rncountry

I know that I am different than most, but I usually tackle problems head on. I would not change my schedule, if it worked for my life I would keep it. I would however tell this nurse she was inappropriate when that happened. I would also write an incident report and also go above the NM head since she is not taking her responsiblity to ensure appropriate care for patients is being done. Have I been in this situation? Yes. About two years ago we had a fairly new grad put in as charge nurse. She irritated me on a regular basis, at the time I was working as a primary floor nurse and absolutely would not put up with someone with less experience expecting me to do what I knew was not right. The worst it ever got was a shouting match in the breakroom, got mighty nasty and within seconds the breakroom cleared leaving me and the charge alone. I let her know EXACTLY where I stood and EXACTLY where she stood with me. After that I not only had no further trouble, other nurses started standing up to her. Eventually this nurse opted to leave our facility and I for one, was not sorry to see her go. My MN also would not do anything, she handles any type of confrontation poorly, be it disciplining someone or not. I like where I work very much, I like more coworkers very much and was not about to let one person on a power trip mess that up. The place I work at is great with teamworking and getting along and one ding dong could not be allowed to turn a wonderful working environment into hell. Confronting someone can be done very professionally and directly. When that did not work with this person, the shouting match did ensue, but I was not about to do something with my patient that I did not feel was appropriate no matter who was telling me to do so. I know not everyone would agree with me, nor feel comfortable doing this, but it simply is not in my personality to put up with crap for anyone.

Renee, I will have to look up the information that you posted. In a facility that I was a DON in we had a patient who was a Nazi Camp survivor. She had alzheimers, and doing nearly anything with her was a trauma for her, and often had staff in tears as well. I went in on a night shift once because I had a nurse who was ill and needed to go home. I was sitting at the desk when the most God awful howls started and had me running down the hallway. When I got to this woman's room she was standing on her bed, howling, screaming wildly and pulling at her hair. The whole scene was so shocking that I literally stood there frozen not knowing what the hell to do. A couple of CNA's came running in past me, got on the bed with her and talked and cooed to her until she was calmer. One of the CNA's, old enough to be my mother, then got the patient out of the bed and held her in her lap and rocked her like a baby. They told me that this situation happened frequently. I did not know that, had been working there about a month. To watch another human being going through what this patient did, day after day, was absolutely heartrending. She seemed to relive her concentration camp days each and every day. I can hardly think of anything so awful as to have alzheimers, yet to be able to remember the terror one went through. I no longer work at this facility and have never had another patient like her, but the information that you passed along would be useful to know just in case. Particularly because were I work now we do get vets from WWII more frequently than we used to. The only other situation I had that could compare was a woman who had nearly drowned as a child who would fight like a tiger when we bathed her. Had her two or three months before we found out that information from her family. After we knew what the problem was we only did an actual shower once a week and sedated with xanax first. The rest of the time she received a bed bath, which did not bother her. We never put her in a tub again, only the shower. Wish I had some answer andrienurse. Very sad situation.

I personally like Lavina Dock. She not only contributed a great deal to nursing, she chained herself to the White House in the attempt to get the vote for Women. She was, of course, arrested. Not that one time but a couple times. She was very outspoken in women's rights, as well as nursing. My kind of gal!

glad2behere, you hit the nail on the head. I have often thought about a nursing group that was designed strictly for political purposes. A group in which it didn't matter if you were for unions or against unions. It didn't matter what your degree was or what area of nursing you worked in. It would be nurse led, nurse directed and it's purpose would be only to consolidate the power and voices of nurses for the good of the profession. Active recruiting would be done. In 11 years of nursing I have never even gotten a flyer from the ANA encouraging me to join. Thought once upon a time that I had the means and ability to do this, but it went to s**t. I would love to hear your ideas.

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.

