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 M/S, Travel Nursing, Pulmonary.
Nursing is nursing, no matter what the role is, or what setting you do it. Everyone has unique talents and skills, and bedside nursing is just as important as administration or education roles in nursing, or vice versa. These are interdisciplinary roles that complement each other. Furthermore, the setting in which one chooses to practice nursing is theirs alone; no one should judge or criticize. Furthermore, the nursing process remains the same, no matter where you practice.

My point exactly.

The thread's complaint is that...........bedside nursing's value and place in the medical model is improperly displayed to decision makers and the general public. My hypothesis is the reason for the slanted and devalued view of bedside nursing is.........well, because of our leaders (partially anyway). And I had two advance degree nurses basically echo my sentiments already: "Bedside nursing is just a physical labor" and "Its for the remedial nurses."

Now, if the leaders of our own profession think so...........why should admin./politicians/the general public think any differently.

Sorry, but IMO, its time for a change. Time to stop supporting these nurses who, once away from the bedside, decide to build themselves up by devaluing nursing. WHEN DID NURSING BEGIN TO BE SO FROWNED UPON.............BY NURSES?

Specializes in M/S, Travel Nursing, Pulmonary.
Excellent point. If in reality the unique skills and talents of bedside nursing were respected,

bedside nurses would be allowed to give their input to improve working conditions on

behalf of their patients. Not given scripts to recite to patients, and have their autonomy to navigate the course of care plan for their patient eroded.

Interdisciplinary roles would then complement again on behalf of the patient, because all disciplines would use their knowledge and skills to unite

for the best comprehensive care plan for each patient without

interpersonal or interdisciplinary conflict.

When the emphasis switched to business, the patient has been left far behind in many healthcare settings, as the acquisition of dollar bills

became the main priority.....

Patient advocates like Eriksoln and many others continue bring the spotlight back to the patient and their needs..........

Exactly, the emphasis is on business, not pt. care. And anyone who doesn't join in on the song and dance and play dumb about the whole thing somehow is "remedial" or doesn't get the whole picture.

Like I said in the OP. I think a lot of nursing leaders get into the crowd with decision makers, find themselves in board meetings and decide to join hands with the business minded for fear of being replaced. Thats the first thing thats gotta stop.

Specializes in ICU.
This was brought up in the first Duck thread. That, even if care plans never cross your mind as you go about your duties, you are actually performing them, albeit on a sub-conscious way or something. IDK, I won't say that's wrong, but at the same time I'm not going to agree.

If I get a patient with some dx I am not familiar with, I don't run to the policies manual and look up the "care plan" for that pt. I look up the disease first, see what the pt. is at risk for etc..........

The "sub-conscious" care plan stuff just doesn't jive with me for some odd reason. I'm mean, really, if you wanna get technical about it, what job/career/profession doesn't that apply to? You could say everyone is doing care plans with everything they do.

A care plan is nothing more than a way to organize, conceptualize, and rationalize care in the context of the nursing process. Most of us drive daily, utilizing a set of traffic rules we've learned at one point or another, either formally or by observation. A driver's guide/manual is a "care plan" for driving - it is a way to organize, conceptualize, and rationalize driving in the context of legal and civil guidelines. But do we refer to your driver's manuals every time we get behind the wheel? No. Is every traffic situation we encounter advised by our driver's manual? No. We use a basic set of rules and contingencies we've learned and adapted over the years to draw from when making decisions and taking action in varying situations. The same is true with nursing.

All care plans do is take what nurses do (or could possibly do) and put it down on paper. It is no substitute for the actual doing. They can inform the doing...but they are only useful for informing practice if they are practical, individualized and patient centered.

Very well written and concise.

For a seperate topic on a seperate day, I would not neccesarily say that "people have risen above bedside nursing or consider it too menial for them", I would like to opine that perhaps people have just moved on to other things.

We can't not always like the same things.

Specializes in M/S, Travel Nursing, Pulmonary.
A care plan is nothing more than a way to organize, conceptualize, and rationalize care in the context of the nursing process. Most of us drive daily, utilizing a set of traffic rules we've learned at one point or another, either formally or by observation. A driver's guide/manual is a "care plan" for driving - it is a way to organize, conceptualize, and rationalize driving in the context of legal and civil guidelines. But do we refer to your driver's manuals every time we get behind the wheel? No. Is every traffic situation we encounter advised by our driver's manual? No. We use a basic set of rules and contingencies we've learned and adapted over the years to draw from when making decisions and taking action in varying situations. The same is true with nursing.

Eh. Makes sense. Guess if someone is great at their nursing and prioritizes well, doesn't miss important assessment details and notes reactions to tx quickly (or lack of)...........and care plans got'em there, more power to them. Its not how I got there. I really don't know anyone who credits their performance to care plans TBH.

<_>

>_>

Wait, your argument is that I do use them, I just don't know it.

That's kinda scary, I copy pasted a lot of that stuff in school. lmao

Specializes in ICU.
Eh. Makes sense. Guess if someone is great at their nursing and prioritizes well, doesn't miss important assessment details and notes reactions to tx quickly (or lack of)...........and care plans got'em there, more power to them. Its not how I got there. I really don't know anyone who credits their performance to care plans TBH.

<_>

>_>

Wait, your argument is that I do use them, I just don't know it.

That's kinda scary, I copy pasted a lot of that stuff in school. lmao

Come on. I think you know better than that. (I hope.)

