Time to call a duck a duck?

Published

I remember having this debate with other students while I was in school. I have seen nothing during my time practicing nursing to change my mind about the issue. Now, with the recession bringing out the true colors of nurses and everyone around them, my opinion seems even more valid. I wonder what others think about it.

I remember sitting in nursing school as the instructor drummed on and on about how "Nursing is a profession." That exact theme butted it's head into almost every single class one way or another, regardless of the subject matter. I often found myself thinking "Who cares?" or "What's the point in that?". Then came the dreaded "Dimensions of Nursing" class. It was the class all RN's must go through at one point or another (IDK if LPNs do or not). There are other names for it "Political Aspects of Nursing" I've heard among a few others. It is the class in which you must discuss the political issues that involve nursing. You are encouraged to join this and that group, Nursing as a Profession is discussed over and over, and you must do a research paper. I never really said in that class how I really felt about the whole business of nursing being a profession in fear of drawing the ire of my superiors.

What is it I had to say that my fellow students got to hear during breaks that my instructors did not? Well: Nursing is not a profession, not even with a very generous stretch. It is a labor, a trade. We are judged solely by the amt. of patients we can handle and still keep the minimal quality expected by our administration up to par. Not very much unlike a McDonald's burger flipper. The faster you can cook those patties without screwing too many up, the better you are. That's all there is to it really. If you don't believe me, take a gander at where nursing expenses falls in the budget. We are not logged next to the admin./doctors/lawyers or any of the other professionals. We are grouped in with dietary/housekeeping/security. As far as budget makers are concerned (and, lets be honest, they make the rules), we are a debt, like a labor.

IT IS TIME FOR NURSING TO GIVE UP THIS IDENTITY CRISIS, THIS INFERIORITY COMPLEX IT HAS DISPLAYED SINCE ITS BIRTH AND MOVE ON, EMBRACE BEING A LABOR AND LOVE IT.

Ever see the movie "Man in the Iron Mask"? The King/spoiled twin tells his brother "Into the dungeon you will go, and you will wear this mask again, and you will wear it until you love it."

We are wearing the mask, but are for some reason we are unable to learn to love it. So we will forever stay in the dungeon denying what we are.

Lets face it. All the aspects of a "profession" are an illusion in nursing.

Definition of a profession:

A profession has a unique body of knowledge and values – and a perspective to go with it.

A profession has controlled entry to the group eg registration

A profession demonstrates a high degree of autonomous practice.

A profession has its own disciplinary system.

A profession enjoys the Recognition and Respect of the wider community.

1. Unique body of knowledge: We do need to go to school and must learn a lot, but I don't know about the unique part of it. Most CNA's pick up on how to do what we do after just a couple years, without the schooling. As far as values and perspective go, lets face it, we can't even agree in here on what that is. How many "Calling from God vs. Its a job" threads/rants have you seen on this site. I've lost count. We can't even agree amongst ourselves what degree we should have. I've also lost count of the "BSN vs. ADN vs. Masters" threads.

2. Controlled entry: Phfffft. It is controlled, but not by us. The hospital/medical field administration decides this. Whatever they decide they are willing to hire is what the rule is. If they decide tomorrow to never again hire ADNs.........that's that for them. We have no say in it. Seen any "Nurses eat their young" vents/threads lately. I know you have;), even if you were a blind, deaf mute with both hands tied behind your back you can't help but run into them on here. If we truly were in control of who came into the profession, such threads would be minimal. Can't be angry about who is allowed in when its your decision who gets in.

3. Demonstrates a high degree of autonomy: Again, I lead with PHfffffft. Our job description continues to be and will forever be everything and anything they can't pawn off on the other laborers. How many of us, since the recession hit, have been told to pick it up and help out in non-nursing job related ways? Empty the trash, stock the cabinets, hand out trays, collect and clean the trays..........its endless. We are unable to define for ourselves what we will and will not do. You don't see them sending the Legal dept. any emails about helping maintenance do you? Any rules/laws concerning scope of practice are simply to protect patients from us should we decide to play doctor. No laws exist to restrict what can be expected of us away from the bedside (no, that would actually be useful, help the pt., can't do anything silly like that).

4. Has its own disciplinary system: Do I need to insert Phffffft again? Oh, I just did. We only qualify here if badgering, cattiness and petty write ups are "disciplinary". Nuff said.

