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.

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.

I totally agree. Let's not insult anyone providing health care by saying "any trained monkey could do that".

Doesn't that imply that some health care roles don't require more than carrying out certain manual tasks without any further thought? Are there *any* hands on health care roles that involve blindly carrying out manual tasks? A medical office assistant who does nothing more than take height and weight still needs to do more than a monkey! Okay, maybe there are some monkeys out there who could run circles around certain lazy office assistants. But there are probably a few monkeys out there who could run circles around some lazy RNs we may have run across before. My point is that 'critical thinking' should be practiced by ALL personnel at ALL levels to the extent of that person's knowledge and experience; it's not something that only starts above a certain level of training and responsibility.

On the other hand, I don't agree with lumping everything a nurse might happen to do in any one particular line of work as specifically "nursing".

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.

I think you put that well!

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."

Some nurses do do this. Too many, perhaps. And I suspect you've had your fill of them lately given the angle you're taking right now. But I think you're detracting from your own point by making assumptions and accusations about any specific individual's motives. Again, there may be too many examples out there of the type of leader you're referring to, but let's talk about what nursing leadership could be and should be as opposed to just deeming a whole group as "not one of us".

I think some very valid issues are raised here and hope they can be addressed without finger-pointing and the like.

Happy Friday, everyone!!!

Specializes in Peds/outpatient FP,derm,allergy/private duty.

We've always had managers in nursing. They may have still worn the white cap and uniform, but they did not take a patient assignment, so therefore they were no more "at the bedside" than the suit and clipboard ladies are. It is highly unfair to their prior years "in the trenches" to say they aren't nurses anymore. I do think it is important that a nurse manager was once a bedside nurse.

The reason many people disagree I think is because of the corporate makeover that started in my career in the early eighties when are we were merged, purged (of the help we needed) and sent to "everyone counts everyone cares" classes. That was when the trend toward an RN with no bedside experience and lots of classes in leadership became an acceptable or maybe even better alternatiive in many people's eyes. I had friends back then who turned into one of "them" from a perfectly reasonable individual as well. It's scary.

Let's not say that simply going into management crosses you inevitably over to the dark side. I've worked with too many managers who while not (usually) working at the bedside would still be willing to in a pinch, and still had the empathy with the staff nurses. No group can function without a leader. Our problem is more about the type of leader they are and who chooses them.

Around the same time as the corporatization, a separate group was looking for ways to make itself stand out as the profession it was already assumed by nurses to be in a recognizable way, and I think that can explain (simplistically) the roots of NANDA. We always had care plans, they were integrated with NANDA.

The theorists are not the corporatists in my mind, and I do feel very uncomfortable when they are tagged with the evils of the business plan people, and that's why I was a little surprised to see some kudo-ing - I don't know ... maybe as I observed it all happening to me it seems the theory people, who may have borrowed from other disciplines (that always is the case) had a different frame of mind that looks at what we do from a more philosophical or esoteric viewpoint that obviously is not everyone's cup of tea, but the motivation was to define ourselves as professionalsthe way other professions do. I would never bash the theory or academic wing as they filled and hopefully are still filling a need.

They've been too slow to let go of unworkable ideas I think - but as I've said the discussion itself should not end. While I personally don't agree that the differences between nurses of various educational pathways is as they say, it appears that after decades of pursuing we will see the BSN entry point become a reality in the near future. Perhaps that will have the incidental benefit of a more broad-based student group where needed upgrades can occur at a faster pace. Let's not bash the theory pioneers with the penny-pinching scripters.

Just as an aside based on a recent thread I participated in -- I'm not sure there's anything that can stop one nurse from undercutting another no matter how clear cut the issue seems to be.

Specializes in Nursing Professional Development.
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.

Without an administrative nurse ... there is no bedside care giver ... there are no meds to be given ... no supplies to use ... etc. Without a nurse educator, there is no knowledgable caregiver at the bedside. Without the nurse researcher, the person at the bedside has little knowledge to use.

There is quote from Florence Nightingale that applies here. She wrote it in "Notes of Nursing: What it is and what it is not." In Ms. Nightingale's words, "Bad sanitary, bad architectural, and bad administrative arrangements often make it impossible to nurse. But the art of nursing ought to include such arrangements as alone by what I understand by nursing, possible." (Pages 8 & 9 of my copy)

Clearly, Nightingale's vsion of nursing included those activities which support patient care and health in general as well as the care of the sick. Her writings show this broad perspective of nursing as does her life's work as an administrator, educator, research, and health crusader.

