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 Spinal Cord injuries, Emergency+EMS.
I hope "ordinary ward work" does not equal pt. care. If so............well, thats between you and your patients.

the 'ordinary ward work' is the basic cares, the medicines administration , it forgets the speciality specific stuff, the specialised teaching , the 'advanced practice' .... the stuff that provides the 'value added'

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.

who who does the specialised patient education ? who does the specialised clinical practice ? the research, audit and education of students ?

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.

Nursing has an identity crisis solely because of the "we don't need no steekin book lernin' " types and the inverse snobbery displayed aobve , admittedly some of the pussyfooting like NANDA ( unknown outside the USA) is a dead end and the messed up way in which US healthcare consumes an obscene amount of resources on pointless adminstration to line the pockets of inusrers and the business model which sees Physicians as the only 'earners' in a health system ...

if you want to be seen as a tradesman that follows orders, fine, just don't come crying when you fall off the back of the bus ....

Specializes in NICU.

Sorry I am late on this debate, but after I read the entire thread I couldn't help but comment that you defined what a profession was, but nobody mentioned the other definitions in question. So I asked my almighty definition consultant, Merriam-Webster (via my handy iphone app of course :)), to enlighten us on what it thinks about this matter.

nurse (3): a person who cares for the sick or infirm; specifically : a licensed health-care professional who practices independently or is supervised by a physician, surgeon, or dentist and who is skilled in promoting and mainating health - compare licensed practical nurse, registered nurse

profession (4): (a): a calling requiring specialized knowledge and often long and intensive academic preparation

(b): a principal calling, vocation, or employment

©: the whole body of persons engaged in a calling

Examples:

- The doctor talked to students who are thinking about entering the profession.

- Most professions in the medical field require years of training.

- Their daughter recently became a member of the medical profession.

labor (4): (a): an economic group comprising those who do manual labor or work for wages

(b1): workers employed in an establishment

(b2): workers available for employment

©: the organizations or officials representing groups of workers

trade (3): (a):the business or work in which one engages regularly: occupation

(b) an occupation requiring manual or mechanical skill: craft

© the persons engaged in an occupation, business, or industry

craft (2): (a): an occupation or trade requiring manual dexterity or artistic skill

service (2): (a): the work performed by one that serves

(b) help, use, benefit

© contribution to the welfare of others

(d) disposal for use

So my opinion is yes, I think there's a little bit of both in nursing. I don't mind being considered a skilled laborer, but I also like being a professional too. :nurse:

Specializes in M/S, Travel Nursing, Pulmonary.
the 'ordinary ward work' is the basic cares, the medicines administration , it forgets the speciality specific stuff, the specialised teaching , the 'advanced practice' .... the stuff that provides the 'value added'

who who does the specialised patient education ? who does the specialised clinical practice ? the research, audit and education of students ?

Nursing has an identity crisis solely because of the "we don't need no steekin book lernin' " types and the inverse snobbery displayed aobve , admittedly some of the pussyfooting like NANDA ( unknown outside the USA) is a dead end and the messed up way in which US healthcare consumes an obscene amount of resources on pointless adminstration to line the pockets of inusrers and the business model which sees Physicians as the only 'earners' in a health system ...

if you want to be seen as a tradesman that follows orders, fine, just don't come crying when you fall off the back of the bus ....

Thats all I'm saying though. Cut the crap like NANDA. Refocus our educational policies and some of our procedures to be more.......pt. focused rather than walking in circles trying to impress our peers.

Did someone say we only follow orders? I don't think it was me. I'm sure it wasn't. Autonomy is part of being a professional, but thats not the part that I have issue with. Its the "unique body of knowlege" for the most part I see lacking.

Despite needing a doctor's order to initiate 99% of care (meds, tests, invasive interventions), once they are in effect, it is our place/job to realize when something is gone awry. Pt. on a heparin gtt. but gums bleed from simply eating bread...........I'm getting a PTT, shutting off the heparin and doing some serious "safety" education (telling the guy not to fall stuff) before I even bother calling the doctor. Yes, I'll call the doctor of course, but my nursing comes first. Thats autonomy enough for me.

Its the "unique body of knowledge" I see lacking. Seriously.................point out one thing nursing has contributed that wasn't already known. Is there anything?

Specializes in M/S, Travel Nursing, Pulmonary.
Sorry I am late on this debate, but after I read the entire thread I couldn't help but comment that you defined what a profession was, but nobody mentioned the other definitions in question. So I asked my almighty definition consultant, Merriam-Webster (via my handy iphone app of course :)), to enlighten us on what it thinks about this matter.

nurse (3): a person who cares for the sick or infirm; specifically : a licensed health-care professional who practices independently or is supervised by a physician, surgeon, or dentist and who is skilled in promoting and mainating health - compare licensed practical nurse, registered nurse

profession (4): (a): a calling requiring specialized knowledge and often long and intensive academic preparation

(b): a principal calling, vocation, or employment

©: the whole body of persons engaged in a calling

Examples:

- The doctor talked to students who are thinking about entering the profession.

