Time to call a duck a duck?

james2309 · Jan 27, 2011

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.

i guess i see our practice as collaborative more than by instruction. when my best fried was terminally ill with cancer, had had her catheter removed too early and was backing up with retained urine, leaking, distressed, in pain etc... the consultant was consulted and 'missed' what was going on, treated her with an antispasmodic which only served to minimise her discomfort briefly and postponed the treatment she really needed (recatheterisation). a senior nurse walked into the room (in response to my umpteenth urgent bell asking for help for my friend), took one look, made one simple assessment test and recatheterised her - the relief was almost instantaneous and my friend fell asleep for the first time in over 24 hours!!! this nurse used her professional experience and expertise to override the consultant - and i'm sure was well able to document and rationalise her decision accordingly. this "illusion" of puppeteering is one of the major problems that nursing faces and one of the most significant reasons i believe we need the ongoing battle for professional recognition and kudos and that it's actually time to realise that the 'duck is in fact a swan'!

james2309 · Jan 28, 2011

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.

for me, for us to understand the alleged 'need' for doctors orders it may be beneficial to have a look at the patriarchal history of health care. once upon a time the breed we call 'men' (of which i am one) ruled the world. only men could do many, many things - including 'doctor'. and poor old florence bought right into this patriarchal hierarchy. no doubt she was a 'mover and a shaker' in her time but i guess with so much energy invested in the best care of patients she was unable to consider or perceive how things might really need to change, for the best health care. nursing has many definitions - and not insignificant is that of breast feeding - to nurse an infant, wet-nurse etc... all very much part of the matriarchalisation (is there such a word???) of nursing.

things have changed (much and not much) along the journey. nursing as health care has changed - and must continue to. doctors are no longer the demi-gods of yesteryear. never to be challenged. never to be questioned. we don't stand up when doctors enter the room anymore (or senior nurses for that matter) but we did when i started my nursing training back in the dark ages of the 80's! and nor should we. my 83 year old father almost has an apoplectic fit when i tell him that we don't 'pull our forelocks and bow' to our doctors anymore! it's his firm belief that they still hold some form of extraterrestrial super power. and heaven forbid that they should be considered as having made a mistake or be wrong - just like the rest of us mortal humans!!! but i digress...

the multi-disciplinary teams (still with doctors as ultimately accountable and the 'lead' of the treating team) are giving way to inter-disciplinary teams - where the team has shared responsibilities within their specialty practice areas. there is some unwritten rule that appears to give doctors this total governance and responsibility for best patient outcomes. but this is not proven in science or research. it is left over from the patriarchal society that was around when nursing first began to evolve into the amazing 'profession' it is today, and will be into the future - whether we like it or not! (and trust me, i do like it!)

sorry, this was a rant and i ended up going completely off topic - but again, men control most of the finances of the world. and organisations such as jacho are probably (i don't live in the states so don't really know what this is) run by men. no? i'm not anti-male btw - just aware that most men don't get affairs of health and nurturing right. they're better at destroying and killing. sad, but true!

jjjoy, LPN · Jan 28, 2011

I had a patient, recently, who asked, "Are you one of the ones who'll wipe my butt?"
...But where... probably many agree is that the business of nursing is nursing.... 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.
...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.

Good points.

As I continue to think on this... it would seem that practitioners of the venerated "true professions" precisely are (at least in idealized imagingings) NOT required to do all the grunt work... whaddayall think?

The modern physician examines the patient, orders a test and prescribes a treatment. But they rarely participate in administering the tests or treatments. A modern surgeon does only the actual surgery. Someone else sets up the supplies, preps the patient, etc. Lawyers have legal secretaries and paralegals. The "true professionals" nursing leaders were using as models tended to hire on "non-professionals" do most, of not all, of the "scut work". And here's the real catch. Nurses were often recruited specifically to take care of physician's "scut work", no?

I'm not saying that nursing *is* physician scut work. But some aspects of many nursing roles *does* include that (eg transcribing orders, administering prescribed meds). And one man's "scut work" can be another man's professional pride, can it not? Scut specialists become just that, specialists in their own right who apply critical thinking and problem-solving to improve quality and advance their practice.

I think nursing hit a wall by trying to define it's scope of practice as something that can be practiced completely independent of medicine when *many* nursing roles are *not* practiced indepedent of medicine! I can accept that things like preventing skin breakdown fall squarely into the realm of nursing care. But wound care methods might overlap between nursing and medicine and not be "unique" to either. And things like health education and therapeutic listening are aspects of care that can be provided outside of a nursing model, can they not?

ahhhh more rambling!!!!

eriksoln, BSN, RN · Jan 28, 2011

i think nursemike said it best. i had a lot of ideas i was going to put down, but its been done for me. he summarized (maybe with a little more tact too) how i feel about it.

its the diva attitude of the crowd who insist nursing is a profession that makes me want to just call it a skilled trade and hope they all go elsewhere to seek a way to pump their chest.

how in the world does the act of "nursing" become entry level and frowned upon by.......................nurses?

