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]

ALL . Overall my biggest complaint is I find it offensive that nursing is graduating and deluding new nurses to consider themselves a masters level professional when they haven't ever given an injection. P.S. doing it to a lab dummy doesn't count.

and who is that the fault of ? the professional regulators who allow people to register without a meaningful amount of properly supervised and properly assessed clinical placements ...

and people wonder why the NMC wants BSN and post reg experience before considering US trained RNs for entry to the UK register ( ditto with other EU nations who have Directive compliant Nurse education) ...

[palemoon]

while i agree that nursing needs to be more consolidated as a community (decide what is the standard entry-level degree, etc.), the fact that you didn't cite any sources for the terms you listed left me unconvinced. call me academic, but there you go.

merriam-webster's 4th defintion of profession seems to be the one you are speaking of, but i don't find anything that excludes nursing:

a : a calling requiring specialized knowledge and often long and intensive academic preparation

b : a principal calling, vocation, or employment

c : the whole body of persons engaged in a calling

dictionary.com more or less agrees with:

1. a vocation requiring knowledge of some department of learning or science: the profession of teaching.

[color=#333333]2. any vocation or business.

[color=#333333]3. the body of persons engaged in an occupation or calling

while we may imagine only doctors, lawyers, and other highly-educated people to be professionals, two different dictionaries disagree. dictionary.com puts them under the heading of learned professionals.

so i'm not saying that you're wrong, op, but that's my defense of calling nursing a profession. language is powerful, and calling nursing simply a "labor" belittles what nurses do and doesn't do anyone any favors or point us toward greater respect.

[nursemike, ASN, RN]

Over the course of this discussion, I think I have become thoroughly agnostic on the professional status of nursing. There are surely qualities than could be described as professional that are desirable in a nurse. I think I'm in much the same boat as the OP in that I believe I project some of them and probably need to work on some of them. I am also pretty uneasy with what some others believe are important aspects of nursing professionalism.

The lab coat is one admittedly petty example. A classmate of mine who worked on my floor a few months wore a lab coat over his scrubs. What it made me feel was that he wanted to look like something more than a nurse, and he did get out of bedside nursing the first chance he got. I don't really blame him. I don't begrudge someone finding a job that makes them happy, and to be honest I've looked at some of the recruiting materials I've gotten for similar jobs and wondered. (Supervisory roles in LTC or home health) I haven't pursued them, since bedside nursing is my first preference, and I am inclined to doubt the money is a lot better. I've also seen ads for the uniform tops I wear (zip front) in which the model wore a dress shirt and tie under the "jacket" top. I like that look, but haven't adopted it, in part because a necktie would be suicidal on a neuro floor, but mostly because it looks a little too fancy. I quickly got over ironing my permanent press uniforms, but I do wear clean ones and bathe every week or two, whether I need to or not.

I'm more disturbed, though, by some of the less superficial aspects of professionalism. The idea of a unified entry level inevitably comes up in these discussions. I'm against it. I'm not opposed to education. One of the best nurses I know is an MSN, and I admire her knowledge base, which is at least partly grounded in her education. But another of the best nurses I know is an LPN, who sometimes asks me for advice, but has a real gift for patient care. In my admittedly limited experience, I just haven't seen a compelling trend in the educational backgrounds of the nurses I'd want to care for my loved ones. Knowledge is important, but a lot of the important knowledge in a typical shift is practical knowledge, and there are other factors just as important.

I guess my most serious concern keeps coming down to the same issue: if we succeed in elevating our professional status, we need to do it in some way that doesn't lead to nurses doing more of what doctors already do while unlicensed staff takes over what nurses have always done. In the few years I've been a nurse, it has been the norm at my facility that aides do vitals and I's and O's and phlebotomists do most lab draws. In general, I'm okay with that, and it does free me up to do more complicated interventions, but also to do a metric buttload of documentation. And while I do appreciate the help of dedicated UAPs, I also can't deny that the level of dedication is variable. We can all think of examples of inept and/or indifferent nurses, but in my experience it seems less common than among unlicensed staff, and I'm not a bit comfortable with the idea of turning over other "routine" tasks, like med passes, to less trained staff. Do we need an MSN to wipe butts? Do we want to be portrayed as butt wipers? I'd say no to both, but still, butts need wiped, and it isn't really a mindless job if you do it correctly. It isn't a job that gives me much pleasure, but I can't help but feel that if you don't want to do the nuts and bolts of nursing, if you really mind fluffing a pillow here and there, do something else. Nursing needs to evolve to meet patient needs, but it feels to me that a lot of the emphasis has been on evolving to meet the needs of nurses who aren't really happy being nurses. I didn't spend two years of my life in nursing school to be a doctor or a lawyer.

