September 2, 2006, 12:12 am

I Know You Are, But What Am I?

rolex

Is it just me or have Rolexes changed over the years?

I mean besides the price.

Back then the glass didn’t break.

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I know you’re expecting a joke or two about nursing in a Rolex.

But I can’t joke about it….because I did it!

Hubby was going to the mall so I asked him to stop at the uniform shop and get me a cheapo wristwatch. I have baaaad watch karma – they always break, so I wanted the cheapest one they had.

He came home with a silver-colored Rolex. Fifteen hundred dollars.

Well WTF, I said as I picked myself up from my syncopal episode.

It wasn’t gaudy like the gold ones, it was beautifully professional. If you didn’t know it was a Rolex, it wasn’t obvious. It was just a pretty, functional watch.

Until I’m in the tub one day and hear, “Clink!”. The crystal just shattered. Right there on the sink. Three feet away from me.

Bummer. I guess they aren’t waterproof/steamproof anymore.

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The following post is known in the blogosphere circles as a “rant”. Hang onto your caps, it’s going to be a bumpy ride….

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I wish nursing would get its act together.

Why is it that in order to be accepted as a “profession”, we have to copy another profession?

Doctors diagnose, so therefore we have to diagnose our special things or we won’t be respected!

Doctors have one route to their degree/license, but between the ADN, BSN and entry-level Masters programs, nursing has three.

So let’s get rid of the one that produces the highest number of working bedside nurses for the degrees that will get us respected!

You know what?

Nursing won’t get the respect we deserve until we start respecting ourselves!

Until we are proud of our unique ability to work our way up the degree ladder while we practice our profession, if we chose to do so.

Until we stop looking down our educated noses at nurses who chose, for whatever reason, to obtain their ADN no matter how long it takes.

Until we stop referring to direct patient care and actual caregiving as “the dirty work”, which is exactly how one nurse blogger phrased it. It’s okay to teach a patient, but god forbid we touch them!

Until Nurse Executive IMA BIGSHOT, RN, MBA, PhDNsc, FAAN, CEN, CCRN, CRNA, RN,C and EMT-P gets off his/her high horse of an office chair and realizes he/she is no better and, in fact, is just as qualified to wipe an incontinent patient as the new ADN graduate three floors down.

And is willing to do it.

Until we stop trying to quantify what we do and who we are using medical models of documentation that are just bull s*** in black ink when it comes to actual patient care.

Constipation is constipation, dammit.

Not: “Elimination, impaired,

  • secondary to post-operative pain meds
  • required due to S/P hip surgery,
  • secondary to hip fracture,
  • caused by a mechanical fall at patient’s residence
  • because of improper lighting
  • resulting in hazardous living conditions
  • because of patient’s lack of ladder to remedy said lighting deficiency
  • secondary to patient purchasing cigarettes
  • instead of household items.”

(You think that’s funny? I lived it. There is a hospital in San Jose that required exactly that type of documentation! I exaggerate much less than you imagine.)

In fact, constipation IS a diagnosis. So we have to couch it in fancy terms because…..

We’ll be respected!

By whom?

By the doctors!

The patients already respect us, for the most part. We’re in the top three most respected professions according to a recent public poll I’d love to cite if I could remember where I saw it.

The hospital administrators damn well respect us, even though they never let us know. All we have to do to shut a hospital down is not show up for work.

We are the reason that patients are hospitalized. It’s called nursing care.

And only nurses can provide it

But the doctors!

You want a doctor to respect you?

  • Know your patients
  • Advocate for your patients
  • Give excellent, safe nursing care to your patients.
  • Act like a professional on the job
  • Dress like a professional on the job
  • BE the professional you are, no matter how many letters you do or don’t have after your name

Because I don’t care if you manage a nursing company, edit a respected nursing journal, conduct nursing research, provide primary care as a nurse pratitioner, teach at a nursing school, manage a med surg floor or stand at the bedside eight hours a day.

We are ALL nurses.

NURSING IS NOT MEDICINE.

So, please, let’s stop trying to emulate what we think a profession should be and be what our profession is.

The profession of patient care. Be it in the research lab, the editorial office, the Cheif Nursing Officer chair, the nursing manager’s’ office or at the actual bed of the patient, be it with an ADN, BSN, MSN or PhDNsc.