if being a "professional" means i have to take on this holier than though elitist approach to pt. care..............then uneducated and "entry level" i will be. so what if i am "holding back" the profession. bet that doesn't matter much to the man who lost his leg yesterday and just wants someone to tell a funny joke to ease his depression. bet he remembers me more for taking a few extra moments with his dressing change than the "professional" who rushes through it to save more time to sit in an office and whoop it up about the latest form they created (that no pt focused nurse will take serious anyway).

llg, PhD, RN · Jan 28, 2011

I don't mean to paint the quoted poster with that brush

Thank you for showing that fairness and coutresy. I have done bedside care -- lots of it after getting my MSN -- some of it even after getting my PhD. It's not my primary role anymore, but I do not think that it is "beneath me." It is a privilege to be granted the permission to be so intimately involved with another person in the way that bedside nurses are with their patients.

It's just that there is other nursing work that needs to be done, too -- necessary work that involves teaching, program planning, knowledge development, securing funds, the establishment of appropriate policies and procedures, etc. I respect the work that direct care givers do and simply ask that my work (also necessary for the provision of nursing care) also be respected and acknowledged as a legitimate part of nursing.

Thank you for recognizing that not everyone in roles away from the bedside is "the enemy."

nursemike, ASN, RN · Jan 28, 2011

I agree particularly strongly with the previous three posts. Maybe that's an argument for my "dissociative disorder" designation. Or, perhaps a happier thought, maybe I've actually been learning something from this discussion. It isn't lost on me that this thread on the professional standing of nursing has gone on for 43 pages. Evidently, it's something a lot of us do care about. And, I think, rightly so.

A lot of what I know about nursing, I learned as a carpenter. I recall a remark attributed to Frank Lloyd Wright, to the effect that if you build a house and the roof doesn't leak, you've been too conservative. I'm lucky enough to live close enough to Fallingwater to have toured it, and I've seen some of Wright's other work in books. It speaks to me. Especially in person. But the carpenter in me is inclined to say, if it doesn't keep the rain off your head, it isn't really a house.

And that's about where I find myself as a nurse. You can't do evidence-based practice without evidence. We're about as applied as a science can get, but we are a science, and if research had stopped with Nightingale, that's how we would still be practicing. And while it seems some nursing theory might more properly be called conjecture than theory, we're a fairly young science, as sciences go. A lot of Aristotle's physics turned out to be half-baked, but his underlying assumption, that the laws of nature were worth thinking about, has been well borne out over time.

So, maybe the problem isn't that there's a schism between, say, ericsoln and llg. Maybe the problem is just recognizing that our proper place is standing with one foot on either side of that schism. Hence the dissociative disorder.

llg, PhD, RN · Jan 28, 2011

I agree particularly strongly with the previous three posts. Maybe that's an argument for my "dissociative disorder" designation. Or, perhaps a happier thought, maybe I've actually been learning something from this discussion. It isn't lost on me that this thread on the professional standing of nursing has gone on for 43 pages. Evidently, it's something a lot of us do care about. And, I think, rightly so.
A lot of what I know about nursing, I learned as a carpenter. I recall a remark attributed to Frank Lloyd Wright, to the effect that if you build a house and the roof doesn't leak, you've been too conservative. I'm lucky enough to live close enough to Fallingwater to have toured it, and I've seen some of Wright's other work in books. It speaks to me. Especially in person. But the carpenter in me is inclined to say, if it doesn't keep the rain off your head, it isn't really a house.
And that's about where I find myself as a nurse. You can't do evidence-based practice without evidence. We're about as applied as a science can get, but we are a science, and if research had stopped with Nightingale, that's how we would still be practicing. And while it seems some nursing theory might more properly be called conjecture than theory, we're a fairly young science, as sciences go. A lot of Aristotle's physics turned out to be half-baked, but his underlying assumption, that the laws of nature were worth thinking about, has been well borne out over time.
So, maybe the problem isn't that there's a schism between, say, ericsoln and llg. Maybe the problem is just recognizing that our proper place is standing with one foot on either side of that schism. Hence the dissociative disorder.

:yeah: :yeah: :yeah:

Now THAT's a great post I can agree with whole-heartedly. I hope a lot of people read it carefully. In fact, I am going to copy it and save it so that I can find it easily to read again later.

I have always had a career that straddled that schism -- most of it spent in Clinical Nurse Specialist and Staff Development roles in which I worked directly with nurses at the bedside (sometimes actually touching the patients myself, sometimes not) . My roles have always involved an attempt to help bring the knowledge to the bedside, develop new knowledge, and help use the existing knowledge to improve the care they provide. My ocassional forays into academia have focused on helping practicing nurses develop the academic skills to understand the scholarly side of nursing and integrate all kinds of knowledge into their practice.

As you have recognized ... we ALL need to straddle that schism to some extent -- some of us more than others depending on our roles. Unfortunately, it seems as if there are a lot of people out there who don't teach the scholarly content very well and/or a lot of students who just don't want to learn it. The same is also true for the "hands on" aspect of nursing. It's not always taught or thought about in a very appealing way.

pedicurn, LPN, RN · Jan 30, 2011

I participated in this thread earlier and changed my view slightly as it progressed.