[jjjoy, LPN]

I can't help but feel that if you don't want to do the nuts and bolts of nursing, if you really mind fluffing a pillow here and there, do something else. Nursing needs to evolve to meet patient needs, but it feels to me that a lot of the emphasis has been on evolving to meet the needs of nurses who aren't really happy being nurses. I didn't spend two years of my life in nursing school to be a doctor or a lawyer.

Interesting perspective. To me it comes back to what *is* nursing care. As you note nursemike many nurses do something besides bedside care... are those other roles also providing nursing care? Is an "infection control nurse" practicing infection control nursing? Or practicing infection control as it relates to the provision of nursing care? Is an LTC DON practicing nursing in that role? Or are they practicing administration as it relates to the provision of nursing care? Uh-oh! Tangent on an already endlessly long thread!!!

[Awakened]

Thank you ericsoln! Your post perfectly summarizes my feelings at the moment.

I am in nursing school and I also work as a PCT in the hospital. Both experiences have been a real eye opener. What concerns me the most is that my education does not match the nurses actual job. Nursing theories and nursing diagnosis are useless. I've never once overheard a nurse these terms. Out of all the stuff that is being drummed into me, only 1/4 of it actually applies to the work. Yet they expect me to get a BSN and go into debt for this! It's insulting!

[candersonRN]

To Awakened;

I realize you think the nurses are not using nursing theories in their work, but you are very wrong. They just do not necessarily think of what they are doing in those terms. It was not until I began working on my masters that I realized how much I use nursing theories in my work. Just because nursing looks like it is merely following orders, a good nurse is also thinking about all the things the patient needs that are not doctors orders. Do the nurses have to get a doctors order to listen to their patient? Does the nurse need a doctors order to care for a patient with understanding of the patients cultural diversity? These are things we do almost automatically once you are more comfortable with the basics. Good luck with nursing if it is what you truly wish to pursue as a career.

[Cul2]

I agree with the last post by candersonRN. Any kind of working "theory," whether it be in nursing or not, is foundational to what we do. There is always some kind of philosophical foundation upon which we sit or stand. The only question is whether we're aware of that foundation. Any philosophy or "theory"courses are or should be designed to make students aware that there are varying world views and, whether they know it or not, what they do and how they do it is based upon certain philosophical assumptions. The idea is to be more deliberate in what we do. If someone asked you, Why are you doing what you're doing? or Why did you do it this way rather than that way? -- How you answer that is getting to to theories or philosophies upon which you're operating -- whether you're aware of it or not. In my opinion, one true characteristic of a professional is that he or she knows, really understands why they're doing what they're doing and can justify it if challenged.

[PennyWise]

The criteria the TC used to distinguish what a profession is...........where did that come from? I can't find it.

[TheCommuter, BSN, RN]

The criteria the TC used to distinguish what a profession is...........where did that come from? I can't find it.

Perhaps Wikipedia?

[PennyWise]

Perhaps Wikipedia?

LOL. Well, if thats the case, I can't use it. Not allowed to reference Wiki for my papers. My teacher says anyone using Wiki will receive a zero on the paper and asked to move to the back of the class (she is kidding but you really can't reference them).

[Asystole RN]

LOL. Well, if thats the case, I can't use it. Not allowed to reference Wiki for my papers. My teacher says anyone using Wiki will receive a zero on the paper and asked to move to the back of the class (she is kidding but you really can't reference them).

There are many nursing articles alone that talk about what a profession is and how nursing fits into it. I would start your search in CINAHL

[tokebi]

LOL. Well, if thats the case, I can't use it. Not allowed to reference Wiki for my papers. My teacher says anyone using Wiki will receive a zero on the paper and asked to move to the back of the class (she is kidding but you really can't reference them).

But the great thing about wikipedia is that they list references. What I used to do is get the general info on wiki, go to the source, get more detailed info and cite it, or follow more references cited in that source, which gives me ample list of references.