Too much the same definately breeds stagnation, I would say we need a curriculum at the BSN level though that is basicly the same so that all nurses start from the same basic framework. Then it is at the master's level where more education is provided in which the many divergent focus' of nursing can be explored more, I particularly like the idea of writing a personal philosophy. BSN programs ideally, would provide several different theories, and again that could be built on more in a Master's program. I know for myself when I go back to school it is with the thought that I am not going to simply go back for my BSN. I want to go into a program where I can become a CNS. At this time I think I would like to go with a focus on infection control, I recall hearing about a program through APIC. Though I enjoy wound care as well. I think it is vital to nursing to have many different focus', but I also think if too many focus' at once, it dilutes the core. This is a bit off the topic, yet isn't. I was watching a program on PBS tonight on the Civil War, very good one I might add. Anyway there was a piece about the Battle of Antietum, and there was a small part in it about Clara Barton, while tending a wounded soldier he was shot and killed, and then this quote, "I had to wring the blood from the bottom of my dress as I went from boy to boy just so I may walk." And it made me think of all the nurses in all the wars that stayed through the battles to tend to wounded and dying soldiers and it made me think that at it's extreme that is what nurses do. It is caring, though I don't think it is something that can be captured in a written way well. It is caring enough about fellow human beings that we seek to ease suffering in some manner. Yet it is not enough the simply care, if the practice is to be effective in easing suffering and pain it must be passed on strong scientific knowledge. Nursing as a profession cannot be one without the other. Call it Art and Science or whatever but it is that simple equation that makes nursing what it is. Perhaps because being able to quantify that elusive quality there will never be a theory in which nursing can ever be fully catagorized, in the strict sense of the word. I do think it is important to be able to have a firm foundation on which nursing practice is based, which in my mind must be more scientific in it's approach than many of the theories out there, but I don't know how much anyone can capture the caring qualities that make one decide to become a nurse, police, firefighters or EMT's. It is there but how does one realistically define it? I don't know that it ever can be. It's a bit like theology in my mind. It exists to provide a framework on which religion is based, yet the actual practice of religion rarely mets it's theortical goals. And some theories may have been relevent given the amount of understanding for their age, yet as people have learned more some theories are obviously wrong. St. Augustine's theory that women are only the carriers of a child, but did not actively contribute to the making of that child. In his time the science of sperm and egg did not exist. The theory that the sun revolved around the earth as the earth was the center of the universe, again something that people's of the dark ages knew nothing about. It took scientists who braved not only ex-communication from the church, but also the real threat of death, to do more investigation and uncover the way the body of both men and women worked and to look into the heavens and understand how they worked. It is always pertainent for any group to continue to question and reason out answers. So to the question who gets to decide, I would say all of us. When I see a theory like Martha Rogers that I feel is invalid, it is up to me to say so and not to only say so, but as to why. If I feel there is too much emphasis on the caring aspect of nursing than I must speak up on that as well. Much like societal norms change because of pressure from within a social group to do so, nursing will do the same. And much like social change, that happens not because the majority all suddenly think at the same thing at the same time, but because a few hardy souls are determined enough to push for those changes and once a majority of people feel it is appropriate then changes happen. Top down change rarely is what actually moves things forward.

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

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.

I lived in Hawaii from the time I was 6, landed on my birthday, till I was just past 8. Got there in 1969 and even then the crime rate was quite high. Nursenoelle, when I went there on vacation we went to Barber's point, now closed, so we could go on. I wanted to go back to the house I lived in. We drove by the road to get to the entrance twice because what used to be cane fields are now housing areas. Eva and Eva Beach had changed so much, used to be just little towns. Going back to my house was very bittersweet. The reason Hawaii has always loomed so large for me is because it was the last place I lived with my dad, after we can back my parents divorced. When I went back to where we lived I found the house by going to the school and walking the route to my house, which looked much too small. That side of the island was having a severe drought and everything was brown. Somebody had cut down the avocodo tree we had in the front yard, and the coconut tree in front of the house across the street was gone too. I used to climb that tree. The plumeria tree was still there that I used to make lei's though. Took a couple blossoms. Driving around there was an old P3-orien sitting on the runway, the plane my dad was a flight engineer of. It was then that I broke down and cried. It was two days before I left for Hawaii that I had found out my dad had inoperable melanoma that had mets to his brain. The emotions rolled that day. Went to the beach on base where I had learned to swim, and my kids saw real surf for the first time. The tension I had felt all day dissolved when I had told my kids not to turn their backs to the ocean because you never knew when a large wave would come up, my oldest who was 16 said you mean like this? and promptly turned his back and looked at me smiling sweetly, I smiled right back as a large wave came up and soaked him from the middle of his back down, nearly knocking him over. I laughed so hard my sides ached and tears ran. A reaction to the emotions of earlier in the day as much as the incredible look of surprise on his face. Wish I had gotten a picture of it. In Eva there used to be a pizza/ Italian restaurant run by this wonderful Italian woman who was quite large, we went there frequently and she would scoop me up in soft fleshy arms and hug me every time. It was the movie set pizzaria, checked tablecloths and all. Eva Beach had an old sugar cane mill still. When I was in second grade had a cane spider jump out at me from my cubby hole in school, they'd been burning the cane off. And those spiders aren't small. My dad put screen over all of out drains after I jumped in the shower one night and three water bugs(coakroaches) fell out of the shower curtain on me. Talk about screaming! Used to go to the beach nearly every day after school. Went barefoot in school. Wondered where the showers on the beach where after we moved back to Michigan. Never could find good teriaki anymore either. When we were on vacation the first day walking around Honolulu, the smells brought things back more than anything. The oriental food, the flowers, the ocean. Going to the International Market, haggling over prices. Got my kids to try pickled seaweed. Didn't bother much with Wakiki beach, went down the way to where the natives go. Still laughed when it started to rain and all the tourists went inside while we kept walking because I knew it would quit in a minute and then it would smell even better. Went to sharks cove so my kids could experience tidal pools and all the life there. Enjoyed living on Hawaiian time, for 10 days anyway.

