For Discussion: What IS nursing? Not so easy to answer...

[jjjoy, LPN]

I'm putting this out there for discussion: a narrower definition of nursing....

I would argue that the most basic level of nursing care includes assisting with basic needs and comfort care for a patient who is ill or injuried (low-grade/low risk), recovering from a crisis, who has a stable, chronic condition or a permanent disability. This level of nursing care could also include administering simple, routine medically prescribed treatments. Ideally, nursing care of any type is delivered with respect and compassion. I'm defining this level of nursing because people practice it every day. "Nursing" one's ill relative or neighbor is a well-established concept in our language and society. I'll call this "non-professional nursing."

A higher level of care nursing care might cover more complex medically prescribed treatments (eg multiple drugs, oxygen), preventing secondary complications (bedsores, contractures, etc) in patients with chronic diseases or a long rehab period, routine monitoring for changes, communication with medical personnel as needed, and recognition of the need for a higher level of care. This type of care needs formal training in common medications, secondary complications and their prevention, patient assessment skills and the like. This I'll call this "professional nursing" using the definition of "profession" as meaning a specialized skill/service that can be traded. This level of care could include nursing home care and some levels of home health care. The patients should be fairly stable and the nurse need only know the most basic of emergency care, calling in other appropriately trained medical personnel (eg paramedics) to take over.

I would then suggest at least one higher level of professional nursing care covering the basic nursing care of acutely ill or otherwise unstable patients. It also includes carrying out advanced medically prescribed treatments, regularly monitoring those unstable, acutely ill patients, recognizing and responding to changes in patient status, being prepared to deal with an acute medical crisis, and regular communication with medical personnel to ensure appropriate patient care. Maybe I'll call this "professional acute care nursing."

Ideally, the nurse, like the physician or OT or any other professional, will respect their patient's autonomy, advocate for them if need be, and explain to (teach) the patient what's happening in a way they can understand.

What about public health nursing? I'd argue that that's it's own unique branch of public health but not necessarily nursing depending on the job role. What about school nursing? Again, I'd argue that it's not necessarily nursing either, depending on the role. It might be more along the lines of first aid and general school health (eg immunizations, lice outbreaks, etc). I'd only call those roles in public health and school health that require the kind of nursing care described above as "nursing" roles.

There are many jobs out there that LIKE hiring nurses because of their knowledge and experience (case managers, occupational health coordinator, infection control personnel). Again, I'd argue that at that point they are nurses working in a field that is different from nursing. They are applying their nursing knowledge and experience, but I'd argue that they are not "practicing nursing" - again, depending on their exact role.

Whew! I know, I think too much sometimes!!! Well, I'm NOT going to even try to address nursing education as it relates to the definition of nursing.... for another day, perhaps??? :typing

FYI - two current definitions of nursing

Nursing per ANA: the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.

Per Wikipedia-

Nursing: a profession focused on assisting individuals, families, and communities in attaining, maintaining, and recovering optimal health and functioning. Modern definitions of nursing define it as a science and an art that focuses on promoting quality of life as defined by persons and families, throughout their life experiences from birth to care at the end of life.

[jjjoy, LPN]

What IS nursing? What is the unifying *professional* aspects that differentiate nursing from the many other helping, health-related roles and professions out there?

Below, I've cut and paste a couple of different definitions of nursing. They seem to encompass just about all aspects of health in the individual and in society. To me, such broad definitions don't really say much of anything at all. They seem more like a statement of philosophy than a description of a profession.

Those long definitions seem to describe several *different* professional arenas. There's public health. Preventive health. Physical rehab. Mental health. Social services. It could range from Mommy-and-me classes to support groups for stroke survivors from surveying immunization compliance rates to organizing & administering free immunizations. Certainly, nurses CAN be involved in those things. But I don't see those activities as "practicing nursing" and a person needn't be trained as a nurse to do a great job in any of those capacities.

Interestingly, those definitions do not describe bedside nursing care - which is still the predominant activity of professional nurses and the main thrust of basic nursing education. Sure, assistance with bathing and toileting falls within those wide, wide definitions of nursing, but so could lots of other things like providing psychotherapy, donating food to the needy and many other non-nursing activities. Administering the right meds, in the right dose, etc "protects" patients and "alleviates suffering" or assists in the recovery of optimal health - however, cooking nutritious meals, advocating for social change, and telling inspirational stories also work towards those same ends and yet I don't think we can say they are a *professional* responsibility of nurses (though one could argue advocating for social change being an ethical responsibility). Being able to recognize and respond to a patient's turn in status does "maintain" and "protect" health. However, that more specific responsibility that IS a key aspect to professional nursing care ISN'T in most definitions of nursing.

If a physician or occupational therapist takes to working in public health or social advocacy or even in a spiritual capacity, would anyone argue that they are "practicing medicine" or "practicing OT" in those roles? I wouldn't think so. Yet, it would seem that according the many broad definitions of nursing that a nurse in public health or social advocacy or even in a spiritual capacity IS practicing nursing - as opposed to combining their nursing skills and experience with other skills.

But the idea of combining nursing skills with other skills isn't so simple because who can say what exactly nursing skills are?

Just some thoughts clinking 'round my head that I thought I'd put out there for discussion and reflection.

Nursing per ANA: the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.

Per Wikipedia-

Nursing: a profession focused on assisting individuals, families, and communities in attaining, maintaining, and recovering optimal health and functioning. Modern definitions of nursing define it as a science and an art that focuses on promoting quality of life as defined by persons and families, throughout their life experiences from birth to care at the end of life.

Medicine: is concerned with maintaining or restoring human health through the study, diagnosis, and treatment of disease and injury.

OT: work with a client to help them achieve a fulfilled and satisfied state in life through the use of "purposeful activity or interventions designed to achieve functional outcomes which promote health, prevent injury or disability and which develop, improve, sustain or restore the highest possible level of independence."[1]. 1-AOTA

Paramedics: charged with providing emergent on-scene treatment, crisis intervention, life-saving stabilization and, when appropriate, transport of ill or injured patients to definitive emergency medical and surgical treatment facilities, such as a hospitals and trauma centers.

[rnmomtobe2010]

Thanks for this post!!

[MrsMommaRN]

forgive me i am in a cynical mood.

nursing is being a beck and call girl, laundress, secretary, psychologist, mediator, social worker, mother, maid, waitress, pack mule, and scapegoat. not necessarily in that order.