Time to call a duck a duck? - page 10

by eriksoln

79,467 Views | 547 Comments

I remember having this debate with other students while I was in school. I have seen nothing during my time practicing nursing to change my mind about the issue. Now, with the recession bringing out the true colors of nurses... Read More


  1. 7
    Quote from VMSR
    Eric, I have one comment to your post: pffft! If you believe nurses are more like McDonald workers than, lets say, pharmacists, I'd like to know where you work, and avoid the place at all costs, either as a RN or a patient. Issues you list to support your opinion are not matter of professionalism, but political problems stemming from healthcare being treated as a commodity and not right. Not to mention that employers (which are out for profit, and not providing the best healthcare) very successfully manipulate the fact thar there is massive amount of self-loathing (as evidenced in lots of replies to this post) in the nursing workforce which prevents them from organizing and exerting pressure to improve both workplace and their status. I'm actually pretty amazed that California nurses (which are, by the way, best payed in the nation) managed to get such a strong union going, considering what obstacles they had to deal with. There are about three million nurses in the nation: we are the largest group of workers in the USA. If there is solidarity and will to stand for the profession (or trade, if you will), you would not have to clean wastebaskets, and would have patient workload that is in the best interest of the patient, not the profit. If that is to happen, nurses need to take pride in what they are doing, and demand to be treated as professionals that they are.
    One thing, though, I can do away with: silly nursing diagnoses. They sound like something from Monty Python.
    I will borrow from one of my favorite philosophers, Satyr, here.

    "We are defined by what we do, not the reasons for what we do."

    In other words, even if your assertion that nursing is where it is because of "political problems", its heresay.

    The very fact that all it takes are some "political problems" to take nursing from being a profession to what it is proves my point. If we were a profession, political problems would have no bearing on it. You don't think doctors and lawyers have any "political problems"? They are still a profession though. See, if we were a profession, the politics would not affect us so.

    And being strong in numbers also does not make us a profession. Landscape laborers and fast food workers outnumber us easily.............not a profession, never will be.
    CCL RN, oliviajolie, Bella'sMyBaby, and 4 others like this.
  2. 8
    Quote from nursemike
    Sing it, Brother! I don't guess I'm enough of a conspiracy theorist to think it's intentional, but I think a lot of the concern over professional standing tends to divide nurses. The debate over entry to nursing is a prime example. According to the ANA, and some allnurses.com members, I shouldn't be a nurse, because I'm only an ASN. My question is, who then will do what I and thousands like me are doing? And I don't mean only that associates and diploma programs are an ad hoc solution to a shortage of BSNs. Nor am I saying that nursing is only about passing meds and wiping butts and holding hands. Critical thinking is important! But it seems to me like a lot of advocates for professional standing are very nearly saying that nurses need to be doing what doctors already do, and seemingly disparage the things that nurses have always done. Why should academic nursing or political advocacy be more nurselike than, oh, say, taking care of patients?

    I've heard and seen "task-oriented," used as a perjorative. I am task-oriented. I've been a nurse for five years, now. I'm well aware that there is a bigger picture. A lot of times I can even see at least some of it. But, like many nurses (and many others) I'm a work in progress, and a lot of times I have to focus on the practical aspects of my job. I respect the nursing process, and I do believe that each part of it is important, but still, without Implementation, all of the other parts are just words. I actually have used NANDA nursing diagnoses in my practice. More often, I'm just thinking about what my patients' problems are and what can I do for them. I'm pretty sure I am capable, if need be, of writing a 20 page paper in APA format about my patient's anticipatory grieving. But I don't particularly want to be a writer. I want to be a nurse, and my patient wants a cup of tea and someone to talk to, and I think that might just give us a basis to interface constructively.
    I do believe in the bigger picture and fully support the argument that we simply can not sleep walk through our work without seeing it.

    Problem is, I see so many nurses patting themselves on the back and claiming to have mastered "critical thinking" and they are simply doing their jobs.