My view now is that nursing is a mix of profession / highly-skilled / trade / manual labour.

IMHO .... the reason why we are still having this discussion ( after all these years) is that

highly-skilled /trade plus experience still trumps our professional side.

Why is it an experienced diploma nurse with no further education and who happens to be heavily trade orientated can run my very busy unit without mishap?

Why does my very professionally orientated masters educated nurse educator (with just five years bedside experience) not perform so well when she gets pulled to bedside care when we are really crazy busy? And it's not just the pace.

I am not so happy with this scenario but this is the reality of nursing that I now accept.

Once I bought into the 'nursing is a real profession' mantra. I had academic choices elsewhere but I believed that I was entering an exciting emerging profession.

It's all been a bit of a con but I like providing nursing bedside care and the usefulness of our role.

For me ... it's a pink collar mostly highly-skilled role with smaller parts profession and trade.

Plus a little bit of manual labour thrown in.

This assertion would have made me furious several years ago - I have accepted it now

Kellie626 · Jan 30, 2011

I just remember seeing someone on here post at one time (in the never-ending ADN v. BSN) discussions, something along the lines of "I hope you don't plan on ever getting out of bedside nursing unless you have at least a BSN". Paraphrased, but you get the gist.

The problem I have with that attitude is that I don't want to "get out of bedside nursing". Bedside nursing is why I want to be a nurse. I spent years working behind a desk doing administrative and other tasks. I hated it. If that's what someone wants to do, as a nurse, then more power to them. If they're doing it, that means I don't have to. I'd much rather spend my time taking care of the patients as a bedside nurse. Does it make me "less of a professional?" I don't know and I don't care. You can call me anything you want as long as I'm doing a job (or craft or profession or whatever) that I want to be doing, it matters not to me.

jjjoy, LPN · Jan 31, 2011

The following is cut and paste from another related thread....

https://allnurses.com/general-nursing-discussion/i-dont-want-192019-page16.html

Originally Posted by eriksoln

Same thing with nurses and "the other roles". Are they nurses.......yes. Are they actively nursing...........nah. They are nurses doing "other roles" as you call it. I call it "working outside of nursing" but eh tomato/tomoto.

Yep, that's how I tend to see it as well. Similarly, a nurse manager is a nurse who in their role as a manager is practicing management, not nursing. A nurse researcher is not practicing nursing when that they "put that hat on". A nurse case manager is practicing case management much of the time. I'd go so far as to suggest that much of what *some* "advanced practice nurses" do isn't precisely nursing practice.

Some roles can be best served by someone with a background in nursing and something else (nursing and psychology, nursing and public health, nursing and nutrition, etc). A school nurse is likely going to be providing more than nursing care. They are probably also going to be providing basic first aid and preventive health measures. A public health nurse is likely going to be providing more than nursing care. They may also be providing some services that would parallel that of a social worker.

Going the other direction, that supports the idea that many tasks performed by nurses are not necessarily "nursing"... things like phlebotomy, taking ECGs, etc. Can nurses do them? Do nurses do them? Absolutely! And so can physicians (just usually don't) and so can adequately trained non-nurses (very common). [added: non-nurses can and do provide nursing care, but a license is required to offer services as a professional nurse; similar to non-professionals doing hair care but needing a certain qualification to offer professional hair services.]

I tend towards a 'conservative' definition of nursing practice because if we broaden the definition of nursing practice to include all of the things that nurses *do* do in some roles, just about everything under the sun (health education, anesthesia administration, case management, prescribing medication) would qualify as nursing practice and then the term "practice nursing" becomes meaningless.

By limiting the definition of what "nursing" is however, does not mean that I believe that nurses can't or shouldn't have other responsibilities. I believe that many nurses are very well suited for many responsibilities beyond and in collaboration with their nursing practice.

blue heeler · Feb 1, 2011

So I think we should embrace our status as tradespeople. Schools, quit droning on about nursing theory (which can be summed up in six words ("we take care of sick people") and prepare your students for hospital work. No student should be writing any papers until he knows how to start IVs, insert foleys and run codes. That way, maybe they can get actual jobs when they graduate.

amen!

ZippyGBR, BSN, RN · Feb 1, 2011

With respect to the above 'amen' by blue heeler to Fungez 's earlier message

Firstly while RNs are accpeting of the above then there is little impetus to change things.

Perhaps if the US addressed it;s pre-registration education - it's perhaps not a suprise that only a sub set of US RNs are eligible for registration in the EU and then only after post -reg experience, due in part to the 4600 hours requirement.

Remind me how many hours of pre-registration clinical contact are required in the US ? vs the 2300 mainly branch specific hours in the EU.

These issues combined with the way in which Nursing in the US has allowed itself to be marginalised by not challenging adequately the view that Doctors are the only earners in healthcare and accepting the position that core Nursing practice requires the permission of others