Time to call a duck a duck, part II

[eriksoln, BSN, RN]

OK. I had an infamous thread going that challenged the notion that nursing is a profession. If you are REALLY BORED, go ahead and read it.

Since then, I've had a bit of an epiphany. I couldn't help but wonder "What was the bug up my butt about it anyway?" and "Why is it so important to convince others of this?" Well, you ever get that wonderful brain fart syndrome going after working a night shift? The next day, you are trying to recall a well known relatives phone number or someone's name you should remember, but you don't. Then, out of the blue, a little while after you stop thinking about it, it comes to you. Thats what happened to me. I stopped stressing over it, and I was all of a sudden able to put my finger on it. The orig. thread touched on it a bit, but in an indirect manner.

In the orig. thread, I rambled a lot about the personality types who "Consider nursing an image instead of a career/job" and all the lovely nurses who preempt every statement with "Well, I'm a nurse and I think................." as if it makes a difference (Seriously, I once answered someone who said that "Well, I'm a nurse and a former landscaper and former student and former brick layer laborer and former grocery bagger and I think................). It was as if I were trying to describe some sort of individual who was bad for nursing, but I couldn't put my finger on "The Issue".

So, finally, today, all the little separate details that were somehow wrong in my eyes came together to make sense.

Nursing is a profession. It does combine intellect with physical labor, and neither one can be successful without the other. It does have it's theory, although I don't agree with most about what said theory is. In fact, that was what the epiphany was about:

Seems nursing theory has been a bit diluted by our "leaders" who came before us AND, most of all, our current leaders. Care plans that no one reads, diagnosis that have no use no matter how far you stretch reality to say they are used and numerous other things that, in reality, are simply ideas borrowed from other fields and renamed. No wonder no one else considers us professionals if this is the best we can do. Many of the things wrong with nursing theory today have one thing in common though: They all take us away from the beside and put us in front of a chart/computer. The mechanics of the theories are followed through from an administrative angle, and are meant for people away from the bedside. NURSING OCCURS AT THE BEDSIDE.

The problem with "nursing theory" is that it is often written by those who consider themselves above bedside nursing. Hence the theory that flows from them, inevitably, really doesn't have much to do with "bedside nursing". But, is not bedside nursing the point? Do we nurse our patients back to health, or do we "nurse" paperwork?

Consider, for a second, nursing before paperwork and impressing administration became so important. Do you think for a second the nurses of old, the ones who nursed back when there were no computers or anything...............weren't "nursing"? Did their patients lack in some way because they didn't jot down in some chart how their care reflected "Age specific needs" or how they "Interpreted the pt. reaction to illness"?

I say, profoundly, "NO". In fact, I'll follow with, they were probably better off. A little less time talking and self important chest pounding and a little more time doing the things that help (dressing changes, help with ambulation to avoid falls, taking one's time passing meds to avoid errors). THAT IS NURSING.

Our profession suffers because we hang ourselves. The people who rise through our ranks and hence represent us to the decision makers often, along the road to progressing in their careers, pick up some sort of disdain for bedside nursing. It's "remedial" and "meant for the ancillary staff". If this is the face of nursing that the public and the decision makers see, is it hard to believe such a low value is placed on what we do and that we often feel the need to call our jobs "thankless"? Our very own leaders from within the field, unfortunately, are often in their position of power because they have worked hard to distance themselves from bedside nursing. Nothing wrong with that, if you don't think it is your niche, you are better off elsewhere. What I do have a problem with is when our leaders forget their roots and why they are where they are. If there was no need for the staff nurses, there certainly is no need for administrative/managerial nurses. They forget their roots, begin to believe and buy into the business side's way of thinking and take on an air that nursing is for the ones who don't get it.

Why this phenomenon occurs is a mystery to me. Might be because, the nurse found out they truly hate bedside nursing and want nothing more than to never have to hear "Nuuuuuurrrrseeee, I want dilaudid/a bed pan/need tissue handed to me" again. In their efforts to distance themselves from clinical/bedside nursing, they unintentionally take on a holier than thou air. Or, it might be that, for fear of being replaced, once they get into the board room meetings they join hands with and take on the attitudes of the business minded. Regardless, the lack of respect for our profession isn't going away any time soon BECAUSE IT STARTS AT THE TOP OF OUR OWN PROFESSION.

I now do believe nursing is a profession, and I'm talking about "Nursing", not board room meetings or care plan evaluating. We can not be replaced. As a "remedial" nurse who still believes my best work is done at the bedside, I will be continuing my my education soon. Why? Because I want a more well informed opinion on who our leaders should be and more say in who they are. Maybe someday I'll be in a position too where I can be the face of the profession, but I don't plan on forgetting my roots.

[SilentfadesRPA]

Thank you. I am in awe not only of your comprehensive evaluation but your style and ability to express our profession not only so completely but with great accuracy. Again thank you.

Marc

[joanna73, BSN, RN]

You are very articulate and reflective, so I think you would probably enjoy higher learning, and make valuable contributions in whatever area you decide. I would agree with your sentiments, and this is precisely the reason that BSN, MSN and Doctorate prepared nurses are required in various fields.

Does higher education make you a better nurse? Certainly not. However, higher education, combined with bedside nursing experience allows one to have more opportunities to affect positive change. While I enjoy bedside nursing, there are various aspects that bother me, and I ponder ways that I could somehow change certain policies and procedures. Thanks for your thoughts.

[barbyann]

NURSING OCCURS AT THE BEDSIDE.

