Time to call a duck a duck?

[eriksoln]

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?

[paganoid]

This debate is not new. It's been going on in this country since the beginning of nurse education over a century ago. I did a paper on it for Nursing History class. (Yes, I'm a BSN graduate.) The argument of "trade" versus "profession" mirrors the argument of which degree should be the entry level position (ADN vs BSN vs diploma).

The point I made in my paper is that there is room in nursing for all kinds of nurses. One size need not fit all. If you and your friends want to be "trade" nurses that's awesome. Be the best trade nurses ever. If some high-fallutin' nurse executive wants to spout an opinion about the "profession" of nursing then I say let her. It doesn't affect me because I don't read those magazines they send me.

All of this is, and IMHO always has been, a tempest in a teapot. We all know that as long as nursing is a "women's profession" then nurses are going to be abused. It will only change when men arrive in significant numbers and refuse to accept the BS that women, taught since childhood to do as they're told and be quiet, have historically accepted as given. But that idea opens a whole new can of worms, doesn't it?

[yogi2000]

Depends on whether you are an administrator, an educator, or a bedside nurse. I'm willing to bet most nurses working directly in patient care will agree with you, and those who sit in an office will not. That is the heart of the problem. The ones in the office become so far removed from what it's really like to be at the bedside, they have no clue what a bedside nurse is really responsible for. Most of them couldn't work at the bedside, because if they once had those skills, they've lost them, or they never had them in the first place.

[SanDiegoScrubs2010]

Paganoid, I agree--there are many kinds of nurses and the OP seems to forget we don't all work in hospitals as floor nurses. Leading a team as a hospice or home health nurse, for example, or a public health nurse, or working in case management, or as a school nurse, or a pain management resource nurse, a wound care specialist, or a diabetes educator are all different kinds of nursing with more autonomy. Most of them require a BSN, but they're still RN jobs.

Yogi2000, you seem to be saying the same thing sort of, although I don't like the hard distinction between bedside nurses and nurses who sit at a desk, and the claim that most nurses involved in patient care would probably agree with the OP. Most of the types of nurses I just mentioned do a combination of direct patient care and desk work (and hey, we all know "bedside" nurses spend a lot of time sitting and charting, too!).

[Grapenut]

As Fungez pointed out : When I started they had things like transportation, hospitality, etc. Our time was considered too valuable to do nonnursing things. Unit clerks were staffed every shift, even nights. Now, if we get a clerk she's expected to take VS, pass ice, in short, to do two jobs for the pay of one. And then we get dinged if our phones aren't answered in a timely manner.

At the hospitals where I have worked, in the absence of any department's presence (housekeeping, lab, secretarial, transporters . . . ), we, the nurses inherited the job. We're expected to do 16 hours worth of hard charging work in a 12 hour shift, and then called into the office and reprimanded when we clock out with 30 minutes overtime too often. Nobody wants to be the one to say the emperor is not wearing any clothes. It's a bad economic time, and we're grateful to have our job, so you don't want to anger the suits. There's a long line outside the door looking for jobs, and they're all too glad to remind you of that.

[nursemike, ASN, RN]

I'm recalling a thread on the Men in Nursing forum about changing our title from "nurse" to something more gender-neutral. I was initially against the idea, until someone came up with Tank Commander. Which, you know, could resolve the whole problem of being respected as professionals.

There are some very caustic (and hilarious, I gotta admit) depictions of nursing and medicine on YouTube from the perspective of a Respiratory Therapist that support the idea that we get no respect. I wonder if they would feel so funny staring down the bore of a 105mm gun. Yeah, I'll fluff your pillow...

[Dianne727]

I seldom post here, but look in from time to time just to see if there are any glimmers of hope for change on our collective horizon. Well, I have to say, this post is one.

Right on!

You have eloquently illustrated the point of this whole exercise. Once we as nurses become self-aware enough to cut through the flowery tales and altruistic delusions we are taught to tell ourselves; we will see that healthcare is simply a business. A business where the few make huge sums of money at the expense of the many. The patients are the many. We Nurses are the many.

We are the labor that has no voice other than to leave. Few of us have unions, and the so-called shared governance popular in many institutions is simply another ploy by management to keep us amused and molified by picking on our peers. Keeping us divided and pliable to thier mandates. The talk of profession and professionalism is laughable. We have NO autonomy. We do what we are told per policies written by others or we are fired. Period.

I came from other fields where professionalism actually existed. I went into Nursing several years ago partly because I too wanted to believe the self congratulating baloney and "high minded" rhetoric of what it is to be a Nurse. However, those dreams soon withered in the light of the reality of what we have to navigate every day. It is amazing and puzzling how so many of us continue to swallow whole the fanatsies that we are fed by our employers and thier minions in Nursing.

