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?

[cherryames1949]

Thank you for stating the obvious. This conversation has been going on for the 30 years that I have been a nurse. Nursing has never really been considered a true profession by any other health care professional. By the way, I love what I do but I too have accepted the realities.

[Davegemtb]

To the OP. Welcome to America! But, If Your This Good: It Sounds Like You Need To Be an NP, an administrator or Go Onto Med School.

I know my place as an EMT, CNA and Now Nursing Student. Doing well clinically but struggling academically.

I think However that you are not Remebering that It Is A Health Care Team. If that Patient Needs a glass of water how hard is it for you to give it to them. If it takes a second or 2 to empty the trash do it.

Nursing Is A Helping Profession - service to others. You don't like it leave it.

[wooh, BSN, RN]

I think However that you are not Remebering that It Is A Health Care Team. If that Patient Needs a glass of water how hard is it for you to give it to them. If it takes a second or 2 to empty the trash do it.

Nursing Is A Helping Profession - service to others. You don't like it leave it.

Yup, it's a team. How about the pharmacist come and empty out the trash? The physician can mop the floor in the room after the patient vomits. After all, it's a "team" and will only take a second or two!

Whenever the nursing staff is overloaded, we're told we have to manage our time better. But when another department is overloaded, nurses are told to be "team players" and help them out. Why is it only nurses that have to be "team players"??? Why can't the other departments take "a second or two" to take out the trash, pass meal trays, pick up meal trays, clean the IV poles, etc, etc, etc....

[Bella'sMyBaby]

To the OP. Welcome to America! But, If Your This Good: It Sounds Like You Need To Be an NP, an administrator or Go Onto Med School.

I know my place as an EMT, CNA and Now Nursing Student. Doing well clinically but struggling academically.

I think However that you are not Remebering that It Is A Health Care Team. If that Patient Needs a glass of water how hard is it for you to give it to them. If it takes a second or 2 to empty the trash do it.

Nursing Is A Helping Profession - service to others. You don't like it leave it.

This is EXACTLY what Employers bank on Nurses doing........

And EXACTLY the reason Nursing is NOT a Profession.........

[d'cm]

Great post and agree with every word. The important point here is how counterproductive the "nurse as professional" theory has proven to be. It's like an adult version of Santa Clause where we are taught this myth and then have to learn for ourselves it's bull. As so many have said, what's the point?

It really is a concept manufactured by the academics who are the only ones who benefit from it. PhD in Nursing? yagottabekiddingme.

[eriksoln, BSN, RN]

To the OP. Welcome to America! But, If Your This Good: It Sounds Like You Need To Be an NP, an administrator or Go Onto Med School.

I know my place as an EMT, CNA and Now Nursing Student. Doing well clinically but struggling academically.

I think However that you are not Remebering that It Is A Health Care Team. If that Patient Needs a glass of water how hard is it for you to give it to them. If it takes a second or 2 to empty the trash do it.

Nursing Is A Helping Profession - service to others. You don't like it leave it.

Who is denying anyone any water?

I think you are going to be shocked when you get into nursing. Your going to find out that team concept for the most part means you taking a bullet for everyone else.........every time, every day. Its not a matter of completing a few simple tasks over here and over there that singularly take less than a minute. The problem is when you have a hospice pt. in one room who needs a lot of comfort measures (frankly, more than q2hrs positioning), two other pt's who should be in the ICU in other rooms, and then 5 other patients....................and your concern is supposed to be emptying the trash so you can be considered part of some "team"?

Is that what your nursing care is going to consist of? Worrying about whether housekeeping or dietary thinks you are part of the "team" and impressing them? Your patients will suffer. The workload placed on the avg. hospital RN does not allow for anything but the most generic of care. If you are busy impressing, TBH, the wrong people while you try to contribute to this "team", then there will be things you miss or neglect in your pt. care.

Just a side note on "teamwork". Its a term thrown out there a lot by managers and administration who love to cloud the job descriptions of everyone and anyone who will listen.

