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?

[eriksoln, BSN, RN]

Eh, yeah. My point with Satyr was that............if we don't have (insert any of the qualifications of being a professional here) then we don't have it. Why we don't have (autonomy etc) is not important. We can make excuses for not fitting in on one or more qualification, but in the end we still don't have that qualification. Why we don't is not essential. A profession would have that qualification instead of excuses.

So that definition comes from the sociology area of study. I looked it up, remember it from school. Hmmmm...........

Have to admit though, I can't argue the fact that I guess if you are splitting hairs..........you could say just about any profession lacks in one area or another.

But, that doesn't change my mind that a more focused/pt. directed educational system and less fluff like nursing diagnosis would further our cause and make us better at what we do................help the patient.

[NocturneRN]

Right there is pretty much the jest of what I am trying to get at here. Eliminate all the walking in circles, creating labels for doing our job (nursing diagnosis, the nursing process, critical thinking........come on, trying way too hard to sound important is what I see it as) and focus on being better at our job. THEN, WE CAN TRULY HOLD OUR CHINS HIGH AS OUR FOCUS WILL ONCE AGAIN BE THE PATIENT.

I am not saying nursing is a useless trade to practice, nor am I saying we are less than anyone else. What I am saying is, the immature inferiority complex that often drives nursing theory is failing us. Refocus schools on teaching nurses to obtain the best outcome for their pt., not on passing some exam that, in theory separates the "concrete thinkers" from people able to "think critically" but in reality is nothing more than a hit and miss lottery. I'll say this much: If the NCLEX were any good, don't you think it would have eliminated someone like me who completely disposes of most "nursing theory" from the get go? I passed first time.

The purpose of the NCLEX is not so much about whether you understand nursing theory, as it is about determining whether it's safe to give you a nursing license. Among other things, it's designed to determine whether you know how to apply nursing theory, for those situations involving off-the-wall symptoms and unfamiliar disorders.

You might think nursing diagnoses are useless, but chances are that you're using them anyway, without really thinking about it. For example, if a patient suddenly develops trouble breathing, the average guy off the street might assume that the remedy is to give him oxygen. But we as nurses are aware that just sticking a cannula or mask on the patient's face doesn't always address the real problem. So we look for a cause or causes: is it ineffective airway clearance? Impaired ventilation/gas exchange? Or possibly a side issue, related to impaired tissue perfusion (cardiac) or anxiety or pain? Each of these conditions, of course, requires different interventions.

So, when you're detecting and documenting a nursing diagnosis, you're indicating that you pursued the problem beyond the obvious (sticking the oxygen on the patient and walking away). You're showing that you followed a scientific method, rather than just going by the seat of your pants. And you're also providing criteria to evaluate the effectiveness of the interventions.

Sure,it's cumbersome and it's a nuisance, when you're first learning to think in those terms. But it's also what causes you, as an experienced nurse, to do an EKG on your patient when he tells you he's having trouble breathing, or to question him a little more closely about his level of pain, instead of automatically assuming that trouble breathing = need for more oxygen.

I'm having a hard time figuring out why that would translate either into immaturity or a poor self-image.

[eriksoln, BSN, RN]

The purpose of the NCLEX is not so much about whether you understand nursing theory, as it is about determining whether it's safe to give you a nursing license. Among other things, it's designed to determine whether you know how to apply nursing theory, for those situations involving off-the-wall symptoms and unfamiliar disorders.

You might think nursing diagnoses are useless, but chances are that you're using them anyway, without really thinking about it. For example, if a patient suddenly develops trouble breathing, the average guy off the street might assume that the remedy is to give him oxygen. But we as nurses are aware that just sticking a cannula or mask on the patient's face doesn't always address the real problem. So we look for a cause or causes: is it ineffective airway clearance? Impaired ventilation/gas exchange? Or possibly a side issue, related to impaired tissue perfusion (cardiac) or anxiety or pain? Each of these conditions, of course, requires different interventions.

So, when you're detecting and documenting a nursing diagnosis, you're indicating that you pursued the problem beyond the obvious (sticking the oxygen on the patient and walking away). You're showing that you followed a scientific method, rather than just going by the seat of your pants. And you're also providing criteria to evaluate the effectiveness of the interventions.

