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Time to call a duck a duck, part II

Nurses   (17,526 Views 158 Comments)
by eriksoln eriksoln, BSN, RN (Member)

eriksoln has 15 years experience as a BSN, RN and specializes in M/S, Travel Nursing, Pulmonary.

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You are reading page 13 of Time to call a duck a duck, part II. If you want to start from the beginning Go to First Page.

llg has 40 years experience as a PhD, RN and specializes in Nursing Professional Development.

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CompleteUnknown: I respect what you are saying, too. And I appreciate the deep consideration that many posters in this threat have given the topic.

I agree that there is something special about that 1:1 direct contact in the delivery of nursing care. For many nurses, that "caring moment" (as Jean Watson calls it) is the heart of the profession. I value those moments and those direct care activities tremendously and I never want to put down those who do them. I hope you, eriksoln, and others never think that I don't value those activities.

My only disagreement is that I don't believe those direct 1:1 direct care moments are the ONLY things that nursing includes. I believe that people who use their nursing knowledge to assess and meet the patients' needs in other ways are also practicing nursing. We should not limit our vision to ONLY those types of activities. To improve the health and lives of the people we serve, we need to have a broader vision of the profession that includes all types of activities that meet the nursing needs of society.

I believe that if we all worked in the same hospital, we would get along. Some of the members of this thread would be providing direct patient care on a 1:1 basis. Others would be providing care to groups of patients and/or supporting the direct care providers. But we would all be focused on doing what is right for the patient and for the staff as a whole. We'd all be fighting against the "dark side" of the health care industry -- each from our own positions, each in our own ways. We wouldn't be alike, but we would be on the same team.

I hope you feel the same way.

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5,568 Visitors; 352 Posts

That's a lovely post llg. Thank you, and yes I do feel the same way. :)

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First off, Erik, that conversation of yours had me laughing out loud! Seriously, what was up?! Too funny!

We should not limit our vision to ONLY those types of activities. To improve the health and lives of the people we serve, we need to have a broader vision of the profession that includes all types of activities that meet the nursing needs of society.

Serious question here, why must we have a broader vision of the nursing profession? Probably the most narrow of nursing definitions would be something like providing for the physical needs of the ill, injured, old and very young. The best nursing care includes emotional support, in depth medical knowledge, health education and more. However, many a good, compentent nurse isn't a great educator, only has a basic understanding of pathophys (compared to some), or is gruff to patients. They can find jobs that fit their strengths and weaknesses. However, if a nurse doesn't provide hydration (via sips or IV) or cleanliness (via bed baths and/or complex dressing changes), then they aren't doing their job at all.

Is a nurse who administers immunizations practicing nursing? It might be part of their overall practice, but in and of itself, I wouldn't call that function providing nursing care. On the other hand, when a non-nurse helps to bathe an ill person, I'd think that that person *is* providing nursing care, even though they may have no formal training in nursing care. I wouldn't say they are providing *professional* nursing care, but nursing care nonetheless.

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eriksoln has 15 years experience as a BSN, RN and specializes in M/S, Travel Nursing, Pulmonary.

2 Articles; 19,508 Visitors; 2,636 Posts

First off, Erik, that conversation of yours had me laughing out loud! Seriously, what was up?! Too funny!

Serious question here, why must we have a broader vision of the nursing profession? Probably the most narrow of nursing definitions would be something like providing for the physical needs of the ill, injured, old and very young. The best nursing care includes emotional support, in depth medical knowledge, health education and more. However, many a good, compentent nurse isn't a great educator, only has a basic understanding of pathophys (compared to some), or is gruff to patients. They can find jobs that fit their strengths and weaknesses. However, if a nurse doesn't provide hydration (via sips or IV) or cleanliness (via bed baths and/or complex dressing changes), then they aren't doing their job at all.

Is a nurse who administers immunizations practicing nursing? It might be part of their overall practice, but in and of itself, I wouldn't call that function providing nursing care. On the other hand, when a non-nurse helps to bathe an ill person, I'd think that that person *is* providing nursing care, even though they may have no formal training in nursing care. I wouldn't say they are providing *professional* nursing care, but nursing care nonetheless.

I am not at liberty to discuss the events which lead up to and included this so called "conversation with self."

<_>

>_>

Because I don't remember them.

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Kevin RN08 has 2 years experience and specializes in Med-Tele, Internal Med PCU.

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Ah, but we are talking about different things now.