Until the majority of us wake-up and speak up....en masse. Our working conditions and PATIENT care will only continue to deteriorate.

Peace,

Dianne

[catiern]

I am an RN/JD, married to an MD. Ultimately, nursing is not a profession because nurses "punch in" and more importantly can, "punch out". And yes, I have worked f/t as a nurse, and yes, I self-identify as a lawyer rather than a nurse when it comes to the actual work I do day-in, day-out, as well as what I consider my occupation. I agree with the original post. The determining factor for me, having been both in what is considered an established "profession" as well as in nursing, is that as a nurse, the buck does not ultimately stop with him/her.

Why I am putting in my two cents' worth here is that I want other nurses to know that the grass is NOT greener on the other side and to be careful of what you wish for (if you are in the camp to have nursing be considered a "profession"). I've represented and defended hospitals, doctors and yes, my share of nurses as a med. mal. defense attorney. The bitter pill is that nurses are seen as "lesser" than M.D.s. Get over it. Juries LOVE nurses and doctors. Unless you are some homicidal, incompetent maniac going around killing patients, nurses are sittin' pretty as far as med. mal. exposure is concerned. Your patients and their family DO appreciate you--the nurse.

Stop putting ridiculous letters behind the names and for goodness sakes, stop talking about "masters prepared nurses". Mater's degrees are generally given in other fields as terminating degrees to those who are not cut out to make it in the PhD programs. I wish nurses would stop insisting too, that the field of nursing is somehow "better" than that of medicine due to its philosophies. It is not. Another harsh truth is that nursing courses are not as rigorous as those in other fields--such as medicine and the law. (Oh, and I have taken some graduate level nursing courses--a lot of made up gibberish which was just downright embarrassing.)

Do you know what? I know a lot of my colleagues who are lawyers want to be nurses--no crushing responsibility, beloved and seen as angelic, etc. Also, as to the compensation--the $$ nurses make is terrific. I know my spouse and I do not work only 36 or 40 hours per week. If you break down that hourly rate, most doctors and lawyers are not really making that much more than nurses on an hourly basis. And yes, one can become an R.N. with only 2 years of community college. It's a good deal. And if the perceived income discrepancy is so galling, no one is stopping any nurse from going into a different field.

Appreciate what you have. I agree that nursing needs to get over its incomprehensible push to have itself be seen as a profession. No matter what, it is a job that must necessarily operate within a framework where doctors give orders to nurses. On the other hand, a bedside nurse has the best chance of literally saving a patient's life in a crisis. Isn't saving human lives good enough? Does it matter so much that you think "doctors and lawyers" think of nurses as "just a nurse"? Do you know how many idiot doctors and lawyers populate this planet?

Final thought--no matter what I think of some of my unprofessional colleagues, I will say that in the law, there's a general feeling that we all pull together to help the newbie lawyer. I know this is true in medicine as well. Nurses need to stick together, not attack and become more and more divisive by insisting on some ridiculous hierarchy of LPN/ ASN/ADN/BSN/MSN/DNP, etc, etc, etc,

[eriksoln, BSN, RN]

Actually too, its important to point out I don't think

bedside nurse = skilled labor nurse

desk/administrative nurse = professional nurse.

Nurse is nurse. regardless of where you practice. Its just that I attack administrative nurses and "being a profession" often at the same time so sometimes I give the impression that I think they are one and the same.

Hey Mike. I work nights. I bet if we do start coming out with code names this new obsession with vampires are the "dark magics" will butt its head into my nickname. I'll probably be called Frankenstein or something.................. that'd be more funny if you knew me, my body shape.

[eriksoln, BSN, RN]

I am an RN/JD, married to an MD. Ultimately, nursing is not a profession because nurses "punch in" and more importantly can, "punch out". And yes, I have worked f/t as a nurse, and yes, I self-identify as a lawyer rather than a nurse when it comes to the actual work I do day-in, day-out, as well as what I consider my occupation. I agree with the original post. The determining factor for me, having been both in what is considered an established "profession" as well as in nursing, is that as a nurse, the buck does not ultimately stop with him/her.

Why I am putting in my two cents' worth here is that I want other nurses to know that the grass is NOT greener on the other side and to be careful of what you wish for (if you are in the camp to have nursing be considered a "profession"). I've represented and defended hospitals, doctors and yes, my share of nurses as a med. mal. defense attorney. The bitter pill is that nurses are seen as "lesser" than M.D.s. Get over it. Juries LOVE nurses and doctors. Unless you are some homicidal, incompetent maniac going around killing patients, nurses are sittin' pretty as far as med. mal. exposure is concerned. Your patients and their family DO appreciate you--the nurse.

