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]

Professionals get paid much more inline with their education.

are you suggesting that world wide Nurses are Underpaid ? or is this on USA centric observation - because it's not necessarily the case in the UK where Nurses, Midwives, Paramedics, OT, Physio and Radiographers are paid against the same pay scales and the reduced numbers and frequency of out of hours work for radiographers , OT, physio etc is offset by eariler promotion to a higher band vs the unsocial hours pay that Nurses, midwives and paramedics get

Professionals get hour long lunch breaks.

alternatively they grab a sandwich at their desk, have a 'working lunch' (or a relative 'treat' in the food industry have to evaluate product )

Professionals get bonuses.

do they ?

Professionals can finish up some work at home.

Professionals can cut a day short if something comes up.

and Nurses never have work related stuff to take home ? as for cutting the day short - ever heard of time off in lieu or taking hours from leave ...

Professionals get holidays off.

Nursing is a 24/7 profession for Nurses who work in 24/7 clinical environments - In many countries the right to time off either on or as extra leave days in lieu + enhanced hourly rates for working is either enshrined in employment law or is a common term of collective bargaining contracts

Also I'm sure the Surgeons operating on Public holidays or the Duty Solicitor seeing clients in the custody suite would argue with 'professionals don't work holidays' equally the Professional Engineers in Power Generation and Distribution, the Food Industry or At Sea

Professionals spend the majority of their days sitting down, often in an office.

I'm sure most Surgeons, Engineers, Architects etc would argue that point as well

Professionals get to pee while they're at work.

That's the failure of your time management and the dysfunctional way in which your unit works

Professionals get carpal tunnel as a work related injury, not dislocated shoulders or herniated discs

oddly enough the incidence of work related moving and handling injuries is much reduced where legislation requires proper moving and handling risk assessments and considers task redesign to be the optimal solution, the only relevance this has to 'professionalism' is the lack of a coherent professional voice in the USA compared to the coherent Professional voice offered by the likes of the RCN in the UK

Professional act professionally.

Do they? there is an element of peer pressure here as well

Professionals exert control over their profession.

Remind me why we have boards of nursing/ registration Authorities and why certainly in the UK Organisations employing nurses have an Executive Director of Nursing and why there is a Nursing chain of command in organisations to that Executive Director

Professionals have higher educational standards.

Than who ?

Also it's a symptom of the fact the US is now lagging behind in Nursing being a profession educated as a preparation for practice vs trained ... ( e.g. the Number of places that are all graduate for 1st level Nurses and the reducing numbers or elimination of second level roles and registrations )

Professionals have high expectations for themselves and their employers.

again this is down to behaviours and what Nurses will let employers do, which comes back to the coherent National voice issue.

[nursemike, ASN, RN]

Professionals get paid much more inline with their education.

Professionals get hour long lunch breaks.

Professionals get bonuses.

Professionals can finish up some work at home.

Professionals can cut a day short if something comes up.

Professionals get holidays off.

Professionals spend the majority of their days sitting down, often in an office.

Professionals get to pee while they're at work.

Professionals get carpal tunnel as a work related injury, not dislocated shoulders or herniated discs.

Professional act professionally.

Professionals exert control over their profession.

Professionals have higher educational standards.

Professionals have high expectations for themselves and their employers.

Nursing is not a profession.

Nursing is labor. We are skilled laborers.

Teachers and clergymen have been professionals for as long as the term has existed. If we define a profession simply as suitable work for a gentleman, then I would say on the whole nursing qualifies, although on this particular morning, this particular gentleman is a bit skeptical. G'night, all.

[eriksoln, BSN, RN]

Teachers and clergymen have been professionals for as long as the term has existed. If we define a profession simply as suitable work for a gentleman, then I would say on the whole nursing qualifies, although on this particular morning, this particular gentleman is a bit skeptical. G'night, all.

Bad day at work?

I'm on vaca..................no bad days for me for a week. I think I might take a little break from AN too.

