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?

[WIN007]

Having gone from punching the clock to salaried - punching a clock is better. I can't even tell you how many extra hours of my "own" time I spend on work and don't get paid for it. At least if I was punching a clock my boss would understand just how much time and effort I'm putting in.

I think if bedside nurses were salaried they'd end up with a lot more mandatory shifts to cover for short staffing, and working much longer hours because they'd tend to stay until a job was done instead of leaving at the end of shift time. The clock is your friend.

ETA: By staying until a job is done, I don't mean to insult bedside nurses. My point is that nursing is a 24 hour a day job, and it's never done, and the tendency of caregivers is to try to get everything done before they leave for the day. The clock makes you accept that you can't finish everything and you have to leave it for the next person to take care of, and vice versa.

I see your point definitely and all things being equal I agree. howeever the thing about NOT being salaried is that they can call you and cancel you based on the census. I'm unaware of any other degreed professional that has to live with that.

[PMFB-RN, RN]

That would be nice, but then you'd probably also have to manage your own insurance and worry about contracting your next job.

*** The physicians & midlevels that own the medical center attached to my hospital don't have to worry about any of that individually. Nor do they (at least I have never hear them) worry about where their next patient is coming from.

I don't know why a group of ICU nurses can't form an LLC and contract with a hospital to provide ICU nursing care. My CRNA friends do exactly this with anesthesia services. They buy their insurance as a group and hire an office person to handle all the insurance and billing with one CRNA over seeing things. The anesthesia group hires CRNAs and pays them until they buy into the group. They are not employees of the hospital but of the LLC that they own.

[JulieCVICURN, BSN, RN]

The physicians & midlevels that own the medical center attached to my hospital don't have to worry about any of that individually. Nor do they (at least I have never hear them) worry about where their next patient is coming from.

Of course they do. Who do you think pays for their malpractice insurance, health insurance, and advertising costs?

[ZippyGBR, BSN, RN]

Of course they do. Who do you think pays for their malpractice insurance, health insurance, and advertising costs?

the partnership , or the company which they are employed by and hold shares in .... it's not rocket science is it - economy of scale.

[JulieCVICURN, BSN, RN]

If they own the medical center, they pay those costs. That's right, it's not rocket science at all. Whether it comes from a partnership or not doesn't matter because it's still money that comes from the profits of the business and affects the amount of money that people who own that business take home.

[PMFB-RN, RN]

Of course they do. Who do you think pays for their malpractice insurance, health insurance, and advertising costs?

*** I know exactly who pays for those things. It's obvious. You missed the part of my post where I said "individually". They don't have to worry or think about it. It's done for them by people they hire to do it. Obviously.

[PMFB-RN, RN]

If they own the medical center, they pay those costs. That's right, it's not rocket science at all. Whether it comes from a partnership or not doesn't matter because it's still money that comes from the profits of the business and affects the amount of money that people who own that business take home.

*** You are being condescending by pointing out the obvious. Where the money comes from is patently obvious to anyone. That costs of doing business affect the amount of money the business owners take home is also patently obvious. You are not talking to a group of small children who do not comprehend how the world works.

[ZippyGBR, BSN, RN]

If they own the medical center, they pay those costs. That's right, it's not rocket science at all. Whether it comes from a partnership or not doesn't matter because it's still money that comes from the profits of the business and affects the amount of money that people who own that business take home.

i have a big serving of 'whoosh' for you as the point seems to haver shot straight past you , the fact is that where there is a service group each practitioner , despite being independent of the facility they are working in , is not having to go home and sit sweating through their bookkeeping and finding insurance etc ...

[JulieCVICURN, BSN, RN]

i have a big serving of 'whoosh' for you as the point seems to haver shot straight past you , the fact is that where there is a service group each practitioner , despite being independent of the facility they are working in , is not having to go home and sit sweating through their bookkeeping and finding insurance etc ...

It's patently obvious that you have never worked as an independent contractor responsible for your own overhead or been a business owner.

[nursemike, ASN, RN]

Excuse me.

Professional nursing organizations are on the frontlines of everything from standardized clinical languages, evidenced based practice, infection control, patient saftey, knowledge dissemination, NIC, NOC, careplans, certifications it's hard for me to think of another profession that covers as much ground so diligently.

PS - I don't disagree with all your points. Clinical competence is paramount for nursing and I certainly wish the nursing programs had given me much more preparation than I got.

I think perhaps the gist of this thread has been that perhaps we try to cover too much ground too diligently. Another thread, on nursing diagnoses, raises the question whether efforts to develop a standardized nursing language haven't gone so far in the effort to both standardize and distinguish from medicine that they haven't left common sense behind, as if in an effort to describe an anatiform avian in exquisite detail with a rigid proscription against using the word, "duck."

