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?

[JulieCVICURN, BSN, RN]

I 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.

[allthesmallthings]

"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.

[JulieCVICURN, BSN, RN]

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.

I think this is true, that nurses are pretty well respected. I think on some survey we were considered to be the number one most respected/ethical "profession" (Ha, I feel like I have to put that in quotes now).

I do have to say, though, that a couple of times recently someone referred to me as "just a bedside nurse" and I about kicked their teeth in. I'm not just a bedside nurse, I'm also a vengeful *****.

[CrunchRN, ADN, RN]

I totally agree Erik. I don't think you sound angry at all. I am a happy nurse, but it is a middle class blue collar job if there ever was one and all that lip service given to the "profession" is wasted breath.

Nurses have no power and they never will because they do not stand together and they pull so much passive agrressive crud.

[BluegrassRN]

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.

I completely disagree with your assertion that nursing is a trade and not a profession. I think nursing is the perfect combination of physical labor and intellectual labor. What differentiates a decent nurse from a great nurse? For me, it often comes down to the mental aspects. If you don't "get it", if you can't put the labs, the assessments, the meds, the situation together, if you can't understand the A&P, the pharmacology, the pathology behind what is going on, I don't care how good of a laborer you are, you aren't a great nurse.

The above quote, however, is spot on. You could be rid of 10 hours of credit in nursing programs with this statement. What would all those nursing theorists do without our inferiority complex? They'd be out of jobs.

[wooh, BSN, RN]

Anyway, my point is, we would further the "profession" by...........not worrying so much if we are one or not.

Absolutely.

There's this whole tizzy about being considered a "profession." We twist and turn what we do so that we can call ourselves "professional." Well, there's lots of people that are quite professional without being in a "profession." And lots of people that are treated professionally without being in a "profession."

But some of it, we kill it ourselves. Autonomy, that one especially. I don't think nurses WANT autonomy. Oh we say we do. But how often do we get a thread: "Some teeny inconsequential thing happened, what should I have done?" and it's ALWAYS answered with a bunch of posts saying, "Call the doctor immediately." And I understand that we have to cover our behinds. But if we want to be autonomous, we have to be willing to take credit and BLAME for our decisions. Not every single thing needs an order from a doctor. I've had nurses argue that they wanted an order to do strict I&Os. Because all Hades would break loose if I put toilet hat in a toilet without a doctor knowing about it! OMG! The horror!! So I really think, there are too many nurses that would rather have their behinds covered by running EVERYTHING by a doctor than to be an autonomous professional.

But when you think of all the energy we put into meeting this random definition of "profession" when we could instead be putting that energy into....well, just about anything truly useful.... I'll just say this, I've had physicians that were impressed by my ideas, my experience, my choice of footwear, my incredible wit and charm, the outfit that I wear every Christmas, basically impressed because I carry myself as a professional and I'm a darn tootin good nurse. I've never had one that was impressed because I'm a member of a "profession" as displayed by it meeting the 5 hallmarks of a profession.

[SandraCVRN]

I never said I don't like nursing. I said I don't like the "inferiority complex" it so boldly displays. The CNA's taking a couple years to figure out what we are doing is a bit over the top, but it got the point across.

You hear about med-techs in Texas? Many of our responsibilities are being divided up into other groups (some nurses will tell you they remember the day when there was no such thing as phlebotomy) and being given to people with...........certificates that take a month or two to earn.

Anyway, my point is, we would further the "profession" by...........not worrying so much if we are one or not.

LOL. I'm not angry. Do I sound angry? btw, IDK what "work should blow wind up your skirt" means. eh, I don't wear a skirt, maybe thats why.

I'm just suggesting that the desire/obsession with being considered a "profession" is holding us back. Its like we are rebels without a cause.

I didn't think you sounded angry or that you hate nursing....

Now I will continue reading the rest of the thread.

[jjjoy, LPN]

I completely disagree with your assertion that nursing is a trade and not a profession. I think nursing is the perfect combination of physical labor and intellectual labor..... I don't care how good of a laborer you are, you aren't a great nurse.

I don't see that "trades" by definition only require physical labor and not intellectual labor. Or that nursing has to be considered "a profession" in order for it to be acknowledged as more than "just following orders" and mindless manual skills.

[wooh, BSN, RN]

Or that nursing has to be considered "a profession" in order for it to be acknowledged as more than "just following orders" and mindless manual skills.

Yeah, I've often wondered. We work so hard to be a profession to get the respect we deserve. So if we only fulfill 4 out of 5 criteria for being a profession, then we don't deserve respect? How messed up is THAT?

[NocturneRN]

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?

After 30 years in this field, I've come to the conclusion that the is-nursing-a-profession-or-not discussion doesn't much matter, except as an attempt to categorize a complex occupation that doesn't fit very well into any category. In my case, I DO see nursing as a profession----a field that requires specialized formal education, intellect and creative problem solving skills, as well as manual skills and the ability to conform to prescribed procedure----and treat it accordingly. Others, who take it just as seriously and are no less competent, might see it as a trade. That's fine with me. I just try to do my job in as professional a way as possible, and those whose opinions I value usually treat me as a professional in return.

[Fribblet]

I don't have too much to add that hasn't already been said, but I wanted to say:

Excellent post, Erik! I agree with much of what you posted.

[blssdrn12]

I read these forums daily and usually do not jump into thr fray but here goes!

I have been an RN for almost 25 yrs now and i have to say that I agree with the OP-with a few exceptions.

In my own career, I truly felt I was able to actually "practice" my profession when I did home health, was a clinical manager at a outpt clinic, and as an outpt case manager. During those times, I was actually involved in the collaborative team practice that nsg school (BSN) drilled into my head. My nursing assessments and recommendations were taken seriously and we worked together to formulate the plan of care that was best for our pt's.

However, I do not think that is the norm for most nurses-esp. in the hospital setting