Welcome to allnurses! Hope to see you here frequently. What you are describing is everywhere. The idea that nurses are not professionals is also everywhere. I would suggest that you take a look under the heading nursing activism on this board, and you will find reams of information. Just type in nursing shortage on a search and so much information will come up it will give you a headache. Nurses worldwide are looking for decent working conditions, decent pay and decent respect. What is minimum wage there? Do you have unions? Socialized medicine? I am really interested in finding out more. Plan to vacation there come next year. sjoe, you've been to Hawaii? What island? I lived there as a child while my dad was stationed at Barber's Point Naval Base. Sometimes the water is cloudy when the surf is heavy. What time of the year where you there? Two years ago took the whole family back there for vacation, it was like going home again. I think I miss Hawaii every day of my life. So many wonderful childhood memories there.

llg, with all due respect the explanation you offered on the relationship between student and teacher at the PhD level does not sound like what happened between Swanson and Watson. Swanson may very well have wanted to work with Watson, but yet it sounds as if a heavy hand was used in terms of what the thesis would be ultimately. Perhaps it would have been better to have supported the student and then directed her where her initial interest would have been better served instead of offering what a student felt was a nonnegotiable deal. You know llg, neither of my older children will even consider nursing as a profession for themselves. My oldest is a Freshman at Western Michigan University and his major is journalism, my 15 year old daughter intends on going into photography at this point. I believe she is quite serious as she bought her own Cannon camera a couple years ago that she saved for herself for over $600. She buys her own film, pays to have it developed. Both of these children picked what they did because both want to freelance, they both want to take routes that allow them more freedom to call their own shots. And that is the direct result of watching me consistantly work overtime and sometimes pull my hair out when I feel I have not been able to meet the needs of a patient, not because I am a poor nurse, but because I didn't have either the time or the resources. The youngest at six wants to be a shark scientist. More power to him! At the same time I take great pride in knowing my children care deeply about their fellow people. This year my older both went on Mission trips with our church. My oldest boy went to WV to help build houses in the Appalation mountains. My daughter went to TN and assisted in helping children learn to read, and to volunteer time in a nursing home. They do the walk for hunger every year, a variety of things through the year to help their fellow human beings. My youngest participates in endeavors that are appropriate for his age. I guess what I am trying to say is that my children are wonderful, caring people, yet there is no consideration to follow me in my career choice. And that is based strictly on them growing up and watching me struggle with so many unrealistic expectations of how much I can consistantly give to my patients. I realize that each child is going to do what fits them, yet I can't help but be sad that they feel the way they do. My oldest child has actually pushed several times for me to leave the profession, it angers him greatly for some of the things that have happened. The first time I was mandated and my youngest was about 9-10 weeks old, still breast feeding and when I flat refused to stay my job was threatened and I was written up for unprofessional behavior. The job I walked out of at 1 in the afternoon because my dad in TN was dying and I was told no I could not have time off to go take care of my dad because a state inspection was due any time. I am grateful I decided to be "unprofessional" and walk out because it was the last time I saw my dad alive. He died three weeks after I came back to Michigan because I had to get my kids back into school. The job I was fired from because I reported abuse to the state the facility tried mighty hard to cover up. In school we were taught that regardless of how a patient behaved we needed to be caring and understanding because they were in pain, they were dealing with loss of control issues etc... we were told that professional nurses did not join unions, they were for blue collar workers not professionals. We were indoctinated with the idea that regardless of our own needs the patient must always come first, and by extension that meant doing whatever it was that management felt was necessary for that to occur. Obviously I am paraphrasing, but that was always the underlying message. I