Stop putting ridiculous letters behind the names and for goodness sakes, stop talking about "masters prepared nurses". Mater's degrees are generally given in other fields as terminating degrees to those who are not cut out to make it in the PhD programs. I wish nurses would stop insisting too, that the field of nursing is somehow "better" than that of medicine due to its philosophies. It is not. Another harsh truth is that nursing courses are not as rigorous as those in other fields--such as medicine and the law. (Oh, and I have taken some graduate level nursing courses--a lot of made up gibberish which was just downright embarrassing.)

Do you know what? I know a lot of my colleagues who are lawyers want to be nurses--no crushing responsibility, beloved and seen as angelic, etc. Also, as to the compensation--the $$ nurses make is terrific. I know my spouse and I do not work only 36 or 40 hours per week. If you break down that hourly rate, most doctors and lawyers are not really making that much more than nurses on an hourly basis. And yes, one can become an R.N. with only 2 years of community college. It's a good deal. And if the perceived income discrepancy is so galling, no one is stopping any nurse from going into a different field.

Appreciate what you have. I agree that nursing needs to get over its incomprehensible push to have itself be seen as a profession. No matter what, it is a job that must necessarily operate within a framework where doctors give orders to nurses. On the other hand, a bedside nurse has the best chance of literally saving a patient's life in a crisis. Isn't saving human lives good enough? Does it matter so much that you think "doctors and lawyers" think of nurses as "just a nurse"? Do you know how many idiot doctors and lawyers populate this planet?

Final thought--no matter what I think of some of my unprofessional colleagues, I will say that in the law, there's a general feeling that we all pull together to help the newbie lawyer. I know this is true in medicine as well. Nurses need to stick together, not attack and become more and more divisive by insisting on some ridiculous hierarchy of LPN/ ASN/ADN/BSN/MSN/DNP, etc, etc, etc,

Well put. Agree with every bit of it, except one part.

I'd mirror your advice that the "grass is not always greener on the other side" to your friends who want to become nurses. No real responsibility? Eh..............no. On paper, yes, it looks like we are simply reading/reacting to what is in front of us and then follow through on the interventions.

Mind you, I said on paper that is what we do. I work on a pulmonary unit. When the ICU is unable to staff itself (this is a 50/50 thing, lots of ICU's out there that just don't have the proper staffing, its not something that happens once a month) guess who recieves the pt's who are borderline, should still be there, but are going to be shipped out because staffing in the ICU dictates them to. Yep, me, on my low level tele unit filled with nurses who take care of vents regularly. So, my assignment of 8 pts more often than not includes 1 or 2 pts who should be in the ICU. That means, I basically have an ICU assignment.........the 2 pts who should be in ICU, AND 6 other patients. Wanna come in one night and shadow me when its like this and tell me "no crushing responsibilities"? Mind you, of the other 6 patients, usually at least two, sometimes three of them, are VERY acute too, they just have not been in the ICU yet. Its a pulmonary floor, these people go from feeling like they could leave and go walk in the park outside to having fatal respirator distress in two minutes. And, as I've said, this is a 50/50 thing. Its not something that happens once in a great while, it is the rule, not the exception.

Every nursing unit is like mine in that it presents you with challenges that don't necessarily show up the the outsider looking in or on paper. There is a reason that, even in the harsh economic times we are in right now, a great many people still say "I will never do nursing, some things just aren't worth any paycheck." I can't help but wonder when I see all these new students on the board who are in it because they got laid off. Are they sure they want to do nursing?

My current manager, I love her, has a flaw in that she from time to time, when she is upset, like to point out that there is a line out the door full of people who want our positions. She often says things like this when people get in her face about trifle little things that really are not a big deal (schedule not exactly how they would like it, someone else always gets the easy assignment etc). Lately, she was given permission to hire two people. She started dipping into this metaphoric "line out the door". LOL. The line is nowhere as long as she though. Seems to be the reality is, there is a line out the door of people who think they want to get into nursing. Two people lasted less than a month, one left because they didn't approve of the off shift rules of the schedule and another because she had no idea she was going to be expected to do "so much aid work." So, my manager has two openings and a month later has only been able to fill in one of them from the outside. Seems that line out the door was a bit of an illusion. The other position got filled internally someone desperate to get off another unit they are not happy with but, other than that, the position would have remained unfilled.

