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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?
We should absolutely perform as professionally as we can.... agree.I am always impressed with the professionalism of people I come into contact with in the US ....shopping, hotels, restaurants, McDonalds, rental car people etc. I have a fantastic experience in the US. Have only ever been a tourist there never lived in the US. From my limited experience the US is much better in this regard than Australia
I can't compare, because I have never been to Australia. And I guess it's unfair for me to generalize anything about the entire US- it's a huge country, and varies considerably between and within each state and region. But I've found in my experiences that many I have worked with- especially those around my age and younger- have a sense of entitlement when it comes to their job. That is, the attitude of "I showed up for work, therefore I fulfilled my obligation, now pay me." That certainly doesn't apply to everyone I've worked with, or everyone I encounter when I interact with people in customer service, but I haven't known it to be uncommon, either.
It was especially frustrating for me while working in long-term care- which is probably why I may seem kind of obsessed with the issue in this thread. I had one particularly bad workplace where I worked as a med aide- and was expected to act as shift supervisor on top of my other duties. I worked with some excellent caregivers, but worked with others who would get absolutely incredulous when I asked them to stop their conversation with one another and start answering call lights. It was especially appalling to me because they were making people wait who were absolutely depending on them for help- it's not like providing slow service at a restaurant where the customers have the option of going elsewhere.
I stated nursing school in 1979 and professionalism courses were going then.The courses will not change anything.
The key is job content ..... nursing tends to contain a mix of professional/trade/highly skilled and manual skills.
Can't try and make it 'professional' when a lot of the job isn't ...... that is reason why we still debate this 30+ years later.
If it were a proper profession like medicine or law....we would be spending 5 minutes on it
the irony of course being Surgery faced exactly the same issues and got over them ...
The main reason that nursing programs are starting to require courses in professionalism is that a lack of professionalism among nurses has been identified as a specific problem in the healthcare workplace, whereas that hasn't been a problem with doctors (however, maybe MDs should be required to take courses on interpersonal communication and holistic care). And by a lack of professionalism, I mean a lack of the qualities I mentioned. They're not just arbitrarily picking on nurses based on prejudice and assumptions- the drive to increase professionalism is based on evidence. For example- did you know that only about 38% of nurses are compliant with federal handwashing guidelines? That should be unacceptable considering the fact that nosocomial infections are currently a leading cause of death in the US. Complying with health and safety guidelines is, in my mind, one hallmark of professional behavior.The OP compared the role of the RN, as he sees it, to the McDonald's burger flipper. This is troubling to me not only because the knowledge base that one needs in order to practice nursing well is far more vast than that of a burger flipper, but also because of what comes to mind when I think of the attitude towards work of the average fast-food employee. I've worked in fast-food. People play hooky, come in late, cut corners, try to do as little work as possible, complain all day about having to be at work, and generally don't care at all about the quality of the finished product (well, in the case of fast food, neither does their employer). None of these things should be acceptable in nursing- because the kind of behavior one sees in the average fast-food employee is unprofessional, and patients deserve care of a higher caliber than the service one would expect at the taco bell drive thru.
And with the medical field, neither does the employer.
I wish to thank Ericsoln for starting this most interesting thread.Whilst I still largely assert that nursing is not a real profession .... I can now more readily see the shades of grey.
Now I believe nursing has SOME professional aspects but it also contains LARGER portions of trade/highly skilled/manual labour.
I am at peace with that.
And I can now more fully appreciate the personal significance of possessing a better employment fit.
Combining aptitude/experience/education as one's own personal skill package and actively seeking out the optimal situation for oneself.
So that means if one has a greater amount of real professional aptitude ...then should choose the right role. Try nurse practitioner or upper management.
Conversely, if one's skill level is more trade ....then go for the task-orientated job.
If one finds their niche with other like-minded nurses then life will be much easier.
I have learned that many smart and professionally-capable nurses are unhappy in their jobs because of the mismatch
Thats about where I've settled with it. I do realize I'm grouping people who claim to be acting out of "professionalism" in with the real professionals to a certain degree, but you have to admit, a lot of the professionalism stuff taught in class is FLUFF, plain and simple. No applicable use on the floor.
