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?

[carolmaccas66, BSN, RN]

Florence Nightingale would be turning in her grave!

She fought long and hard for nursing to be seen as a profession, standing up to the top doctors of her time.

Nursing is a mixture of trade and profession I suppose, but universities charge too much for nursing and the initial degree is too long. We could learn everything we need to in 2 years, easy. And we are not seen as a profession, many people screw up their face and say in a slightly disugsted voice: "Why on earth did you want to be a nurse/are you a nurse?"

I don't really think, in many instances, we are seen as much more than doctor's handmaidens at best to be honest.

[eriksoln, BSN, RN]

Florence Nightingale would be turning in her grave!

She fought long and hard for nursing to be seen as a profession, standing up to the top doctors of her time.

Nursing is a mixture of trade and profession I suppose, but universities charge too much for nursing and the initial degree is too long. We could learn everything we need to in 2 years, easy. And we are not seen as a profession, many people screw up their face and say in a slightly disugsted voice: "Why on earth did you want to be a nurse/are you a nurse?"

I don't really think, in many instances, we are seen as much more than doctor's handmaidens at best to be honest.

That is a whole other debate. FN was displaying severe psychological issues IMO. Can anyone say OVERCOMPENSATION? I know anyone who met her during her lifetime can. I could write a ten page article on how much she is holding nursing back from being a profession.

[Fribblet]

Florence Nightingale would be turning in her grave!

She fought long and hard for nursing to be seen as a profession, standing up to the top doctors of her time.

Nursing is a mixture of trade and profession I suppose, but universities charge too much for nursing and the initial degree is too long. We could learn everything we need to in 2 years, easy. And we are not seen as a profession, many people screw up their face and say in a slightly disugsted voice: "Why on earth did you want to be a nurse/are you a nurse?"

I don't really think, in many instances, we are seen as much more than doctor's handmaidens at best to be honest.

The bolded statements are ideas that are holding nursing back from becoming a profession.

[ZippyGBR, BSN, RN]

I agree with some of your points actually..... Nursing will never be a profession as long as it is controlled by others, does not have a set standard for admission, and does not have capability for autonomous practice.

- Controlled by others ? is this really the case or is this only the case in the USA where who can bill rules all ?

In the UK we have executive Directors of Nursing on the board of the vastest majority of organisations who employ nurses, and they are the professional managers of the Nursing staff not doctors or lay managers ... the one organisation that lets us down in the UK is the Defence Nursing Services as each of the three Services Director of nursing services is 'only' OF-5 at present where the Surgeon general is OF7 or 8- that said the Directors of Nursing services are not a force to be trifled with .

edit to add, the NMC is nurses and managers on the paid side and professional conduct is Nurses and Lay members of the panel, so it;s not as if we are controlled by others there

- Set Standard for admission - there is one , the question is is this set standard high enough in some places - especially when some Countries have had greater than half a bachelors degree ( e.g. the DipHE standard in the UK ) for many years and are on track to all graduate entry for RNs.

There is also the issue of the Duration of the programme, as more and more US educated nurses are discovering if they attempt to get registered in an EU country, the 4600 hours, 2300 in practice placements requirement is often more than they have done so they have to jump through hoops - equally the opposite direction becasue nursing in the US doesn't have 'branch' registration there are issues with the pre-registration exposure to the different 'branches' ...

Tied in with this is what (if any) is the role of the second level registered Nurse ( i.e. LPN/LVN/EN) and are they cost effective enough to be worth while vs paying more for a First level RN or paying less for an None -registered by well educated and trained Asssistant or Associate practitioner grade whose role is defined as supportive to the Accountable first level RN

-Autonomous practice , is this perhaps a symptom from the USAn viewpoint of a system which requires 'physician orders' for intervention and care that is within the domain,skills and knowledge of other Health Professionals to undertake autonomously, which elsewhere in the world they do so.

To illustrate the above see discussions past on things like flushing catheters , getting therapy input, changing dietary status ... even doing a dressing - that said certain none stock dressings for us have to be 'prescribed' by a Doctor ... the reality of course is that the house officer ( intern for leftpondians) prescribes it on the basis of a communication note left in their 'things to do tray' with the Drug chart ...

The position of nurse practitioner, NP, seems to come closest to the "professional" category in meeting those requirements. But obviously not everyone who's a nurse will be an NP. For those who are concerned about being considered a professional maybe the NP route is the one to take.

more toys does not equal more professional ...

[wooh, BSN, RN]

To illustrate the above see discussions past on things like flushing catheters , getting therapy input, changing dietary status ... even doing a dressing - that said certain none stock dressings for us have to be 'prescribed' by a Doctor ... the reality of course is that the house officer ( intern for leftpondians) prescribes it on the basis of a communication note left in their 'things to do tray' with the Drug chart ...

I think I've said before (and probably on this thread) that a lot of nurses do not WANT more autonomy. Me in report, "So I checked residual on the feeds and held it for an hour." Oncoming nurse, "Do we have an order for that?" "No, but I thought it was stupid to continue the feed for an hour when they have the last 4 hours still in their stomach, and since I have some common sense, I figured holding the feeds for an hour was better than them vomiting and aspirating."

