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?

[ZippyGBR, BSN, RN]

Be mindful of the law of unintended consequences: Along with the designation of "learned professional" comes the designation of "exempt employee."

Is that really what you're advocating for?

'exempt from what '

or is this a case of the poorly constructed employment and occupational health and safety legislation in the US being the tail that wags the dog ... combined with the fragmentation of of professional voice that seems endemic in the USA because of the way in which Unions work and the irrational fear of national rather than regional representation and management of things ...

[Altra, BSN, RN]

'exempt from what '

or is this a case of the poorly constructed employment and occupational health and safety legislation in the US being the tail that wags the dog ... combined with the fragmentation of of professional voice that seems endemic in the USA because of the way in which Unions work and the irrational fear of national rather than regional representation and management of things ...

This is a U.S.-specific term meaning an employee exempt from federal labor laws regarding overtime pay for work in excess of 40 hours/week.

[RunningWithScissors]

This thread is getting old.

Then stop reading it.

Kudos to the OP who many months ago began this discussion. I am enjoying it, except for the occasional unintelligable ramblings of a few. (whatthef, if you have to get lost in your own verbage you are obviously trying too hard to make your point). Which leads back to the OP's point, some nurses think that because they can string big words together and hypothesize, they are somehow better than other skilled trades. We can't make any decisions not approved by administration or ordered by a doctor. If you even check a blood sugar on a patient without an order you risk reprimand. If you can't get an order on a patient who is nearing distress you're screwed. It's an illusion of autonomy. I think the term paramedics have for nurses is puppets, isn't it? As in we can only move if somebody else pulls our strings.

[ZippyGBR, BSN, RN]

Then stop reading it.

Kudos to the OP who many months ago began this discussion. I am enjoying it, except for the occasional unintelligable ramblings of a few. (whatthef, if you have to get lost in your own verbage you are obviously trying too hard to make your point). Which leads back to the OP's point, some nurses think that because they can string big words together and hypothesize, they are somehow better than other skilled trades. We can't make any decisions not approved by administration or ordered by a doctor. If you even check a blood sugar on a patient without an order you risk reprimand. If you can't get an order on a patient who is nearing distress you're screwed. It's an illusion of autonomy. I think the term paramedics have for nurses is puppets, isn't it? As in we can only move if somebody else pulls our strings.

that's about a system not about the Profession of Nursing, it's also about Nursing not making sure it has control over nursing actions ...

Paramedics ( or should that be paramuppets given the puppet theme? ) are fine ones to talk about 'illusions of autonomy' especially in places where they aren't Health Professionals and have no scope of practice unless there is Medical control in place.. " hello pot this is kettle, colour check, over "

[eriksoln, BSN, RN]

This thread is getting old. I worked hard to get where I am. I worked all the way through nursing school, my BSN program and still working full time while in a masters program. With each step of my education I have become more professional. I didn't mean to. It wasn't planned. It just happened. Some of what they were teaching me managed to sink in. I repeatedly thought that nursing theory was pointless, and yet, I find myself using parts of it in my practice. Yes, my practice. Isn't that an oddly "professional" term? Crazy thing is that by the time I have finished my education, I will have spent about as much time as I would have had I gone to med school. Do I feel like a professional? Absolutely. If you don't, then maybe you are not promoting nursing in the right light. Maybe you would be better suited to being an electrician. Good luck to ya.

Do you feel that time was wasted if it was suddenly announced that nursing IS a skilled trade, not a profession?

Go to any thread discussing RN to BSN curriculum, the majority of the people, especially those who have done it, will tell you it is all "fluff", writing papers about the obvious. For the most part, post ADN, nursing courses consist of teaching common sense facts with new fangled names and labels. Thats what the majority of nursing theory is. Which brings us back to the skilled trades.............you don't see plumbers or electricians going back to school to make up new names for common sense actions. If they do go on to further their education, its with purpose and direction.........done in the field, and said education truly makes a difference on on the field performance.

Truthfully..................you can line up 100 RNs, some of which are ADN, some BSN, some Master degree...........watch them work the floor...............and you have no idea which is which. Hmmmmmm, I wonder why? Oh, wait, right...................cause post ADN it's all fluff and has no practical application.

[ZippyGBR, BSN, RN]

Truthfully..................you can line up 100 RNs, some of which are ADN, some BSN, some Master degree...........watch them work the floor...............and you have no idea which is which. Hmmmmmm, I wonder why? Oh, wait, right...................cause post ADN it's all fluff and has no practical application.

highly scientific method there, take a small part of nursing practice, which especially in 'ordinary ward work' doesn't need any of the skills or knowledge developed by education above and beyond the bare minimums and use that to 'prove' that education is 'just fluff' , rather than considering the whole of the individual's nursing practice ...

[jjjoy, LPN]

take a small part of nursing practice, which especially in 'ordinary ward work' doesn't need any of the skills or knowledge developed by education above and beyond the bare minimums and use that to 'prove' that education is 'just fluff' , rather than considering the whole of the individual's nursing practice ...

It almost sounds like you're implying that the minimal education required to practice 'ordinary' nursing on a ward isn't very impressive. Did I read that wrong?

I could argue that hospitals don't want it to be *that* difficult to get a nursing license. If it takes an extensive amount of education to earn a nursing license, the more expensive it will be keep those highly educated nurses at the bedside. And more and more work will be 'delegated' to non-licensed staff until getting face time with your licensed nurse might be as difficult as getting face time with your physician! A patient in a hospital might only see a licensed nurse once a day, like the physician, doing rounds or the like, and the rest of their 'nursing care' will be provided by lesser-educated, lower-paid, less autonomous non-nurses!

