Time to call a duck a duck? - page 2
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... Read More
Jul 16, '10Quote from MinnieMomRNErik, Your post was interesting and thought provoking, but I can't say I'm ready to jump on your bandwagon. While I admit that I hold nursing diagnoses with the same respect as I hold pig-latin as a foreign language, I find nursing theory utterly relevent to practice (particularly Benner). Additionally, while I agree that the field of nursing is not where it needs to be as a profession, I do feel that there has been a marked advancement. IMHO, just because we are not yet where we need to be should not mean we retreat --- or maybe this is just my stubborn nature.
Now thats just funny.
I think we would be so much further though if we let people think whatever it is they may and direct our energy towards........goals more likely to help the pt.
Jul 16, '10Quote from NYRN05i disagree with you on so many levels....but answer me this...if you don't like nursing so much. then why are you here posting about it? are you a nurse? then i ask again why? go be a "professional" somwhere else...just my opnion ! maybe whatever job you have encourages this mindset....and if you accept it...then you own it. you will make your professional career what you want it to be.
you want to be the burned out bitter soul that puts down their own profession (yes thats what i call it)....then do. if you think cna's can learn nursing in a few years then i think by now we all would have been out of a job-heck i would have never went to nursing school then-i could've stayed a nurses aide according to you and would have known it all-your rationales make no sense. if you are so much better than you know where the door is...like my gma said...and on your way out...don't let the door hit you where the good lord split you !
and that's my true colors for you.....i know people like you who just want to get people all in a tizzy....its how you get your kicks. but i still love what i do each and every single day...its my profession...its my job....its what i was chosen to do. maybe you weren't...and you chose it instead. there are a lot of people like you who should have never became a nurse. it is for people like you....who just want to keep the profession from advancing with your negativity.....well i guess you could always flip burgers then right!
I've had people say this to me before actually. I'm starting to get a complex about it actually.
Maybe I should seek "professional" help ha ha ha ha.
Jul 16, '10I agree with everything you said. As it is now, nursing is a skilled trade. It might change someday, but I doubt it. I've been doing this nearly two decades, the money has gotten better but EVERYTHING else has gotten worse.
When I started they had things like transportation, hospitality, etc. Our time was considered too valuable to do nonnursing things. Unit clerks were staffed every shift, even nights. Now, if we get a clerk she's expected to take VS, pass ice, in short, to do two jobs for the pay of one. And then we get dinged if our phones aren't answered in a timely manner.
I read a thread once (not here) where a hospital administrator was moaning because because nursing salary was the biggest part of the expenditures. Well, yeah! Hospitals exist for no other reason for nursing care. If nursing care was not required everything would be done outpatient in Ambulatory Whatever Centers. Trust me, if they could the suits would drop our pay down to 15 bucks an hour. Since they can't do that they expect us to do every job under the sun. After all, we're the biggest drain on their financial bottom line.
So I think we should embrace our status as tradespeople. Schools, quit droning on about nursing theory (which can be summed up in six words ("we take care of sick people") and prepare your students for hospital work. No student should be writing any papers until he knows how to start IVs, insert foleys and run codes. That way, maybe they can get actual jobs when they graduate.
Jul 16, '10Quote from eriksolni've had people say this to me before actually. i'm starting to get a complex about it actually.
maybe i should seek "professional" help ha ha ha ha.
nursing diagnosis: thought process, altered...lol:d
Jul 16, '10This is going to be a very interesting and thought provoking thread.
I essentially agree with you, and I don't think that nursing is heading in the more professional direction, in spite of the never ending number of letters we can put after our name if we take the right exams. The market doesn't allow for it. The current healthcare system and reimbursement standards has reduced nursing to a commodity. In theory if we are allowed to practice to our fullest potential, well-educated nurses have the knowledge base to practice professionally. The issue that I see is that there is no reimbursement for that, and likely never will be.
