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 Trauma Surgery, Nursing Management.

i'm painting with a very wide stroke/brush when i say your nursing must include some sort of patient contact. the people i described above.............while not necessarily performing clinical nurse bedside duties (answer call lights, put in foleys), at least have some form of pt. contact. i'd have no problem with the avg. case manager/nurse educator being a part of the "leadership" that shapes the nursing at my facility.

this is my issue as well. my nurse manager came into the or one day to give me lunch. pt was intubated and we had everything ready to go. he told me to go ahead to lunch now, (even though the start of a case is not the best time to relieve a staff member for lunch) and i wasn't going to argue because i knew if i didn't go right then, i might as well kiss any sort of lunch relief goodbye. i gave a brief report and told him that the surgeon wanted a foley placed. he looked at me (i swear erik, he looked stricken) and then at the surgeon (who was looking at him like 'can we get on with it already'). my nm sniffed, squared his shoulders and announced, "well! i haven't placed a foley in 16 years, but i suppose i will have to now!" i was utterly shocked. i offered to do it for him before i left for lunch, but he did the whole "no, no...i can handle this. it is just a foley." the sentiment was clear to me however, that this nurse manager thought that the simple task of placing a foley was just beneath him.

it isn't necessarily that i think that all nurses in administration or in supervisory positions must do patient care all of the time. i do however, strongly believe that they should pull a shift or two per month just to keep in touch with the issues of bedside nursing and furthermore to be able to identify the challenges that their staff nurses face daily.

Specializes in PACU, OR.

No, Canes, I don't think he thought it was beneath him. I think he was scared funkless.

Specializes in Plastics. General Surgery. ITU. Oncology.

No sorry that argument does not wash with me.

You are NOT a nurse if you no longer carry out bedside care. My unit is plagued with so-called "nurse specialists" who do nothing more than bark orders at the already overstretched ward staff.

Head and Neck "specialists" should be able to pass an NG tube. "Palliative Care specialists" should be able to start a syringe driver. "Stoma Nurses" should be capable of changing a stoma bag.

If not then for all your "specialism" you are just a burden to us at the bedside.

This is a great discussion and I'm really enjoying reading everyone's posts because when I try to articulate what I feel on this subject I can never express myself well, even in my own head.

I do understand that feeling of anger that eriksoln is talking about, I feel it too, but I feel it whether I'm working 'on the floor' doing direct care or in the office doing care case management type stuff. I wouldn't be at all surprised to hear that many DONs and mainly or solely 'administrative' nurses feel it too. It's something to do with the disconnect we all feel when we're made to do things that seem pointless and even counterproductive, and the rage we feel when we're given more and more tasks and forms and guidelines and instructions and suggestions and rules that the powers that be say will improve patient care when we're already drowning and feeling like we're not able to provide good care.

I don't really know who or what to blame for this. I just know that I'm not the independent professional that the academics say I should be. I'm not talking about following doctor's orders and things like that, I'm talking about being independent in a nursing sense. If I was an independent professional, I could decide how often I need to do, say, a falls risk assessment, for a particular patient. I can't decide this, it's been decided for me that every patient needs a falls risk assessment every shift. If I think the falls risk assessment tool is pretty worthless or not needed for a particular patient, well too bad for me, I have to do it anyway. Someone in the hospital has decided this and I haven't seen any evidence to prove that it's actually beneficial to do this for every patient. Not saying there isn't any, just that I haven't seen it.

Same for the various skin breakdown risk tools out there. I've seen articles saying that nurses are poor predictors of who is at risk of pressure sores. Really?? I'd love to know who they asked because as far as I can see, anyone who has been a nurse for more than a few weeks has a very good idea of which patients are at risk for skin breakdown. Has anyone actually filled out one of these assessment forms and thought 'oh wow, they're high risk for skin breakdown, I had no idea'???

I'm not against assessment tools, I just think they need to be useful. I can't see any point in doing every assessment under the sun for every patient just to satisfy administration. I'm willing to take the fall if I decide not to do a particular assessment and it turns out it could have told me something I needed to know, but I don't get any credit for spending my time on something that could better benefit the patient like, I don't know, turning them an additional time during the shift. Administration only see that the form wasn't filled in, they don't see that I did that extra turn.

I also think that if we want to be independent professionals, we have to be willing to have our practice scrutinised and our patient outcomes measured. If all my patients are getting pressure sores, well maybe I'm not as smart as I thought and I'd better start using those skin assessments on everybody until I know what I'm doing. This is where it gets back to what heron and others were saying about the primary nursing model and is where I think some of the anger and frustration comes from. I can do everything right during my shift but if the next shift doesn't follow through (for whatever reason), it's all for nothing and I have to start over the next day.

Anyway, this has turned into a long rant and has gone off the topic so I'd better stop now. Like I said, lots of food for thought in this thread. I always have this silly little daydream in my head about winning gazillions of dollars, opening a small facility and staffing it with those truly excellent (in one way or another) nurses and managers I've worked with over the years. I think I'll have to add many of the people in this thread to that list.

No sorry that argument does not wash with me.

You are NOT a nurse if you no longer carry out bedside care. My unit is plagued with so-called "nurse specialists" who do nothing more than bark orders at the already overstretched ward staff.