Often team work is interpreted as person A doing some task that person B can not get to at that moment. Nothing wrong with that, we should always try to pick up our fellows when we have a chance.

The problem is, too often, Person B decides "Hey, I am busier than you, so, you should just do that task for me all the time". Or, as many of you have witnessed, management see's you doing the task for person B and says "Hey, if we can get everyone to pitch in, get all this stuff done, maybe a few people will have to skip lunch breaks and all but, we can save tons of money cause then there really is no reason to keep Person B around at all".

I have a different approach to "team" and it does not incorporate me constantly picking up this and that duty/job for anyone else.

I look at belonging to a healthcare team like it is, eh, playing on a football team.

On the football team, each different position has its thing it does to contribute to the overall outcome of the game. The lineman blocks, the receiver outruns people, the linebacker tackles.

For the healthcare team, as a nurse, my thing I do is take care of "people". I help that elderly person not get bedsores, I educate the young girl on diabetes so she knows what to do if her foot is cut, I make sure everything is in place for the man getting his gallbladder out so the transition from unit to OR and back again is smooth and without complication.

Now, on a football team, if the wide receiver is not up to snuff and isn't outrunning people, what do you do? Do you.......switch him out with a lineman and tell him he must now do it for the receiver? No, you would not only be putting someone in a position where they are not doing what they are meant to be doing, as the lineman can't do the receiver's job, but you are masking the real problem which is the receiver can't get his job done. Plus you lose having your lineman where he should be to block. Maybe they need better plays called or w/e so the receiver cando better, but the answer is not to tell another position to do it for him.

Same thing. If the trash is not getting emptied, the solution is not to redesign the nurse's role, take them from the bedside and tell them to do it. That takes away from time at the bedside. So, OK, the trash is emptied but at what cost? Too often, the cost is...........that elderly person isn't turned and gets the bedsore, the young female diabetic is thrown some papers describing diabetes instead of being properly educated (and she is back in the hospital again in a month with DKA) or something is missed with the gallbladder person and his pain is not managed or his discharge is held up because this or that detail was missed on his admit process.

That is not being a team. Not at all. My contribution to my team is in doing my role well, so well that anything falling under my jurisdiction of pt. care is never a concern for other members of the team. When phlebotomy goes in my pt. room in the morning to get labs, they are not flooded with requests for water and other things. When Social Services goes in to talk about options to pay for home medications with one of my patients, they don't have to stand around and wait half an hour while the pt. explains how their pain is not managed.

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I sound an awful lot like someone who thinks nursing is a profession and has a "unique body of knowledge" don't I?

OK. I'm putting this out there now. If I start putting titles on my name badge, signing everything outside of work with said titles and preempt every comment with "Well, I am a nurse and I think.............." YOU ALL HAVE MY PERMISSION TO SHOOT ME DOWN ON THE SPOT. Just to a simple drive by past my home.

[NocturneRN]

Who is denying anyone any water?

I think you are going to be shocked when you get into nursing. Your going to find out that team concept for the most part means you taking a bullet for everyone else.........every time, every day. Its not a matter of completing a few simple tasks over here and over there that singularly take less than a minute. The problem is when you have a hospice pt. in one room who needs a lot of comfort measures (frankly, more than q2hrs positioning), two other pt's who should be in the ICU in other rooms, and then 5 other patients....................and your concern is supposed to be emptying the trash so you can be considered part of some "team"?

Is that what your nursing care is going to consist of? Worrying about whether housekeeping or dietary thinks you are part of the "team" and impressing them? Your patients will suffer. The workload placed on the avg. hospital RN does not allow for anything but the most generic of care. If you are busy impressing, TBH, the wrong people while you try to contribute to this "team", then there will be things you miss or neglect in your pt. care.

Just a side note on "teamwork". Its a term thrown out there a lot by managers and administration who love to cloud the job descriptions of everyone and anyone who will listen.

Often team work is interpreted as person A doing some task that person B can not get to at that moment. Nothing wrong with that, we should always try to pick up our fellows when we have a chance.