I have seen very intelligent, well educated (master's degree and above) nurses get verbally put in their place by physicians. There is no respect for what we do, even at a high level of education. My current manager, who I respect very much (a BSN, MBA) has told me that she sits in on multidisciplinary meetings and her opinion means little because "I have 'RN' after my name instead of 'MD'."
Even if no one thinks we are professionals (and that's fine, if that's the way it is) I refuse to be treated disrespectfully. I still got through a college degree. I am still educated. There should be clear distinctions between what nursing does and what housekeeping does. There are standards for workplace conduct and they don't involve belittling people for the job they have, even if it involves wiping butts. With this whole "professionalism" debate, that is the biggest issue for me personally -- I don't really care if you want to call me a professional or not, but if you are going to stick up your nose because I do a dirty job, that's when I take issue.
Jul 16, '10I think you make some very interesting points. Some I agree with, some not so much.
I live in an area where the governing body seems to be turning its back on what nursing should be into what the politically correct people want it to be. I also think that nurses tend to be their own worst enemy many times, in all aspects from recruiting new nurses ("no! Don't go into nursing, it's an awful job."), to training them, to the administration and so-called professionalism of the nurses.
There are many tasks that a nurse does that a CNA could do, but there are also many skills that nurses are taught that you can't teach someone who hasn't been through more education than a CNA gets. But, is this the fault of the nurses?
As I said, interesting post. Should make for an interesting discussion as long as it stays civil.
Jul 16, '10Nice post, Eric!
I don't agree with your entire argument that nursing isn't a profession - there are elements of nursing that I think make it a profession, but it when I think about why I love being a nurse, being considered a professional just isn't one of the reasons! I think what matters is my own attitude towards my job - not someone else's. I don't see being a worker as being less important or worthwhile than being a "professional". We have housekeepers at my hospital, but in the middle of the night if a trash can in a patient room is overflowing I don't feel at all demeaned by emptying it.
I agree that nurses are often defensive about their image to a degree that is counterproductive. It's the only profession I have seen where people cite their bachelor's degrees on their IDs! (I've seen some pretty good threads on that one...) Forrest Gump's logic would work here - professional is as professional does....
Jul 16, '10I have to agree with you too. I graduated from an ADN program which thankfully was heavy on clinicals and I only had to do one "leadership" type class. I was clinically prepared and it shows. But if I was really a professional I would have some sort of voice at work. Instead I care for 13-15 sometimes very fragile subacute patients. I am also expected to answer the constantly ringing phone, schedule appointments for patients, set up their transportation to said appointments, take off orders, track down lost laundry, and 1,000 other things that are the nurses responsibility because no one else will do it. ONLY the nurses in my facility answer the phone! As the nurse, EVERYTHING in the facility is my bottom line responsibility so if it isn't written into someone elses job description then I end up doing it. If I was really a professional, somewhere there would be some respect for my time and practice. Instead they try to hold the nurses to a higher standard by calling them a profession, and use that to make them pick up everyone elses slack.
I'm grateful I went into nursing with my eyes wide open and am not surprised. If I thought it would be any different I would be heading for the hills by now.
Jul 16, '10It is kind of pathetic.
I love many aspects of being a nurse. I have been treated with respect by physicians and patients alike. Here and there I get jerks, but so does everyone everywhere.
I have to say that I am almost done with my BSN and I know know what BS stands for. The nursing classes are all rah-rah and don't even build on the assessment skills we have but rehash them. I am not joining the ANA nor do I accept their statements as something to which my practice needs to adhere.
I know I'm smart. I know what I know. I am fortunate that, in LTC, my practice is very autonomous and if I call the doc and say, "Hey, Mary's lungs are really wet. A little Lasix maybe?" I am listened to. I also don't need to make stuff up to support that we are a "separate and distinct" discipline from medicine. We are not. We are inextricably tied to medicine and that's fine because that's what interests me. Altered energy field my tuchis.