Head and Neck "specialists" should be able to pass an NG tube. "Palliative Care specialists" should be able to start a syringe driver. "Stoma Nurses" should be capable of changing a stoma bag.

If not then for all your "specialism" you are just a burden to us at the bedside.

How very true and, sadly, how very often you see this.

Specializes in Rodeo Nursing (Neuro).

Anyway, this has turned into a long rant and has gone off the topic so I'd better stop now. Like I said, lots of food for thought in this thread. I always have this silly little daydream in my head about winning gazillions of dollars, opening a small facility and staffing it with those truly excellent (in one way or another) nurses and managers I've worked with over the years. I think I'll have to add many of the people in this thread to that list.

Is there room on your staff for a marginally competent nurse with a strong back and a soft heart?

Specializes in M/S, Travel Nursing, Pulmonary.
Is there room on your staff for a marginally competent nurse with a strong back and a soft heart?

Cause nursemike knows a few he can send your way, while he holds down the fort at his current facility.

Is there room on your staff for a marginally competent nurse with a strong back and a soft heart?

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. :)

Specializes in ICU.

I think it's important in this discussion to separate theory from the manifestations of theory.

I agree with you that the vast majority of nursing "theory" (if you can even call it that) is the rebranded work of others...there's a lot taken from psychology, sociology, and even some from what could be considered the occult. It's a poor way to resolve nursing's identity crisis and other disciplines must assume that nursing doesn't understand theory, since so often nursing tries to stretch the definition in an attempt to "belong".

The manifestations of theory (i.e., nursing the computer), I believe emerged from the realities of an increasingly litigious society - charting is more about CYA than patient care and I think you know that.

Addressing your quandary about administrative nurses who devalue bedside nursing and the image of bedside nursing.....Honestly, I wonder if much of that doesn't have something to do with internalizing bedside nursing's image, internalizing mistreatment from doctors, co-workers, patients, and families.

Specializes in Med/Surg, Geriatrics.

Erik, if you think the only nursing that occurs is at the bedside then you don't understand what "nursing' is.

I've said this to you before and I'll say it again: you desperately need to get away from the bedside....away from the hospital or acute care altogether to get a different perspective.

Nursing involves much more than a bunch of physical tasks which frankly anyone can be trained to do. The nursing involves assessment, planning as well as the doing. None of those is worth a hill of beans without the other.

I do not touch patients. I do not even see patients. What I do is review medical records, labs, radiology and assess function, psychosocial status and cognitive status sometimes by chart review and sometimes by telephonic assessment and then I go into a room with a bunch of other healthcare professionals and create the dreaded care plan.

And this is going to shock you: we save lives. Through my assessments and the resulting care plan, I've made sure patient's got the care they needed that the people laying eyes and hands on them missed. We've found abnormal labs and radiology that were missed and not followed up on, addressed unsafe home situations, recommended follow-up care that resulted in improved outcomes such as better controlled diabetes and heart failure and the list goes on. More importantly, MY nursing care makes sure that the patient does not end up needing YOUR nursing care.

I nurse and people get better.

In developing a plan of care, though, I still could see the argument that one is drawing upon and applying their nursing knowledge and experience as opposed to *practicing nursing* when developing that plan of care. To be able to be an credible authority in developing that plan of care, the nurse should have already *practiced* nursing as relates to the plan of care that they are helping develop.

Similarly, when a teacher helps develops a subject or grade level curriculum for a district, they, too are ideally drawing upon relevant teaching experience. However, I'm not sure I would say that developing a curriculum is, in fact, teaching. I would agree, though, that the best curriculum developers have substantial experience teaching in that subject or grade level.

Why are nurse specialists so great? Isn't it usually *because* these nurses bring with them years of direct patient care experience? How much credence do you give to a nurse specialist / nurse administrator / nurse fill-in-the-blank if they DON'T have that direct patient care experience outside of nursing school clinicals? What is this highly valued experience? It's *nursing* experience.

I'm just thinking nurses can work in the field of nursing without actively practicing nursing, just as teachers can work in the field of education without actively teaching (eg principal), an airplane pilot may continue working in aviation, drawing upon their flight experience, without ever piloting an aircraft again, etc.

I'm thinking that any role where after years of doing only *that* role, the person can't quickly step back in and *provide direct patient care* *stand in front of a classroom and teach* *get in a cockpit and fly a plan* then they are not, in THAT role, practicing nursing, teaching, 'piloting' etc. (So then that does allow for specialists who CAN jump in and at least practice their particular specialty - L&D nursing, teaching third grade, flying lightweight aircraft.)

Specializes in PACU, OR.
Why are nurse specialists so great? Isn't it usually *because* these nurses bring with them years of direct patient care experience? How much credence do you give to a nurse specialist / nurse administrator / nurse fill-in-the-blank if they DON'T have that direct patient care experience outside of nursing school clinicals? What is this highly valued experience? It's *nursing* experience.

What I've found in private/for-profit hospitals, senior nurses are inducted into admin/management and are offered incentive bonuses to come up with or implement schemes to reduce staffing. In these cases, their "expertise" bears no relation whatsoever to patient care, only company profit.

+ Add a Comment