We are all in this together. Stop trying to drive wedges between us. We have many unique ways to come to nursing.

Let’s embrace them all and let every other profession deal with us.

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Whew!

If anyone is still with me at this point, here is a case of shameless self-promotion for a self indulgent post. Yep, an new post is up over at Scared To Health.

After this one, it’s rather tame!

28 Comments

  • Nurse Hells
    Nurse Hells

    September 2, 2006 at 3:25 am

    Here here!


  • Too Fat 4 Ponies
    Too Fat 4 Ponies

    September 2, 2006 at 4:03 am

    Amen sister!


  • medrecgal
    medrecgal

    September 2, 2006 at 5:41 am

    I laughed with familiarity upon reading the part about “constipation is constipation, dammit…not, ‘Elimination, impaired, secondary to…’ As a medical records person (aka health info tech, just another fancification of terminology IMHO) I’ve actually seen this kind of documentation. I think it’s a result of the attempt to overclassify and be painfully specific about diagnoses so the hospital (or whatever other healthcare institution you might see medical records in) is sure to get its proper reimbursement. But, in the name of satisfying bureaucracy, the terminology often sounds absurdly funny, even to those of us who use it as part of our respective professions.

    And as for respect from doctors…I think part of that problem is the “traditional roles” mindset that many have that says “in the hierarchy of healthcare, I’m higher than you, so I can say or do whatever I want”. Of course, there are a good number of doctors who are not taken in by this line of thinking, luckily for nurses and others in the healthcare system. The funny thing is recalling the stories I heard from my internships in school about having to almost literally drag some physicians down to the HIM department to complete or sign or otherwise finish dealing with their patient records so we could do our jobs. It’s not just the nurses who have to know how to get on the right side of the doctors, after all…


  • TC
    TC

    September 2, 2006 at 6:57 am

    All in favor of KIM being the national nurse, say “aye”…AAAAAAAYYYYYYEEEEEE!!!!!

    I’m right there with you, as the graduate of an ADN program, that we nurses need to get our act together and be united, not divided. We’re our own worst enemy sometimes.

    (and my hubby graduated from a DIPLOMA program and he can outnurse(if that’s a word) anyone-he’s professional, extremely competent and remembers stuff I’m not even sure we covered in my program, so there)


  • Dex
    Dex

    September 2, 2006 at 7:40 am

    Yay! Methinks you may have been hearing Dr. Crippen’s rants ( http://nhsblogdoc.blogspot.com/ ) echoing from across the Atlantic. Bravo!

    No really, my stepmother is a nurse–she started as a BSN, got her CCRN, and eventually ran critical care for a certain noted big cancer center in Houston. When she ended up being office manager for a 1-doc, 30-nurse oncology practice, she ran that too, billing, procurement, payroll, front office, everything. But she still runs to the back office whenever she can to mix chemo, catch puke, do blood draws…she’s a nurse, first. Bravo!


  • Kelly
    Kelly

    September 2, 2006 at 7:51 am

    Doesn’t AUTONOMY mean anything anymore? I think it’s true that doctors tend to look down on the nurses they’re around, and that’s deplorable. Why should it be that a newbie doc can look down upon a seasoned nurse? That nurse is probably top in her field, while that doc is nothing more than a ROOKIE! Yet, it seems to be a common theme: they come out of med school and think they rule the roost, when the nurse has been there 30 years. Nurses don’t have the same job. It’s called autonomy.

    Which leads me to my own annoyance: (and I can’t remember the acronym for it) the nurse who ACTS like a doc? Uh-uh. Bad idea for nursing to do that. It muddies the waters, and it’s probably why the nurse/doc situation is exacerbated. I have a friend who’s one of these. He now wears a shirt and tie to work, and when he sees patients, how are they supposed to know he’s a nurse? That’s like the old saying: if it walks/smells/quacks like a duck, then it’s a duck (DOC?). Well, not in this case! That’s confusing. Patients need to know that there’s a line.