have the personality though in which I do not do this well. But I resent that this is the way in which I was instructed, and in which my fellow students were instructed. I graduated from nursing school in 1991, just in time to watch healthcare evolve into what we have now. I recall when hospitals were shifting to 12 hour shifts because it saved on benefits. I came out into a job market in which there was supposedly a nursing shortage, within two years there was supposedly a glut of nurses and lay offs and hiring freezes were common. I ended up in LTC because when I divorced and my children were still small I needed to leave midnights and work days, something that was flat not available in the area hospitals, including the one I worked in so I couldn't even transfer to another area. I have steadily watched the increasing patient load, the sicker patients to be taken care of in shorter time frames. The elimination of nurse educators in various fields. And for the life of me I cannot understand why while this was happening theorists were working on theoritical frameworks that had little to do with what nurses actually provide. When I hear other nurses bemoan the inability of the public to truly understand what it is that nurses are there to provide it makes me angry to think that there are academic nurses out there that I and the public should be able to look to provide a realistic framework in which what nurses do, the reality of nursing and it's vital importance to healthcare in general and what nursing provides on a more intimate level to sick loved ones, who are not providing that, while pushing theories on caring. It is obvious that you are a well educated person, and I applaud your ideas of marrying academia to reality. That is what I think is missing so very badly in my profession. Every profession needs it's thinkers, that said I believe they need to provide something back to their profession that has real value and meaning to the nurse and the patient. Not to mention basing their theories on something that not only can nurses in general relate to but that the public in general can relate to. In many ways I feel that I have watched the barn burn down while the people who are supposed to be the leaders in my profession stood around and roasted marshmallows over it. I know that is harsh and it is not in any way directed at you. I am making a general statement on my feelings. When my dad was in Baptist Memorial hospital in Memphis his nurse was carrying 14 patients in a surgical oncology floor. His most basic care was provided by his family, not a nurse or a PCA. I found all of his nurses to be caring individuals as well as competant in what they were doing. I also found that they were as overwhelmed and frustrated in their inability to provide basic care, let alone education or anything else, as they possibly could have been. No theory on caring, auras or even patient spirituality will help that situation. Only concrete research will. And not only that teaching theory that has little to do with the reality of what the bedside nurse and their patients are experiencing, will not assist more advanced degreed nurses participate in that concrete research, because their focus and energies are pushed elsewhere. While I don't deny theory is needed, what I am trying to get across is that there should be more focus on theory that has relevence to the actual hands on practice of nursing, and therefore patient care and it's outcomes.

While I understand that Watson's theory is not inclusive to simply caring for a patient, what I was trying to get across is that the idea of caring is overemphasized in the curriculum as Suzy pointed out. To me that has led directly to the idea that nurses will do nearly anything and take nearly anything to reach that ideal goal of always being there for the patient regardless of what happens to them or their home life. The research on the specifics of mandatory overtime, patient to staff ratios has been belatedly done. I didn't say they hadn't been done at all, but it seems to me that it wasn't until there were some horrid problems that it occured to someone that we couldn't just say hey this is harming patient care, without specific research to back it up. It was a reactive way of looking at nursing and the practice of nursing rather than a proactive way of advancing the importance of what nurses do. And I find that to be very frustrating. So now we are in a hole, and it is going to take a long time to dig out and get things back on track. By overemphasizing the caring ideal we have done ourselves and our profession a great disservice, and by extension a disservice to our patients. While it may be important to look at caring as a theory or an issue, it is also important to look at other concrete areas of study, and personally I don't think that has been done well.

