Time to call a duck a duck, part II

Nurses General Nursing

Published

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.

Specializes in PACU, OR.

Hey, you guys the only ones still up? :D

Erik, interesting debate - with yourself! You made a few points, quite a few pages back, about admin and other sections being "support" and that "bedside nursing is the core of the profession". I'd like to expand a bit on that.

The function of any hospital or nursing home (as we call them here), especially private or for-profit, is to provide facilities and staff to care for patients referred by doctors. Therefore their core business is patient care. The rest is ancillary. The team that addresses the actual work of diagnosing, treating and caring for the patient on a day-to-day basis is central to the theme; without them, there is no patient care, hence no business.

All the rest, from admissions clerks to the CEO, should be regarded as health care support, and their actions should be geared towards enabling their care staff to perform their tasks to the best of their ability. If they have developed a "God complex", and consider themselves better/more important/more intelligent than the bedside staff, they have lost sight of core business.

One question; how does a deskbound nurse - or ex-nurse, depending on your point of view - compile care plans if she is not directly involved with the patient? Where is she/he getting the information? Can it be that she/he is drawing conclusions based on bedside nurses' observations? Or does she/he go out there and get the info personally?

Specializes in M/S, Travel Nursing, Pulmonary.
Hey, you guys the only ones still up? :D

Erik, interesting debate - with yourself! You made a few points, quite a few pages back, about admin and other sections being "support" and that "bedside nursing is the core of the profession". I'd like to expand a bit on that.

The function of any hospital or nursing home (as we call them here), especially private or for-profit, is to provide facilities and staff to care for patients referred by doctors. Therefore their core business is patient care. The rest is ancillary. The team that addresses the actual work of diagnosing, treating and caring for the patient on a day-to-day basis is central to the theme; without them, there is no patient care, hence no business.

All the rest, from admissions clerks to the CEO, should be regarded as health care support, and their actions should be geared towards enabling their care staff to perform their tasks to the best of their ability. If they have developed a "God complex", and consider themselves better/more important/more intelligent than the bedside staff, they have lost sight of core business.

One question; how does a deskbound nurse - or ex-nurse, depending on your point of view - compile care plans if she is not directly involved with the patient? Where is she/he getting the information? Can it be that she/he is drawing conclusions based on bedside nurses' observations? Or does she/he go out there and get the info personally?

Good question. Actually, if they get it themselves............than "ooops, my bad", there is you min. requirement of pt. contact.

Since most care plans are pre-written, I imagine they are just made up right there at the desk without any pt. data. Who knows? I'm not going to say I'm the expert on this......................I've shared my view of careplans more than a few times.

Just thought of something too..............wonder if they copy/paste them like I did in school :eek:

Specializes in Rodeo Nursing (Neuro).
Lol Mike, sure there is, but erik is right, they probably need you where you are now. I only joined the site recently but I've been reading for years and I've always enjoyed your posts. If every nurse was as 'marginally competent' as you seem I don't think we'd have a problem in nursing at all. :)

Thanks to you and Erik, both. Truth be told, my "marginally" skates pretty close to false modesty. An honest self-eval would pretty much just be "competent." I tend to cling to the marginally to remind myself of the point when it finally dawned on me that if I kept trying to be Supernurse, I was going to kill somebody, but if I aspired to marginal competence, I might actually get there. And there are still plenty of times when I wonder whether I might have a better future writing about nursing than doing it. I've actually been noodling around the idea of a book, although it has rapidly become clear to me that I need to get some more experience, and possibly do some...eek!... research. And, since I'm being honest, the latter possibility makes the whole idea seem far-fetched. But I really do like the irony that it would be more-or-less a work of nursing theory.

A lot has been posted since I left for work last night, and not all of it delusional. Sharon's remark about physical skills reminds me of a post I saw on another thread suggesting that CNAs could pick up a lot of what we do over a matter of, I think it was months. But I didn't read her to mean bedside nursing was only about physical skills. I'm also reminded of a story my Dad told me of seeing a child prodigy interviewed on t.v. When asked how his parents related to him, he said he thought that his father might be a little uncomfortable, since he "worked with his hads." What did his father do? He's a neurosurgeon. Which in turn reminds me of all the times in my own childhood that my father asked me why they don't send donkeys to school. (Because nobody likes a smart ass.)

I'm going to have to wait until my GCS is in double digits to develop this thought, but while I do genuinely think bedside nursing is the core of nursing, my personal inclination is to consider just about any job with "nurse," in its title a nursing job.

Nursing is nursing. .

It is because of this quote and "a nurse is a nurse is a nurse", is why the nursing profession(eriklson)is seen to be straggling most times.

People most times take you the way you take yourself.

