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?

[NocturneRN]

However, my eyes bugged out when you said that CNA's can "pick up" what we do after a couple of years of watching. Even if you could pick up some hands-on skill like inserting an IV by just being in the room when it's done, what we DO is only half the face of nursing; it's also what we know, of course, from our classroom experience, and from our (hopefully) training in professionalism, therapeutic communication, psychology, research, scientific practice, critical thinking, etc. You show me the CNA who has "picked up" the A+P of pulmonary hypertension, or Maslow's hierarchy of needs, and you're showing me someone much smarter and more intuitive than everyone who went to nursing school to get that knowledge.

That's it in a nutshell, I think: nursing is much more than a series of tasks. Have you ever worked with a nurse who merely came to work and performed whatever tasks were required of him/her, without seeing the bigger picture? It doesn't work well.

I remember one nurse I used to follow, when I worked on a tele unit some years ago. This woman was skilled enough at starting IVs, inserting Foleys and NGs and doing other "nursing" tasks, but there her competence ended. One night I was making initial rounds after getting report from her, and I noticed one patient looking pale and apprehensive, lips slightly bluish; respirations somewhat labored, who said (just like in the textbooks), "I...don't know what's wrong....but....I....feel like....something bad....is about to...happen." O2 sat 82%. I glanced at her IV, which was infusing saline at 125/hr. I turned it off and listened to her lungs: splash!

Well, I called her doctor immediately and did all the usual interventions (the IV Lasix resulted in 2700 cc of urine within 30 minutes), and she ended up spending the night in ICU, although by that time she was feeling significantly better. As I transferred her, she said, "Thank you....I think you saved my life."

As an afterthought, she added, "You know, I kept telling that other nurse all evening that I didn't feel right and was having trouble breathing, but she just said I was fine and didn't do anything about it." In other words, he just let that saline keep on running for eight hours, without ever checking the patient's sats or listening to her lungs. No doubt she reasoned that she was following all the orders, so that must mean that nothing bad could happen, right?

THAT is one big thing makes a (competent) nurse different from unlicensed personnel with a lot of procedural skills: the ability to foresee and prevent problems. And that's also why it takes a lot more than learning a bunch of technical skills to become a surgeon.

[eriksoln, BSN, RN]

I think you've made some really good points. I mostly agree, although I think that in some areas of nursing we do fit the description of a profession and in some we don't. And in some ways, we might appear to be a profession and really aren't. For example, I'm ICU. I can do things like insert/remove foleys and flexiseals without a doctor's order, can remove art lines, and when I recover an open heart patient I do so on my own, with a set of standing orders. I often can write orders for a doctor that I know well because they trust me and I know they'll sign it when they get in. These are things that usually can't be done on the Tele or Med/Surg floors. However, as autonomous as that makes me feel, the fact is that if a single doctor decides he doesn't like what I've done, the official rule book will be thrown at me for overstepping my boundaries.

Someone upthread was insulted by the idea that nursing is a labor instead of a profession. I find THAT insulting. I come from a long line of union laborers - millwrights, carpenters, electricians. These people in my family were without exception brilliant, intelligent craftsmen who took great pride in doing a job properly, in being reliable and honest and fair. There is no insult in being skilled labor. Hell, most of those laborers make more money than we do and have better benefits.

I agree that nursing is hurt by it's lack of identity in the sense that so often it seems to be creating things to appear to be more of a profession than it really is. The biggest thing I keep hearing in my classes for my BSN are that it's difficult to get groups of nurses together to make a difference in politics, etc. That nursing societies suffer from lack of interest in membership or participation. To me, that says that most nurses just want to do their job when they're at work and then go home to their personal lives.

And, just my own pet peeve? It drives me insane when people complain about stuff like the waitresses at the Heart Attack Bar and Grill wearing stethoscopes and naughty nurse outfits, or someone like Helen Mirren stating that she thinks a lot of hookers used to be nurses. I think it makes us all look like humorless twits when people get into a snit about that sort of crap.