llg, your point is well taken. However that does not mean I believe that nursing theory has reached that ideal. There is too much nursing theory based on pseudoscience, not theory, hypothesis etc... You likely know this but I will continue nontheless. The word philosophy is from the Greek meaning "love of Wisdom", and philosophy encompassed the love of ALL wisdom, only in recent centuries has it come to refer to special branches of enquiry. Since the history of philosophy is one in which the philosophers tackled questions on human nature, physical nature, spiritual nature it only reasons that philosophy is the granddaddy of the practice of science. It was a natural progression so one may attempt to prove the theory of the philosopher. And I think anyone who has done much reading of history would easily understand the impact philosophers have had on our lives. French socialism as well as the French Revolution was driven in large part by Voltaire and Jean-Jacques Rosseau. And even today one may competently argue the philosophical reasons of the French Revolution, though 20 million dead French from The Terror could care less about the philosophy of it. Adam Smith's Wealth of Nations is still cited when one discusses the philosophy of Capitalism, as well as it's impact on Western Culture. John Locke's philosophies were read and used by the founding father's of this country. David Hume still looms in the conciousness of Western philosophy. Classical German Philosophy is a hard read, though interesting and while I disagree with much of the religious theory of Kant, I still found it worthwhile to read. Each of the philosophers I have cited started with an education the was most often based on classical literature ie: Ancient Greeks. The Greeks had no written language before the Greek polis' and the only basis of empirical observation was the day to day observations of the philosophers. Socrates, though his works are actually only known to us through his students Plato and Aristotle. Much of the early Christian theologies were based on Greek Stoic philosophy. I understand perfectly "the principles that undergird the practice of Science" I also understand that philosophical theories can have major impact on society at large. That does not always mean, however, that those philosophies are something that are a good impact. While one can declare that Karl Marx's theories are good in principal, the implementation of those theories had disasterous consequences for million of people throughout the world. I will not pretend to know Jean Watson's theory intimately, I don't. But from the seat of my pants I humbly submit that her ideas, theories if you will, have served to undergird the idea that to be an appropriate nurse one must intimately care about a patient. The outgrowth of such a theory is the idea that nurses will give until we drop, all for that deep caring ideal for our patients. We will cheerfully submit to working hours that have been scientifically proven to be a hazard to our own health, a study done in 1914. And I don't mean a theory of what it does to the health of an employee but through rigerous empirical data. As nursing schools have stubbornly clung to the ideal of putting everything and everybody ahead of our own needs not only as nurses but as people, we have allowed everybody and their brother to control our practice, we continually look outside of nursing for validation and while the profession has been struggling for the last 10 years we have PhD nurses who have continued to put out reams of material that has had little impact for the nurses at the bedside. Last year I called the group Leapfrog in hopes that they may be willing to help in the push to eliminate mandatory overtime for nurses based on the idea it is harmful to patient care. However they were unwilling to get involved with that endeavor because there was not any real research at that time that could back up that statement. There is now research that is a beginning on the importance of appropriate staffing at the bedside, based on patient outcomes. Yet the research is still very little, we still have a long way to go to be able to competently point to relevent research to prove the importance of a educated professional nurse at the bedside. So while one can easily find various nursing theory the vast majority of it has not been able to actually provide a framework on what nurses actually do and how it impacts on patient care. So while nursing theory may provide intellectual exercises, it has provided very little of value to the nurse who is actually taking care of the patient, and thus very little of value to those that have traditionally made the decisions on where nursing resources are. And that has been not only a detriment to the profession, but to the patients my profession is supposed to be caring for. So even if I intimately care emotionally for each and every patient I have, the resources necessary to provide the best of care to those patients have been taken away bit by bit because my own field has not provided relevent research to prove that those resources make a difference on patient outcomes. And that is the biggest reason I feel nursing theory has been of very little value. While pie in the sky theory was being written I lost diabetic nurse educators, staff educators, patient to staff ratios increased, underskilled employees were given the duties I went to school to earn a license to be able to perform,patient worsened and my voice as a nurse saying this will harm patient care was ignored because there was no relevent research to prove the direct care nurses fears had any basis in fact. To state again, philosophy has a Greek meaning of "love of Wisdom" the love of ALL wisdom. Instead of distancing themselves from bedside practice issues perhaps they should have embraced them, and been more relevent to those patients we are supposed to care for so much. But than that would have meant delving into issues that would rock that precious view of nurses being all caring, and all giving. Utilizing research to be able to demand control over our practice, to be able to point to why it is important to have patient to staff ratios that allow time to educate, to actually spend time talking to the patient, would have rocked the boat. For way too long nurses have more or less been told to sit down, shut up and be the good little caring girl. Try to find something out there that is research on patient to staff ratio's. That result is so pitfully small it hardly is worth looking at. Instead we gave our power to the bean counters while nursing researchers were busy trying to put together theories that would make nursing relevent and respected, while ignoring the very issues that would have easily done those two things and more. Researching patient to staff ratios and patient outcomes as well as what type of staff is doing the primary care and education could have been incredibly relevent to this profession. Researching the use of mandatory overtime on patient outcomes could have helped us control our practice but it wasn't done. I say focusing on what nursing actually does and what the patient outcomes are based on the current practices is what should be done, and to a very large degree is not. Nursing diagnosis is not going to make my profession relevent to those who control the dollars or healthcare decisions in this country. The theory of caring for patients like my parents is not going to keep that diabetic nurse educator, or an extra public healthcare nurse. Theory that does not meet the needs of it's own profession is then nothing more than busy work that has no relevent meaning.