I'm willing to bet that floor nurses draft care plans all the time - in their minds - and use them to organize and individualize care. They just don't have time to sit behind a desk and type them up because they're busy implementing them.

If it is not charted, you didn't do it.

Careplans in the mind is all well and good...for the people who can read minds.

, but while I do genuinely think bedside nursing is the core of nursing, my personal inclination is to consider just about any job with "nurse," in its title a nursing job.

Maybe true, maybe not. This core of nursing is an implementation of the plans made up behind closed(or open) doors as the case may be.

Bedside nursing is not an independent process but rather the outward fulfillment of that which had already been decided to be implemented by the "non-core nursing".;)

Specializes in Med/Surg, Geriatrics.
Sharon's remark about physical skills reminds me of a post I saw on another thread suggesting that CNAs could pick up a lot of what we do over a matter of, I think it was months. But I didn't read her to mean bedside nursing was only about physical skills.

Thank you for picking that up! In fact, I expressly said that bedside nursing was NOT only about physical skills. I notice a lot of folks have pulled out part of my sentence and seemed to interpret it as a swipe at bedside nursing when it was the opposite.

Specializes in Med/Surg, Geriatrics.
One question; how does a deskbound nurse - or ex-nurse, depending on your point of view - compile care plans if she is not directly involved with the patient? Where is she/he getting the information? Can it be that she/he is drawing conclusions based on bedside nurses' observations? Or does she/he go out there and get the info personally?

I'll be glad to field that question for you:

In my case, we review the medical record extensively. We look at physical status as well as functional, cognitive and psychosocial status. These are all issues that impact health. So for example:

83 y/o lady was recently in the office for a fall, suffered only a wrist sprain. Extensive chart review reveals that she has been in the office 3 times in a 12 month period for falls. Each time, her injury was treated and she was sent home. She has never had a bone density test, vitamin D level was low and she has not had her eyes checked in over a year. She has diabetes and the last foot exam was abnormal. No podiatry follow-up. She lives alone and still drives. Oh yeah and she's on Coumadin. None of her providers have put this picture together.

The patient is contacted by phone and asked about the circumstances of her falls. She minimizes it and states she is just clumsy. If she were to fall and unable to get up, she has no way to call for help. No emergency response. Her son does call about once a week. She states it is important to her to remain independent and live in her own home. Obviously, falling and breaking a hip or cracking her head and getting an intracranial bleed is a threat to that goal, this is a disaster waiting to happen.

In collaboration with the rest of the team, we then create a care plan that centers on her fall risk. Interventions recommended to the provider are:

-bone density testing to check for osteoporosis or osteopenia; treat if found

-vitamin D supplement; calcium supplement

-annual eye exam

-follow-up with podiatry re: potential neuropathy; assist to schedule if needed

-gait and balance assessment by the provider to determine if she needs physical therapy; order if needed

-check for orthostatic hypotension; adjust meds if found

-stop Coumadin until falls are addressed

-personal emergency response system; ask son to check in with her more often

-teach about home environment and safety; ie throw rugs and wall rails, lighting, etc

At 3 month follow-up, it is found that she did indeed have a gait and balance problem. PT has made significant progress with her, she is now using an assistive device. She has an emergency response button and took the throw rugs out of her bathroom and kitchen. Bone density test found osteopenia so calcium supplement is sufficient for now.

6 months later, she remains safe in her own home. No additional falls and she reports that she actually feels more confident and has started going to a senior center 3 times a week. The patient met her goals, did not need bedside nursing care since we kept her out of the hospital and I never laid eyes or hands on her.

I'll be glad to field that question for you:

In my case, we review the medical record extensively. We look at physical status as well as functional, cognitive and psychosocial status. These are all issues that impact health. So for example:

83 y/o lady was recently in the office for a fall, suffered only a wrist sprain. Extensive chart review reveals that she has been in the office 3 times in a 12 month period for falls. Each time, her injury was treated and she was sent home. She has never had a bone density test, vitamin D level was low and she has not had her eyes checked in over a year. She has diabetes and the last foot exam was abnormal. No podiatry follow-up. She lives alone and still drives. Oh yeah and she's on Coumadin. None of her providers have put this picture together.

The patient is contacted by phone and asked about the circumstances of her falls. She minimizes it and states she is just clumsy. If she were to fall and unable to get up, she has no way to call for help. No emergency response. Her son does call about once a week. She states it is important to her to remain independent and live in her own home. Obviously, falling and breaking a hip or cracking her head and getting an intracranial bleed is a threat to that goal, this is a disaster waiting to happen.