If nursing chooses to "disown" activities away from the bedside as "not nursing," we are limiting our effectiveness. To improve the health of society -- to best serve the nursing needs of our patients -- we need to think in terms of "populations" as well as in terms of "individuals." We need to engage in activities that address the needs of groups of people and participate in the promotion of health throughout society. Our students need to be educated about such activities and we need to bring our nursing knowledge and skills to the multidisciplinary groups that are addressing the big health-related problems of the world.

People who engage in such activities are practicing nursing because they are using their nursing knowledge and skills to serve the nursing needs of the patients. That makes it nursing.

The bedside caregiver is a valuable member of the profession -- but the profession includes people in other roles, too. And those other nurses also practice nursing.

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

Again with the codes I have never seen except here. "In Before The Lock".

On gamefaqs its IBM..........."In Before the Mods".

"OP" was like that for me before. "Original Post". Never got what it stood for. But, I could tell it was a lot like the one I had seen, "TC" or "Topic Creator".

I can't keep up with all this. Is there software that interprets these codes?

Specializes in M/S, Travel Nursing, Pulmonary.
We've always had managers in nursing. They may have still worn the white cap and uniform, but they did not take a patient assignment, so therefore they were no more "at the bedside" than the suit and clipboard ladies are. It is highly unfair to their prior years "in the trenches" to say they aren't nurses anymore. I do think it is important that a nurse manager was once a bedside nurse.

The reason many people disagree I think is because of the corporate makeover that started in my career in the early eighties when are we were merged, purged (of the help we needed) and sent to "everyone counts everyone cares" classes. That was when the trend toward an RN with no bedside experience and lots of classes in leadership became an acceptable or maybe even better alternatiive in many people's eyes. I had friends back then who turned into one of "them" from a perfectly reasonable individual as well. It's scary.

Let's not say that simply going into management crosses you inevitably over to the dark side. I've worked with too many managers who while not (usually) working at the bedside would still be willing to in a pinch, and still had the empathy with the staff nurses. No group can function without a leader. Our problem is more about the type of leader they are and who chooses them.

Around the same time as the corporatization, a separate group was looking for ways to make itself stand out as the profession it was already assumed by nurses to be in a recognizable way, and I think that can explain (simplistically) the roots of NANDA. We always had care plans, they were integrated with NANDA.

The theorists are not the corporatists in my mind, and I do feel very uncomfortable when they are tagged with the evils of the business plan people, and that's why I was a little surprised to see some kudo-ing - I don't know ... maybe as I observed it all happening to me it seems the theory people, who may have borrowed from other disciplines (that always is the case) had a different frame of mind that looks at what we do from a more philosophical or esoteric viewpoint that obviously is not everyone's cup of tea, but the motivation was to define ourselves as professionalsthe way other professions do. I would never bash the theory or academic wing as they filled and hopefully are still filling a need.

They've been too slow to let go of unworkable ideas I think - but as I've said the discussion itself should not end. While I personally don't agree that the differences between nurses of various educational pathways is as they say, it appears that after decades of pursuing we will see the BSN entry point become a reality in the near future. Perhaps that will have the incidental benefit of a more broad-based student group where needed upgrades can occur at a faster pace. Let's not bash the theory pioneers with the penny-pinching scripters.

Just as an aside based on a recent thread I participated in -- I'm not sure there's anything that can stop one nurse from undercutting another no matter how clear cut the issue seems to be.

Boy, you and llg can't stand me as it is. I'm SOOOOOOOO glad I haven't posted my article on how Florence Nightingale is bad for nursing yet.

Specializes in M/S, Travel Nursing, Pulmonary.

:crying2: Its late at night, and there's no one to talk to.

I don't care, I'll have a debate/conversation with myself.:D

Specializes in M/S, Travel Nursing, Pulmonary.
:crying2: Its late at night, and there's no one to talk to.

I don't care, I'll have a debate/conversation with myself.:D

And how do you suppose to do that?

Specializes in M/S, Travel Nursing, Pulmonary.
And how do you suppose to do that?

IDK. Haven't you ever seen anyone play chess against themselves? I'll do the same thing.

See, they make a move on the board, then walk to the other side of the board, and make a move..........so on so forth.

I'll do that. Write a post...........then walk around the desk, sit back down, and make another one.

Specializes in M/S, Travel Nursing, Pulmonary.
IDK. Haven't you ever seen anyone play chess against themselves? I'll do the same thing.

See, the make a move on the board, then walk to the other side of the board, and make a move..........so on so forth.

I'll do that. Write a post...........then walk around the desk, sit back down, and make another one.

W/E

BTW, are you drinking?

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

BTW, are you drinking?

No, why? Thats kind'a a rude question.

Specializes in M/S, Travel Nursing, Pulmonary.
No, why? Thats kind'a a rude question.

Oh, just wondered. In light of your "Using Nursing Skills on Vacation" thread...........can you blame me?

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