Are you arguing just to argue now?

Specializes in M/S, Travel Nursing, Pulmonary.
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.

Actually, the essence of the thread is that we need to eliminate the attitude that bedside nursing is "remedial" or for the feeble minded types. Its goes on further to state, step one in achieving this is to start within our own ranks, since a good bit of it comes from there.

The fact that bedside nursing has its value and place in the medical model is lost these days. And, yes, sorry, but the Nursing Leaders who couldn't resist the urge to pump their chests and proclaim themselves above it are, in part, to blame for it. I just can't follow the thought process of someone who in one instance devalues their profession and in the next violently defends their place/title in said profession.

Specializes in M/S, Travel Nursing, Pulmonary.
Come on. I think you know better than that. (I hope.)

Are you arguing just to argue now?

Better than what? [thinks its the "copy/paste" thing]

<_>

>_>

If you show this to any of my former instructors, I'll deny it. I'll say my niece was on the computer.

Specializes in M/S, Travel Nursing, Pulmonary.
Very well written and concise.

For a seperate topic on a seperate day, I would not neccesarily say that "people have risen above bedside nursing or consider it too menial for them", I would like to opine that perhaps people have just moved on to other things.

We can't not always like the same things.

I actually plan on going into Nursing Informatics. Which, I hate to admit, fits my description of an administrator position filled by someone with a nursing background.

I do hope I don't turn into one of these people who develops amnesia once I'm off the floor. I can see it now "Damn nurses. They don't do anything but physical tasks all day, why can't they remember to click this/that/another button so the documentation is right."

Nursing is nursing. The common goal for all should be to help patients in various ways. Sometimes it is in an emergency and surgery for others it is to have a baby and for others to help them die with dignity. These are just a few examples. Sometimes nurses have a more behind-the-scenes type of position. They work hard so that nurses have better working conditions while others dedicate their lives to teaching other nurses. All are vital to our success.

To downgrade one saying well anyone can do what you do or your job isn't as important as mine and I save more lives than you do is ignorant and totally missing the point. We are all part of a much more complicated and comprehensive picture than that. Our goal should be the same with all of us doing our part. It saddens me to see newer nurses and more experienced ones getting it so wrong. We as nurses should all know better than some of what we see on these boards.

It's time we be each other's best friend and not our own worst enemies. This thread is significant in how we fight against one another versus as one like we should.

Specializes in Nursing Professional Development.
Actually, the essence of the thread is that we need to eliminate the attitude that bedside nursing is "remedial" or for the feeble minded types. Its goes on further to state, step one in achieving this is to start within our own ranks, since a good bit of it comes from there.

The fact that bedside nursing has its value and place in the medical model is lost these days. And, yes, sorry, but the Nursing Leaders who couldn't resist the urge to pump their chests and proclaim themselves above it are, in part, to blame for it. I just can't follow the thought process of someone who in one instance devalues their profession and in the next violently defends their place/title in said profession.

But you are doing the very thing you are criticising others for. I agree with you that bedside nurses should be valued, respected, etc. .... but we don't need to devalue nurses who are not bedside staff nurses to do that. We should value and respect ALL types of nurses.

That's one of nursing's biggest problems. Too many people feel that the only way to pump themselves up is to tear other people down. Value bedside staff nurses ... support them ... praise them .... I'm all for that. But don't do that at the expense of all other nurses. Bashing all nurses who are in roles different from yours is not the answer. It's not good for nursing.

Specializes in M/S, Travel Nursing, Pulmonary.
but you are doing the very thing you are criticising others for. i agree with you that bedside nurses should be valued, respected, etc. .... but we don't need to devalue nurses who are not bedside staff nurses to do that. we should value and respect all types of nurses.

that's one of nursing's biggest problems. too many people feel that the only way to pump themselves up is to tear other people down. value bedside staff nurses ... support them ... praise them .... i'm all for that. but don't do that at the expense of all other nurses. bashing all nurses who are in roles different from yours is not the answer. it's not good for nursing.

really? are you sure about that?

think before you answer.........................................................

yes, i consider bedside nursing the core of the profession. why? its simple. if the bedside nursing gets fumbled and poorly done................nothing else matters, the pt. is headed for a poor outcome most of the time.

with regards to non-bedside nursing positions, their primary goal and focus should be in support of nurses and the nursing process as it pertains to their facility. if you are making a budget, said budget should reflect a nurse's point of view and expertise. hence, when put into effect, it will honestly assist the nursing process. all is well, everyone taking care of their corner of the street and the parade goes off without a hitch.

this is not what goes on though. instead, we end up with a lot of former nurses filling administrative roles taking on the business model's views. they turn into a "wolf in sheep's clothing." they join hands with the decision makers (as i described in the op), absorb their biases regarding nursing and become a part of the problem instead of being the solution. instead of educating the powers that be on nursing's value..............they make statements like............ohhhhhh............idk................"bedside nursing is remedial, we should call them techs" and "nursing is nothing more than a bunch of physical duties." sorry, but the profession doesn't need this kind of leadership.

so, i don't see what i'm doing as bashing. i see it as more of a cry to my fellow nurses to put the "wolf in sheep's clothing" in their place. if they can't/won't get the point..........then, eh..........we are better off saying they are not one of us. in truth, they are not...........the are on the business side of things, nursing is not.

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