Time to call a duck a duck?

Published

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.
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.

I'm trying to find where someone said this. Can't find it. Can you direct me to it?

No other dept. in any hospital has the "wildcard" job description nurses do.

As far as what we are and are not being asked to do, let me do some research and find the post for you. I was actually told to search for a pt. at one time. Security was "short staffed" so the nurses had to stop what they were doing and go look for a pt. that went AWOL. Happened while I was a travel nurse, in Balt.

I'm not blind to the fact that everyone is stretched thin. But as nurses, we are always the first option for whatever task isn't getting completed, regardless of what dept. it falls under. The other dept. are not asked to lend a helping hand with nursing...........nurses are told we are "not team members" for not carrying everyone else on our backs. Thats the difference.

Specializes in ER, cardiac, addictions.
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.

I think, if you were to talk to people from those departments, you'd find that they're often asked to do "just one more little thing." The thing is, they're usually doing those extra little things on units other than yours, so you're not fully aware of just how busy they are. You have one unit to take care of, but many of them have the whole hospital. While you're busy grumbling about having to do your own suctioning, RT isn't just sitting around playing tunes on their toes. They might be at a code in the ER, or answering an RRT call, or trying to do a difficult ABG stick. Or (yes, this does happen sometimes!) they might even be helping to lift or move a 500 pound patient down the hall, or fetching a drink for a patient who doesn't like the taste her neb treatment left in her mouth.

If your housekeepers are frequently sitting in the lounge while you're doing their job, that is a management problem.

I'd also like to add that even people who work at "cohesive professions" or "cohesive trades" often have to do extra tasks at times, too. Things like troubleshooting equipment, coming up with newer and better processes for doing certain tasks, repairing or scrapping mistakes, explaining problems to management, colleagues, customers or ancillary personnel, even serving as gofers when deadlines are looming.

Even physicians aren't exempt from the "just do one more little thing" trap. I see the ER doctors I work with being asked to take extra time to explain lab tests to a patient's curious brother in law, or to go back in the patient's room and explain why they won't give Dilaudid for a finger laceration, or to look at an EKG that a floor nurse can't quite figure out, or to fill out a work release form, or to assist an NP with a difficult or complicated case. That just goes with the territory when you're working in a field with many variables and/or strict deadlines.

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I have had to get patient's breakfasts from way down in the bowels of one huge hospital & I was a RN then - there wasn't enough catering staff. I too have chased after patients in parking lots, tried vainly to stop dementia patients escaping 'cos the hospital will get sued'; taken patients to kiosks/shops when no-one else could be bothered helping them - social workers don't seem to care & always seem to leave/be unavailable after 4pm - have emptied overflowing garbage; have cleaned up badly leaking toilets so no-one would slip & engineering couldn't get there to fix it; have had to go get linen trolleys in the morning cos no-one had towels/sheets - have done all this as a nurse.

The point is we DO tell management again and again and AGAIN re these problems as you say above, and nobody ever does anything about it.

We as nurses do enough & many of the things above I was TOLD to do by management, & also to help the patients many whom I was fond of. Do you ever see management running after patients? I have actually seen a dementia patient escaping from a dementia unit one day in her nightie, the manager (who knew this person & many of the patients), walked by and just ignored her! Meanwhile the patient in her nightie was trying to get to the stairs/lift to get out. God knows what the family/lawyers would have said if we had been 'too busy' to chase after her, she got out & got hit by a car which happened at one hospital I worked at. Guess who got the blame for that? The nurses of course.

Nurses are responsible for way too much & there is a limit to how much team work you provide. If you do everyone elses' job, you don't get your own done.

Specializes in Rodeo Nursing (Neuro).

AHA!! This discussion of teamwork and the sometimes lack thereof has prompted me to suddenly realize that we must, by golly, truly be learned professionals--and here's why:

Suppose a Doctor of Medicine, a recognized professional for millenia, prescribes a medication, and a Doctor of Pharmacy, a recognized professional at least in modern times, fills that prescription. Now, if a nurse administers that medication--and let's make it a pill, so an LPN can give it--and the patient dies because they shouldn't have had it, whose fault is it?

And so, my esteemed colleagues, I have clearly demonstrated that we RNs and LPNs must be true professionals, since part of our responsibility is supervising doctors and pharmacists, who are recognized professionals. Eureka!

(Eh, yeah, okay, I know. It's my first full day off after a rough weekend, and I'm feeling silly. It's out of my system, now. Please feel free to continue your intelligent discussion while I take a little nap.)

Hence, in one of my other posts, that, like plumbers, one of the main principles of nursing is that s__t runs downhill.

Specializes in M/S, Travel Nursing, Pulmonary.
Sartre, honey. A satyr is a woodland mythical creature. I'm not usually a correcter but I hadda. ;)

I disagree that anyone can be a good nurse. I agree that most people can master the physical skills of being a nurse.

Yes, thats what I meant. I got that quote from a woodland creature on Friday night after drinking a few too many Miller Lights. He told me to burn the neighbor's house down too and all sorts of things but..........eh, I was too tired to bother.

Specializes in M/S, Travel Nursing, Pulmonary.

