Time to call a duck a duck, part II

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 Hospice.
you sound angry to me. Sorry, but you do

Why wouldn't he? I'm angry, too. I just read a post elsewhere on this site that told of a hospital that the nurses are not allowed to sit AT ALL ... they have to stand at computers in the hall to chart.

There's another thread that tells of a directive that says housekeeping cleans hallways and common areas only ... nursing staff clean the patient rooms. (That way they don't have to pay so many housekeepers.)

The fact is, most hospitals - especially for-profits - think of nursing care as an industrial production line. Furthermore, the nurses aren't the operators ... they're the machinery that gets moved around or taking off/on line as needed.

There's nothing wrong with being angry ... it doesn't invalidate what he has to say.

Specializes in M/S, Travel Nursing, Pulmonary.
you sound angry to me. Sorry, but you do

I am, a little bit, as the post following yours describes. I'm angry things have gotten to the point they have, that our leaders have, for the most part, failed us on so many levels. Which, in turn, means we as nurses also have failed in that we let them become our leaders.

I'm also angry it took me so long to figure out what my problem was, to be able to articulate it. But now I can, and maybe I can do something about it, maybe not. Sometimes the most you can do about a bad problem like the one I am describing is avoid feeding the beast or becoming a part of it. I'll have to remember that as I advance my degree. If I do end up in a position away from the bedside, I'll have to remember my roots.

Specializes in Nursing Professional Development.

I'm happy to read that you now consider nursing to be a profession ... and I agree that SOME of our leaders have forgotten their roots. I also would never hire anyone for a leadership position who had not actually provided direct patient care. So, I agree with much of what you wrote in this thread.

But I am disppointed to find that you think that only 1 type of activity counts as actual nursing. There are many different roles for nurses, not just the one that appeals to you the most.

... and we are all real nurses. We just don't all do the same job. We "take care" of the patients in different ways. We are all valuable. Don't bash other nurses because they focus on on other aspects of nursing. That is one of our professions biggest problems -- we don't support each other and recognize the legitimacy of other people's perspectives. We put down those who disagree with us and/or focus on a different aspect of nursing. Please don't divide our profession and tear it apart. We need to stand together -- and we can't do that if can't recognize that nurses in roles different from our own are also real nurses.

Edit: I just read your post about "real nurses" in the other thread ... the one about nurses insulting other nurses because of their specialty. While you are not exactly inconsistent in these two threads ... I don't think you have fully thought it through and still need to think about how the two topics relate.

Specializes in Gerontology, nursing education.

Eriksoln, you remind me of a friend from nursing school who ended up in management. Even through he was a manager for well over 20 years, he never forgot his roots and never devalued the work of the nurses at the bedside. He used to take a few days every so often to work the floors just to keep in touch with the reality of the bedside. Not surprisingly, his staff loved him. Surprisingly, so did the facility. Win-win for everyone!

Anger can be a terrific impetus. Anger can turn a person into a jerk or it can provide the incentive to make positive change. I see you as taking your energy and making change happen. Thanks for posting this thread!

You are right on target. It seems the more alphabet you get after your name the less bedside nursing occurs. I love bedside nursing. I work in a teaching hospital and the trend now is to push everyone to more education and get credentialed in your field. I don't think people that enjoy bedside nursing and really are good at it need to have masters or PHd's. This really ticks me. Who will take care of me at bedside when I am old and unable to care for myself? I guess with the new healthcare reform I understand why the elderly are so scared, but that opens a whole different can of worms.

Thanks to all the bedside nurses for all they do and put up with on a daily basis and usually have a smile on their face. :) :nurse:

My point is "Its all nursing".

Specializes in Hospice.
My point is "Its all nursing".

Agreed ... but I remember when "primary nursing" was introduced. It was supposed to be analagous to the primary physician role in that the primary functioned essentially as the case manager as well as the main bedside caregiver. Supposedly, it was going to improve pt care by reducing the splintering of nursing roles as well as increase job satisfaction by increasing autonomy/accountability.

Since then, "primary nursing care" has morphed into an institutional excuse to eliminate as much ancillary assistance as possible. Now, as I pointed out in my previous post, the "primary nurse" is supposed to clean rooms as well as do all the care. True, that particular bit of excrement will likely roll downhill to the CNAs ... if there are any available ... Welcome (back)to the 1940's!

