Debate point: What IS nursing?

Nurses General Nursing

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Without going to stock phrases, textbook definitions and the like, how would you define nursing in a way that differentiates it from other health care professions?

I'm asking because even having graduated from nursing school, I find that defining what nursing is is a tricky area.

Nursing is assisting patients with ADLs? That's usually a part of the definition of nursing. There are the basic "nursing care" tasks such as helping patients wash, turning patients to prevent skin breakdown, feeding patients, etc. Professional nurses have had formal training in the rationales for such nursing care and evidence backing it up, but unlicensed personnel often participate in this care and may or may not be supervised by licensed nurses (eg home personal assistant). Professional nurses and other health personnel can implement such care without collaborating with medical personnel.

Nursing is the professional (occupational) performance of health-related tasks? That's usually an assumption and reality of nursing, though it's not always included in definitions of nursing. Traditionally, though, nurses have tended to do the "boring", "routine", and "less skilled" work that MDs could do if their time weren't at such a premium. These are things like prepping patients for procedures, changing dressings, giving injections, patient teaching, etc. Unlicensed personnel are also often trained in such tasks - phlebotomy, administering injections, giving enemas, etc.

Nursing is the on-going monitoring and intervening in collaboration with medical personnel? I think this the bulk of inpatient nursing care, where the nurse is essentially the stand-in for the MD (or PA or PA or DO), monitoring and documenting the patient's status and judging when a change in status merits action. This is a vital function of nurses yet it seems to me that it's often glossed over, as it seems "less professional" since the nurse can't function completely autonomously in such cases.

Nursing is "filling the gaps"? Nurses have often filled the gaps in health care, such as teaching patients when the MDs don't have time. Nurses have also filled in in disadvantaged communities offering health screenings, immunizations and such and thus some of the community health nursing roles developed. Nurses took on the role of providing health services in schools. Now more nurses continue in this tradition stepping into a more medical role (diagnosing and prescribing) as nurse practitioners, helping fill in the gaps for mid-level providers.

I'm just trying to organize some thoughts. I'm curious what thoughts other may have on this.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Nurses today have gone beyond the traditional role and boundaries of the hospital, doctors' office, etc. Because of their education and varied areas of expertise, they can be found in many different settings: schools, community centers, churches, insurance companies, law offices, etc. Even in the traditional hospital setting, nurses go far beyond bedside care. I think a nursing education offers so many more job possibilities than other healthcare professions.

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nurses are... :nurse:

angels?

a life saver? :redbeathe:redbeathe:redbeathe

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Quick and dirty:

Nurses are the jack of all trades or the ultimate middle man in the Health feild.

I know medications but not as much as a pharmicist

I know ADLs but not as well as PT/OT

I know vent settings but not as well as RT

I know illnesses but not as well as the medical doctor

I know what a lap chole is but could perform one.

I can foley someone, but not as well as a urologist.

ect...

BUT, I seem to be the only one that can get all of these separate people on the same page as to how to care/treat MY patient COMPLETELY

Major Domo

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Quick and dirty:

Nurses are the jack of all trades or the ultimate middle man in the Health feild.

BUT, I seem to be the only one that can get all of these separate people on the same page as to how to care/treat MY patient COMPLETELY

Interesting angle. Do you think that current nursing education prepares nurses for this type of middleman role? Or is it that nurses end up being responsible for whatever isn't done by others? Do you think most nurses are able to get those other folks on the same page? Or is that an idealistic image, the reality being just getting the basics covered (meds administered, paperwork signed off, etc)?

In the inpatient setting, I do see the nursing role as trending this way... as patient care coordinators as opposed to patient caregivers. This is partly due to the increased number of people involved with any one patient's care. Someone has to coordinate, and nurses have filled in the gap. However, this extra role puts great strain on the nurses who are also responsible for all other nursing care.

Do you think there should be a specific role of patient care coordinator that is separate from the patient caregiving? If so, would this role be limited to nurses? Or could that possibly be yet another niche allied health role with it's own training for entry?

Just more thoughts! :monkeydance:

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The Nurse is the medical equivalent of "A Jack of All Trades."

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Definitions of nursing seem most similar in kind to definitions of social work - another coordinating and "fill in the gap" role. Both of these seem to aim for whole life harmony, as opposed to focusing on just one aspect of a problem. In contrast, definitions of medicine, physical therapy, respiratory therapy, etc are much more focused.

However, these idealistic definitions seem to ignore the reality of many nursing roles, where the nurse doesn't have the time or resources to do more than the tasks at hand. The inpatient acute care nurse is focused on keeping the patient alive and avoiding complications, bottom line. Bottomline for school nurses is immunization checks, mandatory health screenings, tracking students with med problems and taking care of incidental illnesses and injuries. Bottomline for dialysis nurses is getting the patient dialysed without incident. Teaching, therapeutic listening, helping improve quality of life, etc all end up at the bottom of the list and often are never gotten to.

I'm not saying nursing should throw out it's idealism. I think all health personnel should be encouraged to consider the whole patient and not just treat them as a disease or a problem to solve. Anyway, I find these discrepancies in the ideals of nursing versus the realities of nursing interesting. Anyone else have thoughts on this?