    Scene: Nurse walks into a room, finds IV on the ground, disconnected from pt.
    "Oh, I'll prime new tubing and restart the IV."
    Nurse finds herself in the IV room.
    "Oh, I'll take the IV basket with me in case the IV is damaged too."
    Nurse returns to room, finds they were correct, IV site needs replacing.
    "Oh deary, what an intelligent nurse I am. I critically thought out the problem and was right."

    Give me a break.
    Chin up, ohioSICUrn, CCL RN, and 5 others like this.
  3. 11
    Quote from ktrees
    I am a professional, and I have a professional quest that I am on. Unfortunately, you do sound a bit angry. Good luck, I hope you find what you are looking for.

    Elle
    Oh no. Here we go. You are on a "quest"? Eh? Its just finding a job and applying yourself to it, millions of people do it on a daily basis. Its not uncommon, really it isn't.

    Oh my, another nurse who signs "RN" to everything outside of work and begins every statement with "I am a nurse and I think......................'

    Good luck with that when you realize your place. Make sure you save the employee handouts with the "Employee Assistance" info. for the counselors in it.
    inshallamiami, Chin up, CCL RN, and 8 others like this.
  4. 0
    wow...do you spend much time on this line of thought...?
  5. 2
    Quote from tewdles
    wow...do you spend much time on this line of thought...?
    What line of thought? Profession vs. Skilled trade or the "God Calling" nurses theory?
    Bella'sMyBaby and wooh like this.
  6. 9
    Interesting discussion, but really more like an academic exercise (that one might encounter in their eduction to enter or continue the profession of nursing). I understand most of your points that nursing might not be considered by some to be a profession. Where I disagree with you is that you are applying an ivory tower sociologist's definition of what it means to be a professional or to "join the (good ol' boys) club" (that the sociologists feel they belong to).

    I hold three licenses/certifications: paramedic, RN, and FNP. For all three I can say without a doubt that I am a professional. I have no identity crisis. None. During the course of my professions I use various skills, some basic, some complex, some subtle, and some in your face. I have no doubt that many, if not all of these skills could be taught on the job. That does not mean per se I am not a professional.

    You listed the criteria of a profession. Great. Now show me one using those requirements. MD? Lawyer? Psychologist? Sociologist? Surgeon? Pilot? Clergy? None of those have a "unique body of knowledge" that they own.

    You quote Sartre but I am not sure where you were going based on what followed your quote. However, I do think it applies. I am defined by what I do, and what I do is professional nursing, just like I am a professional paramedic (talk about two professions with a significant amount of crossover in body of knowledge). You are right about the motivation component. I don't find myself as altruistically motivated as some do, but I do care, and I do make a difference...even if its only a small one.

    As for the rest:

    A profession has controlled entry to the group eg registration
    A profession has its own disciplinary system.


    These two are really easy: state boards of nursing. I am pretty sure every state has one. They control who can be a nurse (licensure) and they discipline their licensed membership if need be. Your counter to controlled entry involves employment. Employment is not the first step. Licensure is. I don't understand your counter to the discipline issue. Are you suggesting that nurses aren't disciplined by bodies outside of their employment? Please clarify.

    A profession demonstrates a high degree of autonomous practice.

    I hear the term autonomous used often. First, what do you mean by autonomous? For some the definition falls along the lines of varying degrees of "being told what to do"-ness. This is patently ridiculous. Name a profession where there is no guidance from above. Everybody has rules and protocols. Everybody. Every profession. Nurses often use critical thinking (yes, nurses do use critical thinking...maybe not all nurses all the time, but very silly to suggest otherwise) and autonomous decision making during the course of even a protocol driven day.

    A profession enjoys the Recognition and Respect of the wider community.

    Most easy one of all. Just google "most trusted profession". Having said that, you will also get other professions listed in your search results as well. So again, I get it that you don't feel that nursing is a profession. And since my definition of profession is one of those cheesy "comes from within" kind of things then by (my) definition, you are correct: you are not a professional i.e. you are not doing professional nursing (and you are not alone). But that is you. Not me, and not many here. Using your classic sociology based definition of profession I do hope you can give an example of some (or any) professions.