First, I appologize for how I expressed that. I certainly didn't mean to say that service work is unimportant- I was trying to be funny and came off as incredibly disrespectful. When I used "amateur" in that way, I was thinking back to when I was working in fast food. Myself and almost everyone I worked with were teenagers- generally not too committed to anything besides getting through the workday and making a buck. (oh yeah, and I once watched my manager pick a buffalo wing off the filthy floor and put it in its box with the rest to be sent on its way to the customer. I won't say where I worked, but it started with "Pizz" and ended with "utt." But really, when it comes down to it, the reason I don't expect professionalism from a fast-food employee is that professionalism isn't something that is cultivated by their employer. My employer was looking for someone who could perform their basic duties somewhat competently, and who doesn't steal. There wasn't much encouragement to perform better- except to do your duties faster. But that varies from company to company, I guess. There is a local fast-food chain in Portland that serves excellent food- and they employ high school kids and people without much work experience like every other chain- but they treat their workers well and expect them to provide good service in return. Their food is awesome, and the service is genuinely friendly.Also, there seems to be a lot of subjectivity in everyone's definition of what a profession is, so I consulted Merriam-Webster:
"4 a : a calling requiring specialized knowledge and often long and intensive academic preparation b : a principal calling, vocation, or employment"
I'd say that nursing and top-level cheffing (?) fit b. and to some degree a. I wouldn't consider the chef at TGI Fridays a "professional," but I certainly would use that word to describe someone like Jose Andres, or any chef of that caliber.
It's not cultivated by medical employers either. Come to my unit for a day or two and tell me where its being taught/cultivated/encouraged.
Night shift ratio of 8-10 pts. On any given night, usually about 2 of them are patients who were pushed out of the ICU to accommodate staffing. So, what I am handed is two patients who should be in the ICU and are, in EVERY sense of the word ICU patients........which is your typical ICU nurse workload.................PLUS 6-8 other patients.
Think thats bad? I'm not done yet.
Now, of the 6-8 remaining patients who truly are appropriate for a Pulmonary unit, at least two of them are high acuity. They are the end stage COPD pts and the elderly pneumonia patients who go from being comfortable to needing critical care within minutes. So, now we have an ICU nurse workload plus two acute patients PLUS 4-6 patients who are generally stable.
Want to know what my priority is on almost a daily basis? Not letting anyone die. pass my meds, do chart checks and document well enough that when the whole thing blows up...........I don't get thrown under the bus. Want to ask any of my 4-6 "generally stable" patients how much they saw me during the night? Between the initial assessment and giving meds.............about 10 min. each FOR THE ENTIRE 8 HOUR SHIFT. How much "pt. teaching", "holistic care" or "psychosocial support" do you think they get in that 10 minutes? It is with those 4-6 patients in mind that I used the "flipping burgers" analogy.
Thats not a "professional's" daily expectations/hopes. No quality to be had there regardless of how much I put my heart into it. No "Dimensions of Nursing" class is going to make that situation look "professional". I'll add here too...............my situation is not even slightly unique. The workload I am presented with is the rule, not the exception. This is what the avg. nurse faces on a daily basis.
Do I blame nurses for this? Yes and No.
No because: Its administration and management who let things get that way. Obviously "customer care" is not their priority although they talk about it constantly. They place us in a position where we must choose between the things that make nursing professional (pt. teaching, attending to psychosocial needs, compassion in the sense of spending time with people) and keeping people alive.
Yes because: Lets face it, if nursing were a "profession", they could not do this to us.
It's not cultivated by medical employers either. Come to my unit for a day or two and tell me where its being taught/cultivated/encouraged.Night shift ratio of 8-10 pts. On any given night, usually about 2 of them are patients who were pushed out of the ICU to accommodate staffing. So, what I am handed is two patients who should be in the ICU and are, in EVERY sense of the word ICU patients........which is your typical ICU nurse workload.................PLUS 6-8 other patients.
Think thats bad? I'm not done yet.
Now, of the 6-8 remaining patients who truly are appropriate for a Pulmonary unit, at least two of them are high acuity. They are the end stage COPD pts and the elderly pneumonia patients who go from being comfortable to needing critical care within minutes. So, now we have an ICU nurse workload plus two acute patients PLUS 4-6 patients who are generally stable.
Want to know what my priority is on almost a daily basis? Not letting anyone die. pass my meds, do chart checks and document well enough that when the whole thing blows up...........I don't get thrown under the bus. Want to ask any of my 4-6 "generally stable" patients how much they saw me during the night? Between the initial assessment and giving meds.............about 10 min. each FOR THE ENTIRE 8 HOUR SHIFT. How much "pt. teaching", "holistic care" or "psychosocial support" do you think they get in that 10 minutes? It is with those 4-6 patients in mind that I used the "flipping burgers" analogy.
Thats not a "professional's" daily expectations/hopes. No quality to be had there regardless of how much I put my heart into it. No "Dimensions of Nursing" class is going to make that situation look "professional". I'll add here too...............my situation is not even slightly unique. The workload I am presented with is the rule, not the exception. This is what the avg. nurse faces on a daily basis.
Do I blame nurses for this? Yes and No.
No because: Its administration and management who let things get that way. Obviously "customer care" is not their priority although they talk about it constantly. They place us in a position where we must choose between the things that make nursing professional (pt. teaching, attending to psychosocial needs, compassion in the sense of spending time with people) and keeping people alive.
Yes because: Lets face it, if nursing were a "profession", they could not do this to us.