[GHGoonette, BSN, RN]

Erik, I read the original post, but I didn't respond to it; there were several who echoed my thoughts on the subject anyway.

You're right, the paper avalanche which started with the nursing process has not in any way improved the quality of nursing care. In my student days, I worked with an RN who was absolutely hectic on compiling nursing care plans covering each and every aspect of the patient's diagnosis, to the extent that there were at least six, up to ten assessments that had to be done one each patient, every day, three times a day. Instead of providing care, we were just moving from one bed to the next charting our "findings". Now, I'm not knocking the process over and kicking it to death here, but I think its greatest worth is as an educational tool for new nurses and as a guideline to ensure continuity of care. I do NOT think it is something that should be constantly done and charted, as if it was a dressing change or a med round.

As for computers, my only response to your comment is...thank heavens it hasn't reached our shores yet! By the time it does, I'll hopefully be retired and travelling the world on my hard-earned investments! Anyway, the only possible use I can think of for computers in the theater and PACU setting is for billing and transmitting vital information to the wards.

Your second last paragraph reminded me of our NSM. When I first met her, she was the UM of our medical ward; a brilliant nurse who ran a tight ship, was never afraid to get her hands dirty and in all ways KNEW HER JOB! Then she was appointed to NSM, and at first was excellent. She brought a fairness and humanity to the post which had been totally absent in the former incumbent. A few years later, our company merged with a large corporate, which introduced a whole new management style, and the impression I got was that "the bug bit her." The corporate bug. I can't quite describe it, but she changed, and not for the better. I think she was envisioning a day when the hospital manager (at that time) retired, and the post would be offered to her. Squeezing the last drop of profit out of the facility, at the expense of patient care, and thus pleasing the Gods of Head Office, became her primary focus, to the extent that she was not above....lying.

If the monster Profit could be removed from the equation, you might see a return to the old principles, but as long as companies' only motive for getting into health care is enrichment and share value, nursing will remain nothing more than grist for number crunchers and "time and motion experts" who have absolutely no concept of nursing and less than no respect for either nurses or their patients.

[gettingbsn2msn, MSN, RN]

We are at the point of cutting nursing staff and ancillary staff to the bone. There is no time for patient communication. I was actually told by another nurse is that patients are a bother and they will keep you from getting your work done if you listen to them. Nursing administration with BSN's and MSN's walk around in their suits all day long and ask stupid questions. It is almost like they are trying to justify their positions. Another reason that I am getting off this treadmill SOON!

[Turd Ferguson]

Well written with some very insightful observations. Thankyou for the food for thought.

[steelcityrn, RN]

Nursing also happens behind a desk. Upon looking at pages and pages of documentation, I cannot tell you how many times I have to talk to the direct care nurse to have a patient re-evaluated for a problem, call the physician for a change dressing, medication, decline in condition , possible hospice palcement, adding a discipline , changing visits, and on and on. Bedside nursing is vital, and so are the other types of nursing.

[eriksoln, BSN, RN]

Nursing also happens behind a desk. Upon looking at pages and pages of documentation, I cannot tell you how many times I have to talk to the direct care nurse to have a patient re-evaluated for a problem, call the physician for a change dressing, medication, decline in condition , possible hospice palcement, adding a discipline , changing visits, and on and on. Bedside nursing is vital, and so are the other types of nursing.

Ah. But what you are doing is not "nursing" when you are behind the desk. People appreciate the value of good business and administration, but we have failed in proving to the community that bedside nursing is a vital part of the healing process.

I've said it before, its still how I feel.

I see it like this:

Athletes, sports stars, often are called upon to do public speaking. The ball players visit High Schools to talk about "don't do drugs", they advertise certain products and sometimes even speak at political rallies. Nothing wrong with that. They make great speakers for different reasons: They are already known to the public, and adored by more than a few of them, often are confident and outspoken and are more often than not used to the camera/being in front of people. They make great speakers partially because they are athletes.

So, the Quarterbacks football playing has earned him a spot as a speaker. But, while he is at the podium saying "don't do drugs", is he playing football, or public speaking? He is not actively playing football, although he is a football player.

Same thing with nursing often goes on with nurses who find themselves in administrative positions. They are still "nurses", and their nursing background got them the position. But they are not actively "Nursing", they are filling the role of an administrator. They are not at the bedside, they practice no person to person skills at a desk other than answering the phone politely. There is no theraputic touch, no theraputic communication involved with the patient directly.

Thats my first reaction. I think the fact that many nurses who have moved onto administrative roles still like to proclaim they are "actively nursing" confuses the subject for decision makers and the general public. They are not in fact "nursing", they are a nurse filling an administrative role. Hence, when an administrative nurse speaks to decision makers, they take it as this person is the voice of the nursing staff, and as I described above.................they are not.

[LPNnowRN]

Nursing also happens behind a desk. Upon looking at pages and pages of documentation, I cannot tell you how many times I have to talk to the direct care nurse to have a patient re-evaluated for a problem, call the physician for a change dressing, medication, decline in condition , possible hospice palcement, adding a discipline , changing visits, and on and on. Bedside nursing is vital, and so are the other types of nursing.

That's because floor nurses are so busy with charting and paperwork there is no time to actually critically think about their patients. Lord help you if you don't have all your documentation done because you were thinking about the big picture!! I know my facility won't pay overtime for that, LOL.

[LPNnowRN]

Eriksoln, you can be my nursing profession leader anytime!

[classicdame, MSN, EdD]

you sound angry to me. Sorry, but you do