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Definitions of nursing by nursing organizations:

Nursing is...the use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death. (RCN)

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations. (Nursing's Social Policy Statement, Second Edition, 2003)

Definitions of Social Work (google define:social work)

# Social work" means engaging in psychosocial evaluation and intervention, including therapy, to the extent permitted by the licensure provisions of this chapter, to effect a change in the feelings, attitudes and behavior of a client, whether an individual, group or community. "Social work" also means engaging in community organization, social planning, administration and research. [1985, c. 736, 2 (new).]

jorifice.state.me.us/legis/statutes/32/title32sec7001-A.html

# Professional services of a social worker aimed at the promotion of the social functioning of individuals, families, groups and communities.

http://www.polity.org.za/html/govdocs/white_papers/social97gloss.html

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Specializes in Travel Nursing, ICU, tele, etc.

As one of my favorite nurse friend says:

Let's face it, we all just wipe butt for a living... then we save their ass.

I'm sorry to be gross, but that encompasses a lot of what I do. It is the most humble profession there is, in some ways, and then when the pt is in trouble, you need to step up and be the advocate of that patient, interface with other professionals and make sure he/she gets the care they need, often to save their lives.

It amazes me how my job can go from the most mundane actions to drop dead serious in seconds.

Anyway, not a very poetic slant on nursing, but one that keeps me humble and on my toes!!

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Specializes in Med/Surg, ER, L&D, ICU, OR, Educator.
Quick and dirty:

Nurses are the jack of all trades or the ultimate middle man in the Health feild.

I know medications but not as much as a pharmicist

I know ADLs but not as well as PT/OT

I know vent settings but not as well as RT

I know illnesses but not as well as the medical doctor

I know what a lap chole is but could perform one.

I can foley someone, but not as well as a urologist.

ect...

BUT, I seem to be the only one that can get all of these separate people on the same page as to how to care/treat MY patient COMPLETELY

Major Domo

This is one of the BETTER definitions that I have seen!

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Specializes in retail NP.

nursing=tiring.

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jjjoy,

My belief is that formal nursing education only prepares new grads to be, hopefully, safe nurses. True nursing skills and knowledge occurs on the job. The rest of nursing classes are to give a taste of some different types of nursing and for PhD RNs to attempt to justify the profession. To justify our profession all we nurses need to do is to show what happans, usually in lawsuit form, when nurses are replaced by the various pt technicians due to poor pt outcomes (look at Tucson Medical Center in the late ninties).

Due to our being at the bedside and by doing our pt care activties for 12hrs, we tend to notice things that our Cohorts on healthcare miss. The slight reddening on the sacrum, no BM for three days, slightly dim breath sounds, ect... When was the last time you noticed a surgeon do a complete assessment on a bka?

We also are readily availible to all the consults that see the pt and gain knowledge about that pt, not only by their progress notes, but by informal conversations. The pts and/or family bring up questions/concerns that pop into their heads 10 minutes after the doc's five minute morning rounding on the pt. The nurse notices that the pt isn't eating there food, or has problems swallowing it.

Also, in some skills we are better than the docs, I use to shake my head whenever a pedi pt's parents demanded that the doc start the IV or perform the I/O cath.

Some hospitals do have pt care coordinators (or something similiar), but, then again they loose that ability to be readily availible. And they tend to be nurses.

And now for the social workers. Good ones are angels, great ones are demi-gods in my book, but they, for the most part lack the clinical competancy to notice the medical needs of a pt, unless the doc specifies what is needed by the pt after discharge. They are more about coordinating care after discharge or about how the pt can get funds for their care.

Granted, bedside nursing is hectic and technically challenging, but just by doing our care we notice things that everyone else misses, it's not really an ideal, it is what we, as a profession, have become. Our knowledge base, our skill, and our being their allow us to be the ultimate middle man.

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Thanks for your thoughtful response, MajorDomo. : )

You describe acute care nursing very well. And I agree with you on the value of nurses as middlemen and as having a unique perspective by their on-going presence with patients, as opposed to the periodic visits of other staff. The latter aspect of nursing, though, is only true in inpatient settings.

The point that I'm grappling with here is what professional nursing is across the board, or perhaps what the foundation of professional nursing is. Common arguments about nursing insist that nursing ISN'T limited to or defined by acute care, inpatient nursing. Yet the bulk of non-inpatient nursing positions require at least of few years of inpatient clinical experience, preferably acute care. There's an inconsistency wherein nurses insist that they aren't defined by their clinical skills and yet an insistence on nurses working at least a few years in acute care to become "real" nurses. Understandably, acute care also helps hone time management and assessment skills, but if acute care clinical skills aren't the foundation of nursing care then one ought to be able to develop relevant time management and assessment skills in whatever environment they are working, shouldn't they?

My point about social work was just that it is like nursing in that it's goals are very broad and that like nurses, social workers fill a wide variety of roles and functions (counseling, case management, group work, program administration etc), not that social workers can do the same work as nurses.

Doctors generally diagnose and treat disease and injury. Physical therapists adminster various types of exercise therapy to rehabilitate and maintain physical mobility. Dieticians evaluate diet and create diet plans. Aides assist with ADLs. Nurses do all of that except diagnose and prescribe - unless in advanced practice.

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