It is a wonderful thing that many aspects of nursing have changed over time. One change, in particular, I am glad has disappeared is mentioned by Hood and Leddy (2014) in that hospitals used to staff with “laywomen who were either widowed or repenting from sins of impurity” (p. 38).
Wow!!
Nursing, as a profession, has come a very long way.
One of the most important aspects of nursing that has been maintained over time but has changed as well as is formal nursing education. Hood and Leddy (2014) wrote, “Education in Nightingale’s school focused on teaching nurses what to do and how to do it, following physicians’ orders, knowing why training a nurse’s senses, and linking these things with reflection to decide what should be done” (emphasis mine) (p. 42).
Knowing what to do, how to do it, and why we do it has been the basis of nursing practice from the beginning. And although the what-how-why base has widened to include training at the collegiate level and theoretical knowledge to direct our practice, it remains imperative that, as a profession, we continue to focus on the what-how-why of what we do. That must never change.
Nursing is a Profession
Nursing is a proud profession with a long history. Unfortunately, most people don’t know that nursing is a profession in and of itself.
Professions are distinguished by certain characteristics such as autonomy of practice, formal education requirements, adherence to an established code of ethics, expansion of professional knowledge, and the common culture and values surrounding its members.
The National Council of State Boards of Nursing is the regulating body whose U.S. members include the state boards of nursing from all 50 states, the District of Columbia, and four U.S. territories. Self-regulation is another characteristic of a profession.
We are not doctor’s helpers. We have our own set of nursing diagnoses, treatments, and professional knowledge base from which we practice nursing. We have our own specialties with corresponding advanced education that contribute to our strong professional identity.
Our profession is competent and knowledgeable, and we detest comments like “You’re so smart, you should have been a doctor.” This insult is proof that nurses are failing to educate the public about who we are.
Hospitals are Nursing Institutions
People aren’t admitted to hospitals unless they need nursing care. In addition, practitioners within those hospitals cannot provide medical care without nurses. Nurses make up 30% of hospital personnel. That’s about 1.8 million jobs as of May 2019.
The media often discuss healthcare workers as “doctors and staff” but this terminology misses the one thing that makes nurses distinct: nurses are the one group that is indispensable to hospitals.
Nurses Aren’t Cute and Lovable or Incompetent and Untrained
For too long, nursing has been touted as a virtuous profession in which caring and goodness stand as the pillars that direct our actions. And don’t even get me started about how ridiculous perceptions of baby-angle nurse figurines or “naughty” nurse Halloween costumes have diluted and poisoned nursing’s public image.
It’s nursing knowledge, not nursing virtues, that make the difference in this profession.
The discipline of nursing consists of a body of nursing knowledge that draws from various philosophies, research, theories, ethics, and aesthetics (Smith & McCarthy, 2010). Yes, strength, commitment, and compassion are part of the professional robe we don, but nursing practice is erected solidly on five discrete nursing knowledge types: empiric, personal, aesthetic, ethical, and emancipatory.
Regardless of which nursing theory, philosophy, or dogma I use to describe nursing to non-nurses, these abstract concepts only cloud the issue.
So, here’s an incomplete list of what nurses actually do.
What Nurses Do
Nurses work with high-tech, complex equipment and toxic medications.
Nurses exercise critical thinking skills commensurate with their diverse specialties and educational levels.
Nurses contribute to academia, physical and social sciences, law, psychology, medicine, sociology, business, social work, and communications.
Nurses make snap decisions in life-and-death situations.
Nurses study pharmacology, anatomy, pathophysiology, and ethics.
Nurses contribute to medical cures and medical diagnoses.
Nurses create innovative ideas, processes, products, and procedures.
Nurses use physical assessment skills to deliver holistic care.
Nurses save money and lives.
Nurses administer medications and treatments.
Nurses study psychology and communication.
Nurses lessen suffering and rescue people from preventable complications.
Nurses play critical roles in patient safety.
Nurses teach, advise, and educate.
Nurses prevent medical errors and costly complications.
Nurses advocate and intervene for patients.
Nurses practice from a foundation of evidence-based knowledge.
Nurses work with vulnerable humans who are anxious, frightened, irritable, and sometimes angry.
Nurses help those people survive and thrive.
Nurses are valued as the most trusted profession in the United States for the 18th year running.
Nursing Care is Consequential
Nurses appreciate the gratitude and trust we do. But allowing the media to fictionalize nursing has only allowed us to remain misunderstood. It’s wonderful that we are trustworthy, but it benefits no one if what we actually do remains disconnected from those who trust us.
It’s not our patient’s fault. It’s not the public’s fault. It’s not even the media’s fault that nursing has been sentimentalized beyond recognition.
Our unique education and credentials belong to our profession alone. So it is our responsibility to spread the word about who we are and what we do. And, as a group, we can no longer afford to support our profession on the shaky stilts of trust and compassion.
We will never boost our professional status when it’s associated with ridiculous medical dramas or organizations that have their own agendas, such as Johnson & Johnson or the DAISY Foundation.
Most people, even nurses, think these entities are advancing the profession but, with all their ‘honoring’ and ‘saluting,’ they’re downplaying the nursing standards and practices that make us a profession. Their focus on compassion mitigates the vast body of nursing knowledge that underlies our professionalism.
To raise the status of our profession, we have a legacy of clinical knowledge and skills at our disposal, and it’s time we use it. It’s our responsibility to push past the simplistic care narrative that surrounds us.
It’s our job to let the masses know that what nurses do every day does not “come naturally.” What we do is the product of education, instruction, self-mastery, expertise, experience, and, at times, absolute grit.
Nursing is a profession and it is consequential, not because nurses care but because of what nurses know.
Cheers,
References
Hood, L., & Leddy, S. (2014). Leddy & Pepper’s conceptual bases of professional nursing (8th ed.). Philadelphia: Wolters KIluwer/Lippincott Williams & Wilkins.
Smith M, McCarthy M.P. Disciplinary knowledge in nursing education: Going beyond the blueprints. Nursing Outlook. 2010;58(1):44–51.