5. Respect of the community: I'll resist the urge to insert the obvious lead here. I'll just point out the complaining about surveys that's been the norm lately. Lets face it folks, professions who have respect are not surveyed like this. These surveys resemble grade school report cards "Nursey doesn't play well with others". If we were "respected", we'd be the ones filling out the surveys on how to improve the model of care given.

Think back to your highschool days. Remember that class clown who tried way too hard to be funny? The not so good looking girl who never stopped digging for compliments on her looks? The not so well liked guy always asking if you and he were buddies or not? That's what nursing has let itself become. Constantly running around worrying about impressing people and all the while completely losing its focus on the primary goal. A lost teenager suffering from an inferiority complex.

Maybe if we embrace the fact that we are............:eek:gasp..............a mere labor, we will be able to dedicate ourselves to our patients. Instead of worrying about proving nursing holds a "unique body of knowledge" and making up useless, pointless "theories" and such (tell me one instance you have found a use for nursing diagnosis), we will become more useful. Focus instead on better time management, better understanding of the things we actually use on the job (the equipment for instance) and a better understanding of the tasks expected of us (study IV insertion in school instead of writing papers about why nursing is a profession).

I know many of you will be upset with me and my views. They are what they are. I make no apologies for them. Not having a well liked opinion has never stopped me from saying what I feel needs said before.

So...............am I wrong? Why?

Specializes in M/S, Travel Nursing, Pulmonary.
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..)

This actually is where I see nursing failing requirement #3 "Demonstrates a high degree of autonomy" from my opening post. Like I said a few posts back, I don't take needing doctors orders to initiate care as a poor reflection on us. I see that as more of a check/balance system. Its not as if, in initiating an order, if harm comes to the pt. I can claim "Hey, the doctor ordered it, not me."

Now, what creates the EPIC fail in the autonomy category in my mind is the hoops we must jump through at the whim of.......non-medical people. JACHO being the biggest thorn of the bunch.

I often think pt. education should include what JACHO and other agencies (insurance) require of us, the nurses, for simple routine care. Get the word out to the general public how they have given authority to inept leaders to guide their care, maybe initiate some change.

Specializes in Emergency & Trauma/Adult ICU.
Nursing isn't a trade, or a craft, or a profession. It's a dissociative disorder.

We may have a winner here ... :D

No, it is time to call a professional a professional.

1.) A profession is a vocation founded on specialized training. You insult us all when you state, "CNA's catch on"

I have never seen an assistant calculate IV drips to mcg/kg/min and understand the effect on the human body at the cellular level.

2.) A professional has obtained a degree. I worked very hard for mine. I am subject to rigorous credentialing by the state.

3.) Professionals engage in challenging and intellectual positions. We all know how challenging it is. We are subjected to constant:spbox: input and must make immediate decisions based on evidence based practice. Sounds pretty intellectual to me.

4.) By the personal and confidential nature of their work, professionals require a great deal of trust from the clients they serve.

For several years, nurses have ranked #1 as the most trusted profession in the Gallup poll, even ahead of the clergy.

If we don't see ourselves as professionals, no one else will.

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?

No, I don't believe you are wrong. In fact, I believe you are correct on so many different levels in your post. You definitely have a lot of guts posting this essay on allnurses as you will certainly ruffle some feathers here...I am not offended in the least, as I too have often asked myself the following question: If nursing is really a profession and not a "skilled job", then why are we treated so poorly by our primary employer, hospitals?

Nurses are taught in college that nursing is a profession, but nurses are the only ones who truly believe it.

Now I am not going to say much here due to all of the responses already, but I too wish more nurses would embrace the truth and unionize nationally...I guarantee working conditions, salaries and benefits would improve. The hospitals are so accustomed to bullying us and getting away with it and the only way it will stop it through collective bargaining on a national level. There was a time I did not think this way...a lifetime ago.

All of the time and energy that has gone into college classes such as "Professionalism in Nursing" or Professional Development:Politics and Public Policy" which are more about advocating for your patients than for yourself as a nurse, should be spent learning how nursing can stop being this "altruistic profession" that looks out for everyone but ourselves...We need to look out for ourselves first and foremost...that is not selfish at all. I am sure that happy nurses = happy patients!

The time for change is NOW, while the health care system is in flux, in turmoil, yes?

Yes, I do believe you're wrong and here's why - in very short, succinct sentences.

