Time to call a duck a duck?

Nurses Professionalism

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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?

someone came up with Tank Commander. Which, you know, could resolve the whole problem of being respected as professionals[/quOTE]

LOL! I'm laughing at the image of a particularly small, cute and shy 'all-I-ever-wanted-to-do-is-help-people' classmate of mine from nursing school charging into a patient room announcing 'I'm your Tank Commander today'!

Specializes in CVICU, Obs/Gyn, Derm, NICU.
I have to say at this moment I am sad and nauseated after reading your post. I have been a RN for 13 years and a CRNA for 1. You miss the whole point why nursing schools call for nursing to be a profession. Why is it nurses are always dumped on?? Why is it they have no autonomy?? IT IS BECAUSE NURSES ARE UNORGANIZED AND ARE QUICK TO DENEGRATE THEMSELVES AND EACH OTHER. CRNAs have been successful because of one reason, the AANA (American Association of Nurse Anesthetists). In my state, there are approximately 1000 CRNAs. At least 90% of them belong to their PROFESSIONAL organization. We have a strong voice in the legislator and we have respect from other healthcare providers and hospital administrators. There are approximately 88,000 RN in our state. If half of the RNs joined their professional organization and got involved in the politics of healthcare, nurses would rule the healthcare world. You would have more control over what happens in hospitals, nursing homes, and your nursing practice than any other special interest group in the country. As long as nurses are willing to tear each other down and complain about their situation rather than do something about it, they will continued to be governed by hospital administrators, physicians and others who are not looking out for YOUR best interests. WAKE UP!!!! Nurses have strength in numbers and until you realize that, you will be passing trays, taking out trash and be completely disregarded.

Yes agree....but why don't nurses manage to join together and do that? Why are CRNA and doctors groups strong professional organizations? The answers lie in the inherent RN wider range of orientation, skill and education......this thread has displayed those differences that are both our strength ....and also our weakness. The RN job description is wide.....too wide to slot us into

'professional'. We are wide. We need to be .... to fit our very wide role.

CRNA's and doctors are more homogenous than the RN group because they have common education,orientation and skills. They are tight. This very nature of nursing means that we will remain divided....alas.

Specializes in ER, House Supervision.

Okay, I just have to say that until nurses (not APRN's) can bill for the care they give, we will not be considered professionals by the administrators and financial officers who see nursing as a budget sink-hole. I have found that administration staff really have not got a clue what nursing involves and do not understand that it will sometimes take more nurses to care for the same number of patients but have different acuity levels, so the first thing they want is to cut staff when numbers are not what they want. I too like nurse-craft as a descriptor for nursing duties. I have enjoyed reading this thread, thanks Eric for the thought churner. One point I would like to make is that the nursing diagnosis and process are defiantly needed for those people who come to nursing with no common sense. There are people who go into nursing who have no idea what it means to be a nurse. Like the one on your unit who "didn't know there would be so much aide work", TV and other media have given this notion that nurses never get dirty. The nursing process and diagnosis are a great jump off point for these students, unfortunately those who come with linear thought processes often get bored and irritated with the repetitive nature of this learning process just have to suck it up. Well that my 2cents.

ps. I have RN behind my name cause it was easy to remember for signing in purposes.LOL

agree whole heartedly, unfortunately :yeah:

Specializes in ER, cardiac, addictions.
Okay, I just have to say that until nurses (not APRN's) can bill for the care they give, we will not be considered professionals by the administrators and financial officers who see nursing as a budget sink-hole......

Excellent point, and one that's applicable to many other professions. I once had a friend who was a lawyer (I think most people would agree that that's a profession?), who took a very well paid position ($200,000 per annum, as I recall, and this was fifteen years ago) with a corporation, rather than going into private practice. Sounds good, doesn't it? Well, it wasn't. Her boss, also a lawyer, was obnoxious and sexist. He refused to give her the autonomy she'd assumed she'd have. He treated her like a flunkey, assiging her dumb tasks like making coffee for the department and doing clerical work. (I have no idea why he assigned these tasks to her, rather than just hiring an office aide.) The money was good, but her self-respect took a huge beating.

After about six months of this, she quit the job and took a less lucrative one elsewhere, where she was at least treated like the intelligent professional she was, and not like somebody's maid. No matter what your job title or academic preparation is, when you're on someone else's payroll, too often you're regarded as a liability to profits, rather than an asset to the business. And that problem isn't unique to nurses.

I suppose it depends on where one works as a nurse. My experience in med/surg and small town OB made me feel that a trained monkey could have done the job I was doing, so I'd say that in that case it was not a professional job. But as a case manager, I've had to think and make decisions that weren't mine to make when I did med/surg, and I find it to be empowering, challenging, and rewarding. I couldn't go back to the floor unless I had NO other options.

Nursing does suffer from a complex, I agree, but that is not unique to nursing. I think any line of work where you have little control over your job when it's implied that you should makes one CRAZY. Public education is a good example of that.

Specializes in Trauma ICU, Peds ICU.

OP it's sad... but true.

Spoken as a relatively new nurse who's looking to leave the "profession."

Specializes in multispecialty ICU, SICU including CV.
Okay, I just have to say that until nurses (not APRN's) can bill for the care they give, we will not be considered professionals by the administrators and financial officers who see nursing as a budget sink-hole.

Posted similar sentiments #17 in this thread re: nursing/healthcare as a commodity. We're going round and round in circles now .... LOL

You're not wrong for viewing nursing as a trade or labor. That's your prerogative. But you are wrong to speak as if the role of nurses will remain static- that there is no hope for change- when the reality is the role of nurses has been anything but over the past hundred plus years. It has been nurses themselves driving the evolution of nursing- just as it is currently nurses driving the evolution of nursing from a trade/labor to a profession.

