you, I am a real nurse because I work in a flashy specialty that would shine on prime time TV--leaving others to feel they have to present their credentials, point out their roots, or argue the importance of their jobs.
Can we admit that some of our colleagues do jobs that lack panache but matter greatly to their patients, clients and residents. Can we acknowledge as our peers those who keep renewing their licenses even though they now operate at a remove from the bedside--the teachers, the managers, the researchers, the volunteers?
Maybe it's time we give the rest of the world a demonstration in how to respect nurses by insisting that every one of us who has passed the test and kept the license current is just as nursey as the rest.Last edit by rn/writer on Oct 1, '11
Sep 25, '11i couldn't agree more. it's more than enough to have some of the doctors and other allied health professionals trodding upon nurses who have rightfully earned their titles. it's a bit too much to think that other nurses bring down their colleagues because they happen to be in an area different from theirs. i have encountered some of these individuals and i honestly can't believe how they can manage to fit their big heads through the doors. sure, i'm not an icu nurse but i am a nurse. i have my license to prove it. it matters not which area we work in, what matters most is that we make sure that we work efficiently and diligently to meet the standards of the institution where we are currently employed.Sep 25, '11Thank you for writing this piece. As an LPN I really feel sometimes that I just don't count as a nurse. I get the quarterly newsletter from my state's nursing association and there is plenty in there about what the nurse association is doing to better lives for nurses, but it is all directed toward RNs.
The recent upswing of activism I see lately is all about RNs.
I am an active union member and very interested in nurse advocacy but I feel that my voice doesn't count, that I am locked out of this dialogue. It is very depressing. If advocacy efforts were to include LPNs, all of nurses would have a much stronger voice.
As an LPN I am aware that my scope of practice and knowledge base differs from that of RNs but at the same time I feel that I deal with the same workplace challenges as RNs. The atrocious working conditions, the personal and professional dilemmas, defeats, successes, and challenges.
I go home and cry about the same things as RNs, I go home glowing about the same type of patient interactions as RNs.
LPNs are too often lumped into the same league as RTs, PTs, etc. But we do not focus on one very specific area of patient care, we deal with the whole patient. And depending on where we work we have very similar supervisory duties as RNs, but without the acknowledgement of back up.
Should that be the case? Probably not, but that is the reality of nursing, with facilities trying to pinch pennies and employing underhanded strategies to do so.
I often feel very alone out there in the world trying to do this job, no back up from administration, just like what happens to RNs, but at the same time, not even any support from a nursing community that is all about advocating for RNs.
I seriously do not want to turn this thread into a debate about LPNs vs. RNs. I would just hope that RNs would invite us into the fold. I think we have a lot to offer.Sep 25, '11Yes, I agree that the in-fighting is what the administration counts on so that "divided we will fall". I do not look down on LPNs, but view our roles as more similar than different. Hopefully there will be a meeting of the minds and our intellectual snobbery will be at an end.Sep 25, '11Can remember being in a LTC quality assurance meeting years ago. There were several members of upper management along with 3 MD's. The topic turned to how to improve the image of the LTC nurses as the Drs voiced concerned that the local hospital nurses didn't take the LTC nurses seriously or really seem to have much respect for us. The Drs subtly implied that we were doing something wrong
I politely told the one Dr. that when he went back to the hospital later that afternoon he needed to take a specific parking garage elevator down and he would find the answer to that question in the elevator. He gave me a weird look and asked what that could have to do with anything. As I explained I had been to the hospital earlier in the day and had been in that elevator. In very large letters, written on the elevator wall was "Cardiac Nurses suck - ICU nurses rule".
It will be a great day when we all learn to appreciate the other.Sep 25, '11EXCELLENT article, Miranda........once again, you've proven how good your grip is on what matters, and what doesn't. Bravo to you for a well-thought-out and well-written piece!Sep 25, '11Strange but true, the whole world labels and judges according to what you do in this world and its a darn shame. All nurses GIVE of themselves to helping people, but I have encountered Nurses that were ICU and ER nurses looking for a so called EASIER position then they have encountered in their careers and it just didnt work.....THEY COULDNT HANDLE WORKING WITH ELDERLY PEOPLE!!!!! Its not funny but an ICU deals with people who have under gone surgical procedures, are in critical condition or are NOT abrasive and combative like elderly patients can be at times....they are used to people being in a coma, an altered state of consciousness or just plain too weak to really fight for themselves....Well......its different on the Long Term care side......believe me......and its not easy......most of them QUIT!!!!!!! LOLSep 25, '11I had a stange comment made to me when I did a temp assignment at my state's Department of Health- It was made by a MPH director of a Infectious Disease Dept. This woman clearly did not value my opinnion at all on any nursing practice issue-because I was a acute care bedside RN ( and have been on for 30 yrs) she told me that is what I was "groomed" to be. I think those in other diciplines- Master's of Public Health specifically, feel the hospital bedside nurse is a "Child of a Lesser God" in the healthcare business. Needless to say, I was very insulted by her comment- she started out life as lab tech.Sep 25, '11oh great post. I think about this all the time. In the aspect that I worry how i'll be viewed as a nurse if I go into CM or clinic instead of hospital nursing. I'm still a nurse, a good one. Maybe I just don't want to work 12's anymore, or constantly catch what my private duty patient and her family are passing around. I'm still a nurse and so is every other nurse. It doesn't matter what "kind" of nurse she is, as long as she does the right thing, and does the best she can for her "patients" she is a nurse. There is no rank, that is degrading.Sep 25, '11I don't think it is just nurses who do this. I think this type of hierarchy is prevalent throughout healthcare. Physicians are are often divided along the same lines. The cardiothoracic surgeons or neurosurgeons are often the "gods" of the hospital and are often allowed to get away with disrespectful treatment of staff. Primary care docs are often at the bottom of the heap. Even their reimbursement levels reflect the perceived hierarchy.
That being said, I believe we have our own nursing leadership to blame for a lot of the discord between nurses. How often have we read articles or statements that poo-poos the education of the diploma or ADN RN while crowning the BSN as the "best" nurse? Who do they think is responsible for orienting and mentoring most of these BSN nurses? Why do they think it is ok to alienate at least 50% of the registered nurses we have in the workforce? My preceptor was a diploma RN w/ 20+ yrs of critical care experience and over 7 yrs and a BSN later, I will readily admit that I don't know 1/2 of what she knows. How often do we sit back and listen to our nursing leaders disrespect the care, support and mentoring our diploma and ADN RNs have given us?Sep 26, '11..."nurses take pride in what they do, and they should, so long as they don't--even mentally--let their workplaces give them an excuse to snub other nurses."
Yes. This. Perfect.
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