The problem is, too often, Person B decides "Hey, I am busier than you, so, you should just do that task for me all the time". Or, as many of you have witnessed, management see's you doing the task for person B and says "Hey, if we can get everyone to pitch in, get all this stuff done, maybe a few people will have to skip lunch breaks and all but, we can save tons of money cause then there really is no reason to keep Person B around at all".

I have a different approach to "team" and it does not incorporate me constantly picking up this and that duty/job for anyone else.

I look at belonging to a healthcare team like it is, eh, playing on a football team.

On the football team, each different position has its thing it does to contribute to the overall outcome of the game. The lineman blocks, the receiver outruns people, the linebacker tackles.

For the healthcare team, as a nurse, my thing I do is take care of "people". I help that elderly person not get bedsores, I educate the young girl on diabetes so she knows what to do if her foot is cut, I make sure everything is in place for the man getting his gallbladder out so the transition from unit to OR and back again is smooth and without complication.

Now, on a football team, if the wide receiver is not up to snuff and isn't outrunning people, what do you do? Do you.......switch him out with a lineman and tell him he must now do it for the receiver? No, you would not only be putting someone in a position where they are not doing what they are meant to be doing, as the lineman can't do the receiver's job, but you are masking the real problem which is the receiver can't get his job done. Plus you lose having your lineman where he should be to block. Maybe they need better plays called or w/e so the receiver cando better, but the answer is not to tell another position to do it for him.

Same thing. If the trash is not getting emptied, the solution is not to redesign the nurse's role, take them from the bedside and tell them to do it. That takes away from time at the bedside. So, OK, the trash is emptied but at what cost? Too often, the cost is...........that elderly person isn't turned and gets the bedsore, the young female diabetic is thrown some papers describing diabetes instead of being properly educated (and she is back in the hospital again in a month with DKA) or something is missed with the gallbladder person and his pain is not managed or his discharge is held up because this or that detail was missed on his admit process.

That is not being a team. Not at all. My contribution to my team is in doing my role well, so well that anything falling under my jurisdiction of pt. care is never a concern for other members of the team. When phlebotomy goes in my pt. room in the morning to get labs, they are not flooded with requests for water and other things. When Social Services goes in to talk about options to pay for home medications with one of my patients, they don't have to stand around and wait half an hour while the pt. explains how their pain is not managed.

-------------------------------------------------------------------------------------------------------------------------------------------------------------

I sound an awful lot like someone who thinks nursing is a profession and has a "unique body of knowledge" don't I?

OK. I'm putting this out there now. If I start putting titles on my name badge, signing everything outside of work with said titles and preempt every comment with "Well, I am a nurse and I think.............." YOU ALL HAVE MY PERMISSION TO SHOOT ME DOWN ON THE SPOT. Just to a simple drive by past my home.

I agree that a very busy nurse should not be expected to do tasks that other personnel could be doing.

That said, I also think that, if the other personnel are all busy doing other things, and a nurse has a free moment, then s/he can easily get up and pitch in.

On my unit, the unlicensed personnel are often running their legs off answering call lights, doing EKGs, drawing blood, applying splints, cleaning wounds and doing vitals. Their work is no less important than mine, so, if I happen to be the one with a free moment, I go ahead and answer call lights, empty garbages, fetch extra blankets and so on. That, I think, is what the term "teamwork" is about: we all help each other in whatever ways we (reasonably) can.

(I'm guessing that no one here would disagree with me on this, but I think it needed to be stipulated, anyway...)

[wooh, BSN, RN]

I agree that a very busy nurse should not be expected to do tasks that other personnel could be doing.

That said, I also think that, if the other personnel are all busy doing other things, and a nurse has a free moment, then s/he can easily get up and pitch in.

I agree, we can all pitch in here and there. The problem comes when it's only nursing staff that's expected to pitch in. On my unit, when we're short a tech, each nurse takes a total care patient. When we're short a nurse, we all have to take an extra patient. Guess what, when we're short a nurse AND a tech, the nurses take an additional patient AND one of them is total care. So no matter what, the nurse gets more work. The techs don't.