Yeah, sometimes I can't get over the thought process that leads one to believe laborer = loser.

If you really believe that, you need to go out and create for yourself a new "body of unique knowledge" lol, and ready up on the Mason's Guild. Yeah, such losers there. People kill themselves to be accepted.

Its also important to point out, I don't equate not being a profession with not acting professionally. I was a landscape laborer for a long time and had to deal with irate customers (yelling at me for what the boss charged them last month, some other laborer was smoking in front of their kids). I had to handle these situations with a professional manner. But that does not make me a professional while I do it.

[pedicurn, LPN, RN]

However, my eyes bugged out when you said that CNA's can "pick up" what we do after a couple of years of watching. Even if you could pick up some hands-on skill like inserting an IV by just being in the room when it's done, what we DO is only half the face of nursing; it's also what we know, of course, from our classroom experience, and from our (hopefully) training in professionalism, therapeutic communication, psychology, research, scientific practice, critical thinking, etc. You show me the CNA who has "picked up" the A+P of pulmonary hypertension, or Maslow's hierarchy of needs, and you're showing me someone much smarter and more intuitive than everyone who went to nursing school to get that knowledge.

That's it in a nutshell, I think: nursing is much more than a series of tasks. Have you ever worked with a nurse who merely came to work and performed whatever tasks were required of him/her, without seeing the bigger picture? It doesn't work well.

THAT is one big thing makes a (competent) nurse different from unlicensed personnel with a lot of procedural skills: the ability to foresee and prevent problems. And that's also why it takes a lot more than learning a bunch of technical skills to become a surgeon.

In Australia, we are SUPPOSED to be a profession too.

However ....Why is theory such as Maslow's considered part of our 'academic core' ? Maslow is very basic ...it's so easy one could learn it in high school.

Why is the nursing process considered so highly? Again so very basic (and obvious) it's embarrassing. It's a basic problem solving process that any intelligent person uses.

A smart senior high school student could handle this 'professional' stuff.

I have been ripped off obtaining my BScN.

Hospitals realize this....that's why they value those nurses who have learnt 'a bunch of technical skills' JUST AS HIGHLY as those who have these plus the broader picture.

Which then leads us to the big point. Why do so many areas perform well with so many of those nurses with 'a bunch of technical skills' leading the pack? They are good at performing skills quickly and moving patients through ...conveyer belt nursing. Not much else gets considered ...nothing collapses.

IMHO there was a good glimmer of hope years ago that we might become real professionals. What has happened?

Perhaps the following factors have contributed to the bedside nurse deskilling:

- Large nurse shortages in the past contributing to reduced entry levels nursing schools (prior to this recession)

- Increased use protocols and other processes = reduced professional autonomy

- Arrival mid-levels who have carved their chunk out...taken a bit of doctor ground and taken quite a big chunk of our ground (the stuff that used to grab me as a younger nurse.... great for professional development is now not my domain)

[pedicurn, LPN, RN]

Yeah, sometimes I can't get over the thought process that leads one to believe laborer = loser.

If you really believe that, you need to go out and create for yourself a new "body of unique knowledge" lol, and ready up on the Mason's Guild. Yeah, such losers there. People kill themselves to be accepted.

Its also important to point out, I don't equate not being a profession with not acting professionally. I was a landscape laborer for a long time and had to deal with irate customers (yelling at me for what the boss charged them last month, some other laborer was smoking in front of their kids). I had to handle these situations with a professional manner. But that does not make me a professional while I do it.

Yes agree.

There is GENERIC professional (coming to work on time, controlling ones emotions, certain level written and verbal communication)

and there is PROFESSIONAL which mainly pertains to the level at which information is handled.

Too many nurse confuse the two

[Bella'sMyBaby]

Eriksoln.......

You "hit the nail on the head" with this thread......

You are so right........

This IS why Nursing is not a Profession........

