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?

[MinnieMomRN]

Erik, 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.

[eriksoln, BSN, RN]

Erik, 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.

[eriksoln, BSN, RN]

i 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.

[fungez]

I 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.

[rocki718]

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.

nursing diagnosis: thought process, altered...lol:d

[CNL2B]

This 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.

[clemmm78, RN]

I 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.

[jzkfel]

Nice 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....

[JenniferSews]

I 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.

[SuesquatchRN, BSN, RN]

It 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.

[SuesquatchRN, BSN, RN]

Oh, 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.

[jjjoy, LPN]

There 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"?

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.

I agree that it's a stretch to define nursing as a profession by the above definition.

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 nursing jobs 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.