[ThePrincessBride, MSN, RN, NP]

Why does it have to be either or? You can be considered both a trade AND a profession, and nuring happens to fit both, imo.

[Fribblet]

I was being a bit facetious, guys. Chillax.

Although, I stand by the statement that we're skilled labor.

[eriksoln, BSN, RN]

Why does it have to be either or? You can be considered both a trade AND a profession, and nuring happens to fit both, imo.

WHY? HUH? WHY U ASK?

Cause people like me who like to rock the boat will have to find other forums to post on.

But, yes. In the end, if I had to answer "Is it, or is it not?"...............I'd pretty much say what you said. My issue/point of contention is with the people who insist we strive to be a profession, and how its been pulling nursing in the wrong direction.

[notjustanurse]

I personally don't care if I'm considered a professional or a laborer. I just want the basic respect that should come with doing a difficult job, no matter what label is slapped on it.

[steelydanfan]

Most certainly. I remember and agree with my instructor who used to say "You are not a nurse until you've practiced about five years."

A one year apprenticeship, reduced salary more than likely, would do wonders for a lot of new nurses. It would have helped me. I had a great preceptor, but when my time was up, it was up. Throw to the wolves after that. No well thought out assignments for me. Straight to the fire and high expectations right off the boot.

This USED to happen during nursing school. It was called a diploma program.

During the first year, a student had 3 class days, mixed with 2 clinical days of 6 hours each, during which they were expected to come in the night before and prepare themselves for TOTAL care of the pt. including all po meds, any treatments they had studied, and present a written care plan. The 2nd 6 months, they were expected to care for 2 pt.s.

In years 2 and 3, the clinical hours were 6, 3 days a week, with 2 8-hour classroom days. By the 4th quarter of the senior year, the student was expected to team lead a load of 8 pt.s, and give and receve a detailed report on each, with a team of 1 RN and 1 aide. This included all meds, MIXING IV's, and signing off all orders with a RN's cosign.

Now, I know the pt's were not as sick then, but the load kind of makes it even for a team of 4 as we would have now. The point is, a lot more was expected of a student then; now I have SENIOR students who come onto the floor with a 2 pt. assignment that was made up on the spot. How can a student POSSIBLY command care for 2 pt's she has not seen, prepped for, or had 5 minutes to organize with? This was the whole point about getting and prepping for pt's the night previously. You had a chance to think, look up and plan, so at least you had the chance to succeed, or at least have some interesting questions to ask.

I just think that unless students are prepped properly, and given REALISTIC expectations, they will fail miserably in the real world. You should NOT NEED a 12 month apprenticeship. Your education should have enabled you to be a basic functioning nurse who can outline her weaknesses and work to overcome them during a 3 month orientation on a general med-surg floor. If you cannot, it is the schools fault. In this incredibly technical and scientific speciality, maybe the AD program is obsolete.

[eriksoln, BSN, RN]

This USED to happen during nursing school. It was called a diploma program.

During the first year, a student had 3 class days, mixed with 2 clinical days of 6 hours each, during which they were expected to come in the night before and prepare themselves for TOTAL care of the pt. including all po meds, any treatments they had studied, and present a written care plan. The 2nd 6 months, they were expected to care for 2 pt.s.

In years 2 and 3, the clinical hours were 6, 3 days a week, with 2 8-hour classroom days. By the 4th quarter of the senior year, the student was expected to team lead a load of 8 pt.s, and give and receve a detailed report on each, with a team of 1 RN and 1 aide. This included all meds, MIXING IV's, and signing off all orders with a RN's cosign.

Now, I know the pt's were not as sick then, but the load kind of makes it even for a team of 4 as we would have now. The point is, a lot more was expected of a student then; now I have SENIOR students who come onto the floor with a 2 pt. assignment that was made up on the spot. How can a student POSSIBLY command care for 2 pt's she has not seen, prepped for, or had 5 minutes to organize with? This was the whole point about getting and prepping for pt's the night previously. You had a chance to think, look up and plan, so at least you had the chance to succeed, or at least have some interesting questions to ask.

