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?

[eriksoln, BSN, RN]

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....

Funny you say that. I'm waiting for an opponent of my assertion that nursing is a skilled trade to name a few but no one has. They just resort to name calling and tell me to get out of the trade. All emotion and no substance, probably one of the reasons we are not respected by other professions.

I love that you too notice the defensive nature concerning image. Refer to my last post to see why. Thats exactly the problem, too many nurses who consider it their image to be a nurse. Good grief get some counseling.

[eriksoln, BSN, RN]

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.

Which brings us back to the point that we have no autonomy or say in what we will or won't do. Professionals do not get stretched around the facility to do a little of everything everywhere.

You don't see notes pasted to the wall telling doctors to clean the windows. I somehow doubt the legal dept. is getting emails to sweep the parking lot. It doesn't work that way with "professionals". But it's OK to take nurses away from the bedside to do.............w/e.

My problem is, if nursing were a profession, this "wild card" view of nursing duties would have been put to a stop a long time ago. But we lack the power to do this. And that is why we are a trade, not a profession in the classic sense of the word.

[eriksoln, 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.

I don't care much. I have other things in my life to keep my esteem afloat. What I resent is having to constantly humor those who walk around in a fog and think it is. Refer to my post about these types.

When I am forced to humor these nurses, my practice inevitably leaves the bedside and turns into some song and dance meant to posture nursing as a profession. But, if I do as they say, I lose my license not them. Like I've said before, a big aspect of nursing is knowing when to listen to admin/managers and when to pretend you are listening.

[eriksoln, BSN, RN]

"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.

To be honest, I think every aspect of nursing separately could be taught to a 15 year old. It is in putting the pieces together that we apply skill to it and prove why not anyone can do it. Yes, most CNAs have simply memorized the steps and really don't understand the "why?" to any of it.

I live in an area that has medical services as the core of its economic stability. Lots of hospitals competing for patients, and some are doing better than others at their job. Unfortunately, there is a juggernaut of a medical facility near me that is not popular for how it treats its patients. Talk about conveyor belt style medical practice. So, the outlook on hospitals in my immediate and surrounding area tends to be gloom and doom.

[eriksoln, BSN, RN]

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.

The fact that intellectual labor is a part of what we do does not make us a profession. Honestly, I really don't know of a single job out there beyond grocery bagging or the like that doesn't require one to think about what they do.

For instance: Pretend for a second you are a landscape laborer. (Gasp, a laborer............, what will become of you). Seems like a simple enough job right? Push the lawnmower, empty the bag when it is full. Wrong. To go into a dirty yard and leave it clean and cut it terribly complex. You have to time it so the yard is cleaned first, in a way where the people running the blowers don't counteract one another and so once something is clean it stays clean. Then you have to time when the mower pushers start right so they work at the right pace behind the blowers. Every yard is completely different and presents you with new obstacles, much like how different patients are different. You have to watch that you don't blow anything into someone else's yard, know how to work with the wind instead of against it. Its more than just blowing leaves around. BUT...................landscape laborer is not a profession. Never will be.

[eriksoln, BSN, RN]

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.

By abandoning this donkey carrot chase for the title and instead focusing on the task at hand, we could achieve the heights we so desire.

[eriksoln, BSN, RN]

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.

I will borrow from one of my favorite philosophers, Satyr, here.

"We are defined by what we do, not the reasons for what we do."

In other words, even if your assertion that nursing is where it is because of "political problems", its heresay.

The very fact that all it takes are some "political problems" to take nursing from being a profession to what it is proves my point. If we were a profession, political problems would have no bearing on it. You don't think doctors and lawyers have any "political problems"? They are still a profession though. See, if we were a profession, the politics would not affect us so.

And being strong in numbers also does not make us a profession. Landscape laborers and fast food workers outnumber us easily.............not a profession, never will be.

[eriksoln, BSN, RN]

Sing it, Brother! I don't guess I'm enough of a conspiracy theorist to think it's intentional, but I think a lot of the concern over professional standing tends to divide nurses. The debate over entry to nursing is a prime example. According to the ANA, and some allnurses.com members, I shouldn't be a nurse, because I'm only an ASN. My question is, who then will do what I and thousands like me are doing? And I don't mean only that associates and diploma programs are an ad hoc solution to a shortage of BSNs. Nor am I saying that nursing is only about passing meds and wiping butts and holding hands. Critical thinking is important! But it seems to me like a lot of advocates for professional standing are very nearly saying that nurses need to be doing what doctors already do, and seemingly disparage the things that nurses have always done. Why should academic nursing or political advocacy be more nurselike than, oh, say, taking care of patients?

