Time to call a duck a duck?

pedicurn, LPN, RN · Jul 19, 2010

Well yes, you have been using your "nursing" DX in the ER. I think your disconnect is that because you have experience two things are happening. Your "nursing" DX happens and is sometimes addressed almost simultaneously. Additionally, you're ER experience gives you a pretty good idea of the "medical" DX or as you mentioned, your medical differential DXs. That doesn't mean that at some point you didn't (almost subconsciously) raise your bed-rails because you recognized your CVA rule out patient is a fall risk. All of the other tasks you mention (labs, imaging, etc) are protocol/standard of care driven and used to make/confirm/rule out a medical DX. That is a different process than is used in the forming of a nursing DX. Nomenclature is often a matter of semantics, but the fact remains that there are nursing DXs and there are medical DXs and nurses use (if not make) both.

If we use the CVA example .... my p'ts relatives might recognise the need to raise bed-rails. Does this mean they are using

nursing DX?

eriksoln, BSN, RN · Jul 19, 2010

If we use the CVA example .... my p'ts relatives might recognise the need to raise bed-rails. Does this mean they are using
nursing DX?

Which, thankfully, brings us back to topic and...........

Nah, I understand what you mean when you say I am performing nursing diagnosis on the job, but perhaps subcontiously. But, it just isn't the same. I am not using nursing diagnois in any way shape or form in my nursing care. Why?

Well, problem is, I was able to "read and react" long before I was taught was a nursing diagnosis was. I see a fire, I know to figure out how to stay safe first, then worrry about putting it out blah blah blah. I diagnosed the "fire", and performed the right interventions (which, as with medical problems, can be different from one fire to the next. Is it a grease fire? A chemical fire? How big is it? Can the fire be put out with the extinguisher I have?). Its just simply reading and reacting with the information I have. There is no need to name the thought process I went through and add all kinds of labels to make it seem like more than it is.

Now, I go to nursing school, and they are trying to present to me this new, nursing field reserved way of thinking "critically" so that I can be a great nurse. I go through the nursing diagnosis in my studies and keep getting stumped by it because........I don't get their point. There has to be......something new, something I don't already do on my own without calling it anything. There isn't. Nursing diagnosis to me are a lot like the "Who's burried in Gran'ts tomb" joke.

I can bend a little on the Nursing Process and say it does have its place. First step.....assessment. Rule #1 is always to assess/treat the patient first. I see new nurses standing at the nurses station argueing about what it is the heart monitor screen says/means. One thinks its artifact with underlying NSR, another thinks something else, another says the leads are on wrong. They forget to first, treat the pt. not the monitor. Go look, make sure they are OK, and assess if there is a problem. Then debate what it is the monitor is telling you.

RetRN77 · Jul 19, 2010

nursing is not a profession, not even with a very generous stretch. it is a labor, a trade. we are judged solely by the amt. of patients we can handle and still keep the minimal quality expected by our administration up to par. not very much unlike a mcdonald's burger flipper. the faster you can cook those patties without screwing too many up, the better you are. thats all there is to it really. if you don't believe me, take a gander at where nursing expenses falls in the budget. we are not logged next to the admin./doctors/lawyers or any of the other professionals. we are grouped in with dietary/housekeeping/security. as far as budget makers are concerned (and, lets be honest, they make the rules), we are a debt, like a labor.
it is time for nursing to give up this identity crisis, this inferiority complex it has displayed since its birth and move on, embrace being a labor and love it.
1. unique body of knowledge: we do need to go to school and must learn a lot, but i don't know about the unique part of it. most cna's pick up on how to do what we do after just a couple years, without the schooling. as far as values and perspective go, lets face it, we can't even agree in here on what that is. how many "calling from god vs. its a job" threads/rants have you seen on this site. i've lost count. we can't even agree amongst ourselves what degree we should have. i've also lost count of the "bsn vs. adn vs. masters" threads.
2. controlled entry: phfffft. it is controlled, but not by us. the hospital/medical field administration decides this. whatever they decide they are willing to hire is what the rule is. if they decide tomorrow to never again hire adns.........thats that for them. we have no say in it. seen any "nurses eat their young" vents/threads lately. i know you have;), even if you were a blind, deaf mute with both hands tied behind your back you can't help but run into them on here. if we truly were in control of who came into the profession, such threads would be minimal. can't be angry about who is allowed in when its your decision who gets in.
3. demonstrates a high degree of autonomy: again, i lead with phfffffft. our job description continues to be and will forever be everything and anything they can't pawn off on the other laborers. how many of us, since the recession hit, have been told to pick it up and help out in non-nursing job related ways? empty the trash, stock the cabinets, hand out trays, collect and clean the trays..........its endless. we are unable to define for ourselves what we will and will not do. you don't see them sending the legal dept. any emails about helping maintenance do you? any rules/laws concerning scope of practice are simply to protect patients from us should we decide to play doctor. no laws exist to restrict what can be expected of us away from the bedside (no, that would actually be useful, help the pt., can't do anything silly like that).
4. has its own disciplinary system: do i need to insert phffffft again? oh, i just did. we only qualify here if badgering, cattiness and petty write ups are "disciplinary". nuff said.
5. respect of the community: i'll resist the urge to insert the obvious lead here. i'll just point out the complaining about surveys thats been the norm lately. lets face it folks, professions who have respect are not surveyed like this. these surveys resemble grade school report cards "nursey doesn't play well with others". if we were "respected", we'd be the ones filling out the surveys on how to improve the model of care given.
maybe if we embrace the fact that we are............:eek:gasp..............a mere labor, we will be able to dedicate ourselves to our patients. instead of worrying about proving nursing holds a "unique body of knowledge" and making up useless, pointless "theories" and such (tell me one instance you have found a use for nursing diagnosis), we will become more useful. focus instead on better time management, better understanding of the things we actually use on the job (the equipment for instance) and a better understanding of the tasks expected of us (study iv insertion in school instead of writing papers about why nursing is a profession).
i know many of you will be upset with me and my views. they are what they are. i make no apologies for them. not having a well liked opinion has never stopped me from saying what i feel needs said before.
so...............am i wrong? why?

i think you make some valid points, especially that there is quite a lot of wheel-spinning in the educational arena to make obvious conclusions seem to be results of arcane mental acrobatics, and to turn planning for your patient's care into an unnecessarily fettered art form.

however, i have to say that even if we cannot always agree on which way to approach learning that "unique body of knowledge" due to changes in education, it nevertheless is unique, and unknowable without that education. i do very much agree with you that nurses should spend more time learning how to start those iv's than dwelling on political aspects of nursing.

as for "controlled entry" one must pass the nclex, designed by the ncsbn, which board of directors are all rns. things may be different today, but i've only ever been hired for hospital work by the nursing department, nor could i have been fired except by them, and supervisors were exclusively nurses. doctors could not fire me, nor could anyone but my fellow nurses.

i doubt you could be a travel nurse if you didn't "demonstrate a high degree of autonomy." autonomy means you can function on your own without constant oversight and direction. it doesn't mean someone in higher authority can't give you differing assignments. also, again, only someone in nursing services can assign you - housekeeping can't tell you what to do. i do however, relate to feeling like a lackey at times - but that's lack of control, not lacking in the ability to be autonomous if they'd just leave me alone, lol.

as to disciplinary system, once again, the department of nursing, which at least used to be run by nurses, is in charge here. i'm retired, and with the "progress" into the the business arena, maybe that is no longer the case everywhere, but it should be. respect is something i usually get. never have had anyone look down on me for being a nurse. ever.

focus instead on better time management, better understanding of the things we actually use on the job (the equipment for instance) and a better understanding of the tasks expected of us (study iv insertion in school instead of writing papers about why nursing is a profession).

:yeah:

jopacurn: there's something not quite mentally, emotionally correct with people who follow idealistic goals. those are the ones who are let down easily and leave the profession altogether after only a few years.

it's the idealistic ones who keep patients from being regarded as nothing but burgers to be turned and who will work under privations such as war to get the best for their patients.

NeoNurseTX, RN · Jul 19, 2010

At first I disagreed with you but I think you are right. No need to flame. You seem happy doing what you're doing but we really are just laborers who do things most laborers do not...dealing with people in their most vulnerable state. I think we're higher on the labor scale than a lot, but at the bottom of the professional scale.

eriksoln, BSN, RN · Jul 19, 2010

i think you make some valid points, especially that there is quite a lot of wheel-spinning in the educational arena to make obvious conclusions seem to be results of arcane mental acrobatics, and to turn planning for your patient's care into an unnecessarily fettered art form.
however, i have to say that even if we cannot always agree on which way to approach learning that "unique body of knowledge" due to changes in education, it nevertheless is unique, and unknowable without that education. i do very much agree with you that nurses should spend more time learning how to start those iv's than dwelling on political aspects of nursing.
as for "controlled entry" one must pass the nclex, designed by the ncsbn, which board of directors are all rns. things may be different today, but i've only ever been hired for hospital work by the nursing department, nor could i have been fired except by them, and supervisors were exclusively nurses. doctors could not fire me, nor could anyone but my fellow nurses.
i doubt you could be a travel nurse if you didn't "demonstrate a high degree of autonomy." autonomy means you can function on your own without constant oversight and direction. it doesn't mean someone in higher authority can't give you differing assignments. also, again, only someone in nursing services can assign you - housekeeping can't tell you what to do. i do however, relate to feeling like a lackey at times - but that's lack of control, not lacking in the ability to be autonomous if they'd just leave me alone, lol.
as to disciplinary system, once again, the department of nursing, which at least used to be run by nurses, is in charge here. i'm retired, and with the "progress" into the the business arena, maybe that is no longer the case everywhere, but it should be. respect is something i usually get. never have had anyone look down on me for being a nurse. ever.
:yeah::yeah::yeah::yeah:
it's the idealistic ones who keep patients from being regarded as nothing but burgers to be turned and who will work under privations such as war to get the best for their patients.

ah, you said it better and more efficiently than i did. thats my problem with nursing theory........a lot of posturing and bantering for credit that isn't due. naming things people do on their own does not constitute having a body of knowledge.

i have to disagree about nurses being in charge of nurses here though. idk, seems to me the decisions are made by administrative non-nurses and nurses with administrative titles deliver the message for them (don = mercury). they do have input and a lot of say in a wide variety of things, but if there is a difference of opinion, i don't think the nurses are the one's with the final say.

eriksoln, BSN, RN · Jul 19, 2010

At first I disagreed with you but I think you are right. No need to flame. You seem happy doing what you're doing but we really are just laborers who do things most laborers do not...dealing with people in their most vulnerable state. I think we're higher on the labor scale than a lot, but at the bottom of the professional scale.

I think too, maybe because I was sickly when I wrote the article, I may have come off strong or unhappy. This lead a few people to believe I was slamming nursing or its importance to our cultural system. In truth, I am simply opening up discussion on where we could improve things for everyone involved, most importantly the patient.

I am happy with what I am doing. I went back and read a very old article I wrote some time ago. "Talked into a career in nursing by Stephen King". I still feel the same way I did when I wrote that.

I just wish our trade had more focus, less posturing.

eriksoln, BSN, RN · Jul 19, 2010

Forgot to say, RetRN77's definition of autonomy is correct. I do take it a step farther and take it to mean, since we act on our own, function without our hands being held........we should be the rule makers. My interpretation is.......just that......an interpretation.

Indy, LPN, LVN · Jul 19, 2010

I seriously don't mind being a laborer. I love the work that I do, and I tend to love working with other folks who also like to WORK. I emphasize work because there are quite a few of us whose first love is finding reasons to sit on their orifice and abuse the nursing assistants. I make a point to not abuse them, and while I don't do all of their work normally along with mine, I will do some of it and I do like an agreement of mutual help. If we act like we are above helping those who are there to work alongside us, what we get is no help and a bad attitude to boot.

There is a lot of thinking involved in the job, however, and that is what folks don't see, but it's precisely one half of what makes us so valuable- the other half being the work part. Nurses who don't work may kill people but it's rare. Nurses who don't think kill people doing normal everyday work. My opinion is, it's the thinking aspect of the job that makes us want to be "professional" or at least recognized as creatures with a brain.

RetRN77 · Jul 19, 2010

Addendum to the "respect" debate - I feel it's situational. For instance, in social situations, if it comes out that I'm a nurse, people seem to regard that well. While working for the pediatrician, I felt respected by the parents because they trusted the doctor who'd hired me and I treated their children well. Working in the ED or L/D, it would depend on the patient and how unhappy they were about being hospitalized in the first place and/or how vulnerable they felt.

Whenever there are discussions about striking nurses, the public's respect will plummet toward the strikers. I believe that occurs among people who generally respect nurses as well as among those who don't.

ivanh3 · Jul 19, 2010

If we use the CVA example .... my p'ts relatives might recognise the need to raise bed-rails. Does this mean they are using
nursing DX?

Why not? If a teenager can diagnose her own Crohn's, then I would say sure. What about when an MD raises the bed-rails after an examination? Doesn't matter what you call it, the steps are still there.

Nah, I understand what you mean when you say I am performing nursing diagnosis on the job, but perhaps subcontiously. But, it just isn't the same. I am not using nursing diagnois in any way shape or form in my nursing care. Why?

Why isn't it the same? You tell me. You might combine steps, and perform them at the speed of thought, but does that mean you didn't do them? You say "no way shape or form". That seems awfully absolute and doesn't reconcile with your first sentence.

Well, problem is, I was able to "read and react" long before I was taught was a nursing diagnosis was. I see a fire, I know to figure out how to stay safe first, then worrry about putting it out blah blah blah. I diagnosed the "fire", and performed the right interventions (which, as with medical problems, can be different from one fire to the next. Is it a grease fire? A chemical fire? How big is it? Can the fire be put out with the extinguisher I have?). Its just simply reading and reacting with the information I have. There is no need to name the thought process I went through and add all kinds of labels to make it seem like more than it is.
Now, I go to nursing school, and they are trying to present to me this new, nursing field reserved way of thinking "critically" so that I can be a great nurse. I go through the nursing diagnosis in my studies and keep getting stumped by it because........I don't get their point. There has to be......something new, something I don't already do on my own without calling it anything. There isn't. Nursing diagnosis to me are a lot like the "Who's burried in Gran'ts tomb" joke.

Great, you were able to do this before nursing school. Me too. I was a paramedic before I was nurse. Not a whole lot of surprises for me in nursing school. But there are quite a few nursing students who show up basically empty handed. They are not dumb, but they still need this stuff broken down for them. So I don't get what makes you so upset: that this tool is used to help students or that they have named it. Seems like you are expending an awful lot of energy worried about what something is called.

Like I posted before (relating back to your OP), some of this nomenclature was probably done in an effort to meet that criteria of "unique body of knowledge" from your classic definition of profession. No me importa. The content is still necessary even if some don't like the tittle. Many of the "nursing" steps are performed by other professions and even laypeople.

By the way, I have met plenty of people who didn't know who was in Grant's tomb.

NocturneRN · Jul 19, 2010

If we use the CVA example .... my p'ts relatives might recognise the need to raise bed-rails. Does this mean they are using
nursing DX?

If they're doing it because they recognize that the patient has an increased fall risk, then, yes, I'd say they are.

You don't have to have "RN" or "LPN" after your name to make a nursing judgment and act on it.

eriksoln, BSN, RN · Jul 19, 2010

Why not? If a teenager can diagnose her own Crohn's, then I would say sure. What about when an MD raises the bed-rails after an examination? Doesn't matter what you call it, the steps are still there.
Why isn't it the same? You tell me. You might combine steps, and perform them at the speed of thought, but does that mean you didn't do them? You say "no way shape or form". That seems awfully absolute and doesn't reconcile with your first sentence.
Great, you were able to do this before nursing school. Me too. I was a paramedic before I was nurse. Not a whole lot of surprises for me in nursing school. But there are quite a few nursing students who show up basically empty handed. They are not dumb, but they still need this stuff broken down for them. So I don't get what makes you so upset: that this tool is used to help students or that they have named it. Seems like you are expending an awful lot of energy worried about what something is called.
Like I posted before (relating back to your OP), some of this nomenclature was probably done in an effort to meet that criteria of "unique body of knowledge" from your classic definition of profession. No me importa. The content is still necessary even if some don't like the tittle. Many of the "nursing" steps are performed by other professions and even laypeople.
By the way, I have met plenty of people who didn't know who was in Grant's tomb.

Oh nooo. LOL:yeah:

I have to tell you guys this. I brought up this whole debate up to a nurse I LOVE last night. Now, this nurse can put all the pieces together. She is able to pinpoint process flaws and correct them before they happen and predict oncoming complications for the pt's care and anticipate what to do to avoid the problem. At the same time..............she approaches her bedside duties with every bit the motivation of a student or fresh brand new nurse. No missing turning your patients or passing water pitchers cause you are too busy boasting about the latest mistake you caught with this nurse.

Want to know what she said?

I'm telling you anyway:

"I don't care either way if history judges us as a profession or a skilled trade. Won't change anything for me or my family. (Somehow, I think most of the better nurses around the world probably think this). The problem with getting too tied up in "is it or isn't it" is you can be right either way, but in the end, thats all you get, to be right. Being right about that isn't going to make you a good nurse.

Problem is, nursing makes us run and hustle like we are laborers, and some nights thats really all you need to do. Other nights, you really need to have your thinking cap on or someone is going to lose a leg, or die.

Nursing draws upon the good aspects of both skilled laborers and professionals. We must carry ourselves like professionals, but be willing to get dirty like a laborer. All in the same night. We must bring our best both with the pen and with our hands. Simply doing the tasks/chores of the job but not applying your brains will just mean you have a pt. who doesn't get any better.............with clean sheets. Only being a desk nurse and thinking you are above the tasks means you have a bunch of patients who will get the proper medical treatment, but probably won't follow through anything after because they don't respect you.

So, really, when you get down to it, its neither a profession or a skilled trade. We are too important for either category."

And there you have it folks. The answer I've pretty much decided is right for me.

And when she was done yelling this at me (yes, she said all this in a tone that I imagine Patton used with his troops before a big battle), she quickly prompted me to help her bath a pt. cause...........well, if we have enough time to talk about stuff like this we should be doing something for the patients.

Doh.