[Divergirl]

I have to say at this moment I am sad and nauseated after reading your post. I have been a RN for 13 years and a CRNA for 1. You miss the whole point why nursing schools call for nursing to be a profession. Why is it nurses are always dumped on?? Why is it they have no autonomy?? IT IS BECAUSE NURSES ARE UNORGANIZED AND ARE QUICK TO DENEGRATE THEMSELVES AND EACH OTHER. CRNAs have been successful because of one reason, the AANA (American Association of Nurse Anesthetists). In my state, there are approximately 1000 CRNAs. At least 90% of them belong to their PROFESSIONAL organization. We have a strong voice in the legislator and we have respect from other healthcare providers and hospital administrators. There are approximately 88,000 RN in our state. If half of the RNs joined their professional organization and got involved in the politics of healthcare, nurses would rule the healthcare world. You would have more control over what happens in hospitals, nursing homes, and your nursing practice than any other special interest group in the country. As long as nurses are willing to tear each other down and complain about their situation rather than do something about it, they will continued to be governed by hospital administrators, physicians and others who are not looking out for YOUR best interests. WAKE UP!!!! Nurses have strength in numbers and until you realize that, you will be passing trays, taking out trash and be completely disregarded.

[catiern]

Let me modify and clarify, Eriksoln--crushing and unabating responsibility. And no, I would be the last person to think or say that nursing is not without its crazy-busy-scary responsibilities and staffing issues. (With the ULTIMATE stakes of human lives). But the responsibility I speak of as a lawyer or a doctor IS different. We are basically "on duty" 24/7 and responsible for the acts and omissions of all of our staff (I know, I know, RN's are as well for the acts of CNAs/LPNs, etc., but RNs can always palm it off up the chain).

I do agree with you that unless you've been in the trenches, everything on paper sounds hunky-dory. I nearly went mad one night as a pool nurse, thrown on a M/S floor I'd never been on, in a hospital I'd never worked at, with 16 patients, 10 of whom were on IV ABTs. I did not even know where to get the IV tubing and you know what? Neither the regular staff nurse or the noc. supervisor bothered to help me out. But, at the end of the shift (or rather, almost an hour after the shift end when I was finally done with the paperwork), I got to go home and not be responsible for the patients once I went out that door.

The lawyers who say they want to be nurses probably won't make it as nurses anyway--way too combative as a rule, and most can't stand the sight of blood.

Sorry to hear though, that there's this "line out the door" mentality.

[eriksoln, BSN, RN]

I have to say at this moment I am sad and nauseated after reading your post. I have been a RN for 13 years and a CRNA for 1. You miss the whole point why nursing schools call for nursing to be a profession. Why is it nurses are always dumped on?? Why is it they have no autonomy?? IT IS BECAUSE NURSES ARE UNORGANIZED AND ARE QUICK TO DENEGRATE THEMSELVES AND EACH OTHER. CRNAs have been successful because of one reason, the AANA (American Association of Nurse Anesthetists). In my state, there are approximately 1000 CRNAs. At least 90% of them belong to their PROFESSIONAL organization. We have a strong voice in the legislator and we have respect from other healthcare providers and hospital administrators. There are approximately 88,000 RN in our state. If half of the RNs joined their professional organization and got involved in the politics of healthcare, nurses would rule the healthcare world. You would have more control over what happens in hospitals, nursing homes, and your nursing practice than any other special interest group in the country. As long as nurses are willing to tear each other down and complain about their situation rather than do something about it, they will continued to be governed by hospital administrators, physicians and others who are not looking out for YOUR best interests. WAKE UP!!!! Nurses have strength in numbers and until you realize that, you will be passing trays, taking out trash and be completely disregarded.

Ah. Political movements. Not my strong suit. I have to admit, I've spent the better part of my life being Apolitical. I have my reasons, stuff not appropriate for this board. I'm not.......ummm............well educated or knowledgeable about the how to and why of political movements.

I do agree with you though even though its not my niche. Being more uniform and having a strong voice would certainly cause an awful lot of changes in how pt. care is approached. Lets face it, right now the medical field is driven by the "Business Model" with some input from the doctors on how the "Medical Model" would do things (have to do this to avoid too many lawsuits). Not much room in there for any Nursing theory. It would take a true political movement, a revolution, to bump the suits who insist the "Business Model" approach is #1 priority.

But, I don't think you give me credit where it is due either. Again, many people read my article, it strikes at their ego, and they react by pinning lots of meaning to the article that just is not there. Again, I am not slamming the nursing field nor understating its place in our culture. What I am unhappy with is how it conducts business.

For me, I want to bring on the revolution you speak for, but from a different angle. I say let the suits and everyone else who thinks they have all the answers act as they wish. I'm too busy focusing on the pt. to be bothered. If we as nurses refocus on the pt. and let the chips fall where they will...............we will win in the end. People will not be able to deny the fact that we are the only group with their best interest in mind. Then, with the backing of millions as opposed to the thousands you speak of who belong to this or that nursing group..................then we can initiate change. I guess I'm just.......going to the same place as you but from a very different route.