Meanwhile, the case management function has been split off and handed over to nurses in civvies who work on salary ... no need to worry about overtime since they don't get paid for it anyway.

As I said ... machinery to be turned off and on as needed.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

Some of our "ills" related to identifying as a profession relate to the fact that the vast majority of us cannot bill directly for our services and that our employers can bundle nursing care in with all sort of decidely "non-professional" service.

What results is the situation where patients stay in the acute hospital or skilled nursing facility in order to have access to 24/7 NURSING care. Yet those very same hospitals and facilities behave as though the nursing care is optional and unimportant when compared to the cost. Thus, patients who are in the hospital precisely for continuous, ongoing nursing assessment and care are subjected to repeated shifts where the nurses do not actually have time to assess or care for them. And the CEOs don't care because they still get their bonuses and 6 wks of vacation.

Just sayin...

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.

I'd agree with you that this is nursing too but I don't think it's the ideal. I'd like it if the nurses actually caring for the patient at the bedside were the ones to do this. I think it's the lack of time to actually go through the chart properly and think about what's happening that causes the need for this sort of review but unfortunately there are plenty of nurses who wouldn't, or maybe couldn't, think any further than the day's tasks even if they did have the time.

Specializes in Hospice.
I'd agree with you that this is nursing too but I don't think it's the ideal. I'd like it if the nurses actually caring for the patient at the bedside were the ones to do this. I think it's the lack of time to actually go through the chart properly and think about what's happening that causes the need for this sort of review but unfortunately there are plenty of nurses who wouldn't, or maybe couldn't, think any further than the day's tasks even if they did have the time.

That's what "primary nursing" was supposed to be. They were supposed to do all bedside care for the pt everytime they were on duty, write real careplans telling other nurses how best to care for that pt when primary was not on duty, collaborate with the medical caregiver and do case management in preparation for discharge. Hospital administrations got as far as "do all bedside care" and "poof" went the help ... and case management went out the window.

As time went on, acuity and census increased, techs were re-introduced to compensate for a shortage of nurses willing to work at the bedside and case management became a whole new job description - because it really does reduce costs and improve care. Meanwhile, the bedside nurses were left twisting in the wind, still having no autonomy ... just responsibility ... with a whole new layer of people telling us what to do.

That's what "primary nursing" was supposed to be. They were supposed to do all bedside care for the pt everytime they were on duty, write real careplans telling other nurses how best to care for that pt when primary was not on duty, collaborate with the medical caregiver and do case management in preparation for discharge. Hospital administrations got as far as "do all bedside care" and "poof" went the help ... and case management went out the window.

As time went on, acuity and census increased, techs were re-introduced to compensate for a shortage of nurses willing to work at the bedside and case management became a whole new job description - because it really does reduce costs and improve care. Meanwhile, the bedside nurses were left twisting in the wind, still having no autonomy ... just responsibility ... with a whole new layer of people telling us what to do.

Totally agree with you heron. The thing that worries me though is that I really do feel there are nurses who just cannot see that famous 'big picture' (maybe it's an experience thing and that makes it difficult when the brand new nurse is expected to be able to perform at the same level as the experienced nurse) and I wonder how much of that has contributed to the introduction of case management.

That's what "primary nursing" was supposed to be. They were supposed to do all bedside care for the pt everytime they were on duty, write real careplans telling other nurses how best to care for that pt when primary was not on duty, collaborate with the medical caregiver and do case management in preparation for discharge. Hospital administrations got as far as "do all bedside care" and "poof" went the help ... and case management went out the window.

As time went on, acuity and census increased, techs were re-introduced to compensate for a shortage of nurses willing to work at the bedside and case management became a whole new job description - because it really does reduce costs and improve care. Meanwhile, the bedside nurses were left twisting in the wind, still having no autonomy ... just responsibility ... with a whole new layer of people telling us what to do.

Right on target. Primary nursing did work years ago and the patients at our hospital had excellent care.

With the patient having the same team of nurses each day for all shifts,follow through and followup was excellent on the care plan.

It is sad to see how things have gone downhill. No matter how much the management/business people like the figures,

you will never be able to run nursing at the bedside like the fast food drive thru complete with scripted dialog....

If I am admitted to the hospital, know I'm taking my own private duty nurse with me--as long as Erikslon is available.:)

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