I'm still not getting what nursing being a "profession" or not has to do with this- law is supposedly a "profession," but ask a public defender if their workload is gives them adequate time to provide a decent legal defense for their clients.
The distinction I make is between a "profession"using a Merriam Webster definition of profession: "a principle calling, vocation or employment" vs. a "job": "a specific role, duty, or function." I make the distinction not because I think that "profession" holds more prestige, but because it's something I'm dedicating myself to for the long-run rather than something I'm simply doing right now to pay the bills.
But this is clearly a problem- no nurse can perform their duty safely under those conditions, and patient care clearly suffers when that happens. And I've experienced some of that in long-term care- with lower-acuity clients, just far more of them. In memory-care I'd spend entire shifts it seems running from tab-alarm to tab-alarm trying to keep people from falling down- often without success.
As a CNL, poor staffing ratios is an issue I will have to address once I'm done with school- it's definitely something that our instructors are already challenging us to start thinking about, though we're just in the first semester of our pre-licencure component of our program. No easy answer, since from the hospital's perspective it's all about the $$$.
I must admit that I haven't read the entire thread, just bits and pieces. My apologies if this post is redundant.
Inferiority complex... This was one of the first things that I noticed upon considering nursing as a career. There is no clearer evidence than the desire to hang letters off of nurses' names. It never ceases to crack me up when I see the alphabet soup that's twice as long as the person's name... especially when it starts with a bachelor's degree.
The inferiority complex is also evidenced by the decision to publish nursing articles in APA format rather than using the AMA standard found in medical journals.
Unique body of knowledge... I'm still waiting on this one. I didn't see it in my pre-reqs. I didn't see it in my core nursing classes. I didn't see it in my MSN classes. I haven't seen it yet as a practicing nurse. Just what is this unique body of knowledge?
I was simply amazed at the heavy emphasis on writing in nursing school as opposed to an emphasis on rigorous hard sciences and problem solving.
Autonomy... What a joke. We do what the physicians and the hospital protocols tell us to do. If we had autonomy, we wouldn't have to get permission from the physicians for every little thing.
Sure, some nurses in some units have earned some autonomy from the physicians that they work with but that is something that those individuals have been given by the physicians under protocols, not true autonomy and independent decision making.
There is nothing wrong with being a skilled trade. I spent nearly 20 years as an engineer and there is nothing special about being a "professional."
Another thought regarding autonomy...
What do physicians do when they admit or round? They write ORDERS. To whom are those orders directed? The nurses.
From where, then, do we get this silly notion that we are somehow collaborating with the physicians rather than reporting to them? Let's be honest... we are not autonomous... we are essentially the eyes, ears, and hands (for very simple tasks) of the physician in carrying out their ORDERS as regards THEIR patients.
The only nurses with some autonomy are the APNs.
Autonomy... What a joke. We do what the physicians and the hospital protocols tell us to do. If we had autonomy, we wouldn't have to get permission from the physicians for every little thing.
One of the things that I find kind of troubling from my nursing classes so far is that despite the fact that doctors still seem to hold most of the power in most healthcare workplaces, a nurse can have action taken against their licence for carrying out a doctor's order if it is contraindicated for a patient, or just plain wrong. Ultimately having multiple layers of accountability is a good thing, but it doesn't seem fair in a workplace with an environment where nurses are made to feel entirely subordinate to doctors.
Boognish
85 Posts
First, I appologize for how I expressed that. I certainly didn't mean to say that service work is unimportant- I was trying to be funny and came off as incredibly disrespectful. When I used "amateur" in that way, I was thinking back to when I was working in fast food. Myself and almost everyone I worked with were teenagers- generally not too committed to anything besides getting through the workday and making a buck. (oh yeah, and I once watched my manager pick a buffalo wing off the filthy floor and put it in its box with the rest to be sent on its way to the customer. I won't say where I worked, but it started with "Pizz" and ended with "utt." But really, when it comes down to it, the reason I don't expect professionalism from a fast-food employee is that professionalism isn't something that is cultivated by their employer. My employer was looking for someone who could perform their basic duties somewhat competently, and who doesn't steal. There wasn't much encouragement to perform better- except to do your duties faster. But that varies from company to company, I guess. There is a local fast-food chain in Portland that serves excellent food- and they employ high school kids and people without much work experience like every other chain- but they treat their workers well and expect them to provide good service in return. Their food is awesome, and the service is genuinely friendly.
Also, there seems to be a lot of subjectivity in everyone's definition of what a profession is, so I consulted Merriam-Webster:
"4 a : a calling requiring specialized knowledge and often long and intensive academic preparation b : a principal calling, vocation, or employment"
I'd say that nursing and top-level cheffing (?) fit b. and to some degree a. I wouldn't consider the chef at TGI Fridays a "professional," but I certainly would use that word to describe someone like Jose Andres, or any chef of that caliber.