I just think that unless students are prepped properly, and given REALISTIC expectations, they will fail miserably in the real world. You should NOT NEED a 12 month apprenticeship. Your education should have enabled you to be a basic functioning nurse who can outline her weaknesses and work to overcome them during a 3 month orientation on a general med-surg floor. If you cannot, it is the schools fault. In this incredibly technical and scientific speciality, maybe the AD program is obsolete.

I agree students are not prepared properly but two things will keep that from being fixed:

1. Schools are judged by whether its students pass state boards first time or not, more than any other factor. So, cause-effect.........that is their focus. Whether the students can do well afterwards is heresay as far as they are concerned.

2. Schools, like us, are a business. They do whatever it takes to fill their seats in the classroom. They push "living the college years", make it seem as though dead end majors will lead to riches ect ect......

Schools like people to go for BSN more so than diploma and ADN (well, everyone except the community colleges) because its more classroom time. More money. It wouldn't surprise me if some school officials and CEO's were the biggest proponents of making BSNs necessary to practice bedside.

[nursemike, ASN, RN]

This USED to happen during nursing school. It was called a diploma program.

During the first year, a student had 3 class days, mixed with 2 clinical days of 6 hours each, during which they were expected to come in the night before and prepare themselves for TOTAL care of the pt. including all po meds, any treatments they had studied, and present a written care plan. The 2nd 6 months, they were expected to care for 2 pt.s.

In years 2 and 3, the clinical hours were 6, 3 days a week, with 2 8-hour classroom days. By the 4th quarter of the senior year, the student was expected to team lead a load of 8 pt.s, and give and receve a detailed report on each, with a team of 1 RN and 1 aide. This included all meds, MIXING IV's, and signing off all orders with a RN's cosign.

Now, I know the pt's were not as sick then, but the load kind of makes it even for a team of 4 as we would have now. The point is, a lot more was expected of a student then; now I have SENIOR students who come onto the floor with a 2 pt. assignment that was made up on the spot. How can a student POSSIBLY command care for 2 pt's she has not seen, prepped for, or had 5 minutes to organize with? This was the whole point about getting and prepping for pt's the night previously. You had a chance to think, look up and plan, so at least you had the chance to succeed, or at least have some interesting questions to ask.

I just think that unless students are prepped properly, and given REALISTIC expectations, they will fail miserably in the real world. You should NOT NEED a 12 month apprenticeship. Your education should have enabled you to be a basic functioning nurse who can outline her weaknesses and work to overcome them during a 3 month orientation on a general med-surg floor. If you cannot, it is the schools fault. In this incredibly technical and scientific speciality, maybe the AD program is obsolete.

I have on other occassions, mostly to be difficult, agreed with those who've argued for a single entry path to nursing--as long as it's a diploma program. In reality, I think any of the current routes can work fine. I've worked with some very good nurses who've been diploma, ASN, BSN, LPN, accelerated BSN, and MSN. What they have in common is being very good nurses. I've also seen poorer examples from several of those backgrounds. It leads me to believe that the difference between a capable, competent nurse and an inept, unprofessional one must be something other than their education. I've never actually met an inept diploma nurse, but I've also never met one with less than twenty years' experience. The program you describe does sound like it would offer a better chance to become proficient, sooner. As an alternative, if I had started younger, I might have taken a CNA-LPN-RN route, which is the route several very good nurses I've known followed.

The diploma nurses I've spoken to did not say they finished school, took their boards, and hit the floors as fully competent nurses. I wasn't there, so I can't really say, but I strongly imagine they were better prepared than I was. The BSNs I've worked with seem to have benefited a lot from a semester of "leadership," in which they work with a nurse for numerous hours on regular shifts, and a couple who've been especially strong did summer externships before graduation.