I've heard and seen "task-oriented," used as a perjorative. I am task-oriented. I've been a nurse for five years, now. I'm well aware that there is a bigger picture. A lot of times I can even see at least some of it. But, like many nurses (and many others) I'm a work in progress, and a lot of times I have to focus on the practical aspects of my job. I respect the nursing process, and I do believe that each part of it is important, but still, without Implementation, all of the other parts are just words. I actually have used NANDA nursing diagnoses in my practice. More often, I'm just thinking about what my patients' problems are and what can I do for them. I'm pretty sure I am capable, if need be, of writing a 20 page paper in APA format about my patient's anticipatory grieving. But I don't particularly want to be a writer. I want to be a nurse, and my patient wants a cup of tea and someone to talk to, and I think that might just give us a basis to interface constructively.

I do believe in the bigger picture and fully support the argument that we simply can not sleep walk through our work without seeing it.

Problem is, I see so many nurses patting themselves on the back and claiming to have mastered "critical thinking" and they are simply doing their jobs.

Scene: Nurse walks into a room, finds IV on the ground, disconnected from pt.

"Oh, I'll prime new tubing and restart the IV."

Nurse finds herself in the IV room.

"Oh, I'll take the IV basket with me in case the IV is damaged too."

Nurse returns to room, finds they were correct, IV site needs replacing.

"Oh deary, what an intelligent nurse I am. I critically thought out the problem and was right."

Give me a break.

[eriksoln, BSN, RN]

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

Oh no. Here we go. You are on a "quest"? Eh? Its just finding a job and applying yourself to it, millions of people do it on a daily basis. Its not uncommon, really it isn't.

Oh my, another nurse who signs "RN" to everything outside of work and begins every statement with "I am a nurse and I think......................'

Good luck with that when you realize your place. Make sure you save the employee handouts with the "Employee Assistance" info. for the counselors in it.

[tewdles, RN]

wow...do you spend much time on this line of thought...?

[eriksoln, BSN, RN]

wow...do you spend much time on this line of thought...?

What line of thought? Profession vs. Skilled trade or the "God Calling" nurses theory?

[ivanh3]

Interesting discussion, but really more like an academic exercise (that one might encounter in their eduction to enter or continue the profession of nursing). I understand most of your points that nursing might not be considered by some to be a profession. Where I disagree with you is that you are applying an ivory tower sociologist's definition of what it means to be a professional or to "join the (good ol' boys) club" (that the sociologists feel they belong to).

I hold three licenses/certifications: paramedic, RN, and FNP. For all three I can say without a doubt that I am a professional. I have no identity crisis. None. During the course of my professions I use various skills, some basic, some complex, some subtle, and some in your face. I have no doubt that many, if not all of these skills could be taught on the job. That does not mean per se I am not a professional.

You listed the criteria of a profession. Great. Now show me one using those requirements. MD? Lawyer? Psychologist? Sociologist? Surgeon? Pilot? Clergy? None of those have a "unique body of knowledge" that they own.

You quote Sartre but I am not sure where you were going based on what followed your quote. However, I do think it applies. I am defined by what I do, and what I do is professional nursing, just like I am a professional paramedic (talk about two professions with a significant amount of crossover in body of knowledge). You are right about the motivation component. I don't find myself as altruistically motivated as some do, but I do care, and I do make a difference...even if its only a small one.

As for the rest:

A profession has controlled entry to the group eg registration

A profession has its own disciplinary system.

These two are really easy: state boards of nursing. I am pretty sure every state has one. They control who can be a nurse (licensure) and they discipline their licensed membership if need be. Your counter to controlled entry involves employment. Employment is not the first step. Licensure is. I don't understand your counter to the discipline issue. Are you suggesting that nurses aren't disciplined by bodies outside of their employment? Please clarify.

A profession demonstrates a high degree of autonomous practice.

I hear the term autonomous used often. First, what do you mean by autonomous? For some the definition falls along the lines of varying degrees of "being told what to do"-ness. This is patently ridiculous. Name a profession where there is no guidance from above. Everybody has rules and protocols. Everybody. Every profession. Nurses often use critical thinking (yes, nurses do use critical thinking...maybe not all nurses all the time, but very silly to suggest otherwise) and autonomous decision making during the course of even a protocol driven day.

A profession enjoys the Recognition and Respect of the wider community.

Most easy one of all. Just google "most trusted profession". Having said that, you will also get other professions listed in your search results as well. So again, I get it that you don't feel that nursing is a profession. And since my definition of profession is one of those cheesy "comes from within" kind of things then by (my) definition, you are correct: you are not a professional i.e. you are not doing professional nursing (and you are not alone). But that is you. Not me, and not many here. Using your classic sociology based definition of profession I do hope you can give an example of some (or any) professions.

Just my .02

Ivan