:smokin:

OK. Its been a great debate. Time to wrap it all up with a pretty little bow.

After much discussion and introspective assessment, I think I've put my finger on what the problem is:

Reading through my posts, you will see many assertions that "Nurses who think nursing is a profession act like this/say and do that." But not all nurses who think nursing is a profession do those things. In fact, most don't. Why do I associate things like having an inferiority complex, being lazy and using nursing as an image to thinking nursing is a profession? Well, because most people who act that way use "I'm a professional" as their shield from the things they don't want to do. We all know the nurse who, with perfectly ironed scrubs, a great smile made for TV (that only comes out when administration is around) and a wonderful list of theories, can't be bothered with pt. care. "I'm a professional nurse, not a bed pan cleaner. You'll have to get the aid to do that."

So many of the bad nurses I've had the privileged (ahem, cough) of working with like to use "Nursing is a Profession" as a shield against everything th,ash) and takes us away from the bedside while people are not getting the care they deserve. I will point out though, these nurses never stop there. "I am a professional, not a simpleton laborer" is their mantra to avoid changing bedpans, getting someone a much needed glass of water, ambulating someone to the BR etc......

It would seem, these people have so effectively annoyed me that I've been turned off completely to the idea of Nursing being a profession. But it is not wanting to be a professional that drives these people's actions. It is laziness, pure and simple. Their complete lack of concern for pt. care in my eyes, and more than likely in the eyes of those who do consider nursing a profession, practically makes calling them a nurse at all difficult, much less a "Professional Nurse".

Not fair to group every nurse who considers what we do a profession in with them. Completely different animals entirely.

So, I will continue to evolve my understanding of the CRAFT of nursing, but will do so with eye's wider open as I accept, if not embrace, the idea of nursing being a profession. I definitely agree, the old Sociological view of what is and what is not a profession probably in not applicable today.

Perhaps we can shape a new definition of "profession" that fits nursing like a boot and at the same time can not be used as a shield against the less loved duties of a good nurse.

Specializes in Spinal Cord injuries, Emergency+EMS.
This is going to be a very interesting and thought provoking thread.

I essentially agree with you, and I don't think that nursing is heading in the more professional direction, in spite of the never ending number of letters we can put after our name if we take the right exams. The market doesn't allow for it. The current healthcare system and reimbursement standards has reduced nursing to a commodity. In theory if we are allowed to practice to our fullest potential, well-educated nurses have the knowledge base to practice professionally. The issue that I see is that there is no reimbursement for that, and likely never will be.

looking at this from the persepctive of a Uk educated RN who practises in the UK , at least some of the issue is the way in which Nursing i nthe USA is constructed within the Healthcare world, the USA with it;s 'Doctors bring income ' , Nurses cost money attitude and the way in which that means lay management sees nursing as labour rather than an integral part of the 15 or so key Health Professional groups - which Nursing and Medicine (especially if you make that ' medicine and dentistry') make up the bigger groups , followed by Physios, Pharmacists, OTs , ODPs and Paramedics and so one down in numbers ...

I have seen very intelligent, well educated (master's degree and above) nurses get verbally put in their place by physicians. There is no respect for what we do, even at a high level of education. My current manager, who I respect very much (a BSN, MBA) has told me that she sits in on multidisciplinary meetings and her opinion means little because "I have 'RN' after my name instead of 'MD'."

whereas in our MDT meetings everyone involved Doctors, Nurses , physios, OT , social worker and the patient ( and their family) all has an equal part to play

Even if no one thinks we are professionals (and that's fine, if that's the way it is) I refuse to be treated disrespectfully. I still got through a college degree. I am still educated. There should be clear distinctions between what nursing does and what housekeeping does. There are standards for workplace conduct and they don't involve belittling people for the job they have, even if it involves wiping butts. With this whole "professionalism" debate, that is the biggest issue for me personally -- I don't really care if you want to call me a professional or not, but if you are going to stick up your nose because I do a dirty job, that's when I take issue.

a lot of this is about perceptions , when reading on here about requiring medical 'orders' to undertake core nursing interventions it's unsuprising that Nursing in the USA doesn't seem to be as much of a profession as it should be ... especially with the ridiculous silos of different professions role and never shall any other group of staff do that ..

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

I would guess that nursing in the US is about as 'professional' as here in Australia.

However, reading these boards.... I am concerned about the working conditions in the US.

I have been shocked at some of the things that I have read here ...especially with regard to the 'right to work' states

Do you ever see management running after patients?

God, yes, Everyone where I work will, from housekeeping right up to the administrator.

Specializes in CVICU, Obs/Gyn, Derm, NICU.
God, yes, Everyone where I work will, from housekeeping right up to the administrator.

Yes we all run after them too .... though we leave the dangerous ones for security :)

Specializes in Spinal Cord injuries, Emergency+EMS.
Agree ...especially more pathophys. And more clinical skills. Plus generally slant more toward medical model with nursing art as adjunct.

which is why there are issues with Associates Degree RNs from the USA getting registered in the EU becasue they don't have enough education hours and may not have enough practical hours

the EU standard is 4600 hours pre-registration programmes with a 50/50 split between classroom and clinical

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