Personally, I view the paradigm that you speak of which currently exists in healthcare institutions- where nurses are treated like "burger flippers"- as being ultimately detrimental to patient outcomes. I've worked in a setting as a medication aide where care staff is forced to work with the absolute maximum number of residents they can possibly handle, and as a result residents receive far worse care than they deserve. Our healthcare system needs to shift in a far more patient-centered direction- one in which the role of nurses as patient advocates and holistic care providers is fully realized and valued- and it's not doctors or hospital administrators who are going to change this state of affairs- its nurses themselves. Nursing is still changing- it's in a constant state of change- so you can either accept things how they are and sneer as others work for change, or you can be a force for change yourself- it's your choice.

Specializes in M/S, Travel Nursing, Pulmonary.
You're not wrong for viewing nursing as a trade or labor. That's your prerogative. But you are wrong to speak as if the role of nurses will remain static- that there is no hope for change- when the reality is the role of nurses has been anything but over the past hundred plus years. It has been nurses themselves driving the evolution of nursing- just as it is currently nurses driving the evolution of nursing from a trade/labor to a profession.

Personally, I view the paradigm that you speak of which currently exists in healthcare institutions- where nurses are treated like "burger flippers"- as being ultimately detrimental to patient outcomes. I've worked in a setting as a medication aide where care staff is forced to work with the absolute maximum number of residents they can possibly handle, and as a result residents receive far worse care than they deserve. Our healthcare system needs to shift in a far more patient-centered direction- one in which the role of nurses as patient advocates and holistic care providers is fully realized and valued- and it's not doctors or hospital administrators who are going to change this state of affairs- its nurses themselves. Nursing is still changing- it's in a constant state of change- so you can either accept things how they are and sneer as others work for change, or you can be a force for change yourself- it's your choice.

Ah, but see that is my problem. In my view, it is insisting that we are professional that holds us back. In order for us to take the "pt. centered direction" you speak of, we must stop focusing on trying to improve our "image" and titles and........well, worry about the pt's.

Actually, its not doctors or hospital administrators OR nurses who is going to change this state of affairs. For the most part, it'll be the patients. Through "voting with your feet" and not giving poorly functioning facilities their money and through voting in candidates/politicians who get tougher on facilities. The American people tend to be a sleeping giant. They let things slide, put up with a an awful lot and turn the other check to the point of being called "lazy". Once they decide to change something though........forget it, its over. I believe the poor medical care delivery that was accepted a few years ago no longer is now. People are getting lawyers, going after institutions and demanding better.

Now, IDK about you, but.............I'd rather these people say "You know what, the nurses are the only ones outta this bunch that cares." than have them thinking "Eh, they are just like everyone else, more concerned about their compensation and title than their patients."

IDK. Seems to me a lot of nurses hung up on being a "professional" would rather see their pt's get bad care and be called a professional than be called a laborer and see their pt's happy.

Specializes in ortho, urology, neurosurgery, plastics.

You are absolutely right. Nail on the head. Needle threaded...ad nauseum. We nurses I believe, think of our selves as professionals. A professional, by definition, is someone who does something specific (in nursing it is many things specific) for money. I do not think it is the everyman who discredits us as professionals, but the managerial and financial hierarchy that does so.

Specializes in ER, cardiac, addictions.
Ah, but see that is my problem. In my view, it is insisting that we are professional that holds us back. In order for us to take the "pt. centered direction" you speak of, we must stop focusing on trying to improve our "image" and titles and........well, worry about the pt's.

Actually, its not doctors or hospital administrators OR nurses who is going to change this state of affairs. For the most part, it'll be the patients. Through "voting with your feet" and not giving poorly functioning facilities their money and through voting in candidates/politicians who get tougher on facilities. The American people tend to be a sleeping giant. They let things slide, put up with a an awful lot and turn the other check to the point of being called "lazy". Once they decide to change something though........forget it, its over. I believe the poor medical care delivery that was accepted a few years ago no longer is now. People are getting lawyers, going after institutions and demanding better.

Now, IDK about you, but.............I'd rather these people say "You know what, the nurses are the only ones outta this bunch that cares." than have them thinking "Eh, they are just like everyone else, more concerned about their compensation and title than their patients."

I think you might be missing one important point: that what you might regard as useless semantics or tasks might not seem so to another, equally competent and qualified nurse.

Some of those nurses, who are being looked down on because they work at a desk instead of the bedside, actually create the policies that the rest of us take for granted. For example, someone here mentioned the old ways we used to treat pressure ulcers, with heat lamps. (I remember taping the patient's buttocks apart with wide, heavy adhesive tape----can you imagine the damage done to the patient's skin?----and shining that light on their backsides. I also remember painting those open wounds with Betadine, or washing them with hydrogen peroxide. What were we thinking?) In many cases, it wasn't the doctors or supply salesmen that changed our way of thinking: it was nursing research. It was nursing research, too, that showed that overuse of Foleys isn't a good thing. And that pushed for universal precautions in hospitals and nursing homes.

I'm a front-line patient care nurse, and will be one until the day I retire (or die in harness). But I'm the first to admit that we wouldn't be as effective as we are today, if it weren't for the nurses who work behind the scenes, to make sure that we have all the tools we need to do our jobs well. I wouldn't want their job, any more than they'd want mine-----but I think there's room for all of us in this field.

IDK. Seems to me a lot of nurses hung up on being a "professional" would rather see their pt's get bad care and be called a professional than be called a laborer and see their pt's happy.

I can't think of a single nurse I know who'd want his/her patients to get bad care, or who'd sacrifice good patient care in the interest of showing off a credential.

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