In collaboration with the rest of the team, we then create a care plan that centers on her fall risk. Interventions recommended to the provider are:

-bone density testing to check for osteoporosis or osteopenia; treat if found

-vitamin D supplement; calcium supplement

-annual eye exam

-follow-up with podiatry re: potential neuropathy; assist to schedule if needed

-gait and balance assessment by the provider to determine if she needs physical therapy; order if needed

-check for orthostatic hypotension; adjust meds if found

-stop Coumadin until falls are addressed

-personal emergency response system; ask son to check in with her more often

-teach about home environment and safety; ie throw rugs and wall rails, lighting, etc

At 3 month follow-up, it is found that she did indeed have a gait and balance problem. PT has made significant progress with her, she is now using an assistive device. She has an emergency response button and took the throw rugs out of her bathroom and kitchen. Bone density test found osteopenia so calcium supplement is sufficient for now.

6 months later, she remains safe in her own home. No additional falls and she reports that she actually feels more confident and has started going to a senior center 3 times a week. The patient met her goals, did not need bedside nursing care since we kept her out of the hospital and I never laid eyes or hands on her.

This is good stuff Sharon and I think it's a bit pointless to be asking whether or not it's nursing. To me anyway, it is. What I wonder is why it is that you 'never laid eyes or hands' on this woman. Surely meeting her, talking to her and maybe her son, and assessing her yourself could only make this process work better? What about visiting her at home to check for falls risk factors like steps, mats, clutter, poor lighting, unsuitable furniture layout, etc? I think this may be what some are meaning when they say 'bedside' or direct care is devalued.

The fact that 'none of her providers have put this picture together' makes me quite uneasy. Why haven't they? They have access to all the same information that you used and they have the advantage of actually talking to her and observing her. It just seems to me that there's something wrong with the entire system when it takes a chart review for someone to notice that this patient has fallen 3 times in the past year, low vitamin D hasn't been followed up, and other potential problems are evident. Surely when she presented with the sprained wrist all this should have been addressed by her provider then? Or am I missing the point and the chart was referred to you because the problems were noted?

Thanks to you and Erik, both. Truth be told, my "marginally" skates pretty close to false modesty. An honest self-eval would pretty much just be "competent." I tend to cling to the marginally to remind myself of the point when it finally dawned on me that if I kept trying to be Supernurse, I was going to kill somebody, but if I aspired to marginal competence, I might actually get there. And there are still plenty of times when I wonder whether I might have a better future writing about nursing than doing it. I've actually been noodling around the idea of a book, although it has rapidly become clear to me that I need to get some more experience, and possibly do some...eek!... research. And, since I'm being honest, the latter possibility makes the whole idea seem far-fetched. But I really do like the irony that it would be more-or-less a work of nursing theory.

A lot has been posted since I left for work last night, and not all of it delusional. Sharon's remark about physical skills reminds me of a post I saw on another thread suggesting that CNAs could pick up a lot of what we do over a matter of, I think it was months. But I didn't read her to mean bedside nursing was only about physical skills. I'm also reminded of a story my Dad told me of seeing a child prodigy interviewed on t.v. When asked how his parents related to him, he said he thought that his father might be a little uncomfortable, since he "worked with his hads." What did his father do? He's a neurosurgeon. Which in turn reminds me of all the times in my own childhood that my father asked me why they don't send donkeys to school. (Because nobody likes a smart ass.)

I'm going to have to wait until my GCS is in double digits to develop this thought, but while I do genuinely think bedside nursing is the core of nursing, my personal inclination is to consider just about any job with "nurse," in its title a nursing job.

Looking forward to one day reading that theory. :D

Specializes in Oncology; medical specialty website.
Good point -- worth repeating. Until you have experience in a job (such as nursing leadership and/or advanced roles), your understanding is limited to that of an outsider. People who have only held one type of job within nursing have had a very limited view of the profession.

That doesn't mean their ideas should be ignored ... but we do have to take their limited perspective into account as we consider them.

I know ... I'm not being very nice ... but the very essence of this thread is insulting to all us nurses out there who are not in traditional staff nurse positions. Staff nurse is just one role within the larger profession. It is not the only nursing role.

ITA. And why are people treating the OP as if he were the final arbiter on who is/is not a nurse? It's his opinion, nothing more, nothing less.

Specializes in M/S, Travel Nursing, Pulmonary.
ITA. And why are people treating the OP as if he were the final arbiter on who is/is not a nurse? It's his opinion, nothing more, nothing less.

And another one. ITA.

mmmmmmm:mad:

In the.........................attic? No, I Talk A lot...............eh, no.

oh, wait, "I totally agree".........................? seems to fit. I'm going to invent software for this stuff, right after I'm finished with the doctor's hand writing decoder ring.

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