Sure,it's cumbersome and it's a nuisance, when you're first learning to think in those terms. But it's also what causes you, as an experienced nurse, to do an EKG on your patient when he tells you he's having trouble breathing, or to question him a little more closely about his level of pain, instead of automatically assuming that trouble breathing = need for more oxygen.

I'm having a hard time figuring out why that would translate either into immaturity or a poor self-image.

I see where you're coming from. IDK, its a good point and I'm certainly not going to completely dismiss it. But I do have to say, when a pt. says "I can't breath", nursing diagnosis don't start playing across my mind. I guess you could say the nursing process does in a way.................cause my rule of thumb is always to check the pt. first. Guess that could be translated to the "assess" part of the process lol.

OMG NOOOOOO.........I'm using the nursing process..............I'm going to start signing "RN" to everything outside work and preempting everything I say with "I'm a nurse". KILL MEEEEE NOOOOOOWWW.

Anyway, all kidding aside, I've never once walked in on a problem then said "Hmmm, what nursing diagnosis is this? Oh, yes...........its (insert nursing diagnosis), now I know what to do."

IDK. Using the nursing diagnosis to me seems like...........instead of going from A to B, you are gong from A to a to B. If that makes sense.

[NocturneRN]

I see where you're coming from. IDK, its a good point and I'm certainly not going to completely dismiss it. But I do have to say, when a pt. says "I can't breath", nursing diagnosis don't start playing across my mind. I guess you could say the nursing process does in a way.................cause my rule of thumb is always to check the pt. first. Guess that could be translated to the "assess" part of the process lol.

OMG NOOOOOO.........I'm using the nursing process..............I'm going to start signing "RN" to everything outside work and preempting everything I say with "I'm a nurse". KILL MEEEEE NOOOOOOWWW.

Anyway, all kidding aside, I've never once walked in on a problem then said "Hmmm, what nursing diagnosis is this? Oh, yes...........its (insert nursing diagnosis), now I know what to do."

IDK. Using the nursing diagnosis to me seems like...........instead of going from A to B, you are gong from A to a to B. If that makes sense.

I'm guessing that that's because it's become second nature to you. You are using the nursing process every time you look for any possible causes for a sign or symptom, rather than just assuming the obvious, as someone with no medical/health care background would do. You're not just grabbing for the pain medication every time a patient groans; you're not just grabbing more blankets every time the patient shivers, and you're not just assuming that, if the patient says he's thirsty, it's a good idea to give him a drink of water. You're looking deeper than that, which means that, whether or not you're spelling them out, you ARE making nursing diagnoses (call them "educated observations" if you prefer), and acting on them.

The nursing diagnosis is also a key to your care plan. Yes, we as nurses DO need to develop care plans, since our work is a tad more complicated and individualized than just babysitting the patient for eight or twelve hours. If you determine that the breathing difficulty is related to anxiety and not impaired ventilation, you can then look at possible causes for anxiety, and develop a plan for addressing them. Is it an anxiety attack? Anxiety related to pain? (we're all familiar with those patients who want to be "good patients," and decline pain medication even though they're not functioning very well without it). Or might it be anxiety related to knowledge deficit?

I'll never forget a post CABG patient I had once, who was crabby and uncooperative the day after surgery, refusing to get out of bed, refusing to cough and deep breathe, refusing visitors, and so on. Came to find out that he'd been poorly prepared before surgery, and, when he woke up afterward, saw all the tubes and lines and assumed he was dying. Once he realized that he was actually doing very well, his attitude did a 180 degree turnabout. Nursing diagnosis in action!---even though I don't recall having written it out as such.

[Lunah, MSN, RN]

Once he realized that he was actually doing very well, his attitude did a 180 degree turnabout. Nursing diagnosis in action!---even though I don't recall having written it out as such.

LOL ... "Energy field, disturbed." That was always one of my favorites!

[eriksoln, BSN, RN]

Makes good sense.

Actually, you brought something to mind that I recall an instructor telling me. This instructor was THE LONE teacher I ever shared my true feelings with.......my disdain for nursing diagnosis, process and care plans etc.

