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?

[Glad2behere]

llg,

After having read and reread all your posts regarding this thread, I conclude that your message is that higher education should direct it efforts so that nursing reaches a pinnacle of independence, in both theory and practice.

If I am correct, how could this be done? Is it feasible?

[semstr]

Hi to you all and especially Susy,

Sorry I couldn't respond sooner, loads of work plus the flue got me and my daughter.

But, hey that's life, isn't it.

Now, for these European gals, i tried to give in there names at google.com and hey, they do pop up. So give that a try.

As for these nursing-phenomenens (what a word!!) try http://www.acendio.net or: http://www.icn.ch/icnp.htm

Everything you want to know and more is there.

Me for my part, I can't help but thinking, what the h... are they doing now? Trying to invent the wheel again?

But when you are interested have a look.

Take care, Renee

[fab4fan]

Been a nurse for 17y and never heard of her, so I guess my answer would be "yes."

[NRSKarenRN, BSN, RN]

Semster:

Thanks for the great links....more nursing worlds to travel via my fingertips!

[rncountry]

When my daughter was a baby her primary was a NP. Her father was in the Air Force and the military (at least at that time) put a premium on wellness, not illness. Well baby checks were expected. Her older brother had been born on base in New Hampshire, and well baby checkups were made for him before we even left the hospital. My daughter was born off base, as her dad was working as a recruiter in the community, no base nearby. There were few providers that would take CHAMPUS insurance and one of those few was an office that was primarily NP's. This was before I was a nurse and didn't have a clue what a NP was or what they did. I was incredibly pleased to find a primary whose focus was a bit different than one traditionally found in medicine. While I had been pleased with the care that my oldest child had received on base, I was more pleased to find the NP did not do much of the same in the mechanical way that the physician for my older child had done. Thinking on that makes me feel there is a role for caring theory, as it was obvious there was a difference in the behavior of the NP and the physician. My daughter continued with the NP until she was around 2. The reason for that is the NP and the other NP's in the office were connected to one of the area hospitals, who decided to close the facilities. I don't know where they ended up.

To me there are many avenues in which nurses can work and go, but ultimately right now, the vast majority of us are connected to medicine in such a way that it is difficult to have an independent practice. I see nursing as a relatively young profession and I wonder what others thoughts are on nurses carving out more of a niche. I believe that as time goes on there are good possiblities for nursing to grow professionally and specific areas in which we will be able to have a more independent role.I don't even think that it is necessary for us to be fully independent of medicine, as it can be a very advantagous working relationship in the right context. Right now I work as a wound/infection control nurse. I have been able to establish a working relationship with the physician who heads these, and while I have been able to teach him many points in wound care, he has taught me a great deal about infection control, an area in which I had very little experience to start with. I have a long way to go yet, but the ability to pick one another's brains in a context of mutual respect has been quite gratifying. I want to go back to school but currently the funds are just not there. With one child in college and my husband also taking classes, it isn't something I can afford. In the meantime I am studying to be able to take wound certification through the American Academy of Wound Management, and then my CIC through APIC. It is my hope once I have done that I can take my skills and use them in the role of a consultant. I just haven't figured out exactly how I will do that yet.

Everyone's responses here have been thought provoking and I look forward to hearing some opinions on where nursing can go and how.

[llg, PhD, RN]

Originally posted by Glad2behere

llg,

After having read and reread all your posts regarding this thread, I conclude that your message is that higher education should direct it efforts so that nursing reaches a pinnacle of independence, in both theory and practice.

If I am correct, how could this be done? Is it feasible?

My "vision of the perfect world" would be that we, as nurses, could sit down at a table and engage in a discussion with other people of many other disciplines and have something to contribute to that discussion that would be recognized as being equally valuable as what the other people are contributing. Only then, will we be respected and compensated appropriately. As long as our practice and our knowledge base is viewed as being "lesser than" or "subservient to" that of physicians, that "hand-maiden" image will keep holding us back -- both politically and economically.

I'm not sure that "independence" is the best word to use to describe that, because some people may misinterpret that and think that I mean a complete lack of connections. I don't. All the disciplines are and should be "mutually interdependent" -- but we should all have our unique contributions both to patient care and to knowledge development recognized and properly respected. A doctorally prepared nurse and a physician should be able to stand side-by-side and consider each other to be equals. The nurse should NOT have to consider herself to be "lower" because her discipline is considered to be less worthy.

I think it is vital to the advancement of the nursing profession that the academic branch of our profession continue to try to identify and articulate that which nurses contribute that we can claim as "our area of expertise" -- a realm of activity or the fulfillment of a function that "defines" nursing and distuiguishes it from other professions and disciplines. I certainly don't agree with the results of every scholar's attempt to settle the question, but I respect their attempt to do so -- knowing that they are attempting to enhance the status of nursing within the academic community and within the world at large.