Research based practice is different than nursing theory. Concrete scientific research is why we don't use betadine and suger to heal a wound anymore, not philosophical reasoning. Assessment, planning, implementing and evalution are not pie in the sky theory. It is concrete thinking, it is what nurses do every day put down so it makes an effective teaching tool. After time it becomes second nature through repetition. Providing care to a patient is much different than caring about that patient. I have had many, many patients I care a great deal for. There has been a minority of patients I have heartedly disliked. Yet given that situation care is still provided at the same level the patients I really care about emotionally were given. The vast majority of PhD prepared nursing have long ago left direct care nursing behind, and I feel it would benefit the career field much more if these nurses did scientific based research(and I know many do) that concretely benefits nursing practice, not nursing theory. As a wound and infection control nurse I actually enjoy reading new research regarding both of those practices, it enhances my abilities and enhances my ability to provide the best of wound care to my patient, based on scientific methods. In October perhaps November the CDC will be coming out with new hand hygiene guidelines, one of the things expected is not allowing direct care workers to wear artifical nails. Empirical data, and loads of it, point to articifical nails as a harbor for bacteria that has passed nosocomial infections on to patients. It is that type of research I feel I need, not a theory on fluffing aura's. I also believe that nurses do interepet labs as well as many other things. If you do not have the ability to do so it makes it very difficult to be a patient advocate if you cannot present to a physician why you believe doing or not doing something is important. Not to mention I wasted an awful lot of time and paper in nursing school while writing what my patients labs were and the likely reasons they looked like that. And of course there is the heparin protocal based on PT and INR results, if I could not interpet the results of these two labs I surely could not adjust the heparin rate if needed. Everyday I go through cultures on all the patients on my floor so I can track what bugs are out there, is the patient symptomatic, is this a nosocomial infection or do I have colonization, and that when looking particularly at MRSA and VRE. Is it appropriate to be treating this bug, do I have a new resistant form of something? Is the antibiotic ordered one that the microbe is sensitive to. And so on. My infection control practice is based on CDC guidelines as well as SHEA and APIC. All scientific based research and often done by nurses. Perhaps because I am more of a concrete thinker I have very little use for philosophical theory. I enjoy philosophical thinking in relation to many other aspects of life, religious theology springs to mind. But as far as my nursing practice I prefer concrete scientific reseach that allows me to better take care of the particular illness or illnesses of my patients.

rachel I hope I helped some. And thanks to all who agreed with me, I actually expected to be told that I was not caring enough, or something to that effect. Next time you have a rude patient, take a deep breathe, explain you are a professional and expect to be treated like one. Leave the room if necessary, letting the patient know you will be back when they can be calm. When this happens make sure you immediately go to your supervisor and let them know what happened and how you handled it. That way you don't give the patient a way to bite you back. And stuck with the career, we need nurses like you!It is my belief that big changes are coming to this profession. The nursing shortage is going to be too severe for it not to. Stick around the fun is only beginning.