1. Unique body of knowledge: yes, nursing has this. how else did it get to be a doctorate subject? You're trying to tell us all those academics all over the world are wrong - just because you don't see it?

2. Controlled entry: In fact, academia controls who gets into the training and the various professional nursing bodies around the world control who gets on the registers and also who gets to stay on them. I don't get your point here but maybe that's because I don't nurse in the States?

3. Demonstrates a high degree of autonomy: It is both my professional and my personal experience (when my best friend died of cancer) that highly experienced NURSES teach inexperienced doctors. In the best ward settings the multi-disciplinary team approach has been around for years. In fact, more recently the INTERdiscliplinary team approach (removing the doctors perceived perch at the top of the hierarchy) is taught. Again, in the best health settings Doctors (and in fact all other health professionals, again in my experience) defer to and include nurses in treatment planning. Why? Because we know what we're talking about and have the most exposure to the patient/consumer/client...

4. Has its own disciplinary system: I've worked in both NZ and Australia and ALL nursing governing bodies have a highly effective and often high performing discliplinary system. If only doctors were as diligent as nurses about correcting and removing their poorly functioning members, there would be considerably less deaths or harm done. Do you call Doctors professionals, btw? I just wondered

5. Respect of the community: It's NOT nurses that initiate these surveys of the most popular 'professionals' but on many occasions it's nurses that come out on TOP of them. Google the results. You might find something to lighten your spirit?

So there are some contradictions to all of your points in favour of nursing NOT being a profession. IMPOV, you are most definitely wrong.

No, it is time to call a professional a professional.

1.) A profession is a vocation founded on specialized training. You insult us all when you state, "CNA's catch on"

I have never seen an assistant calculate IV drips to mcg/kg/min and understand the effect on the human body at the cellular level.

2.) A professional has obtained a degree. I worked very hard for mine. I am subject to rigorous credentialing by the state.

3.) Professionals engage in challenging and intellectual positions. We all know how challenging it is. We are subjected to constant:spbox: input and must make immediate decisions based on evidence based practice. Sounds pretty intellectual to me.

4.) By the personal and confidential nature of their work, professionals require a great deal of trust from the clients they serve.

For several years, nurses have ranked #1 as the most trusted profession in the Gallup poll, even ahead of the clergy.

If we don't see ourselves as professionals, no one else will.

I'm of the opposing opinion that those of us that see ourselves as professionals and consistently BEHAVE in that manner will be viewed as professionals. Those of us that don't... won't! And ultimately I believe more and more nurses are seeing themselves as professionals. Because we are...

Yes, I do believe you're wrong and here's why - in very short, succinct sentences.

1. Unique body of knowledge:

2. Controlled entry:

3. Demonstrates a high degree of autonomy:

4. Has its own disciplinary system:

5. Respect of the community:

But why do schools even feel that the need to present these arguments to "prove" that nursing is a profession? I know my school very explicitly and deliberately taught this exact argument. But why? Would nursing be any less deserving of respect or require less knowledge and judgement if it didn't meet all these criteria? What difference does it make to anyone, to nurses, to their colleagues, to their employers, to the patients, whether or not nursing is "a profession" or if it meets the above criteria?

1. relevant knowlege, of course, is important - who really cares if there's a unique body of knowledge so long as that knowledge contributes to quality care and improved outcomes?

2. nursing has 'controlled entry' as do many, many other fields of practice; for example, not just anyone can 'hang a shingle' and offer professional hair styling services

3. what exactly is a "high degree of autonomy"? How many jobs out there can be done well totally mindlessly, without any comprehension of any level of "why" and absolutely no independent thought or initiative? What's important is that the practitioner has the knowledge, experience, and resources to safely carry out their responsibilities whether those responsibilities are self-directed or collaborative or directed by another.

4. before nursing had it's own disciplinary system, did that make any real difference to how one would responsibly practice nursing?

5. a totally useless 'measure', is it not? Law practitioners include some of the most disrespected professionals out there!

Specializes in Nursing Professional Development.

Maybe it's time to divide nursing in half -- and make a distinction between those who want a true profession and those who want to be a skilled trade. We could call the two groups "professional nurses" and "technical nurses."