    Just my .02
    Ivan
    Last edit by ivanh3 on Jul 18, '10
    WyndDrivenRain, JacobK, tewdles, and 6 others like this.
  7. 6
    Eh, yeah. My point with Satyr was that............if we don't have (insert any of the qualifications of being a professional here) then we don't have it. Why we don't have (autonomy etc) is not important. We can make excuses for not fitting in on one or more qualification, but in the end we still don't have that qualification. Why we don't is not essential. A profession would have that qualification instead of excuses.

    So that definition comes from the sociology area of study. I looked it up, remember it from school. Hmmmm...........

    Have to admit though, I can't argue the fact that I guess if you are splitting hairs..........you could say just about any profession lacks in one area or another.

    But, that doesn't change my mind that a more focused/pt. directed educational system and less fluff like nursing diagnosis would further our cause and make us better at what we do................help the patient.
    ivanh3, CCL RN, oliviajolie, and 3 others like this.
  8. 5
    Quote from eriksoln
    Right there is pretty much the jest of what I am trying to get at here. Eliminate all the walking in circles, creating labels for doing our job (nursing diagnosis, the nursing process, critical thinking........come on, trying way too hard to sound important is what I see it as) and focus on being better at our job. THEN, WE CAN TRULY HOLD OUR CHINS HIGH AS OUR FOCUS WILL ONCE AGAIN BE THE PATIENT.

    I am not saying nursing is a useless trade to practice, nor am I saying we are less than anyone else. What I am saying is, the immature inferiority complex that often drives nursing theory is failing us. Refocus schools on teaching nurses to obtain the best outcome for their pt., not on passing some exam that, in theory separates the "concrete thinkers" from people able to "think critically" but in reality is nothing more than a hit and miss lottery. I'll say this much: If the NCLEX were any good, don't you think it would have eliminated someone like me who completely disposes of most "nursing theory" from the get go? I passed first time.


    The purpose of the NCLEX is not so much about whether you understand nursing theory, as it is about determining whether it's safe to give you a nursing license. Among other things, it's designed to determine whether you know how to apply nursing theory, for those situations involving off-the-wall symptoms and unfamiliar disorders.

    You might think nursing diagnoses are useless, but chances are that you're using them anyway, without really thinking about it. For example, if a patient suddenly develops trouble breathing, the average guy off the street might assume that the remedy is to give him oxygen. But we as nurses are aware that just sticking a cannula or mask on the patient's face doesn't always address the real problem. So we look for a cause or causes: is it ineffective airway clearance? Impaired ventilation/gas exchange? Or possibly a side issue, related to impaired tissue perfusion (cardiac) or anxiety or pain? Each of these conditions, of course, requires different interventions.

    So, when you're detecting and documenting a nursing diagnosis, you're indicating that you pursued the problem beyond the obvious (sticking the oxygen on the patient and walking away). You're showing that you followed a scientific method, rather than just going by the seat of your pants. And you're also providing criteria to evaluate the effectiveness of the interventions.

    Sure,it's cumbersome and it's a nuisance, when you're first learning to think in those terms. But it's also what causes you, as an experienced nurse, to do an EKG on your patient when he tells you he's having trouble breathing, or to question him a little more closely about his level of pain, instead of automatically assuming that trouble breathing = need for more oxygen.

    I'm having a hard time figuring out why that would translate either into immaturity or a poor self-image.
  9. 5
    Quote from NocturneRN
    The purpose of the NCLEX is not so much about whether you understand nursing theory, as it is about determining whether it's safe to give you a nursing license. Among other things, it's designed to determine whether you know how to apply nursing theory, for those situations involving off-the-wall symptoms and unfamiliar disorders.

    You might think nursing diagnoses are useless, but chances are that you're using them anyway, without really thinking about it. For example, if a patient suddenly develops trouble breathing, the average guy off the street might assume that the remedy is to give him oxygen. But we as nurses are aware that just sticking a cannula or mask on the patient's face doesn't always address the real problem. So we look for a cause or causes: is it ineffective airway clearance? Impaired ventilation/gas exchange? Or possibly a side issue, related to impaired tissue perfusion (cardiac) or anxiety or pain? Each of these conditions, of course, requires different interventions.