[jjjoy, LPN]

However ....Why is theory such as Maslow's considered part of our 'academic core' ? Maslow is very basic ...it's so easy one could learn it in high school.

Why is the nursing process considered so highly? Again so very basic (and obvious) it's embarrassing. It's a basic problem solving process that any intelligent person uses.

A smart senior high school student could handle this 'professional' stuff.

I agree. Yes, the nursing process IS important... AND it's a basic problem-solving process that any intelligent person uses. Does that mean that nursing is "just" basic problem solving that doesn't require any special skills or knowledge? No! It's the knowledge and skill base that can make a nurse out of any intelligent person.

Hospitals realize this....that's why they value those nurses who have learnt 'a bunch of technical skills' JUST AS HIGHLY as those who have these plus the broader picture. ...........

Which then leads us to the big point. Why do so many areas perform well with so many of those nurses with 'a bunch of technical skills' leading the pack? They are good at performing skills quickly and moving patients through ...conveyer belt nursing. Not much else gets considered ...nothing collapses.

Very good point! The reality is that task-oriented nurses do thrive in many environments. Many nursing functions ARE task-oreinted. Being task-oriented isn't inherently a bad thing. One can be task-oriented without being oblivious to the bigger picture. ANY good worker will not be so focused getting tasks done that they let bad things happen. If task-oriented nursing didn't work, why is it that we see so many task-oriented nurses surviving for decades in the field?

[wooh, BSN, RN]

Which then leads us to the big point. Why do so many areas perform well with so many of those nurses with 'a bunch of technical skills' leading the pack? They are good at performing skills quickly and moving patients through ...conveyer belt nursing. Not much else gets considered ...nothing collapses.

Well, nothing collapses because there's the occasional "thinking" nurse that comes in here and there. Like the lady getting fluids practically straight into her lungs. If she'd had another "follow the directions" kind of nurse, she'd have called the doctor, the doctor would have come, eventually, hopefully before she codes. If nothing else, the code team would show up and give her some lasix.

How many nurses do you know who seem to have a few more patients go bad than average? More that code, more that have to be transferred to ICU? Or how many nurses on the shift opposite the one you work do you notice giving report on patients that go bad more than average? (This is not a "bad nurses on night shift" thing, I'm talking either shift.) How often do you have to "fix" things at shift change? That's a result of the blindly doing without really thinking kind of nurses.

The patients don't usually crash on them. They crash on the next shift if it's not picked up really quick. "Failure to rescue" is the closest data you can get on it. But I think it's even more subtle than that. Failure to fix things 24 hours before they went really bad. And then failed to fix them 12 hours before. Then failed 6 hours before. Then they crash. Woops.

So the bean counters see the bottom line. And they do what they did at my last job. Run off the experienced nurses. Hire new grad LPNs in their place. From a crummy LPN school. Because they're cheaper. They don't get that without someone coming along and taking that patient now and then that can see the bigger picture and fix them, they've got longer length of stays. They've got more "never" events. (This is not a slam against LPNs, but a new grad LPN from a crummy LPN school isn't going to see the big picture until they've had some experience thrown at them.)

Nursing is more than tasks. And you can survive as a nurse just doing the tasks. But your patients, if they have too many task-oriented folks in a row, they may not survive.

[pedicurn, LPN, RN]

I agree. Yes, the nursing process IS important... AND it's a basic problem-solving process that any intelligent person uses. Does that mean that nursing is "just" basic problem solving that doesn't require any special skills or knowledge? No! It's the knowledge and skill base that can make a nurse out of any intelligent person.

Very good point! The reality is that task-oriented nurses do thrive in many environments. Many nursing functions ARE task-oreinted. Being task-oriented isn't inherently a bad thing. One can be task-oriented without being oblivious to the bigger picture. ANY good worker will not be so focused getting tasks done that they let bad things happen. If task-oriented nursing didn't work, why is it that we see so many task-oriented nurses surviving for decades in the field?