- Most professions in the medical field require years of training.

- Their daughter recently became a member of the medical profession.

labor (4): (a): an economic group comprising those who do manual labor or work for wages

(b1): workers employed in an establishment

(b2): workers available for employment

©: the organizations or officials representing groups of workers

trade (3): (a):the business or work in which one engages regularly: occupation

(b) an occupation requiring manual or mechanical skill: craft

© the persons engaged in an occupation, business, or industry

craft (2): (a): an occupation or trade requiring manual dexterity or artistic skill

service (2): (a): the work performed by one that serves

(b) help, use, benefit

© contribution to the welfare of others

(d) disposal for use

So my opinion is yes, I think there's a little bit of both in nursing. I don't mind being considered a skilled laborer, but I also like being a professional too. :nurse:

Ah ha. Yes. Way back in this thread, someone suggested "craft" for the new term. "Nursing Craft".

I think that one fits best too. Because of the "artistic skill" needed. I've always said nursing is aesthetic, not painting by numbers.

Thats what I am. Not one of these "professionals" I described before. I am a study of the Nursing Craft.

Specializes in Rodeo Nursing (Neuro).

I can't help getting my hackles up a bit when I read someone disparaging the US system of healthcare, but then I recall, oh, yeah, I too disparage the US system of healthcare. I don't actually think most of the problem is with the healthcare industry, itself, but with the multiple layers of hoops we have to jump through to satisfy insurance companies and lawyers.

But I think disparaging "ordinary ward work" goes to the crux of this argument. It at least appears that there is an element in nursing that prioritizes patient education, for example, over a clean bottom and turn, deep breathe, and cough. It sure looks like a lot of the advocacy for professional standing is about nurses doing what docs already do, and aides doing what nurses used to do. I think that's what jjjoy fears, and I know it's what I fear. I've never worked in LTC, so I may be all wrong, but from what I understand, that's about how it works: RN sits in an office, delegating to LPNs who supervise CNAs who do most of the direct patient care. (And news services report the appalling state of care in LTC facilities.) I don't think that's a model for acute care.

I don't really have an argument with Zippy and others if they're saying nursing is more than wiping butts and passing pills. My problem is with the view I have at times encountered that nursing is instead of wiping butts and passing pills. I have encountered a few--not many, really--professionally trained nurses who see a fair portion of nursing care as beneath their dignity. And I am disturbed that a portion of nursing leadership seems to come from that school of thought.

I don't really have a problem with being designated a professional. I'm not actually offended if you call me a gentleman. I do think both terms are a bit archaic, and I've known a fair number of women who bridle at being called ladies. I do try to practice professionally and I think I am a gentle man, but I don't even own a lace hanky, much less carry one. I'm not entirely sure about Erik's "unique body of knowledge." I'm not sure how I would define one. But I have called a neurosurgeon at 0300 to say a patient "doesn't look right," and had them come right away to see what's going on. As far as I can recall, there is no NANDA definition for "doesn't look right," and I wouldn't have time to look it up if there was. To me, where nursing becomes nursecraft is that area where intuition takes over because science is too slow or too focused. It's that Aha! moment when you realize a patient is asking how their incision looks not because they are worried about infection, they're worried whether they're going to look like Frankenstein.

I like the term that someone used elsewhere in this thread, "paraprofessional." It seems, to me, to place us right where we belong: one foot in the Ivory Tower--because we do need evidence based practice and nursing theory, and even nursing diagnoses--but one foot also in the trenches, because if not us, who?

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

I appreciate your thoughtful response and perspective! I'm wondering specifically about those non-specialized ward nurses. Are they of a different professional ranking than more specialized nurses? I could see an argument that acute care floor nursing *is* it's own specialty. To be able to handle several patients with such a wide variety of conditions and acuities *is* a skill unto itself that some nurses great in other areas (such as ICU) might not be prepared to handle.

I don't know about in other countries, but in the US floor nursing is considered by many as the "ground floor" of most clinical nursing practice. Yes, some may go directly into public health, or even advanced practice, but RNs are generally valued due to their EXPERIENCE not their EDUCATION. The education is required to get the license that is legally required. But the real value most employers are looking for is proficient clinical skills (prioritization, judgement, and the practical skills to provide required intervention) which many new US nursing graduates do not possess until after working in acute care for at least a year or two.

- Speciality specific skills, ...

- Be an effective teacher , mentor/ preceptor

- Be able to research, develop guidelines and undertake research activities...

- Manage your team...

Your list of skills that go beyond 'basic' floor nursing is valid and demonstrates the many different roles that nurses may play. I'd question, though, how much of those functions is "nursing" versus a nurse who is filling another function in relation to nurses. Lawyers, accountants, plumbers, etc all may have to teach, research, manage as part of their job. Many nurses do manage others or train new nurses; but some nurse roles never call for those functions I'll agree that nurses are professionaly obligated to educate patients on some level. But some nursing positions do not require or allow for much educating, eg a circulating nurse. And with that broad of a definition of 'educating', I'd argue that all people in custome service engage in 'educating' customers on some level.

