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?

Specializes in CVICU, Obs/Gyn, Derm, NICU.

Another thing that I ponder....

Why can a PA walk into healthcare with an unrelated bachelors...only have two years of medical education and then be writing orders for nurses????

Totally wrong, wrong, wrong

Specializes in CVICU, Obs/Gyn, Derm, NICU.

Also .....

Still no CONTROL= still not a profession

Another thing that I ponder....

Why can a PA walk into healthcare with an unrelated bachelors...only have two years of medical education and then be writing orders for nurses????

Totally wrong, wrong, wrong

Don't bash the midlevels. The PA must have a broad range of sciences under his belt and the two years of post-grad are intense. Six years vs. two for the diploma.

:)

Specializes in CVICU, Obs/Gyn, Derm, NICU.
Don't bash the midlevels. The PA must have a broad range of sciences under his belt and the two years of post-grad are intense. Six years vs. two for the diploma.

:)

If the PA is a midlevel...then what does that make the bedside RN? LOW LEVEL?? ENTRY LEVEL??

I have a BScN plus numerous post-grad certificates and a masters degree. I have more education than most PA's ...as do many of my bedside coworkers. I have been a nurse since 1982 and have an awful lot of knowledge. I don't think a PA is my superior.

Let's compare this to medicine. Is the GP doc inferior to the surgeon? Just because the surgeon did a surgical fellowship?

Aren't they both doctors? Does one of them become midlevel or highlevel? Ofcourse not.

Yes I sound annoyed...because I am annoyed.

We have given away so much.

Example ... OT and PT evolved from nursing, they are supposed to be allied roles.

So why are they writing orders for nursing???

Nurses have let their power slip away. There was a glimmer, when I started nursing, that we might become real professionals. Now it's gone

I don't think I am inferior to anyone, nor superior. That goes from our medical director down to housekeeping.

Midlevel simply means diagnostic/prescriber. You know that. That's simply the nomenclature. An NP or PA can diagnose and prescribe in certain situations and must hand off others to a physician. But if you want that role you have to train specifically for it and pass the boards. Were I younger I would do it. Had I 28 years of strong clinical experience I'd do it! You can become an NP online through some very strong programs.

Specializes in CVICU, Obs/Gyn, Derm, NICU.
I don't think I am inferior to anyone, nor superior. That goes from our medical director down to housekeeping.

Midlevel simply means diagnostic/prescriber. You know that. That's simply the nomenclature. An NP or PA can diagnose and prescribe in certain situations and must hand off others to a physician. But if you want that role you have to train specifically for it and pass the boards. Were I younger I would do it. Had I 28 years of strong clinical experience I'd do it! You can become an NP online through some very strong programs.

Yes ...point taken....however what is inescapable is that the midlevels write orders for bedside nurses. There is no getting around this.

The midlevels often have a whole lot less experience than the RN's as well ....some only have a couple years bedside before becoming nurse practitioners.

Ok, I will start of saying I love being a nurse...(most of the time) and I am proud of my Associate Degree. I consider myself a professional, but I don't feel that we as nurses as treated as such. I usually feel like I am working at the Hilton. Customer Service, customer service...Blah! I know many people feel nurses are trustworthy, but they do not put us in the same league as other professionals. Lawyers, doctors, executives....those are considered "professions". I do feel we fall under the definition of a "Profession", but I think most of us nurses are not treated as such.

Nursing is a pink (or blue) collar job.