To be a "professional nurse," you would have to have a higher level of education and be prepared to develop knowledge (research) and develop policies, etc. You would also be educationally prepared for more autonomy, leadership positions, the consideration of community health issues on a broader scale than just the bedside, etc. To be a "technical nurse," you wouldn't need that extra education. Your education could focus on just following established practice guidelines in the care of individual patients and/or small groups.

That's the schism this thread seems to be creating. Why don't we make it official?

Oh wait ... that proposal has been around since the 1965 ANA Social Policy Statement. Perhaps those people were right back then after all?

Specializes in Clinical Research, Outpt Women's Health.

:lol2::lol2::lol2::lol2::lol2::lol2::lol2::lol2:

:smokin:

it always comes back to the BSN vs ADn thing.......

Yes, I do believe you're wrong and here's why - in very short, succinct sentences.

1. Unique body of knowledge: yes, nursing has this. how else did it get to be a doctorate subject? You're trying to tell us all those academics all over the world are wrong - just because you don't see it?

2. Controlled entry: In fact, academia controls who gets into the training and the various professional nursing bodies around the world control who gets on the registers and also who gets to stay on them. I don't get your point here but maybe that's because I don't nurse in the States?

3. Demonstrates a high degree of autonomy: It is both my professional and my personal experience (when my best friend died of cancer) that highly experienced NURSES teach inexperienced doctors. In the best ward settings the multi-disciplinary team approach has been around for years. In fact, more recently the INTERdiscliplinary team approach (removing the doctors perceived perch at the top of the hierarchy) is taught. Again, in the best health settings Doctors (and in fact all other health professionals, again in my experience) defer to and include nurses in treatment planning. Why? Because we know what we're talking about and have the most exposure to the patient/consumer/client...

4. Has its own disciplinary system: I've worked in both NZ and Australia and ALL nursing governing bodies have a highly effective and often high performing discliplinary system. If only doctors were as diligent as nurses about correcting and removing their poorly functioning members, there would be considerably less deaths or harm done. Do you call Doctors professionals, btw? I just wondered

5. Respect of the community: It's NOT nurses that initiate these surveys of the most popular 'professionals' but on many occasions it's nurses that come out on TOP of them. Google the results. You might find something to lighten your spirit?

So there are some contradictions to all of your points in favour of nursing NOT being a profession. IMPOV, you are most definitely wrong.

1) No.

2) Not in the USA, not the way that term is meant.

3) No, that is the med school getting free instruction.

4) the BON is FOR the community at large, is not based in caring about nursing at all.

5) Used to manipulate nurses, more than anything....the angel image, etc

Maybe it's time to divide nursing in half -- and make a distinction between those who want a true profession and those who want to be a skilled trade. We could call the two groups "professional nurses" and "technical nurses."

Oh wait ... that proposal has been around since the 1965 ANA Social Policy Statement. Perhaps those people were right back then after all?

The irony is appreicated! Maybe they were on the right track but didn't quite nail it. To me it seems that the desire to be considered a "true profession" tripped up nursing leaders as the profession developed.

To be a "professional nurse," you would have to have a higher level of education and be prepared to develop knowledge (research) and develop policies, etc. You would also be educationally prepared for more autonomy, leadership positions, the consideration of community health issues on a broader scale than just the bedside, etc.

This definition sounds like leadership, management, policy-making, research, and community health... I don't see how it's any more "professional" than a nurse who provides direct patient care, whether in an ICU or an LTC.

To be a "technical nurse," you wouldn't need that extra education. Your education could focus on just following established practice guidelines in the care of individual patients and/or small groups.

If a nurse has the "professional" training but is functioning in a "technical" capacity, are they practicing a profession or a vocation? This question comes up over and over on these boards.

Okay, so some nursing roles have limited autonomy and don't directly contribute to developing the nursing knowledge base... but how many physicians, lawyers, accountants, do function in roles with limited autonomy and don't directly contribute to developing their fields's knowledge base? Does that mean that those physicians and lawyers are in fact "technical" physicians, lawyers, acountants?

Nursing as a field has much to offer, deserves respect, requires intelligence and skills and is not "subservient" to medicine (physicians) regardless of whether or not it fits any particular defintion of "true profession".

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Nursing shares with child care and early childhood education the history of developing from the arena of everyday home domesticity. Mothers, grandmothers, aunties, and spinsters throughout the ages provided for the basic needs of the young, sick and old. The degree of expertise and quality of service provided would vary greatly, of course, from individual to individual and community to community, depending on various economic, social, cultural, and historic factors. And in various communities and societies, there were those who specialized in this type of care... midwives, nuns, monks. The professions upon which the definition of "true profession" are based developed differently.