    So, when you're detecting and documenting a nursing diagnosis, you're indicating that you pursued the problem beyond the obvious (sticking the oxygen on the patient and walking away). You're showing that you followed a scientific method, rather than just going by the seat of your pants. And you're also providing criteria to evaluate the effectiveness of the interventions.

    Sure,it's cumbersome and it's a nuisance, when you're first learning to think in those terms. But it's also what causes you, as an experienced nurse, to do an EKG on your patient when he tells you he's having trouble breathing, or to question him a little more closely about his level of pain, instead of automatically assuming that trouble breathing = need for more oxygen.

    I'm having a hard time figuring out why that would translate either into immaturity or a poor self-image.
    I see where you're coming from. IDK, its a good point and I'm certainly not going to completely dismiss it. But I do have to say, when a pt. says "I can't breath", nursing diagnosis don't start playing across my mind. I guess you could say the nursing process does in a way.................cause my rule of thumb is always to check the pt. first. Guess that could be translated to the "assess" part of the process lol.
    OMG NOOOOOO.........I'm using the nursing process..............I'm going to start signing "RN" to everything outside work and preempting everything I say with "I'm a nurse". KILL MEEEEE NOOOOOOWWW.

    Anyway, all kidding aside, I've never once walked in on a problem then said "Hmmm, what nursing diagnosis is this? Oh, yes...........its (insert nursing diagnosis), now I know what to do."

    IDK. Using the nursing diagnosis to me seems like...........instead of going from A to B, you are gong from A to a to B. If that makes sense.
    CCL RN, Bella'sMyBaby, frumpter, and 2 others like this.
  10. 4
    Quote from eriksoln
    I see where you're coming from. IDK, its a good point and I'm certainly not going to completely dismiss it. But I do have to say, when a pt. says "I can't breath", nursing diagnosis don't start playing across my mind. I guess you could say the nursing process does in a way.................cause my rule of thumb is always to check the pt. first. Guess that could be translated to the "assess" part of the process lol.
    OMG NOOOOOO.........I'm using the nursing process..............I'm going to start signing "RN" to everything outside work and preempting everything I say with "I'm a nurse". KILL MEEEEE NOOOOOOWWW.

    Anyway, all kidding aside, I've never once walked in on a problem then said "Hmmm, what nursing diagnosis is this? Oh, yes...........its (insert nursing diagnosis), now I know what to do."

    IDK. Using the nursing diagnosis to me seems like...........instead of going from A to B, you are gong from A to a to B. If that makes sense.

    I'm guessing that that's because it's become second nature to you. You are using the nursing process every time you look for any possible causes for a sign or symptom, rather than just assuming the obvious, as someone with no medical/health care background would do. You're not just grabbing for the pain medication every time a patient groans; you're not just grabbing more blankets every time the patient shivers, and you're not just assuming that, if the patient says he's thirsty, it's a good idea to give him a drink of water. You're looking deeper than that, which means that, whether or not you're spelling them out, you ARE making nursing diagnoses (call them "educated observations" if you prefer), and acting on them.

    The nursing diagnosis is also a key to your care plan. Yes, we as nurses DO need to develop care plans, since our work is a tad more complicated and individualized than just babysitting the patient for eight or twelve hours. If you determine that the breathing difficulty is related to anxiety and not impaired ventilation, you can then look at possible causes for anxiety, and develop a plan for addressing them. Is it an anxiety attack? Anxiety related to pain? (we're all familiar with those patients who want to be "good patients," and decline pain medication even though they're not functioning very well without it). Or might it be anxiety related to knowledge deficit?

    I'll never forget a post CABG patient I had once, who was crabby and uncooperative the day after surgery, refusing to get out of bed, refusing to cough and deep breathe, refusing visitors, and so on. Came to find out that he'd been poorly prepared before surgery, and, when he woke up afterward, saw all the tubes and lines and assumed he was dying. Once he realized that he was actually doing very well, his attitude did a 180 degree turnabout. Nursing diagnosis in action!---even though I don't recall having written it out as such.
    Chin up, oliviajolie, tewdles, and 1 other like this.


Top