My goal: Bash (yes, bash, to death if need be) the attitude that bedside nursing is "remedial" or work meant for "the techs who can't grasp the whole scope of things thus are better meant for the physical labor." The Core of nursing is at the bedside, you don't deliver theraputic touch or communication from behind desk or through emails. With that in mind, any view/theory of nursing that devalues bedside nursing is pointless.

My goal is not to: Bash anyone who doesn't have direct contact with patients. If your role, as an administrative nurse, is to foster better pt. care via good management/decision making.............then by all means, get your jiggy with it and continue. Only a few good/well informed (that's where the nursing background comes in) decisions that mold/shape a facility are necessary to foster enormous change in bedside nursing and the facility as a whole. Who could find a problem with this?

But is that what is going on? Not in my experience. What I see happening is: Decision makers hand pick nurses who are more apt to be absorbed into their culture/way of thinking for administrative roles. These nurses then become the "Wolf in Sheep's Clothing" I identified earlier..................and all of a sudden you have a nurse who not too long ago was struggling at the bedside making comments like "Bedside nursing is remedial".................."Bedside nursing is just physical labor, anyone can do it".....................or "Bedside nurse's views should be taken into account, with a grain of salt since their understanding of the whole picture is slanted/limited."

Then, you have some CEO make outlandish suggestions, and said nurse who is in a position to guide/direct them fumbles the ball. A good example would be the LTC whose decision makers decided turning off the hot water each weekend would save the facility money. Now, IDK about you, but I don't think it takes a degree to see the problems there. As a former nurse, one who sits on the board and helps make these decisions, one would think the one with a nursing background would have quipped up and explained "Ummmm, that's a terrible decision. Nursing care doesn't stop just because its Sat. or Sunday. Furthermore, elderly people are more prone to be cold already because......................" But no, no such thing happened. The leaders of the LTC facility kept their mouths shut and let it go on, expecting prepared scripts of what to say about it to solve any complaints. Now, my guess is, this facility had a lot of leadership who were the sort to make comments like what I described above.

Maybe I'm just expecting too much of our leaders when I look at things that way, IDK. I know as a bedside nurse, the gap between expectations and reality are wider than the ocean. Maybe I'm doing to our leaders what often is done to me, I'm handed the fixings for a burger and told to make a steak/lobster dinner of it. Perhaps they don't have the pull/say in things I think and are just scrambling to get the day done, much like me.

If thats the case, then yes, I'm being too harsh. I'm not of the opinion that is the case though. Its hard to side with/stand by someone when you know................more than likely, their true colors are that you are "remedial" and don't matter.

I couldn't help but notice, your "poster" concerning nurses bashing nurses was one sided. Talked about bedside nurses who don't think any "real" practice goes on anywhere except the bedside. Somehow, the leaders who commit the same crime with regards to bedside nursing were left out. Coincidence? I don't think so.

Yes, many bedside nurses believe the world begins and end with their perspective on things. But, even more damaging is an administrative nurse who believes the same. The bedside nurse who speaks their voice is VERY unlikely to be heard. On the other hand, an administrator is going to be heard, and many decision makers base their opinions of nursing on what they say/show. One slip from a nurse in an administrative role can cause a lot of grief for the floor nurses. Hence, my insertion that we either, as nurses remember our roots or........bedside nurses separate. I'll risk nursing being more limited in its scope to be free of leaders, leaders who come from our own ranks especially, who believe the very core of what we do is of no value.

Great summation.

If we all aren't pulling in the same direction we are working against each other. Organizationally, bedside Nurses provide the broad (hopefully) stable base which the Hospital is built. If this broad base isn't properly represented in the board room they become less stable. Too often this occurs because of poor communication, unclear goals, and/or lack of desire from all concerned.

IF we at the bedside are accused of "not getting the big picture", then that is a management problem. If the organizational goals are not clear how can it be expected to be supported?

The problem can be on either side of the fence, the bedside nurse that chooses not to participate in Shared Governance, Staff Meetings, or Eductation ... worse yet, those who are too obstinate to try to understand or be constructive.

Then there are the Managers who approach everything with a "my way or the highway" attitude, those that have lost touch with the bedside or (worse yet) lost touch with their Staff.

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Is a nurse who administers immunizations practicing nursing? It might be part of their overall practice, but in and of itself, I wouldn't call that function providing nursing care.