Jul 16, '10Oh, and as to whether it's a profession or not -- who cares?! And if you have to ask it ain't, like the old adage if you need to ask how much it costs you can't afford it.
Jul 16, '10There are definitely valid points to be made in the discussion of "is nursing a profession?" The problem in my school was that it wasn't a discussion, it was doctrinal. It was as if you didn't think nursing was a profession, then you must conclude that nurses can't be professional and/or don't deserve to be treated professionally. But whether or not their particular line of work is considered a profession, a person can be professional in how they carry out their work and they should be treated professionally by others. And a job can demand critical thinking and autonomy in how to carry out their work whether or not the job fits any particular definition of "profession". Do we really think that all of the people out there who don't work in "a profession" are doing the equivalent of "mindlessly following orders" and "fluffing pillows" and "being handmaidens"?
Quote from eriksolnI agree that it's a stretch to define nursing as a profession by the above definition.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) Nursing knowledge overlaps considerably with other fields. The only reason I can see to try to define a "unique body of knowledge" is to fit the above definition of profession.
2) Nursing fits this one perfectly! Yeah!
3) The majority of nursing positions rely heavily upon decision-making by others, be they physicians or other nurses. That doesn't mean most nurses have NO autonomy or that nurses CAN'T practice independently, just that MANY do not seem to fit the definition of "high degree" of autonomous practice relative other "professions". Many physicians would probably argue that medicine is becoming LESS of a profession what with medical practice being dictated by insurance reimbursement policy.
4) Nursing does have it's own disciplinary system with BONs, but most nurses are employed by non-nurses, don't own their own practice, and are more immediately subject to employer disciplinary systems.
5) Huh? What kind of "criteria" is that? Is there any line of work out there that meets the first 4 criteria but not the 5th and therefore doesn't qualify as "a profession"? A line of work most certainly can have recognition and respect whether or not it's considered a profession.Last edit by jjjoy on Jul 16, '10
Jul 16, '10I think you've made some really good points. I mostly agree, although I think that in some areas of nursing we do fit the description of a profession and in some we don't. And in some ways, we might appear to be a profession and really aren't. For example, I'm ICU. I can do things like insert/remove foleys and flexiseals without a doctor's order, can remove art lines, and when I recover an open heart patient I do so on my own, with a set of standing orders. I often can write orders for a doctor that I know well because they trust me and I know they'll sign it when they get in. These are things that usually can't be done on the Tele or Med/Surg floors. However, as autonomous as that makes me feel, the fact is that if a single doctor decides he doesn't like what I've done, the official rule book will be thrown at me for overstepping my boundaries.
Someone upthread was insulted by the idea that nursing is a labor instead of a profession. I find THAT insulting. I come from a long line of union laborers - millwrights, carpenters, electricians. These people in my family were without exception brilliant, intelligent craftsmen who took great pride in doing a job properly, in being reliable and honest and fair. There is no insult in being skilled labor. Hell, most of those laborers make more money than we do and have better benefits.
I agree that nursing is hurt by it's lack of identity in the sense that so often it seems to be creating things to appear to be more of a profession than it really is. The biggest thing I keep hearing in my classes for my BSN are that it's difficult to get groups of nurses together to make a difference in politics, etc. That nursing societies suffer from lack of interest in membership or participation. To me, that says that most nurses just want to do their job when they're at work and then go home to their personal lives.
And, just my own pet peeve? It drives me insane when people complain about stuff like the waitresses at the Heart Attack Bar and Grill wearing stethoscopes and naughty nurse outfits, or someone like Helen Mirren stating that she thinks a lot of hookers used to be nurses. I think it makes us all look like humorless twits when people get into a snit about that sort of crap.
Jul 16, '10"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."