Eric, I have one comment to your post: pffft! If you believe nurses are more like McDonald workers than, lets say, pharmacists, I'd like to know where you work, and avoid the place at all costs, either as a RN or a patient. Issues you list to support your opinion are not matter of professionalism, but political problems stemming from healthcare being treated as a commodity and not right. Not to mention that employers (which are out for profit, and not providing the best healthcare) very successfully manipulate the fact thar there is massive amount of self-loathing (as evidenced in lots of replies to this post) in the nursing workforce which prevents them from organizing and exerting pressure to improve both workplace and their status. I'm actually pretty amazed that California nurses (which are, by the way, best payed in the nation) managed to get such a strong union going, considering what obstacles they had to deal with. There are about three million nurses in the nation: we are the largest group of workers in the USA. If there is solidarity and will to stand for the profession (or trade, if you will), you would not have to clean wastebaskets, and would have patient workload that is in the best interest of the patient, not the profit. If that is to happen, nurses need to take pride in what they are doing, and demand to be treated as professionals that they are.

One thing, though, I can do away with: silly nursing diagnoses. They sound like something from Monty Python.

Yes ...point taken....however what is inescapable is that the midlevels write orders for bedside nurses. There is no getting around this.

The midlevels often have a whole lot less experience than the RN's as well ....some only have a couple years bedside before becoming nurse practitioners.

How about new physicians? None at all.

Specializes in MS, LTC, Post Op.

Wait...as an LPN, I was told that I was not a professional nurse, I was a technical nurse. Meaning I knew how do to basic technical procedures and had basic knowledge of why I was carrying out this order. However, the RN, with their educational background, made them PROFESSIONAL NURSES. (Case in point, the ANA only accepts RN as members). I felt I was a laborer as an LPN...a very skilled laborer...but yes, I felt my job was to basically lighten the RN's load so they could attend to the paperwork, assessements, ect. I was fine with that for 8 years!

So now that I am an RN, you're telling me I am not a professional nurse? That a CNA could do my job? Yeah, I know lots of CNA's that know their stuff...but I can bet ya that somewhere along the way, they had an RN explain to them WHY we were doing XYZ for the patient.

I also have a slight problem with the thought that nurses are not respected in the community.

What profession has been listed as the most trusted profession 8 years running?

1. Nurses - 84 percent

2. Druggists/Pharmacists - 70 percent

3. High school teachers - 65 percent

4. Medical doctors - 64 percent

5. Policemen - 56 percent

I think that the community looks at us as being professionals, obviously! Most ppl I encounter, respect the fact that I am a nurse.

Very interesting post though...made me think a lot. I start taking "Concepts of Professional Nursing" this fall with my BSN classes...so I think I will be bookmarking this to send to my instructor!

Specializes in Med-Surg/Oncology.

Just reading these posts made me way stressed out on the "are we a profession or not?!" opinions.

Quite frankly... I don't care, personally, what you call me, as long as you respect me as a person. Me demanding you respect me because I had four years of college and have a Bachelor's Degree is tantamount to a doctor demanding I respect him because he had six years of college and has MD behind his name. I respect people based on their behavior, not based on their titles, and I don't expect anyone to automatically respect me because I have RN behind my name.

Calling nursing a profession vs. a labor is like calling nursing a job vs. a career. For some people its a job, for others a career, just like for some its a profession and others its a labor. Nursing IS a service field. That's why I became a nurse, to SERVE people, not because I wanted to be a "professional". When someone mentions a professional I have the mental image of some dude in a suit or some chick in a two piece pant suit or something, and that's actually the exact opposite of what appeals to me about nursing (scrubs and tennis shoes are way more comfortable than skirts and stilettos).

Its entirely possible to be professional without being a profession, and thinking respect is going to automatically fall from the heavens if nursing is ever "officially" declared a profession is foolish. Superiority complexes within physician circles, for instance, is always going to exist. To some doctors we will ALWAYS be "just a nurse". Its kind of like we're fighting to fit in even as we're fighting to stand out. We're fighting to validate nursing with physicians even as we're demanding to be separate from medicine. Entirely too much wasted energy is being put into changing people's opinions, and a "profession" as a whole is never going to be able to do that.

Whatever you consider nursing, you must realize that it is diverse and necessary. And even if nobody else knows that, be content with the fact that you know who you are and what you're capable of, regardless of what anyone else calls you.

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