Can Someone Be a Nurse Without Jean Watson??

[Q.]

Ok now, as I delve back INTO nursing philosophy and theories, I come across, again, the theories of Jean Watson that have been hailed as the greatest thing since polyurethane IV bags - The Caring Theory of Nursing.

Personally, I have never been a fan of Watson, only because I feel that she OVERemphasized the caring aspect, and, in my opinion, dumbified nursing - hence, the ad campaign in the late 80's "If Caring Were Enough, Anyone Could Be a Nurse." Watson threw a fit when she saw this.

As nursing evolves to a more technically challenging field, requiring more acute assessment skills, and as the

"How Women Know" movement which has shaped nursing education for the last decade or so has become archaic, wondering what your thoughts are on if someone can be a nurse and NOT subscribe to the caring theory. Can one be a competent nurse and NOT care about her patients any more deeply than simply getting the job done?

Watson's theory goes a bit deeper than simply "caring" - more so than "caring" about any other job. But "caring" as far as honestly caring about the patient as you would your mom or dad.

Do you think someone CAN be an effective nurse WITHOUT having so much an emphasis on loving her patients?

[canoehead, BSN, RN]

That mandatory membership already exists in the form of state nursing boards...but still doesn't function in the way you envision.

When I studied nursing theory I was appalled that most of the theorists were psych nurses, and that their theories were used to describe care of physically ill patients. I think psych and med surg come with different priorities. Most of the theories I read helped with care of M/S patients, but only after the physical was taken care of.

Nurses DO need to find and embrace a vision of themselves as being uniquely prepared to fill a role in health care. As I see it, nurses are where the buck stops in day to day care- no matter what the specialty. We coordinate knowledge from all the specialized disciplines, and incorporate the patient's personal priorities, and bring everyone together to make an effective holistic plan.

We could probably all agree that anyone can start an IV, but if you get a nurse to do it they are prioritizing all the tasks needed from other departments, tending to psychosocial needs, aware of all the respiratory, cardiovascular etc, and may be giving direction to several team members, at the same time. The unique contribution of nursing can be found if you contrast a nurse in charge of his/her patient's care as opposed to the doc writing all the orders and having separate people come in to do their own tasks. Without nursing it all gets done, but the quality outcome doesn't exist.

I believe that the difference between experienced and new nurses has less to do with physical tasks, and more to do with gaining an understanding of how caretaking interventions and professionals mesh together, and how to "work the system" for a smooth, efficient flow. The best nurses will pull in family strengths, community resources, and hospital depts. We even know the quirks of individuals, and have the skill and finesse to get what we need from people in the system.

Maybe we should market ourselves as the professionals that put it all together to make the system work. It's a unique position and role that nursing already takes care of- but we only get credit for taking orders. We all know that's not what we do- in fact if the nurses doesn't regularly look at the big picture for each patient they often end up with conflicting instructions.

There is a place for research in how to best pull together expertise to benefit the patient and decrease LOS. Even a NP is often successful because he/she looks at family, culture, environment instead of just physical exam and intervention. The result may be that the family says "That nurse really CARED about what happened to our mom." Maybe thats why we have been defining ourselves as the "caring" profession- we take a look at interventions from the receiver's perspective- do they make sense? do they all coincide? are they prioritized properly?

I think this is a role unique to nursing, essential for healthcare, and absolutely requires education and the outlook of a group of committed professionals. Hope this all makes sense as putting it into words is difficult- but my own personal vision of nursing is coming together as a result of our discussion.

Thanks for the great thread.

[Stargazer]

canoehead said

I believe that the difference between experienced and new nurses has less to do with physical tasks, and more to do with gaining an understanding of how caretaking interventions and professionals mesh together, and how to "work the system" for a smooth, efficient flow. The best nurses will pull in family strengths, community resources, and hospital depts. We even know the quirks of individuals, and have the skill and finesse to get what we need from people in the system.

Maybe we should market ourselves as the professionals that put it all together to make the system work. It's a unique position and role that nursing already takes care of- but we only get credit for taking orders. We all know that's not what we do- in fact if the nurses doesn't regularly look at the big picture for each patient they often end up with conflicting instructions.