I needed a medication asap. The pharmacy's job is to send medications to the floor. When they're short, and I need a med asap, I have to go down 4 floors and across the hospital to go get that med, because they're short of staff. Now if the nurses are short of staff, does someone from pharmacy come and administer my meds for me? Or do my assessments? Or my charting? Or for that matter, take out the trash?

When the swine flu was going around, the housekeeping staff was getting behind because of the high census. Of course, nursing staff was suffering too, taking extra patients, etc. But since housekeeping was behind, they tried to make it our job to take the trash and linens out of the room at discharge. Now I'm already behind because I'm working harder due to the same thing that's making it harder for them. And I have to work even harder to make it easier on them?

Respiratory therapists were working harder during the swine flu season too. So the nurses were told they had to do all the suctioning of patients. Now if I go in a room, and they need suctioning, I'm going to do it. But RT doesn't come around when I'm overloaded and do my admission paperwork.

Physical therapist doesn't have time to get a patient up to a chair and then back to the bed? Don't worry, the nurses will put them back to bed.

It's always things that only "take a minute." And when I have time, sure, I'll do it. But usually, I don't have time. And really, if it only takes "a minute" then why can't the person who's job it really is find the time to do it? Because they don't have to. Because the nurses will be "team players" and skip their lunch and breaks and stay over 2 hours charting. Then get told that we don't have good time management skills because obviously we should have time to do our own job and everyone else's at the same time.

It is ALWAYS the nursing staff that has to work harder to be a team player. If another department doesn't have time, well, they're overloaded. If nursing doesn't have time, don't worry, there will be some holier than thou nursing student or administrator that will opine how it will only "take a minute" and then it will all be ok, because if it only takes a minute, then I guess it will be ok to put off CPR in the other room for just "a minute" to take out the trash.

[fungez]

Well said, wooh.

"If nursing doesn't have time, don't worry, there will be some holier than thou nursing student or administrator that will opine how it will only "take a minute" and then it will all be ok, because if it only takes a minute, then I guess it will be ok to put off CPR in the other room for just "a minute" to take out the trash. "

It always cracks me up when a STUDENT takes it upon herself to lecture us about to get the job done.

[eriksoln, BSN, RN]

I agree, we can all pitch in here and there. The problem comes when it's only nursing staff that's expected to pitch in. On my unit, when we're short a tech, each nurse takes a total care patient. When we're short a nurse, we all have to take an extra patient. Guess what, when we're short a nurse AND a tech, the nurses take an additional patient AND one of them is total care. So no matter what, the nurse gets more work. The techs don't.

I needed a medication asap. The pharmacy's job is to send medications to the floor. When they're short, and I need a med asap, I have to go down 4 floors and across the hospital to go get that med, because they're short of staff. Now if the nurses are short of staff, does someone from pharmacy come and administer my meds for me? Or do my assessments? Or my charting? Or for that matter, take out the trash?

When the swine flu was going around, the housekeeping staff was getting behind because of the high census. Of course, nursing staff was suffering too, taking extra patients, etc. But since housekeeping was behind, they tried to make it our job to take the trash and linens out of the room at discharge. Now I'm already behind because I'm working harder due to the same thing that's making it harder for them. And I have to work even harder to make it easier on them?

Respiratory therapists were working harder during the swine flu season too. So the nurses were told they had to do all the suctioning of patients. Now if I go in a room, and they need suctioning, I'm going to do it. But RT doesn't come around when I'm overloaded and do my admission paperwork.

Physical therapist doesn't have time to get a patient up to a chair and then back to the bed? Don't worry, the nurses will put them back to bed.

It's always things that only "take a minute." And when I have time, sure, I'll do it. But usually, I don't have time. And really, if it only takes "a minute" then why can't the person who's job it really is find the time to do it? Because they don't have to. Because the nurses will be "team players" and skip their lunch and breaks and stay over 2 hours charting. Then get told that we don't have good time management skills because obviously we should have time to do our own job and everyone else's at the same time.