Having seen an epidemic of flu arrive to our area from a group of visitors to the town (verified by the State Public Health),and the resulting spread of the flu from my point of view, a nurse who administers immunizations

is practicing nursing.

Preventing the spread of disease by educating and administering immunizations is a nursing practice.

I can tell you, the individuals affected were without immunization and very ill. Many business and schools closed down.

You can rest assured all of us caring for adolescents inpatient with this flu epidemic were practicing nursing ..............

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Preventing the spread of disease by educating and administering immunizations is a nursing practice.

I'd agree that those functions can be part of a professional nurse's practice. However, I'm still not convinced that that means that that particular function is *nursing care* per se. In this case, I'd say preventing the spread of disease through education and immunization is more of a public health function that can be (and often is) carried out by nurses, physicians, and/or properly trained community public health workers.

Nurses, after all, do provide *medical care* as part of the their nursing practice, do they not? And, again, a non-nurse can provide nursing care (parents of medically fragile children, for example). So a nurse most certainly can provide public health services as part of their nursing practice.

If a public health nurse is *only* providing education and immunizations, is it fair to say that that nurse is still "practicing nursing"? When I say *only* here, I am not diminishing the value of the activity, I simply mean to emphasize if the person wasn't providing any other services in that role. Just because nurses have often been behind many public health efforts 9and they most certainly have!), does that necessarily make it "nursing", as opposed to public health efforts that may be carried out by nurses or physicians... or if the demand is great enough, perhaps a specialized public health role with its own training and certification?

I guess maybe I'm conceptualing the concept of the provision of nursing care as akin to the concept of teaching. If a principal hasn't been in front of a classroom in 10 years, would you consider it accurate to say that they've been teaching for the last 10 years? They most certainly have been involved in education! And ideally have been facilitating quality teaching through supportive policies and management. I'm thinking some 'expanded' nursing roles are kind of like that. They most certainly are involved in the provision of qualify health care, perhaps directly providing medical care (administering injections, prescribing treatments) or perhaps directly responsibility for the provision of nursing care (DON). But I'm not sure I agree with then labelling all that they may be doing as "nursing".

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Well, I can tell you at the time I was not a public health nurse...:D

but all of the nurses on our unit were running 24 hours a day to personal exhaustion providing

nursing care to the affected individuals.

The next year the MD ordered flu clinics, and yes we were administering nursing care via

immunizations.

Not arguing, but honoring the hard work my colleagues gave to the adolescents and staff who were

ill (at the bedside). And the numerous clinics that were staffed for prevention.

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nursemike has 12 years experience as a ASN, RN and specializes in Rodeo Nursing (Neuro).

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First off, Erik, that conversation of yours had me laughing out loud! Seriously, what was up?! Too funny!

Serious question here, why must we have a broader vision of the nursing profession? Probably the most narrow of nursing definitions would be something like providing for the physical needs of the ill, injured, old and very young. The best nursing care includes emotional support, in depth medical knowledge, health education and more. However, many a good, compentent nurse isn't a great educator, only has a basic understanding of pathophys (compared to some), or is gruff to patients. They can find jobs that fit their strengths and weaknesses. However, if a nurse doesn't provide hydration (via sips or IV) or cleanliness (via bed baths and/or complex dressing changes), then they aren't doing their job at all.

Is a nurse who administers immunizations practicing nursing? It might be part of their overall practice, but in and of itself, I wouldn't call that function providing nursing care. On the other hand, when a non-nurse helps to bathe an ill person, I'd think that that person *is* providing nursing care, even though they may have no formal training in nursing care. I wouldn't say they are providing *professional* nursing care, but nursing care nonetheless.

I believe I am right there with you and Erik in my frustration with the sort of "Ivory Tower Nursing" that seems to exalt the profession of nursing but disdains the practice of nursing, and I have to say, I've seen that attitude. Even in a few bedside nurses. But I think we've seen that that attitude isn't universal even among nurses who practice away from the bedside, and I don't think it's as pervasive as it can sometimes feel. I don't buy the idea that a bedside nurse who has never been a nurse administrator, nursing instructor, case manager, etc. cannot understand these roles. Of course there is no substitute for experience, but we aren't stupid. We can see, we can think, and we all wear a variety of hats in the course of our shifts.