Re the nursing process ... It's the fact that it is formalized as a key nursing skill that is so embarrassing.

No other profession does that. It is a 'given' in other professions....no need to formalize something so obvious.

Yes many task orientated nurses do thrive....however I was making another point.

Why is their contribution to nursing considered equal (or even superior) to other nurses who have the same practical skills PLUS the other skills?

One can see the relative lack of value of these higher skills at management level.

Where I work, diploma nurses have the management jobs and they are firmly cemented into them. However I do not see a lot of skill with process improvement, for example...or many creative solutions re retention. These problems occur because of their relative lack of education. Hospitals prefer to utilize consultants to handle this stuff rather than demand these skills from their senior nurses.

Middle-management in other industries are expected to come up with this stuff by themselves.

I agree a lot of nursing is task-oriented ....however when REAL professional skill is not valued in nursing...then we have a problem.

Perhaps it is time to call a duck a duck

[SuesquatchRN, BSN, RN]

However I do not see a lot of skill with process improvement, for example...or many creative solutions re retention. These problems occur because of their relative lack of education.

I disagree that is based in education specifically. One of the reasons that I am valuable in nursing management is that I have decades of corporate experience and can organize stuff. I can also divorce sentiment from fiscal reality while being able to see a few quarters beyond bonus time and can also see the bigger picture, such as how a larger expenditure on X will save Y dollars down the road. A lot of nursing management seems tied to never increasing expenditures ever, with nary a thought given that it could actually end up saving money.

[wooh, BSN, RN]

am i the only one that wants to come in here and just post:

goose!

just me? carry on...

[pedicurn, LPN, RN]

Well, nothing collapses because there's the occasional "thinking" nurse that comes in here and there. Like the lady getting fluids practically straight into her lungs. If she'd had another "follow the directions" kind of nurse, she'd have called the doctor, the doctor would have come, eventually, hopefully before she codes. If nothing else, the code team would show up and give her some lasix.

How many nurses do you know who seem to have a few more patients go bad than average? More that code, more that have to be transferred to ICU? Or how many nurses on the shift opposite the one you work do you notice giving report on patients that go bad more than average? (This is not a "bad nurses on night shift" thing, I'm talking either shift.) How often do you have to "fix" things at shift change? That's a result of the blindly doing without really thinking kind of nurses.

The patients don't usually crash on them. They crash on the next shift if it's not picked up really quick. "Failure to rescue" is the closest data you can get on it. But I think it's even more subtle than that. Failure to fix things 24 hours before they went really bad. And then failed to fix them 12 hours before. Then failed 6 hours before. Then they crash. Woops.

So the bean counters see the bottom line. And they do what they did at my last job. Run off the experienced nurses. Hire new grad LPNs in their place. From a crummy LPN school. Because they're cheaper. They don't get that without someone coming along and taking that patient now and then that can see the bigger picture and fix them, they've got longer length of stays. They've got more "never" events. (This is not a slam against LPNs, but a new grad LPN from a crummy LPN school isn't going to see the big picture until they've had some experience thrown at them.)

Nursing is more than tasks. And you can survive as a nurse just doing the tasks. But your patients, if they have too many task-oriented folks in a row, they may not survive.

My ED is full of experienced task-orientated nurses who have NEVER believed nursing is a profession. Some of them don't know 'their' from 'there'.....or 'too' from 'to'.

Some of them even do charge. It is a absolute paradox to me how they can run a large, busy Level 1 trauma ED ...yet not be the broad thinking types.....in fact many of them are gobsmackingly narrow.... I spend hours pondering this.

But they are all observant and they are all sharp. None of them miss an overloaded patient. None of their patients sit around for hours before they crash. Cripes even our aides notice there is something different about an overloaded patient.

A lot of this is not rocket science

[imintrouble, BSN, RN]

I'm with the OP. I tell my family frequently, nursing is a service job.