In regard to specialized clinical skills, how do we deal with the overlap between specialized nursing skills and almost identical specialized clinical skills provided by adequately prepared non-nurses? (I will assume employers ensure adequate preparation on the part of non-nurses since I'm also assuming adequate preparation on the part of licensed nurses; after all, one could argue that current regulations do not *actually* ensure adequate preparation for many nursing roles.)

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'.

What you say makes sense. I just don't see that it has any real relation to whether or not the term "profession" applies to nursing. It sounds like you're saying that practitioners in fields not traditionally considered "professions" need not be more than just "warm bodies who wait for orders." Granted, in some jobs mindless, low quality performance doesn't put as much at risk as in direct patient care. But any decent employer will not allow mindless, low quality performance. Of course, there are some employers that will allow mindless, low quality performance to persist, in order to keep costs down for example, and that's true unfortunately in health care as well.

we do need evidence based practice and nursing theory, and even nursing diagnoses--but one foot also in the trenches, because if not us, who?

Good point (with the caveat that nursing diagnoses as taught in US nursing schools need some major reworking!)

Specializes in Nursing Professional Development.

I appreciate the civil tone and thoughtful exploration of some participants in this thread. But I have to disagree with the idea that because there is such a significant "action" element (or "craft") that we shouldn't be professionals.

If the "action" element were sufficient to disqualify us from being considered professionals, then no one would be a professional. Doctors, scientists, lawyers, teachers, etc. -- all have "crafts" that they practice. That doesn't prevent them from being professionals.

The key that you are missing is that: In a profession, the practice of that profession (craft) is based on knowledge that the person has learned through study -- usually, a combination of formal education and practical experience. The senior members of a professional oversee the education and certification of those new to the profession.

The profession of nursing includes both the academic discipline of nursing and practice of nursing. Nursing is both an art and a science. Our science is our knowledge base. Our art is how we practice -- what we do with that knowledge to help people through the practice of nursing. Nursing is a practice discipline: the purpose of our knowledge development is to provide a foundation upon which to base our nursing care. The fact that we do something with our knowledge and take action does not take away from our professionalism.

If teaching is a considered "a profession" then I'll put nursing into that category. I'm wondering, though, if teaching fits that definition of profession that includes a "unique body of knowledge". I'm not convinced that that's a necessary criteria to call a line of work a "profession." What would the unique knowledge base be in the profession of teaching? Certainly not the content of what's being taught as that falls into a subject area such as math, physical science, language arts, etc. Teaching methodology and education theory? There's definitely some overlap between teaching/education and nursing methods and theory, is there not? And the whole assess/plan/implement/evaluate framework is used in *many* fields including medicine. So I don't see methodology as part of a profession's unique body of knowledge. Pharmacology, pathophysiology, psychology, etc are not unique to nursing though they are integral to nursing.

What I would consider unique 'nursing knowledge' would be things like how to prevent deterioration/complications (eg skin breakdown, pulmonary emboli) during periods of acute illness (and other acute situations such as surgery and recovery, labor and delivery). Other preventative health measures that nurses take (such as teaching hand-washing & administering immunizations) I'd argue are not *unique* to nursing practice.

I'm not sure what field chronic care/rehab/disability support professionals fit. Are they non-nurses who at times provide/coordinate nursing care? If a nurse determines the need for and then implement ROM exercises, is that nursing care? If a physical therapist determines the need for and then implements ROM excerises, is that then physical therapy? If an UAP is assigned to do ROM, is it nursing care or physicial therapy that they are providing? Does it depend upon if they are being delegated to by a nurse or a PT?

As usual, I ramble, go off topic and ask lots of questions!

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.
"As usual, I ramble, go off topic and ask lots of questions!

Don't worry joy so do I!!

An interesting discussion.

Specializes in Rodeo Nursing (Neuro).

Well, dang it. I'm not at work, tonight, because I'm full of poop, and not in a nice way. And I've just finished posting some kind of idealistic stuff on another thread about non-compliant patients and looking beyond the superficial, and as I hit submit, a random brain cell fired, and it occurred to me that I was arguing for nursing as a profession on one thread and at least sort of against it on another.

And that's when it hit me. Nursing isn't a trade, or a craft, or a profession. It's a dissociative disorder.

But, as previously noted, I'm full of poop. Although, surely I'm bound to run out, soon.

I don't actually think most of the problem is with the healthcare industry, itself, but with the multiple layers of hoops we have to jump through to satisfy insurance companies and lawyers.

The way I see it, most if not all of nursing's mindless paperwork compliance problems rest with JCAHO, an organization which makes rules for bedside care, yet is comprised of a bunch of business people, not even healthcare people. (can you SHOW that you rated that pain relief within 1 hour? Pass all those meds within 30 minutes of scheduled time! etc..)

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