[Cul2]

There's been a bit of comment here about "nursing theory" and it's relationship to professionalism. Theory is theory. Call it nursing theory or teaching theory or or legal theory. The key to any professional is that they don't "only" follow orders. Of course, we all have a supervisor and have to follow some orders. Any real professional should be able to describe his or her philosophy of education, nursing, law, etc, and demonstrate its relationship to that individual's practice. Why do you do what you do the way you do it. If your DON asked you why you just did what you did the way you did it, could you explain? Granted, some things we do because that's how we've been taught. But if that's the only reason you do something, if there's no critical thinking involved, no weighing of the alternatives, no questioning what's best under the specific circumstances -- then, yes, you're not a professional. Most nurses are not just following orders. They're making critical decisions every day, some that make the difference between life and death.

[backatit2]

yeah, i guess teachers aren't professionals either since they have to answer to administration, huh?

they just have to pretend to be

[eriksoln, BSN, RN]

highly scientific method there, take a small part of nursing practice, which especially in 'ordinary ward work' doesn't need any of the skills or knowledge developed by education above and beyond the bare minimums and use that to 'prove' that education is 'just fluff' , rather than considering the whole of the individual's nursing practice ...

I hope "ordinary ward work" does not equal pt. care. If so............well, thats between you and your patients.

Ordinary ward work is why we exist. The point of nursing is to "nurse" people back to good health. If we don't do that, anything else is just wasted time and effort. Thats why I can't stand the "nose in the air" types with 10 different titles on their badge who think they contribute something to nursing because they sit in an office and write of forms for the real nurses to fill out. Those are your "professional" m-f, no holidays salaried "nurses" (if you call them that) walking around in circles putting labels on common sense things and acting like they have some sort of "Jedi Critical Thinking" power or something. Bah.

If nursing were to give up the identity crisis and accept that it is a skilled trade..............those types would be out the door. There is some huge addition by subtraction, and the nursing field needs it.

[backatit2]

I hope "ordinary ward work" does not equal pt. care. If so............well, thats between you and your patients.

Ordinary ward work is why we exist. The point of nursing is to "nurse" people back to good health. If we don't do that, anything else is just wasted time and effort. Thats why I can't stand the "nose in the air" types with 10 different titles on their badge who think they contribute something to nursing because they sit in an office and write of forms for the real nurses to fill out. Those are your "professional" m-f, no holidays salaried "nurses" (if you call them that) walking around in circles putting labels on common sense things and acting like they have some sort of "Jedi Critical Thinking" power or something. Bah.

If nursing were to give up the identity crisis and accept that it is a skilled trade..............those types would be out the door. There is some huge addition by subtraction, and the nursing field needs it.

at least we know the motivation behind the post now.

[ZippyGBR, BSN, RN]

It almost sounds like you're implying that the minimal education required to practice 'ordinary' nursing on a ward isn't very impressive. Did I read that wrong?

the fact is that the education required to required to be a 'bog standard staff nurse' whose role to provide a warm body with a pIN no. and do none specialised ward work, serves it's purpose, however in the interests of patient care you need to be better than 'bog standard' ideally in more than one of the following areas

- Speciality specific skills, knowledge and experience e.g. the ED nurses who are referrers for X ray, can close wounds, apply PoP, provide 'provider irrelevant' assessment and resuscitative care ... each speciality has it;s own set of speciality specific special skills to be developed

- Be an effective teacher , mentor/ preceptor , by having a suitable preparation for the role to be able to deliver specialised teaching to patients and to be able to support and supervise pre and post registration Student Nurses , other Health professional students and support the development of your Assistant and Associate Practitioner grades.

- Be able to research, develop guidelines and undertake research activities and have those activities accepted across the multi disciplinary team

- Manage your team whether that's day to day being 'in charge' of a clinical area or the greater responsibilities that come with team leader / Ward manager roles and to be able to case manage 'your' patients and ensure their care is progressed against the ideal and deal with deviations from this. ( or perhaps the full page lists of multi disciplinary actions we routinely create are just 'fluff' and not a valid tool in coordinating the patient journey. the Doctor may be 'Master' of the vessel , but the helm and the chartroom are Nurses .... )

I could argue that hospitals don't want it to be *that* difficult to get a nursing license. If it takes an extensive amount of education to earn a nursing license, the more expensive it will be keep those highly educated nurses at the bedside.

despite the savings in reduced admission length, reduced re-admission rates, reduced complications etc that come with receiving speciality appropriate care rather than the warm body with the PIN no who waits for someone, anyone to give them an 'order'.

And more and more work will be 'delegated' to non-licensed staff until getting face time with your licensed nurse might be as difficult as getting face time with your physician! A patient in a hospital might only see a licensed nurse once a day, like the physician, doing rounds or the like, and the rest of their 'nursing care' will be provided by lesser-educated, lower-paid, less autonomous non-nurses!

This is some thing where the multidisciplinary team and good coherent evidence based standards of care comes into play, of course the failed baked bean stackers will try and cut corners if there is no 'line in the sand'. It's far harder to cut those corners if the line in the sand is drawn firmly and all clinicians regardless of their professions agree that the line is drawn there and profressional and regualtory approvals require that line not to be crossed ...