Other "true professions" - the ones upon which the defintion of "true profession" is often based upon - don't exist without a certain level of civil society and technology available. Modern medicine (versus "traditional medicine" and "barbershop" surgery) is based upon the utilization of modern technologies to treat pathologic conditions... pharmaceuticals, anesthetics, prostethetics, etc. Lawyers require a well-established civil society with a robust judicial system before the practice of law could ever develop. Even professions such as carpentry relies upon a society with enough resources and technology to harvest and transport a significant amount of lumber and produce the durable tools without which carpentry couldn't be practiced.

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just rambling thoughts!

Specializes in Rodeo Nursing (Neuro).
Maybe it's time to divide nursing in half -- and make a distinction between those who want a true profession and those who want to be a skilled trade. We could call the two groups "professional nurses" and "technical nurses."

To be a "professional nurse," you would have to have a higher level of education and be prepared to develop knowledge (research) and develop policies, etc. You would also be educationally prepared for more autonomy, leadership positions, the consideration of community health issues on a broader scale than just the bedside, etc. To be a "technical nurse," you wouldn't need that extra education. Your education could focus on just following established practice guidelines in the care of individual patients and/or small groups.

That's the schism this thread seems to be creating. Why don't we make it official?

Oh wait ... that proposal has been around since the 1965 ANA Social Policy Statement. Perhaps those people were right back then after all?

I think part of the problem is that the schism you speak of already exists. I had a patient, recently, who asked, "Are you one of the ones who'll wipe my butt?" It was a pertinent question, at the moment, and yes, I am. It needed done, she wasn't able, and I was there. I think what may have prompted this thread, and I know what keeps me engaged, is that there are a number of nurses who are the ones who'll call the aide. Don't get me wrong--I'm all about the delegation. I don't especially enjoy wiping butts, and I usually have three other things I need to do, two of which the aide can't do for me. Nor do I see myself as a personal servant. I'll wipe you butt to prevent skin breakdown, fluff your pillows and turn you to prevent bedsores, hold your hand and listen to your life story to promote psychosocial/spiritual health. My job is not to pamper clients, but to nurse patients.

Where I begin to bridle is at the apparent view that what I do is some lesser form of nursing. I suppose by that light I should have a problem with Erik's premise--and truth be told, I guess I do disagree. After much wrangling, I confess I do consider nursing a profession, at least to the extent the term "profession" still matters. But where I think Erik and I, and probably many others who've disparaged the "professional" designation, agree is that the business of nursing is nursing. There seems to be an attitude that bedside nursing is "entry level" nursing. Well, of course it is how many nurses enter the field. But just as a nurse isn't someone who couldn't get into med school, a bedside nurse isn't someone who couldn't be an administrator or a researcher or a CRNA. It sometimes appears that no one disrespects the profession of bedside nurse as much as nursing leaders.

I don't mean to paint the quoted poster with that brush or make a serious argument about semantics, but consider the expression "higher" education. I have several coworkers studying for ASN-BSN or LPN-RN, and I've been studying for certification in my specialty. I've been learning about the pathophysiology of conditions I see almost daily and some that are rather rare, medications I actually give, interventions I put into practice. Meanwhile, one of my friends is slogging through statistics. She'll make an A in the course, because she's driven, but she won't use it, because she's a bedside nurse. I haven't discussed why she wants the BSN. She may well aspire to advance beyond bedside nursing. I'm 54, so I've had to consider that I may not be able to meet the physical demands of bedside nursing all the way to retirement. My friend is much younger, but not all of the stressors of bedside nursing are purely physical. I don't think either of us believes bedside nursing is beneath us.

Earlier in the thread, the OP alluded to some "professional" nurses who appear to think themselves "too good" for mundane bedside nursing interventions. I should emphasize "appear," since I confess I haven't done a bath in January, and maybe only one in December. Baths, unlike bedpans, can wait until the aides are free. Well, unless you're late with the bedpan. But when I see my CNO in the hallways--rare, since I work nights--I don't get the impression of someone ready to roll up her sleeves and wipe a butt if it needs it. And that's okay, I guess--as long as she doesn't think that makes her a better nurse than me.

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