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?

[ktrees]

I am a professional, and I have a professional quest that I am on. Unfortunately, you do sound a bit angry. Good luck, I hope you find what you are looking for.

Elle

[SharonH, RN]

Erik, I really feel for you. How must it feel to go to work every day feeling that you have no power, no respect and that your knowledge level is only a couple of years beyond a CNA? And look at how many people signed on to that POV! Wow!! I find it even more curious that you held this opinion before you even completed your degree yet you chose to enter nursing anyway? That's very odd.

Anyway, you are entitled to your opinion and I don't intend to try to rebut each one of your points. However, I think you would greatly benefit from a change in work venue. Nurses work in so many different capacities both in clinical and administrative positions that it still amazes me the opportunities that are available to us (experienced) nurses. Look for those opportunities, go for it, good luck.

[wooh, BSN, RN]

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.

:)

Yep, I love all of our midlevels. Love them.

[Healsalot, BSN, RN]

Wow, really enjoyed this thread! Great discussion!! Keep em coming =)

[nursej22, MSN, RN]

Erik,

Thank you for starting such a provocative thread. So many thoughtful replies and not nearly as much flaming as I would have predicted. And I don't find you angry or odd. I appreciate your bluntness.

I do believe nursing has a controlled entry via licensure, and discipline via the states' BON, but I find most of your other points valid. We may be respected in polls but the public doesn't have a clue about our education, training or job responsibilities. Especially if you don't work in ED or OR! So you respect me because I don't get queasy at the sight of blood, or because I have to work off-shifts, weekends and holidays, or because I can read that awful doctors' handwriting?

VMSR: right on about Monty Python! How about the Ministry of Silly Nursing Diagnoses? Potential for Ineffective Airway Coping? Alteration in Skin Exchange?

Absolutely, nursing schools need more pathophys and clinical time and less theory BS.

[pedicurn, LPN, RN]

Absolutely, nursing schools need more pathophys and clinical time and less theory BS.

Agree ...especially more pathophys. And more clinical skills. Plus generally slant more toward medical model with nursing art as adjunct.

[ktrees]

That is great, but I must ask respectfully if you love them, please do not insult them by using the term mid levels. My state license has on it Advanced Registered Nurse Practitioner. My degree no where states that I am a mid level provider. Does that mean that physician providers are high level providers and that nurses are low level providers? This is a physician, derogatory driven term, why do you use it? Paraprofessional and physician extender fall in the same category. I am not less than professional nor am I a physician extender. I work independent and in collaboration with other professionals.

Thank you for your post. It has allowed for a new conversation

[CNL2B]

That is great, but I must ask respectfully if you love them, please do not insult them by using the term mid levels. My state license has on it Advanced Registered Nurse Practitioner. My degree no where states that I am a mid level provider. Does that mean that physician providers are high level providers and that nurses are low level providers? This is a physician, derogatory driven term, why do you use it? Paraprofessional and physician extender fall in the same category. I am not less than professional nor am I a physician extender. I work independent and in collaboration with other professionals.

Thank you for your post. It has allowed for a new conversation

I don't think that said poster was being derogatory and I think that midlevel is generally an accepted term -- I've actually never heard someone take issue with it (until now). PA and NPs cannot, in most states, do everything that a physician can do on their licensure.

The distinction with paraprofessionals is that they aren't licensed. I have usually seen that word tossed around with nursing assistants, not NPs.

I would never call an NP or a PA a PE because they are not. I have worked with a few PEs over the years and they have no prescriptive authority (the few I have seen were RNs working with MDs.) Yes, they write orders and order tests, but the doctor has to follow behind them and sign off on absolutely everything.

[eriksoln, BSN, RN]

Oh my gosh, this thread has run away from me. Never thought it'd have this kinda popularity. Kinda just felt like it was me talking to myself more than anything else. Then again...........I should have expected some interest in the topic. Seems there are a few people out there who think like I do. I'll be on later to post some responses, WAY too tired now.

[eriksoln, BSN, RN]

OK. Lots of posts I could only read and not respond to in the past day or two. Now, I'll throw a few more logs on the fire at the end of a day off. I am also creating a photo album from my travel nurse days, putting it on CD for my parents, so forgive me if I miss you.

[eriksoln, BSN, RN]

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.

Right there is pretty much the jest of what I am trying to get at here. Eliminate all the walking in circles, creating labels for doing our job (nursing diagnosis, the nursing process, critical thinking........come on, trying way too hard to sound important is what I see it as) and focus on being better at our job. THEN, WE CAN TRULY HOLD OUR CHINS HIGH AS OUR FOCUS WILL ONCE AGAIN BE THE PATIENT.

I am not saying nursing is a useless trade to practice, nor am I saying we are less than anyone else. What I am saying is, the immature inferiority complex that often drives nursing theory is failing us. Refocus schools on teaching nurses to obtain the best outcome for their pt., not on passing some exam that, in theory separates the "concrete thinkers" from people able to "think critically" but in reality is nothing more than a hit and miss lottery. I'll say this much: If the NCLEX were any good, don't you think it would have eliminated someone like me who completely disposes of most "nursing theory" from the get go? I passed first time.

[eriksoln, BSN, RN]

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.

For me, that goes without saying. Again, I'll highlight the fact that I am not talking about the generic sense of "professional" when I write in here. Meaning, I am not saying we don't have to act professional/mature. I also won't put up with people treating me unprofessionally. You want to raise your voice about triffle things and get nasty with me, be ready to go at it with me till I am done. I have no tolerance for disrespect.

Being considered a "professional" isn't going to make all the doctors all of a sudden want to hear our opinion. It isn't all of a sudden going to made hospital administration consider us a good debt. It isn't all of a sudden going to make that annoying family member stop blaming us for process shortcomings we have no control over. The only thing that changes with us becoming an official "profession" is what is written in the books, it has no tangible/practical effect in RL.

You can find more than a few threads in here discussing certain nurses who.......seem to think being a nurse is...........more than being a nurse. I'm sure you know more than a few of the types I'm talking about. They seem to think somehow that RN on their name badge makes them...........something more. IDK what. These are the people who sign everything "RN" outside of work, preempt every statement with "I am a nurse and I think.............." (as if what they are saying is different cause they are a nurse) and people who seem to be working only for the recognition of being called a nurse (as if it means something so cosmic). They usually go around beating every ear with the misfortune of listening about how they "have a calling and everyone else is here for money."

Basically, I'm talking about people for whom nursing is............an image, not a job. Low self esteem and a lot of eggs in the basket of being a "professional nurse". Their spouse is unhappy with them, they have poor coping mechanisms crawling outta every orifice of their body and they have little to no control of their personal lives. But somehow, it's OK, cause they are "A professional nurse'.

These are the people who live and die with whether nursing is considered a profession or a trade. Their self esteem and life values would just implode if all of a sudden everyone took nursing as a mere skilled trade. How are they supposed to beat their chest and justify all their shortcomings now? Sad but true, their false ego tied up in nursing makes them individuals of very poor character indeed. I already responded to the "Skilled trade = Loser" attitude these nurses resonate in their arguments that nursing is a profession. I won't go there again.

Me, I don't have all my eggs in the "nursing" basket. I was taught from the very beginning not to let nursing become my image or who I was. Its neither here not there if nursing is a skilled trade or a profession. But, when people make me sit and listen to hours and hours of senseless dribble that serves no purpose other than to feed the egos of those I talked about above, I am going to get resentful. Then, you add the fact that we are losing our focus on why were are here (again, mostly because of the people I spoke of above) and put patients at risk................and I can't help but wonder where it stops.