Great post, canoehead. This is an excellent point, and it's similar to what has been proposed for years as a way to keep both the ADN and BSN as entry-level degrees, but distinguish between the two. It's also similar to the clinical ladder program that my hospital implemented the year before I left--nurses had the option to be hourly or salaried employees, and the salaried employees were slotted into the ladder based on a number of factors. The more continuing ed (as learner and teacher), involvement in unit- and hospital-based shared governance committees, involvement in research projects, and documentation of evidence-based practice you logged, the higher on the ladder you were and the higher your salary was. It was really a much more professional model than the typical hourly-employee-clocking-in model, and it seemed to encourage greater responsibility and accountability, while also being a flexible system.

[rncountry]

Exactly Canoehead. It is that "guardenship" of the patient that glad2tobehere stated earlier. I believe it is from that aspect that we must begin to educate the public to, and to an extent our fellow nurses who have difficulty in expressing what it is we do daily. I firmly believe a theory of nursing can be based on it. It is more than process, which is incredibly important, but we must take it further.

The question would be how. The idea's and ideals being expressed here are quite stimulating to the brain. I hope to see more.

[Glad2behere]

OK, Quick questions.

1. How many RN's, LPN's, and LVN's respectively, in the USA?

2. What source would be the most feasible if no one can answer

Question #1?

3. How is change initiated? First procedure to do that is...

[Dayray, RN]

I have known some very technicly talented nurses that dident seem to care much about the patients.

In my opinion they were not good nurses. Technical skills are important but careing is the very heart of nursing. If you dont care about your patients and people in general then you should not be a nurse.

It is true that science intelegence and technical skills are important but these are simply tools the nurse uses to express compasion for their patients and bring them to their highest possible level of health (becuase they care).

In the begining of nursing it was less about outcomes and more about comforting the sick. We live in a wonderful time where many of our patients can return to a very high level of functioning and now we can use the nursing proccess to heal as well as comfort.

Please, If you have reached a point were you no longer care about your patient, get out of nursing. Become a legal nurse or a drug rep or heck go back to school and become a Doc. I cannot see why anyone would stay in nursing if they dident care. The money isent that good hours are demanding and wow does it get busy not to mention getting yelled at by everyone from houskeepers on up to doctors.

[canoehead, BSN, RN]

Hey, you can care about getting an excellent outcome without caring specifically about one patient. Think about how you cared for the last person your found personally repulsive.

I would argue that an RN skilled and aware of meshing all aspects of care will take a look at what we are doing as a health care team from the patient's point of view and make adjustments. That could be interpreted as "caring" about the patient that no other profession currently does.

I also think that LOS/costs would be justifiable if we looked at the outcomes when an RN with these skills is doing direct bedside care, not just in a resource management committee. For example- the RN knows that for a septic pt the labs are the most critical result as opposed to Xray, and they take the most time to get back, and that pt does not look like an easy IV stick. So he/she will call lab to draw before Xray takes their picture, and then instruct lab to draw with a butterfly if possible and will stand by to give whatever abx can be pushed through their site. Also will watch for VS changes with position changes and needle sticks and will start fluid, hold meds, while procedures are taking place. No other profession knows and uses info from so many different depts to get needed care to the pt more efficiently. In fact I think we can all agree that someone just running through the "to do" list on this pt might not get the abx in for an hour (if anesthesia was needed to start the line) and the nurse in question did it immediately. Plus all the ongoing monitering of changes in the meantime.

How many professionals/family members notice when you as a nurse see a dropping BP, lower the HOB, stop/hold a med, repeat vitals after a minute, started O2, get IV started just in case, draw the needed lab tubes from the IV cath, and report all this to the MD? They see a vitals check, and then the MD comes in and says that based on vitals and symptoms we are going to do XXX.

BUT THE NURSE JUST CUT 30 MIN OFF THE ASSESS/INTERVENTION TIME, AND MAY HAVE AVERTED A PT CRASHING!!

We need to get credit for this, and teach new RN's that this is the difference between a UAP doing tasks and a professional nurse.

[Q.]