Lots of nurses want an MD order for EVERYTHING because that frees them from having to think for themselves and be held accountable for their practice. Autonomy leads to accountability, and it's so much easier to just do exactly as we're told.

[jjjoy, LPN]

I sometimes think that it's just asking too much to maintain one generic RN curriculum/licensure across the board (as it is in the US). You can only fit so much education/training into any given time frame/curriculum. So do you go with very specialized training (such as X-ray techs, ultrasound techs, scrub techs) who learn what they need to work in a specific area? Or with a generalist qualification (eg RNs) who know a little about a lot but still need lots of training in whatever speciality they end up working in? (In this case, I'm considering bedside care as it's own specialty.) MDs do have just one basic MD license but to practice even "general medicine" requires formal specialization beyond the MD.

It would seem that in the past, many health care roles were filled by RNs. After all, why train up someone from scratch when you could just lure an already experienced nurse away from the bedside? However, as medical technology and specialties grow, it makes more sense to train up personnel 'from scratch' into various specialties rather than to cull them from the ranks of registered nurses. The same is happening to MDs. It would seem that primary care providers (NPs and PAs) can be specially trained up, so why insist on only MDs filling that role?

Sometimes it seems that in attempting to keep one standard RN license, RN education has to cover such a broad spectrum of topics in such a short time that new grad RNs may feel underprepared to work in just about any area! If one instead increased the depth of this education in addition to maintaining the bredth, then you might end up coming up with something that takes as long as physician education/training. Could we afford to pay enough to keep these RNs at the bedside or in other roles that have traditionally been filled by RNs?

(I specifically tried to avoid referencing 'nursing' or 'medicine' as fields as I don't see them as mutually exclusive).

[cbcle]

I agree with you 100%! Nursing is ultimately blue collar work. We wear a uniform, we perform tasks, we clock in and clock out and follow orders. I have no problem with this and don't understand why so many people do! I love being a nurse. I feel fulfilled, I love my patients, but I don't feel the need to seek additional respect or make my job seem more glamorous than it is. I wish others would stop being so pretentious about nursing. All it does is create additional paperwork.

[RunningWithScissors]

If you have to punch a clock and wear a uniform, you ARE a laborer. Simple.

Also, what "profession" do you know of has to leave the office early with a cut in pay for the day if work is slow?

[RunningWithScissors]

They responded "Well, you don't sign RN after everything, you don't tell people you are an RN (in other words, every sentence out of my mouth isn't preempted with "I'm a nurse and I think" as if it matters)

I saw an episode of "I shouldn't be alive" last week where they had a plane crash and some chick runs around saying "I'm a nurse I'm a nurse" tending to major gashes and head wounds and then she runs off into the jungle with 2 others leaving the injured people totally alone to fend for themselves. Funny.

I also remember an Expedia commercial where some gal is browsing hotels for "some conference" she is being sent to by her employer...well, here in the nursing world, we have to BEG to use ETO in order to attend conferences paid for ourselves. Just what you would expect from burger-flippers...I mean granny-flippers.

[RunningWithScissors]

Yes, the plumber and electrician and chimney sweep don't spend as much time in school. Hmmmm.......could it be partly because their school curriculum is not flooded with silliness like "Chimney sweep diagnosis" or "plumbing toilet overflow careplans"?

I have long thought about how expensive it would be if electricians and plumbers had to document every wire or hose used and explain why they chose that particular item and diagnosis for the problem, but also needed an order from the company before they could actually perform the task, and then document retrospectively what they had just done. You know, for safety, and in case they get sued for malpractice if the place burns down or floods. Nothing would EVER get done. We, as nurses, are VERY good at getting **** done, jumping through the obstacles set by administration. This is as bad as it' s ever been, and I feel we are nearing the tipping point as far as how many tasks can you pile on before it collapses.

[Music in My Heart]

If you have to punch a clock and wear a uniform, you ARE a laborer.

Quite UNTRUE.

The distinction between laborer and tradesperson, either of whom may or may not wear a uniform, is made between the skill required to perform the task and the level of responsibility.

In the machine shop, for example, the laborer will unband the stock and position it for use. The laborer may cut the stock to the specification of the machinist (or their SOP). There is very little thought required to fulfill the laborer's duties. The machinist (a tradesperson), however, has the responsibility of converting the raw material into the finished part which meets the specification ordered by the engineer. The engineer (a professional), is responsible for developing the specifications to ensure that the finished part will be suitable for its application.

Nurses are most certainly not laborers. Bedside nurses are analogous to machinists, electricians, etc - they (we) are skilled tradespeople. The CNAs fit the laborer bill.

[Music in My Heart]

Yes, the plumber and electrician and chimney sweep don't spend as much time in school.

I don't know much about chimney sweeps (besides Bert, that is) but my initial reaction is that they are not tradespeople as are the electricians and plumbers. And I hate to burst your bubble but the training required to become a journey-level electrician or plumber exceeds that to become an RN.