  • Mel
    Mel

    September 2, 2006 at 8:54 am

    Go, Kim, Go!!!!
    I work in billing/finance for our local health system and I am very good at getting the money that insurers owe us. It’s my job and I like it. I know that it’s not the glitzy side of medicine, but I know it helps *you* be a better nurse when you don’t have to worry about the financial stability of your employer.
    The Powers That Be recently changed our dress code and so many of my co-workers in billing have started wearing scrubs because they don’t want/can’t afford to wear the ultra-professional suits that TPTB seem to want. I have found things in my existing wardrobe (which has a week’s worth of power suits in it, just in case) to wear that meet the new code which are comfortable without being scrubs.
    I won’t wear scrubs because I am not clinical staff. I don’t know enough to have patients or their families stopping to ask me that kind of question. And I know that I don’t know it. I am what I am – a bean counter – and I don’t care who knows it.
    I have the ultimate respect for our nursing staff (and every other clinician out there) and most of our doctors do as well. Without you, there would be nothing for me to do. And without you, neither I nor my husband would be here to raise our kids. Thanks for being what you are and being proud of it. Nurses ROCK!!!


  • MICU RN
    MICU RN

    September 2, 2006 at 9:14 am

    I dig it. That ridiculous language just muddles everything up and makes other disciplines not want to read our notes! And the nursing credential alphabet soup thing is so irritating to me– no one else knows what all those letters mean. It’s a good thing that nurses want to develop their practice with specialized education and skills, but why must we prove ourselves with all these letters? Maybe we need to rethink the way we talk, and think, about ourselves and our work.


  • Teresa
    Teresa

    September 2, 2006 at 12:49 pm

    I apologize for being one of those nurses with all the iinitials after her name. I do agree with much of what you said. Nursing diagnosis has very little practical application to what real nurses do. (IMHO). I do think the public has many misconceptions about what we do, largely due to how we are portrayed in the media.

    Nurses take care of patients. Sometimes nurses even save patients lives. Hospitals exist because patients need nursing care. Doctors practice medicine, not nursing. Doctors don’t own nurses. They don’t hire and fire them. Doctors bill for their services; nursing charges are hidden. “Caring” only one component of what it takes to be a nurse. Nurses need brains, technical and organizational skills, and physical stamina. End of my rant!


  • Sid Schwab
    Sid Schwab

    September 2, 2006 at 3:53 pm

    I really wish I’d been able to work with you. I’m absolutely certain you are one hell of a nurse. It’s so great to have a relationship of mutual trust and respect for the DIFFERENT but equally important things we do for our patients. Nurses like that have been and remain my friends, after all these years.


  • Bardiac
    Bardiac

    September 2, 2006 at 5:37 pm

    Really interesting post!

    (Your link to your other blog in the post is broken; I think it’s got a double url in there; the sidebar link works, though!)


  • Melissa
    Melissa

    September 2, 2006 at 5:39 pm

    Bravo! Nursing diagnoses are completely idiot and a waste of time. It is not going to make doctors respect us more because we can diagnose patients too. Most doctors I’ve talked too have never even heard of nursing diagnoses.

    It’s kind of pathetic the way we are saying, in effect, look at me. I can diagnose patients too.

    We should be proud of what we do, taking care of patients.


  • Mother Jones RN
    Mother Jones RN

    September 2, 2006 at 10:00 pm

    Rant ON Sister. Bravo! I’m sooooooo glad to read posts like this. I’m sick and tired of the alphabet soup. A nurse is a nurse. Amen!


  • Susan
    Susan

    September 3, 2006 at 10:06 am

    Many patients need caring touch, even if it’s just a hand on the shoulder. So the “we’ll treat them but God forbid we should touch them” approach isn’t just anti-nursing; it’s anti-medicine.


  • Jodi
    Jodi

    September 3, 2006 at 11:10 am

    This post was Beautiful!
    Thank-you!


  • Carol
    Carol

    September 3, 2006 at 11:39 am

    A couple of years ago I had occasion to be a trauma patient in a local Big Deal Hospital. I am grateful for the doctors who fixed all the broken bits of me. But the people I REMEMBER through my dilaudid and morphine haze? The nurses. I remember their skill, professionalism, kindness, compassion, genuine concern for my pain and fear, their energy, their determination to help me, their complete confidence that I would be OK. The nurses couldn’t have helped me if the MD’s hadn’t fixed my structural problem first, but the MD’s work would have be pointless without the CARE that was given to me by the nurses. THANK YOU. THANK YOU. THANK YOU.


  • Karen
    Karen

    September 3, 2006 at 12:44 pm

    ::: APPLAUSE :::

    Sing on, woman! =)


  • