Time to call a duck a duck?

Nurses Professionalism

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I remember having this debate with other students while I was in school. I have seen nothing during my time practicing nursing to change my mind about the issue. Now, with the recession bringing out the true colors of nurses and everyone around them, my opinion seems even more valid. I wonder what others think about it.

I remember sitting in nursing school as the instructor drummed on and on about how "Nursing is a profession." That exact theme butted it's head into almost every single class one way or another, regardless of the subject matter. I often found myself thinking "Who cares?" or "What's the point in that?". Then came the dreaded "Dimensions of Nursing" class. It was the class all RN's must go through at one point or another (IDK if LPNs do or not). There are other names for it "Political Aspects of Nursing" I've heard among a few others. It is the class in which you must discuss the political issues that involve nursing. You are encouraged to join this and that group, Nursing as a Profession is discussed over and over, and you must do a research paper. I never really said in that class how I really felt about the whole business of nursing being a profession in fear of drawing the ire of my superiors.

What is it I had to say that my fellow students got to hear during breaks that my instructors did not? Well: 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. That's 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.

Ever see the movie "Man in the Iron Mask"? The King/spoiled twin tells his brother "Into the dungeon you will go, and you will wear this mask again, and you will wear it until you love it."

We are wearing the mask, but are for some reason we are unable to learn to love it. So we will forever stay in the dungeon denying what we are.

Lets face it. All the aspects of a "profession" are an illusion in nursing.

Definition of a profession:

A profession has a unique body of knowledge and values – and a perspective to go with it.

A profession has controlled entry to the group eg registration

A profession demonstrates a high degree of autonomous practice.

A profession has its own disciplinary system.

A profession enjoys the Recognition and Respect of the wider community.

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.........that's 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 that's 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.

Think back to your highschool days. Remember that class clown who tried way too hard to be funny? The not so good looking girl who never stopped digging for compliments on her looks? The not so well liked guy always asking if you and he were buddies or not? That's what nursing has let itself become. Constantly running around worrying about impressing people and all the while completely losing its focus on the primary goal. A lost teenager suffering from an inferiority complex.

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?

Specializes in M/S, Travel Nursing, Pulmonary.
In peds we have a new directive to do "Asthma Action Plans" whenever we send home an asthma patient. So we write all their inhalers on there. Now I was being good, telling them to take their albuterol, how many puffs, how often. Then get a note back that we have to write the strength, even though albuterol only comes 90mcg/puff (For other puffers, ok, there are different strengths but albuterol only comes in 90!). So I write that all the time. Then we get a note saying we have to write the route out. Now if I send a patient home, and the family decides that they're going to go for doing their puffs rectally or lady partslly instead of by mouth, I think they have bigger problems than just the asthma, and those problems aren't going to be fixed by writing "albuterol 90 mcg/puff 4 puffs BY MOUTH every 4 to 6 hours as needed."

I hate to say this, but if I were looking at this with a critical eye......................:Dlike a "professional nurse", I'd say I fell a little short with this guy. I don't think lack of understanding of how the meds work were his issue.

Maybe a psych. issue that is being ignored as we rush him through care, maybe a GI problem that makes him want to do this. I wonder if I would not have handled it differently had it been in the middle of the night instead of the end of my day.

In regard to professional self-regulation, here's another way nursing as a profession/trade has limited power- it's up to employers, not nursing boards, to decide the minimum qualifications above and beyond an RN license for (and additional formal training/certification, if any) for most RN positions.

The upside is the relative ease with which a nurse can switch specialties. If a facility is willing to hire someone without proven experience or certification in a particular area, that's their prerogative. On the downside, having no formal requirements beyond RN license for many positions reinforces the incorrect notion that a nurse is an easily replaceable cog doing work that doesn't take much to master.

Good places will offer strong training and support. But many places take the "sink or swim" approach to on-the-job training. Either way, it's between individual employers and individual nurses what is acceptable; there often isn't an industry-wide standard set by and for nurses.

Specializes in CVICU, Obs/Gyn, Derm, NICU.

So, over the past weekend, I was in our stepdown subunit, and overheard a nurse on days reporting off to one of my coworkers that one of her patients had a Disturbed energy field. She was joking--sort of--but I watched my coworker, an old-school nurse if ever there was one--working magic with this dude, using old-school interventions like maintaining proper body alignment and therapeutic communication. Her "therapeutic touch" wasn't the new age version, it was rubbing his shoulders to help him relax. She demonstrated caring because she's a nurse and that's what she does. I don't know whether the guy had an aura or not, but if he did I think it was probably in better alignment by morning. At least his behavior was more appropriate. And while the problems that put him in a stepdown bed were probably scientific in nature, his most pressing needs from his POV, r/t dealing with a life-altering injury, were ones that called on the art of nursing. It was cool to see him getting both.

This is not magic .... this is effective rapport+kindness+sales.

She sold him the idea of improving his behaviour.

Some nurses are very good at sales (that's why so many of the more successful real estate salespeople are ex-nurses)

Nursing seems to be good training for this ....a lovely combination of verbal and nonverbal communication/need assessment/empathy/kindness injected at the right moment ......and the p't changes behaviour.

I am good at this ...my coworkers think I have magic skill ....well no...just sales skill :)

However it can't really be taught. One either does this very well or one doesn't ....either got it or haven't

Specializes in PICU, NICU, L&D, Public Health, Hospice.
Thats not candy you have in your hand there. Unless denial is chocolate flavored all of a sudden.

LOL at the state/nurses get to choose who is licensed and who is not. Sooooo.........as they currently are in NY, when the businesses decide they are only hiring BSN................what good does being allowed the ADN license do you? After the business (the non-nurses) set the standard, the BON just follows suit. They don't make any decisions.........they just adjust and cater their "policies" to whatever the non-nurse decision makers are saying.

And yes, you can technically have your license after an incident but be fired by your employer. In essence, you are not being disciplined by the "nursing" BON. Won't do you a bit of good unless you can relocate to the other side of the country once you've been fired........................for forgetting to empty the trash cans. Again, actually having your license in this case is simply cosmetic. If you have a bad rap with the business suits and get black listed..........well, nuff said.

Your post kinda reminds me of a lot of the administrative type nurses I knew a few years ago. You know the type............hasn't seen the bedside except through pictures in the hospital news flyer in years, has some special title and area of "expertise" that they are accountable for (:p) and...........for the most part are invisible other than in the lunch room and a few emails they send the nurses. These people walk around the hospital, strutting like they owned the place and had it all figured out. Annoyed the hell outta the bedside nurses more than anything else.

Well, these were your "I am a professional" nurses. Guess who was excused out the door first when the recession hit. Yep. Most of them were told "You have no practical role to the hospitals functioning and we are relocating your (cough, ahem) duties to other people". It happened overnight almost. One day the hospital is full of em, next day................well. Some even tried to return to bedside nursing but, most were given a nice, political "you are overqualified" pat answer.

They had the "I am a professional" part of nursing a little too blown up and lost their value because of it. Didn't have the "get down and dirty" part that is necessary for all nurses, even the one's who say nursing is a profession. And they all felt they could be autonomous and had a body of knowledge that was so unique too.

Eric, you make me laugh...

I find it amusing that you and I disagree about this and so...in your estimation, I am in denial...LOL...see, made me chuckle right out loud just now typing it.

Yo are correct...that NY facilities may decide that they will hire only BSNs...okay...does that mean that no other degrees may practice nursing? That decision STILL only determines who they will hire...not what defines a nurse...and until the NY BON changes that there will continue to be nurses with a variety of educational prep. Even if the BON does decide to change the educational requirement it will include "grandfathering" language.

Seriously Eric, do you think that being fired by an employer is worse than BON discipline? You speak as if you may have experienced a blacklisting. Honestly, unless you work in a rural area with limited access to health care jobs/employers...nurses get fired and get new jobs all the time...even in this economy. It is not easy...but a good and qualified nurse can usually find a job...I have (too many times in the recent past). Yes, you may get blacklisted by a particular company or organization., often wrongly (not emptying trash)..but heck, health care is a profitable for-profit endeavor and there are lots of young companies with growing employment needs. So...if your local ALF, SNF, sub-acute, LTC, etc talks dirt about you...consider taking a break from that area for a few years and learn a new skill set.

However, when you are disciplined by the BON you do not have the option of seeking employment as a nurse if they say so...period...this will also affect your ability to get licensed in other states. Because you are trained as a nurse, it is difficult for some employers to hire you in a different capacity, so CENA jobs are not necessarily east to come by. Dependent upon the cause of the discipline, the nature of work permitted, once they allow you to resume practice, may be radically different from previous jobs. This is not a process, in my estimation, that should be equated in anyway with being blacklisted by an employer/group/corporation, etc.

You are correct...I know the "administrator professional nurse" types. I had to deal with them all the time when I was in my 30s, running a very busy regional PICU. I had to deal with them all the time...people who had not actually cared for patients for sometimes 8 or 10 years. Today that gap is often much worse as nurses now prepare themselves early for the advancement, and the ambitious ones will be promoted, quickly. That puts a pretty significant part of the clinical power in the hands of nurses who are not expert at being nurses.

I caution you, however, to avoid making the mistake of thinking that I am removed from patient care. I provide hands on nursing care daily. I am good at it. By this time in my life I can birth you and take care of your momma, provide all of your neonatal and pediatric nursing care. I can provide for your ongoing primary nursing care and and have done manyy sports and camp physicals. If you need nursing in the ICU, I can be your nurse (with some exceptions of course). When you go home and need home care...I'm your gal. If you need vaccinations to travel overseas or for INS...I can help you. And when you finally get tired of it all and decide that 6 months is all you are going to live...you DEFINITELY want me as your nurse. So...I may sometimes sound like someone who is all "pie in the sky" removed from reality...but I really am just an old professional nurse who really enjoys nursing. My mother was a nurse, my husband is a nurse, my brother married a nurse, 2 of my 4 cousins are nurses.

Maybe my attitude about nursing as a Profession is a familial defect??? (please don't comment on the genetics of this...it was a joke)

Specializes in M/S, Travel Nursing, Pulmonary.
Eric, you make me laugh...

I find it amusing that you and I disagree about this and so...in your estimation, I am in denial...LOL...see, made me chuckle right out loud just now typing it.

Yo are correct...that NY facilities may decide that they will hire only BSNs...okay...does that mean that no other degrees may practice nursing? That decision STILL only determines who they will hire...not what defines a nurse...and until the NY BON changes that there will continue to be nurses with a variety of educational prep. Even if the BON does decide to change the educational requirement it will include "grandfathering" language.

Seriously Eric, do you think that being fired by an employer is worse than BON discipline? You speak as if you may have experienced a blacklisting. Honestly, unless you work in a rural area with limited access to health care jobs/employers...nurses get fired and get new jobs all the time...even in this economy. It is not easy...but a good and qualified nurse can usually find a job...I have (too many times in the recent past). Yes, you may get blacklisted by a particular company or organization., often wrongly (not emptying trash)..but heck, health care is a profitable for-profit endeavor and there are lots of young companies with growing employment needs. So...if your local ALF, SNF, sub-acute, LTC, etc talks dirt about you...consider taking a break from that area for a few years and learn a new skill set.

However, when you are disciplined by the BON you do not have the option of seeking employment as a nurse if they say so...period...this will also affect your ability to get licensed in other states. Because you are trained as a nurse, it is difficult for some employers to hire you in a different capacity, so CENA jobs are not necessarily east to come by. Dependent upon the cause of the discipline, the nature of work permitted, once they allow you to resume practice, may be radically different from previous jobs. This is not a process, in my estimation, that should be equated in anyway with being blacklisted by an employer/group/corporation, etc.

You are correct...I know the "administrator professional nurse" types. I had to deal with them all the time when I was in my 30s, running a very busy regional PICU. I had to deal with them all the time...people who had not actually cared for patients for sometimes 8 or 10 years. Today that gap is often much worse as nurses now prepare themselves early for the advancement, and the ambitious ones will be promoted, quickly. That puts a pretty significant part of the clinical power in the hands of nurses who are not expert at being nurses.

I caution you, however, to avoid making the mistake of thinking that I am removed from patient care. I provide hands on nursing care daily. I am good at it. By this time in my life I can birth you and take care of your momma, provide all of your neonatal and pediatric nursing care. I can provide for your ongoing primary nursing care and and have done manyy sports and camp physicals. If you need nursing in the ICU, I can be your nurse (with some exceptions of course). When you go home and need home care...I'm your gal. If you need vaccinations to travel overseas or for INS...I can help you. And when you finally get tired of it all and decide that 6 months is all you are going to live...you DEFINITELY want me as your nurse. So...I may sometimes sound like someone who is all "pie in the sky" removed from reality...but I really am just an old professional nurse who really enjoys nursing. My mother was a nurse, my husband is a nurse, my brother married a nurse, 2 of my 4 cousins are nurses.

Maybe my attitude about nursing as a Profession is a familial defect??? (please don't comment on the genetics of this...it was a joke)

I actually was talking to someone about this and they said I had it backwards. That the BON made the decision not the hospitals. Eh, IDK now. There's an article on this site somewhere about it, I'll have to go educate myself.

Yeah, IDK. Might be residual from travel nursing. Having a strong resume and as many letters of recommendation as possible is important when you do that. One bad review and all of a sudden you can't get hired anywhere except Arkansas or Detroit. No offense to anyone living there, I just didn't want to travel nurse there. And you are right. I do fear blacklisting more than the BON. Just me I guess. Mind you, when I say "fear it more" I mean, I think they are equally bad things but I am afraid of the blacklisting more............I think it happens more often. I rarely hear complaints of the BON being unreasonable. Can't recall a single case where someone has said so and I didn't think to myself "Well, what'd you expect acting the way you did?". Now, on the other hand, hospitals will let you go for all sorts of reason's that have notta to do with how well you perform your job. Politics.

I've seen GNs, straight outta school and on orientation, acting like being in a pt. room is beneath them. Emptying the trash bins and fetching ginger-ale for people? You must be joking. They are perfect little nurses when..........certain people are around to witness it, otherwise they are much too busy social networking to be bothered with teaching grandma how to us that inhaler she is going to be D/C'd with. Blah. Hate'em. This is one of the types I equate "Professional Nurse" to.

Somehow I knew you were a bedside nurse. IDK why. I didn't mean I thought you were one of the people I described, just that your insistence that we have autonomy and all this power seems to match them. (:o...........Don't yell at me though when I tell you, not making fun of you or anything but...........I also thought you were a guy DOH).

Today that gap is often much worse as nurses now prepare themselves early for the advancement, and the ambitious ones will be promoted, quickly. That puts a pretty significant part of the clinical power in the hands of nurses who are not expert at being nurses.

I'll never understand the people that go through nursing school, and really have no interest in actually NURSING. They're immediately applying for advancement, to be managers. Why do they go to nursing school? Getting a business degree would have been easier!

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

you just made me laugh again...of course, just because I have a husband does not necessarily mean that I am a woman...

and I rarely yell at my peers...

Specializes in M/S, Travel Nursing, Pulmonary.
you just made me laugh again...of course, just because I have a husband does not necessarily mean that I am a woman...

and I rarely yell at my peers...

Eeek. Don't go there. I got yelled at in another thread for not having compassion for the gay.

Besides, you said "I'm your gal" that where I go that UR female from.

I tend to be the "rare" exception a lot when people "rarely yell". IDK. Maybe they think I am a threat cause I am so beautiful ha ha ha ha.

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

caught me...yup I am a woman and have been for awhile now

Specializes in M/S, Travel Nursing, Pulmonary.
caught me...yup I am a woman and have been for awhile now

I KNEW THERE WAS SOMETHING ODD ABOUT YOU LMAO:yeah:

Specializes in Pediatrics, ER.

If I may ask, does it really matter? Labor or profession, we are all college-educated individuals whose goals remain the same - to give quality patient care. Being a labor vs. a profession does not impact relationships with our patients or change the amount of effort we put into our career. Duck, swan, or Canadian goose, they're all ultimately a bird, no?

Specializes in M/S, Travel Nursing, Pulmonary.
If I may ask, does it really matter? Labor or profession, we are all college-educated individuals whose goals remain the same - to give quality patient care. Being a labor vs. a profession does not impact relationships with our patients or change the amount of effort we put into our career. Duck, swan, or Canadian goose, they're all ultimately a bird, no?

Yes. And No. lol

Actually, IDK, I kinda thought I was making the point that it doesn't matter so much and that obsessing over "We are a profession" kills us.

But, somehow, it got turned into me being obsessed with us not being one, and being a trade instead. Which, in the end, if all the "pie in the sky" types settled for that, we'd still be ahead.

I'm not bantering about if we are or not as much as I am........eh, complaining.........about the time wasted on trying to convince everyone we are.

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