She pointed out it was mostly for students, not really something we do in RL. Meaning, it wasnt like we are going to go to the hospital and spend our day writing nursing diagnosis. She said they were more...........teaching tools. They made sense when I looked at them that way.

Then I got into the real world, and they were still there. When I was a travel nurse, I went to a couple places that made you write them out. And this whole business about writing out care plans.............such a waste of time. Takes us away from the bedside.

I think a lot of my resentment about them stems from............I thought I'd never hear about them again once I was done with school but.........well. I could agree they are probably good teaching mechanisms. I wouldn't argue they should remain a part of the curriculum in schools. But, shouldn't we be past all that once we are in RL?

[eriksoln, BSN, RN]

LOL ... "Energy field, disturbed." That was always one of my favorites!

:eek:You mean that really is a diagnosis? Eh? Oh my.

:oMe not pay enough attention to that part in school maybe? lol

[Lunah, MSN, RN]

:eek:You mean that really is a diagnosis? Eh? Oh my.

:oMe not pay enough attention to that part in school maybe? lol

Truly. The recommended nursing intervention is therapeutic touch.

[NocturneRN]

Truly. The recommended nursing intervention is therapeutic touch.

Okay, okay, I admit it----THAT is a really hokey sounding nursing diagnosis, and I'm guessing that we could all manage to get through an entire lifetime of nursing without resorting to it. I know I have.

[NocturneRN]

Makes good sense.

Actually, you brought something to mind that I recall an instructor telling me. This instructor was THE LONE teacher I ever shared my true feelings with.......my disdain for nursing diagnosis, process and care plans etc.

She pointed out it was mostly for students, not really something we do in RL. Meaning, it wasnt like we are going to go to the hospital and spend our day writing nursing diagnosis. She said they were more...........teaching tools. They made sense when I looked at them that way.

Then I got into the real world, and they were still there. When I was a travel nurse, I went to a couple places that made you write them out. And this whole business about writing out care plans.............such a waste of time. Takes us away from the bedside.

I think a lot of my resentment about them stems from............I thought I'd never hear about them again once I was done with school but.........well. I could agree they are probably good teaching mechanisms. I wouldn't argue they should remain a part of the curriculum in schools. But, shouldn't we be past all that once we are in RL?

Well, you have to document some sort of a care plan, if for no reason other than to show why this patient requires a nurse or nursing interventions. If you're doing that, then you ARE identifying and using nursing diagnoses, even if you're not expressing them in the pretentious wording that they teach in school.

[Lunah, MSN, RN]

Okay, okay, I admit it----THAT is a really hokey sounding nursing diagnosis, and I'm guessing that we could all manage to get through an entire lifetime of nursing without resorting to it. I know I have.

So I imagine you might choke on a mouthful of coffee if you got to the part in the interventions that said, "Assess by scanning a person's energy field for openness and symmetry"?

Honestly, I'm not one to disparage other people's beliefs, etc. (and I say this as a [somewhat infrequent] practitioner of Reiki). But I have to agree about the hoke factor here. But I do feel that nursing as a profession (for I believe it is one!) is an art as well as a science, and is beautifully diverse. :)

[NocturneRN]

So I imagine you might choke on a mouthful of coffee if you got to the part in the interventions that said, "Assess by scanning a person's energy field for openness and symmetry"?

Honestly, I'm not one to disparage other people's beliefs, etc. (and I say this as a [somewhat infrequent] practitioner of Reiki). But I have to agree about the hoke factor here. But I do feel that nursing as a profession (for I believe it is one!) is an art as well as a science, and is beautifully diverse. :)

Okay, I've got to agree that some nursing diagnoses are more hokey than others. That one sounds as if it came right from some snake oil salesman's pitch. I'm defending the idea of nursing diagnosis, in that we use scientific method to determine the patient's needs....but ruminating about "energy fields" would do nothing, in my opinion, to enhance either our professional status, or clinicial competence.

But maybe I'm missing something. Is there anyone here who would like to defend that diagnosis, or explain how identifiying it might help the patient?