Originally posted by Dayray

Please, If you have reached a point were you no longer care about your patient, get out of nursing. Become a legal nurse or a drug rep or heck go back to school and become a Doc.

Nursing does not own the patent on caring. Those professions you listed above care just as much about their jobs as nurses do about theirs.

In addition, I think physicians get a very bad rap. They DO care.

[Q.]

Originally posted by Glad2behere

OK, Quick questions.

1. How many RN's, LPN's, and LVN's respectively, in the USA?

I recently heard a figure of 2.7 million licensed nurses in the US.

[llg, PhD, RN]

To: Glad2behere: I think I have some of the data to answer the questions you asked in my file cabinet somewhere. Later this morning, I will look for and post it. The government and the state boards of nursing keep those stats and I have been saving them as I find them.

"talk" to you later,

llg

[Glad2behere]

Thank you Suzy,

That's a lot!

I hope llg's figures confirm that. I read that figure somewhere too, but an unable to find my source. I put them in one of those special places....if you can find the documentation please post it.

Thanks

[Dr. Kate, BSN, RN]

Forgive me for holding onto the words but not the speaker. Somewhere in the last 4 days of discussion nursing was described as the highly skilled, scientifically based, problem solving, multi-task, competently confident guardianship of the patient. It seems like a good and defensible definition of nursing.

As llg said using a problem solving method does not distinguish nursing from the other professions. The human and theoretical premises which underlie the utilization of the problem solving method are precisely what distinguish nursing from the other "caring" professions. I had the great good fortune to have had all of my basic nursing education guided by the Roy Adaptation model of nursing. What this meant was that every instructor in both the classroom and clinical area spoke within the intellectual framework of the model. The model was not simply something we tacked onto a nursing care plan as an afterthought, but was an integral part of the thinking process we were taught. Over the years I have found that I think far less about the categories of the model than I did as a student. That is probably to be expected. But, when I find myself confronted with a problem or issue that demands analysis I fall back immediately to applying the model. The activity of focusing on the behaviors and the immediate, secondary and tertiary factors that support the behaviors helps me work through the problem.

I have never thought of the Roy Adaptation model as providing a theory of nursing though I am aware that Calista Roy would disagree with that statement. I am also aware that there are a lot of people who find the Roy model cumbersome and unwieldy. And at the beginning it was all that and more, but so is any system where you have to do a full bio-psycho-social careplan for a person having minor surgery. That's school. In the real world, I find I selectively use the categories of the model to deal with issues of concern. What the model provided me as a student and minimally experienced nurse was a framework for critical thinking. Those areas of thought that so many people have to learn by trial and error, and through the longsuffering patience of preceptors and coworkers, I found to have been facilitated by having learned to think about physical, as well as psychosocial needs, in a systematic manner, i.e., according to the categories of the model.

And, yes, I learned the model in a two year AA program.

To those who would say that they don't like or believe in models or theories, I would have to say that it is quite possible to become a good nurse and never have learned a specific model. But, my suspicion is that you had to learn how to think like a nurse on your own. My question is, why do it the hard way, when it is possible to teach people to think like a nurse using a model?

And lest I fall into the trap I identified, I am using the term model to mean a framework that describes the step-by-step process a human being goes through to accomplish an end.

[llg, PhD, RN]

To SuzyK:

The most comprehensive source I know of for information about RN's is the US Department of Health and Human Services -- the Health resources and Service Administration -- Bureau of Health Professions -- Division of Nursing report that come out recently. That data is from the year 2000 and makes a lot of comparisons between 2000 data and 1980 data. That 121 page report can either be purchased in book form (which might be available in a library) or can be downloaded and printed directly from their web site.

The specific web site for the document is:

http://bhpr.hrsa.gov/healthworkforce/rnsurvey/rnss1.htm

If that doesn't work, go to the "hrsa.gov" site and then to the Burea of Health Professions, etc. to get to the report. If you go through their "information center" pathways, you can buy it but not view it online.

As for LPN data, I don't know. The information I have about my state came from the State Board of Nursing's web site. However, when I went to the National State Boards of Nursing (nsbn) web site, I was very disappointed.

llg