Is it feasible? Hmmm... I doubt we will see true equality in our lifetimes. However, I think substantial progress can be made -- and that will be a good thing. It will be interesting to see how the nursing shortage will stimulate discussion (both inside and outside nursing) about why nurses are needed. What is it that we do that the world wants and is willing to pay for?

llg --- who came into her office at work this afternoon just to respond to any posts on this thread. I won't be back until Monday.

[llg, PhD, RN]

Oops! I should have added to my post of a few minutes ago ...

I don't expect a beginner-level staff nurse, just out of school to be considered "equal" to the average physician in every way -- though, of course, we should all be considered equally worthy of considertion and respect as human beings. That beginner staff nurse has neither the education nor the experience to be considered a truly equal professional partner to the physician. However, even that beginner RN should be recognized for bringing some valuable knowledge and skill to the situation -- uniquely nursing knowledge and skill, not just some watered-down, second-hand knowledge borrowed from a variety of other disciplines.

Also, nursing administration should have equal power to medicine in decisions regarding resource allocation, which beds to open or close, etc. It's not easy to run a hospital or run a unit (as though of you who have tried it know.) The politics can be brutal as you work with people who don't really understand nursing's needs or support the advancement of nursing. Even the most idealistic of nurses can get burned out very fast as they see their efforts for improving their work environment get stifled again and again. In order to make advancements on the political front, we need to have the nursing profession (and the academic discipline of nursing) on equal footing with other doctoral level professions.

A few of you might not realize that there was no such thing as a doctoral degree in nursing until the 1970's. Ours is still a very young academic discipline and nursing scholarship is still in its infancy. We scholars need support from our colleagues as we take our first wobbly steps into doctoral-level research and theory. We need that support so that we might someday run and play with the big kids.

llg

[Q.]

Originally posted by rncountry

I see nursing as a relatively young profession and I wonder what others thoughts are on nurses carving out more of a niche.

I somewhat agree with you on the idea of nursing being relatively "young." Yes, nursing is some form has existed for quite some time, but nursing as WE know it is indeed new.

I wonder if perhaps we should take on a whole different route altogether, and allow the physicians to have their MA's and UAP's etc - and nurses work with patients on a different level....

[Glad2behere]

llg,

Thank you for your thoughts. I am truly amazed at how much we are in agreement. You made many points that have logical and valid basis. Actually I feel we are rewording each other. It seems we wish the same end result in nursing, but the interdisciplinary influences, financial, administrative, and legal intricacies affecting us thwart positive effects at a rate acceptable to us and to those from whom we must solicit this change.

You did make one statement in there that truly underscores what has been to me a very rewarding discussion, and I confess that I have savored typing every word. Your statement:

"As long as our practice and our knowledge base is viewed as

being "lesser than" or "subservient to" that of physicians, that

"hand-maiden image" will keep holding us back--both poltically

and economically."

Total agreement with that statement. The inference is not questionable. I submit that in a vain effort to define nursing as a profession as one having absolute criteria upon which to base itself we have exacerbated the concept of "hand-maidens", and have actually forwarded that concept by immersing ourselves in assorted theories that reinforce handmaidenship. We did this to ourselves by sensing an urgency to define our profession and were reaching for straws, simply human, desiring to fill a need of gratification and recognition.

I respect you for having a doctoral degree...I wish I had one...and maybe someday I will. If I do, rest assured that I will do everything I can to study and initiate change towards a concept of nursing that embraces a highly skilled, scientifically based, problem solving, multi-task, competently confident individual that wields influence to other health care members and the public thereby increasing its value to those entities supported by the concept of guardianship for the patient.

In the meantime......I'll do everything I can to persuade doctors of your caliber to begin exerting your influence to your peer colleagues and healthcare in general to seek a more realistic philosophy and cheerlead your efforts.

Now may I call you Doctor? Doctor.

Thank you

[rncountry]