What seems to me a common thread is that nurses who do well get grounded early in the practical aspects of nursing, and I see some of that in my own development. What I found was that it was hard to find time to do a lot of critical thinking when it was a chore to get pill packages open. And I think that relates to my position on this topic. It's not really that I despise the professional, intellectual side of nursing. Truth be told, I love some of that crap. One of my favorite courses in my ASN program was American Government--had diddly to do with patient care, but it was Con Law for dummies with an excellent instructor. Really good English courses, too. See how I consciously chose to use a sentence fragment, for emphasis. Over time, I've come to appreciate the value of nursing research and even--gasp--nursing theory, and I have credited allnurses with helping me define my philosophy of nursing before I even knew I needed a philosophy of nursing. But it frustrates me to no end to hear nursing leaders, nursing educators, and sometimes even bedside nurses downplay the importance of the nuts-and-bolts of nursing. Nursing is legitimately more than direct patient care, just as self-actualization is an important and worthy goal in life. But if we do a Maslow-style hierarchy for what nursing needs, direct patient care should be on the bottom of the pyramid. My cyanotic patient doesn't want to tell me why he's feeling blue.

[eriksoln, BSN, RN]

I have on other occassions, mostly to be difficult, agreed with those who've argued for a single entry path to nursing--as long as it's a diploma program. In reality, I think any of the current routes can work fine. I've worked with some very good nurses who've been diploma, ASN, BSN, LPN, accelerated BSN, and MSN. What they have in common is being very good nurses. I've also seen poorer examples from several of those backgrounds. It leads me to believe that the difference between a capable, competent nurse and an inept, unprofessional one must be something other than their education. I've never actually met an inept diploma nurse, but I've also never met one with less than twenty years' experience. The program you describe does sound like it would offer a better chance to become proficient, sooner. As an alternative, if I had started younger, I might have taken a CNA-LPN-RN route, which is the route several very good nurses I've known followed.

The diploma nurses I've spoken to did not say they finished school, took their boards, and hit the floors as fully competent nurses. I wasn't there, so I can't really say, but I strongly imagine they were better prepared than I was. The BSNs I've worked with seem to have benefited a lot from a semester of "leadership," in which they work with a nurse for numerous hours on regular shifts, and a couple who've been especially strong did summer externships before graduation.

What seems to me a common thread is that nurses who do well get grounded early in the practical aspects of nursing, and I see some of that in my own development. What I found was that it was hard to find time to do a lot of critical thinking when it was a chore to get pill packages open. And I think that relates to my position on this topic. It's not really that I despise the professional, intellectual side of nursing. Truth be told, I love some of that crap. One of my favorite courses in my ASN program was American Government--had diddly to do with patient care, but it was Con Law for dummies with an excellent instructor. Really good English courses, too. See how I consciously chose to use a sentence fragment, for emphasis. Over time, I've come to appreciate the value of nursing research and even--gasp--nursing theory, and I have credited allnurses with helping me define my philosophy of nursing before I even knew I needed a philosophy of nursing. But it frustrates me to no end to hear nursing leaders, nursing educators, and sometimes even bedside nurses downplay the importance of the nuts-and-bolts of nursing. Nursing is legitimately more than direct patient care, just as self-actualization is an important and worthy goal in life. But if we do a Maslow-style hierarchy for what nursing needs, direct patient care should be on the bottom of the pyramid. My cyanotic patient doesn't want to tell me why he's feeling blue.

OMG funny.

I'll tell ya why I'm feeling blue any time;).

You'd get tired of hearing me talk but, eh................

We could say we are developing how you deal with patients with "Ineffective Coping Mechanisms".

[jjjoy, LPN]

I have to wonder if some of the old-school "ready-to-hit-the-floor-running" nursing programs simply didn't just implement the "sink-or-swim" methodology of nurse training during the first year of the program? I can imagine where making it through as a student in such programs may have been akin to making it through one's first year/s working as a nurse today. I know liability issues can also constrict student opportunities these days. That's where one might need a kind of backwards license-then-apprentice system of nurse training. Just thoughts!