Time to call a duck a duck?

[eriksoln]

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 and everyone around them, my opinion seems even more valid. I wonder what others think about it.

I remember sitting in nursing school as the instructor drummed on and on about how "Nursing is a profession." That exact theme butted it's head into almost every single class one way or another, regardless of the subject matter. I often found myself thinking "Who cares?" or "What's the point in that?". Then came the dreaded "Dimensions of Nursing" class. It was the class all RN's must go through at one point or another (IDK if LPNs do or not). There are other names for it "Political Aspects of Nursing" I've heard among a few others. It is the class in which you must discuss the political issues that involve nursing. You are encouraged to join this and that group, Nursing as a Profession is discussed over and over, and you must do a research paper. I never really said in that class how I really felt about the whole business of nursing being a profession in fear of drawing the ire of my superiors.

What is it I had to say that my fellow students got to hear during breaks that my instructors did not? Well: Nursing is not a profession, not even with a very generous stretch. It is a labor, a trade. We are judged solely by the amt. of patients we can handle and still keep the minimal quality expected by our administration up to par. Not very much unlike a McDonald's burger flipper. The faster you can cook those patties without screwing too many up, the better you are. That's all there is to it really. If you don't believe me, take a gander at where nursing expenses falls in the budget. We are not logged next to the admin./doctors/lawyers or any of the other professionals. We are grouped in with dietary/housekeeping/security. As far as budget makers are concerned (and, lets be honest, they make the rules), we are a debt, like a labor.

IT IS TIME FOR NURSING TO GIVE UP THIS IDENTITY CRISIS, THIS INFERIORITY COMPLEX IT HAS DISPLAYED SINCE ITS BIRTH AND MOVE ON, EMBRACE BEING A LABOR AND LOVE IT.

Ever see the movie "Man in the Iron Mask"? The King/spoiled twin tells his brother "Into the dungeon you will go, and you will wear this mask again, and you will wear it until you love it."

We are wearing the mask, but are for some reason we are unable to learn to love it. So we will forever stay in the dungeon denying what we are.

Lets face it. All the aspects of a "profession" are an illusion in nursing.

Definition of a profession:

A profession has a unique body of knowledge and values – and a perspective to go with it.

A profession has controlled entry to the group eg registration

A profession demonstrates a high degree of autonomous practice.

A profession has its own disciplinary system.

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

1. Unique body of knowledge: We do need to go to school and must learn a lot, but I don't know about the unique part of it. Most CNA's pick up on how to do what we do after just a couple years, without the schooling. As far as values and perspective go, lets face it, we can't even agree in here on what that is. How many "Calling from God vs. Its a job" threads/rants have you seen on this site. I've lost count. We can't even agree amongst ourselves what degree we should have. I've also lost count of the "BSN vs. ADN vs. Masters" threads.

2. Controlled entry: Phfffft. It is controlled, but not by us. The hospital/medical field administration decides this. Whatever they decide they are willing to hire is what the rule is. If they decide tomorrow to never again hire ADNs.........that's that for them. We have no say in it. Seen any "Nurses eat their young" vents/threads lately. I know you have;), even if you were a blind, deaf mute with both hands tied behind your back you can't help but run into them on here. If we truly were in control of who came into the profession, such threads would be minimal. Can't be angry about who is allowed in when its your decision who gets in.

3. Demonstrates a high degree of autonomy: Again, I lead with PHfffffft. Our job description continues to be and will forever be everything and anything they can't pawn off on the other laborers. How many of us, since the recession hit, have been told to pick it up and help out in non-nursing job related ways? Empty the trash, stock the cabinets, hand out trays, collect and clean the trays..........its endless. We are unable to define for ourselves what we will and will not do. You don't see them sending the Legal dept. any emails about helping maintenance do you? Any rules/laws concerning scope of practice are simply to protect patients from us should we decide to play doctor. No laws exist to restrict what can be expected of us away from the bedside (no, that would actually be useful, help the pt., can't do anything silly like that).

4. Has its own disciplinary system: Do I need to insert Phffffft again? Oh, I just did. We only qualify here if badgering, cattiness and petty write ups are "disciplinary". Nuff said.

5. Respect of the community: I'll resist the urge to insert the obvious lead here. I'll just point out the complaining about surveys that's been the norm lately. Lets face it folks, professions who have respect are not surveyed like this. These surveys resemble grade school report cards "Nursey doesn't play well with others". If we were "respected", we'd be the ones filling out the surveys on how to improve the model of care given.

Think back to your highschool days. Remember that class clown who tried way too hard to be funny? The not so good looking girl who never stopped digging for compliments on her looks? The not so well liked guy always asking if you and he were buddies or not? That's what nursing has let itself become. Constantly running around worrying about impressing people and all the while completely losing its focus on the primary goal. A lost teenager suffering from an inferiority complex.

Maybe if we embrace the fact that we are............:eek:gasp..............a mere labor, we will be able to dedicate ourselves to our patients. Instead of worrying about proving nursing holds a "unique body of knowledge" and making up useless, pointless "theories" and such (tell me one instance you have found a use for nursing diagnosis), we will become more useful. Focus instead on better time management, better understanding of the things we actually use on the job (the equipment for instance) and a better understanding of the tasks expected of us (study IV insertion in school instead of writing papers about why nursing is a profession).

I know many of you will be upset with me and my views. They are what they are. I make no apologies for them. Not having a well liked opinion has never stopped me from saying what I feel needs said before.

So...............am I wrong? Why?

[eriksoln, BSN, RN]

I have an idea. We could make the nursing diagnosis easy to learn. Sorta..........use a mnemonic for them. That'd make them fun to learn too.