It is ALWAYS the nursing staff that has to work harder to be a team player. If another department doesn't have time, well, they're overloaded. If nursing doesn't have time, don't worry, there will be some holier than thou nursing student or administrator that will opine how it will only "take a minute" and then it will all be ok, because if it only takes a minute, then I guess it will be ok to put off CPR in the other room for just "a minute" to take out the trash.

Which is EXACTLY why the whole "team" arguement has no bearing with me. "Teamwork" is ALWAYS interpreted as me picking up someone else's slack, NEVER as someone helping me when my pt. load is too much and "customer service" is suffering as a result.

Want to take a try at asking housekeeping to stuff charts? How about we see if security wants to empty foleys. Maybe have phlebotomy help ambulate pt's to the BR. Let me count the ways in which we are laughed at with these requests. One, two, three...............TEN THOUSAND.

"Teamwork" implies a two way relationship, and that does not exist. I'm perfectly OK not being considered a "good team member" when the team is a one way street. In fact, I prefer it.

[NocturneRN]

Which is EXACTLY why the whole "team" arguement has no bearing with me. "Teamwork" is ALWAYS interpreted as me picking up someone else's slack, NEVER as someone helping me when my pt. load is too much and "customer service" is suffering as a result.

Want to take a try at asking housekeeping to stuff charts? How about we see if security wants to empty foleys. Maybe have phlebotomy help ambulate pt's to the BR. Let me count the ways in which we are laughed at with these requests. One, two, three...............TEN THOUSAND.

"Teamwork" implies a two way relationship, and that does not exist. I'm perfectly OK not being considered a "good team member" when the team is a one way street. In fact, I prefer it.

You don't think RT and phlebotomy and pharmacy and housekeeping are also having to pick up slack at times? That RT isn't being stretched thin when there are many patients requiring their services? That housekeeping isn't being run ragged on those occasions when they have very messy patients to clean up after, or several terminal cleanings to do? That phlebotomy doesn't sometimes have to scramble to keep up with an unusual number of difficult blood draws?

Sure, when it comes to the patient, nurses end up doing 1001 different tasks. But those other departments are also doing a lot of different tasks behind the scenes. Security might not be emptying your Foleys for you, but on the other hand, they're not asking you to run outside and help them hunt down the suicidal patient who just escaped from the ER. Housekeeping might not be stuffing charts for you, but, then again, they're not asking you to go to other units and spend an hour terminal cleaning patient rooms for them. Phlebotomy might not be ambulating your patient to the bathroom, but, then again, they're not asking you to run down to the nursery and do heel sticks on babies when they're short staffed.

I agree that, too often, nurses are expected to be the ones that pick up the slack when other departments can't come through 100% for them. But it's a mistake to assume that the people who work in those other departments are just sitting around, while nurses are running their legs off. Often they're busy, too, doing tasks that we might not even realize have to be done, just to keep their own unit functioning.

[wooh, BSN, RN]

Security might not be emptying your Foleys for you, but on the other hand, they're not asking you to run outside and help them hunt down the suicidal patient who just escaped from the ER.

Well actually, I one time WAS the one outside chasing down my suicidal patient, with security nowhere to be found. :)

Does RT have short-staffed days? Yep, and when they're busy, I am doing everything I can do respiratory wise.

Housekeeping? Well we won't talk about how much time they have to sit in our family lounge at the same that nursing staff is being told to do part of their job.

I think the point is, I don't mind helping out. But where is the help when I need it? How often is security told to do just one more little thing? How often is lab told to do just one more little thing? How often is RT told, "The nurses are short-staffed, so for this week you need to give all the nasal spray." How often is housekeeping told that since the nurses are short-staffed, they'll need to clean the IV poles instead of expecting the nursing staff to do it?

And it goes right back to the OP. The nurses can do whatever anyone else doesn't want to do. And since we aren't a cohesive profession or even a cohesive trade that will stick up for itself, we end up doing it. Because we can't even decide amongst ourselves that enough is enough, someone else needs to pick up the slack in the hospital for a change.