It really isn't as simple a problem as I thought at the beginning of this thread. Honestly, the more I think about it, the less optimistic I become that the conflicting needs of professional nursing versus practical nursing can be resolved. Each of the attributes of a professional nursing practice mentioned in the quoted post is, to at least some extent, important, but most, in a day-to-day bedside setting, seems more of a distraction from patient care than an aid to it. One comes to feel that the powers that be (nursing administrators, nursing researchers, academics, governing bodies, etc.) would have us perform a careful assessment, arrive at an appropriate nursing diagnosis of, say, ineffective airway clearance, intervene by educating the patient on the importance of regular deep breathing exercises and splinting while coughing, then evaluate the outcome. Which is all well and good, except that in some instances the patient might be better served by a "sloppier" nurse who would simply observe, "he's choking," and start the Heimlich maneuver. It is, in a way, a false dichotomy. In my latter example, the nurse has actually followed the nursing process, starting with the assessment, "he's choking" and in a seamless, intuitive way moving through diagnosis, planning, straight to intervention. And, of course, the nurse will evaluate as he or she intervenes and presumably cease abdominal thrusts once the patient begins to complain. Then, too, the problem with the more "professional" process I described is mostly that the intervention chosen, for the purpose of illustration, is not the most appropriate one in the case of a choking patient. (It does, however, sometimes appear that at least some nurses who are the most diligent in a applying a formal, professional nursing process are also the most likely to stand around debating evidence based practice as the patient grows increasingly cyanotic, and to generally favor the least hands-on interventions.)

Frankly, I think the manner in which nurses are paid isn't really relevant to our professional status. An attorney or a physician may be paid through billable hours. A bookkeeper may, as well, but a bookkeeper isn't a professional, and a certified public accountant has only fairly recently been recognized as a professional. Among traditional professions, neither clergy nor educators are paid as much or in the same manner as attorneys. Historically, neither acting nor athletics were occupations suitable for a gentleman, yet there are numerous examples in either occupation who enjoy much greater income and public esteem than any professional. Part of my personal impatience with the debate over the professional standing of nursing is that the term has lost much of its original meaning and relevance in modern society. Many doctors, I believe, would say that in aiming to achieve the same level of respect they enjoy, we are setting our sights pretty low.

I do see an important parallel to the time clock argument, though, in the issue of documentation. The adage that if it isn't documented, it wasn't done, can at times seem a pretty serious slap in the face. And I think it really undermines the useful purposes of documentation, as well. It isn't uncommon, in my experience, to begin a shift and find a med that wasn't charted as given near the end of the previous shift. If it was literally true that not documented=not done, then I should go ahead and give it. But a dose of metoprolol will have the same physiological effect whether it was charted or not, so giving another is not necessarily the best solution. The risk of repeating patient education is less obvious, and I would argue the risk of omitting education for a shift is less immediate than the risk of omitting a prescribed medication. Yet, the climate in nursing is such that we perform chart audits to ensure we are compliant in documenting education, even as nurses in the real world are sometimes hard pressed to find time to document medication administrations. In short, it often seems that performing the professional duties of a nurse is not so burdensome as the need to prove we did them. I could spend a lot more time educating patients if I didn't have to spend so much time charting that it was done, and that doesn't even address the plain fact that a lot of my patients have needs far more immediate than education.

I mention education particularly in part because it's something my facility is emphasizing, lately, and in part because it's an issue that came up, recently, in my actual practice. A patient recently started on warfarin received the same booklet every patient on warfarin gets, and for a change it was actually documented. In the course of my care for said patient, I mentioned using a soft toothbrush to prevent his gums from bleeding, which was the first he'd heard of it. Then I rushed off to see about another patient whose blood glucose was dangerously low and never got around to charting my little remark about a soft toothbrush. I guess I'm just saying I wouldn't really care how we describe nursing, as long as it's a definition that recognizes that putting in an 18 ga. to push an amp of D50, or later assisting a stroke patient to a bedside commode, is more valuable than spending 10 minutes to document two minutes of education. In a perfect world, I'd like to see report at shift change deal less with vital signs and lab values that I can look up and more with education needs or collaborating on a plan of care for the day. And informal discussion of these matters does happen. Too often, though, it just seems like it doesn't matter so much whether a patient lives or dies, as long as the charting gets done correctly.

[PMFB-RN, RN]

It's patently obvious that you have never worked as an independent contractor responsible for your own overhead or been a business owner.

*** I have but it's irrelevent since nobody is talking about working as an independant contractor. Nobody has yet raised the issue of being an independant contractor. There been no discussion about the subject of independant contracting at all.

[msn10]

PMFB-RN

The physicians & midlevels that own the medical center attached to my hospital don't have to worry about any of that individually. Nor do they (at least I have never hear them) worry about where their next patient is coming from.

Trust me, they are constantly worrying about it. As a former business owner, I know that first-hand. Even if you "pay" someone else to do that for you, it is a constant worry.

I don't know why a group of ICU nurses can't form an LLC and contract with a hospital to provide ICU nursing care. My CRNA friends do exactly this with anesthesia services. They buy their insurance as a group and hire an office person to handle all the insurance and billing with one CRNA over seeing things. The anesthesia group hires CRNAs and pays them until they buy into the group. They are not employees of the hospital but of the LLC that they own.

AND the statement

I have but it's irrelevent since nobody is talking about working as an independant contractor. Nobody has yet raised the issue of being an independant contractor. There been no discussion about the subject of independant contracting at all.

Contradict each other.

All I can say is if you don't absolutely love every nurse you work with, then don't start an LLC with them. Instead of co-workers who can come and go, you have now entered into a independent contracting business with them. Profit sharing, health insurance, marketing, hospital contracts, negotiations, board of directors, etc. It is no where as easy as it seems. Notwithstanding the fact that more and more physicians and CRNA's are becoming employees because of the headaches and/or hospital demands. Look at the Cleveland Clinic as a prime example.