Oh glad2behere, excellant post. That's it exactly. I especially like "guardenship of the patient" if I were to boil down what I feel I do on a day to day basis that would be it. Not only do nurses take care of a patients needs, we coordinate the care from other healthcare workers. I can give it all task oriented features, yet in truth we pull the pieces of different disciplines together to form the whole needs of the patient. That is the concept of holistic nursing in my mind. It is more than being a patient advocate, it is looking at all of the various parts of the patient needs and then ensuring that the various disciplines designed to meet those needs are utilized in the care of the patient. Then it is one step further, not only are we to ensure specific disciplines are involved we also then oversee those other disciplines, while needing some knowledge of each of them, to ensure that the appropriate treatments from the disciplines are what the patient is getting. This naturally involves an interdisciplinary approach, something we all know is expected, but perhaps what is not recognized well is the extremely important role that nursing plays in that interdisciplinary framework. Nursing is not simply another part of the interdisciplinary team, while it is part of the team, it is also coordiates the team. There is no other part of the team as uniquely qualified to fill this role as nursing is. As llg pointed out the ability to state what nursing is, is difficult, because we take a bit of every discipline to form the whole of nursing. More than any other part of the team, we also spend more time with the patient, thereby being able to see the needs of that patient in a perspective unique to us. Many are the times a patient is more willing to share their needs and fears with a nurse when they have not given the same information to their physician, their therapist, the social worker or the dietician. As well as the assessment skills of a nurse picking up those issues when the patient either doesn't share them or doesn't even realize that there is an issue.

Perhaps it is the inablity of the other disciplines not recognizing this, as well as the patient and family members, that creates such frustration for nurses as well. Day to day observation of what a nurse does with the various contacts with other disciplines, consultations with those disciplines, would easily point to the whole of what nursing does beyond passing meds, running IV's and getting water. In my mind it is this inability to understand that this is what nurses do when we speak of lack of respect. I have yet to have a member of the general public not respect that I am a nurse, what I do find is there is a great lack of understanding about what I do and what role I fulfill in the healthcare field. When I pick up a problem and call a physician with an assessment and request for labs or other diagnostic information the patient invaribly believes it is the physician who has done the "footwork" in this. One can substitute the physician for any other discipline we work with. The role of coordinator, guard of the patient's health if you will, is the invisible role the nurse plays. Yet it should not be invisible, it should be taught and recognized for what it is.

If I were able to design a nursing program I would have all the nursing classes that are required, get rid of some of the classes that I feel while they may be interesting have no real value to what we do(history of medical art, a requirement for a friend who finished her BSN at MSU a couple years ago) and then have student nurses rotate and shadow the disciplines which we will work with intimately. PT, OT, dietary, speech, social services etc... that would give nurses an deeper understanding of each of these disciplines as well as the mechanics of them, instead of having to learn that on the floor, which is definately not conducive to that type of learning. It would be an "internship" for nurses if you will. While doing those internships the lecture portion would involve actual study and classwork on those disciplines. So while I would be working with a speech therapist I would also be learning the functions of the muscles that allow speech and swallowing. With my 11 years of nursing I am still frustrated at times about my LACK of knowledge of these specifics. Then when a nurse actually starts their practice on the floor there would be specific guidelines on orientation before that graduate nurse ever took a patient load. They would be fixed guidelines everywhere instead of facility decided, so the practice of throwing graduate nurses out there hoping they swim instead of sink, would cease.

One last thing, and before anyone starts a tangent on a great thread please know I am an ADN nurse, I would also eliminate the LPN and the ADN and require a BSN for all nurses nationwide. It would be the only way to have the nursing program I envision. And personally I think that is the only way to stop the interfighting that is so endemic to nursing. If we are to be able to stand together as nurses then we must stop that infighting. A practice act that is also not different from state to state could also be put into place based on a nursing curriculum that would more or less be congruent state to state. And of course in order for any of this to take place there needs to be a theoritical framework that curriculum could be based on. This type of curriculum would allow more hands on nursing and thus experience along with theory of it all. And then when a graduate nurse begins their practice they would be more prepared for real world patient care.

>dusting off my hands

[HazeK]

Originally posted by Stargazer

I think nurses should provide the same level of care to their patients that they would want for their own family members, but that is not the same as loving your patients as your own. [/b]

I think Stargazer is on the right track!

Some of us are more 'technically oriented', completing assessments and tasks competently, and professionally...others of us are more 'pillow-fluffers',

"aw, poor baby", nurses who complete the technical work and then "adopt" our patients into our hearts.

I think either kind of nurse can be a GREAT nurse, just a difference in "styles" of nursing.

I confess, I want to take my patients home with me way, way too often! LOL!

Hugs!

Haze

[Glad2behere]

rncountry,

Thank you!

You wouldn't believe how much I had to pay my cousin to write that!(Laugh)

I like all your ideas as well, and we are getting there....slowly.

I do think your point about orientation to a certain specialty should not be the burden of the care facility. I like that idea of an extended preceptorship affiliated with a university and the care facility simply being the setting.

The idea of everyone having a BSN. I have thought about that alot. I agree that it is an excellent goal to achieve. There would have to be some specific duties outlined in a Nurse Practice Act that may achieve a better differentiation between what nurses with X amount of formal education can do. That is where the problem really is I think. But that will be a bloody issue if it is forced. I think you are correct that it is one of the most logical steps forward.