Like...................for breathing issues we could make the mnemonic Darth Vadar. So, if someone is breathing heavy it would be:

"Breathing, resembles Vadar."

Now...............I don't care if they are useless if we do it that way. At least they'd be fun then.

[Lunah, MSN, RN]

But maybe I'm missing something. Is there anyone here who would like to defend that diagnosis, or explain how identifiying it might help the patient?

Carpenito's does note that it is rather unique, and is included in the Handbook of Nursing Diagnosis because it corresponds to a specific theory (the human energy field theory). It's under the Spiritual Well-Being NOC. Whether or not I think it's valid, I agree with you -- this does nothing to enhance our image as a profession. But hey, if therapeutic touch helps a patient feel better, I won't knock it, either.

[eriksoln, BSN, RN]

This is an idea here. Yes. I propose we make all nursing diagnosis Star Wars related.

Activity intolerance is now: Jabba the Hut movement.

Impaired communication is now: Chewbacca speaking.

Hmmm............need to think up one for R2D2.

[eriksoln, BSN, RN]

Therapeutic communication now is: Jedi Mind Trick

[Lunah, MSN, RN]

Hmmm............need to think up one for R2D2.

Risk for Disproportionate Growth? Or perhaps that's Yoda.

[eriksoln, BSN, RN]

Risk for Disproportionate Growth? Or perhaps that's Yoda.

Most definitely Yoda there.

Any ideas for Han Solo?

:oHave I lost all credibility with this? Not that I had any to begin with.

[Lunah, MSN, RN]

Hey, it's your thread. You can do what you want with it!

Han Solo: risk for impaired mobility r/t carbonite application AEB lack of movement! This does make nursing diagnosis much more fun. Princess Leia's should have something to do with hearing loss related to huge bilateral hair buns ...

[NocturneRN]

Carpenito's does note that it is rather unique, and is included in the Handbook of Nursing Diagnosis because it corresponds to a specific theory (the human energy field theory). It's under the Spiritual Well-Being NOC. Whether or not I think it's valid, I agree with you -- this does nothing to enhance our image as a profession. But hey, if therapeutic touch helps a patient feel better, I won't knock it, either.

I won't, either. But I'd just as soon leave the energy field assessment to someone else, who's schooled in that theory. I'll stick with a handful of more traditional nursing diagnoses, which are quite adequate, I think, in 99.9% of cases.

[NocturneRN]

Hey, it's your thread. You can do what you want with it!

Han Solo: risk for impaired mobility r/t carbonite application AEB lack of movement! This does make nursing diagnosis much more fun. Princess Leia's should have something to do with hearing loss related to huge bilateral hair buns ...

Jabba the Hutt: impaired mobility related to severely elevated BMI......

[eriksoln, BSN, RN]

O-B-1 can do the energy field assessment.

"I feel a disturbance in the force, as if millions of voices cried out at once and then were suddenly silenced."

[wooh, BSN, RN]

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.

Well when a doctor walks in the room, they can figure out why a patient isn't breathing well, using medical diagnoses. And quite honestly, I don't determine if it's "ineffective breathing pattern vs. altered energy fields." I determine if it's, "CHF vs. asthma vs. pneumonia vs. just plain choking on something vs. cardiac ischemia."

Yes, nursing diagnoses and care plans teach you to think through why you're doing what you do. And I would argue that nursing care plans, as much as I hated them, really were beneficial during nursing school in teaching me to think through what interventions to go through. But I also remember buying a little book, where I could look up the MEDICAL diagnosis and translate that into a nursing diagnosis. Because goodness gracious, it would be horrible of me to put the language of another profession on my NURSING care plan. But that extra step, translating it from a medical diagnosis to a nursing diagnosis IS STUPID and we only do it for the sake of calling ourselves a "profession" with our own "language" and our own "body of knowledge."

I don't need a nursing diagnosis. I need the medical diagnosis. If I walk in a room, and someone has slurred speech and can't move one side of their body, I'm not going to call a doc and say they have "altered circulation" and we need to start the "altered circulation protocol." I'm going to call the doc and say, "They're having a stroke and we need to start the stroke protocol." Nobody cares about the nursing diagnosis except the people that desperately want this to be a "profession with their own language."

[ivanh3]

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.

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.

The flaw in your reasoning is that you are not looking at the big picture. First, I agree with you that nursing education should be improved. Without getting into what is "fluff" vs what is "relevant", I don't think anyone feels that nursing education has reached the point where there is nowhere else to go. However, what does that have to do with being/not being a profession? Do other "known" professions not also try to improve their education and training?

Where you are losing sight of the big picture is that you have either forgotten or become acclimated to the enormous diversity of nursing. I will always believe that learning fosters more learning. So knowledge is always good. So the question is then what do you consider relevant? What would you include in your more "focused and directed" curriculum to prepare a new grad nurse to work in the ER, med-surge, psych unit, community health center, peds neurology clinic, sports clinic, neo-natal ICU, pediatric ICU, surgical ICU, cardiac step down, hem-onc, rehab, ambulatory surgery, substance abuse center, mobile primary care clinic, advice line, ob-gyn, labor and delivery, mother-baby, school nurse, jail nurse, occupational health, ortho floor, dialysis, LTC, ground/air transport, etc. Please factor in the modifiers of pediatric vs adult vs geriatrics, urban vs rural, and hospital vs free standing. That is going to be one hell of a curriculum.

The fact is nurses are (and should be) taught what is minimally necessary to successfully complete a new grad program. New grad and transition programs are where the focused and directed training takes place.

May the force be with you.

Ivan