Certainly, nursing has an inferiority complex; NO DISAGREEMENT THERE. Just look on any of the many, many Internet postings in which nurses attempt to convince themselves that we are "better than" those "overrated" MD's, and that the MD's greater education doesn't matter, and that "we do all the work" and we keep "picking up on" their mistakes; and how we're so underpaid (quit whining, we make a decent salary) for back-breaking (ladies, if your're breaking your back, maybe you need to review basic body mechnics that any idiot can learn, and/or call for help, or just do some back exercises and core training like a sensible person) drudgery (get over it, how is your self-respect determined by whether or not cleaning up crap is part of your job? if you don't have pride in your job, WHATEVER it involves, that's no one's fault - not culture, not admin, not MDs, not patients - but your own, I don't care if you're a CEO, a janitor, or a burger-flipper.).
And, YES, I have ALWAYS firmly believed that nursing diagnoses were cooked up by the nursing equivalent of the women's lib movement to try to "convince" nurses that "we're as good as doctors - see, we even have our own 'diagnoses', we're so darn clever!" Please. I never treat a patient's "impaired respiratory status", I treat pneumonia and COPD, and if I ever had to recite a nursing diagnosis in front of an MD, or a patient, I would try not to cringe and apologize as I did it. Enough bull, we're here to fight germs and degenerative processes, not give the nursing profession's ego a good stroking (read that last word any way you want it).
And, to keep going on my soapbox, if you have to "diagnose" someone with something psychosocial that nursing may be more concerned with than medicine, such as "breast-feeding, interrupted" or "coping mechanisms, ineffective" or "communication, impaired" and write out goals and a plan for it, what kind of an idiot are you? No offense, but treating someone psychosocially is just being a human being with empathy and a little common sense. And for treating physical impairments, I am perfectly fine with treating someone both medically (e.g., antibiotics, O2, for pneumonia) as well as with common-sense nursing (e.g., turn-cough-deep-breath, incentive spirometer, and positioning) instead of wrapping myself up with "impaired respiratory status."
However, my eyes bugged out when you said that CNA's can "pick up" what we do after a couple of years of watching. Even if you could pick up some hands-on skill like inserting an IV by just being in the room when it's done, what we DO is only half the face of nursing; it's also what we know, of course, from our classroom experience, and from our (hopefully) training in professionalism, therapeutic communication, psychology, research, scientific practice, critical thinking, etc. You show me the CNA who has "picked up" the A+P of pulmonary hypertension, or Maslow's hierarchy of needs, and you're showing me someone much smarter and more intuitive than everyone who went to nursing school to get that knowledge.
That opinion aside, I suppose one could argue either way that nursing is a profession, if we go by the definition that you provided. I think of it as a labor-intensive profession, and I think of it as a profession because of our knowledge, our bureaucracy and certification/licensure (LPN, RN, APN, and of course all the NCLEX and certification stuff), and the fact that we're supposed to conduct ourselves with professionalism.
However, I'm surprised that you don't think that nursing is prestigious / receives respect. I'm always greeted by respect from the lay public (and even by a few of my patients, haha) when I say that I'm a nurse, and I'm automatically proud of myself for being a nurse. Nursing, in a way, has the best of both worlds, when it comes to how culture perceives us...that is, we get respect for being in medicine/science/health, and for both knowing academic knowledge, knowing hands-on, practical things like how to insert an IV, or how to treat someone who passes out or has a seizure, and we're, of course, a byword for "caring" and "compassion;" but at the same time, we're not seen as Ivory Tower, self-centered, arrogant doctors who entered the profession for the money and the prestige, a sad stereotype that sometimes is directed towards MD's, whether earned or not. We're not, like MD's, automatically under suspicion for not being "down there" with the patient; we're happily considered to be "regular joes" who stand beside patients and help them, vs. some adversarial, cold, clinical relationship that may be supposed to exist between MD's and patients (again, warranted or not). To sum up, I've always received the impression that people kind of automatically approve of, like, and respect the nursing profession and the individuals comprising it.Last edit by allthesmallthings on Jul 16, '10 : Reason: incomplete sentence