Not long ago, I had occasion to care for a parent of one of my high school teachers, who remembered me from the days when my goal was to become an astrophysicist. As we were catching up, he remarked, "So you did at least become a scientist." He got it, in a way that most lay people and some nurses and nurse leaders don't. I am, indeed, a scientist, and the nursing process is very much a scientific process. We form hypotheses and test them, implement the ones that prove out and revise the ones that don't. Many, probably most patient interactions are experiments, and our assessments are our data collection. We're a life science, and we may be as empirical as they come, but we do science on a daily basis. And in my thoughts on nursing theories, I have concluded we are rather young, as a science. Some nursing theory seems "out there" not because I'm not capable of understanding it, but in the way some of Aristotle's physics was "out there," because it was grounded in a mixture of dogma and "common sense," rather than observing reality. But I do think we, individually and collectively, have been working toward a more "Newtonian," evidence-based science.

The point I think I'm trying to make, at least in my own present GCS=12 state-of-mind, is that I don't believe to best hope of resolving what appears to be a distinct schism between the practical and the professional aspects of nursing is to simply accept it as the way it is, to "call a duck a duck." A narrow interpretation of nursing, I believe, is apt to be a static one. At times we bedside nurses can be a conservative bunch, skeptical beyond healthy skepticism. That's the voice in me that tends to cringe when one of my nurse leaders at work begins to talk about evidence-based practice, because the discussion often leads to something that will make my job more difficult. Then, two weeks later, I'll be on the phone with some resident saying, "Yes, but evidence-based practice shows..." again proving my conclusion that nursing is most properly to be seen as a dissociative disorder.

We have sort of skirted around the distinction between bedside/applied nursing and higher or more advanced areas of practice, but it's a plain fact that there are some areas of nursing for which my ASN doesn't qualify. I can't be a Dean of Nursing, or at my facility, a Nurse Manager, without a higher degree. A case management job at my facility requires a BSN. So, A BSN, MSN, or Ph.D. is qualified to do my job, but I'm not qualified to do theirs. But I think Erik and Joy and I have a legitimate point that some of them might not necessarily do my job as well as I do. It would be nice if there were some less hierarchical way of discussing it, although some relationships are unavoidably hierarchical. (Kudos to spell check, by the way.) I am willing to ride along for a way with the idea that I don't so much obey doctors' orders as implement doctors' prescriptions, but there is no escaping that I follow my manager's orders. Most of the time, anyway. It isn't a threat to my identity because I don't equate my place in a corporate structure with my worth as a person. I'm the same guy I was when I pushed beds for a living, I just get paid more and have more responsibility. Also worth noting, I have in common with my manager and my CNO that we are all middle management, in that part of our duties are supervising others who may have varying estimations of our sanity, while following the orders of superiors whose lucidity may sometimes be suspect.

Eh, well. The coffee I started brewing when I began this is almost certainly done, by now, and I have a strong intuition that the answer to all my concerns may be at the bottom of my cup.

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eriksoln has 15 years experience as a BSN, RN and specializes in M/S, Travel Nursing, Pulmonary.

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Sooooo.......................

What should the "Duck Duck Goose" thread be about?

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tewdles has 31 years experience and specializes in PICU, NICU, L&D, Public Health, Hospice.

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Goslings often don't look or act much like geese...but they will soon enough, if they survive.

New grad nurses also often don't look or act much like professional nurses...but they will soon enough, it they survive.

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The next year the MD ordered flu clinics, and yes we were administering nursing care via

immunizations.

And if physicians were administering the immunizations, would then they be "administering nursing care"? How about if it's trained health workers (non-nurse) administering the immunizations? (eg in a rural third world immunization campaign)

Lawyers often help craft policies based upon their knowledge and experience with the law. That's a vital perspective that only an experienced lawyer can provide. A lawyer engaging in policy-crafting makes sense and is necessary in many circumstances. A nurse engaging in policy-crafting, in providing medical care, in infection control, in designing medical information systems, etc makes sense and is necessary in many circumstances. I'm just thinking that that still doesn't mean that those activities *are* nursing per se.

Part of a nursing assessment is determining if the patient needs medical care (eg medical workup for chest pain). A nurse (or non-nurse) may determine that the patient needs social work services or a perhaps a psych referral. A nurse (or non-nurse) may determine that the patient needs nursing care - assistance with carrying out medical care (IV med administration), assistance with ADLs, close monitoring of unstable conditions. Something like that.

Hmm... maybe I'll start a new thread on that, revisiting a favorite question of mine... what *is* nursing?

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