Time to call a duck a duck? - page 7

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... Read More

  1. by   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
  2. by   CNL2B
    Quote from 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
    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.
  3. by   eriksoln
    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.
  4. by   eriksoln
    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.
  5. by   eriksoln
    Quote from fungez
    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.
  6. by   eriksoln
    Quote from CNL2B
    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.
  7. by   eriksoln
    Quote from jzkfel
    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.
  8. by   eriksoln
    Quote from JenniferSews
    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.
  9. by   eriksoln
    Quote from AlmostABubbieRN
    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.
  10. by   eriksoln
    Quote from Allthesmallthings

    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.
  11. by   eriksoln
    Quote from BluegrassRN
    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.
  12. by   eriksoln
    Quote from wooh

    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.
  13. by   eriksoln
    Quote from VMSR
    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.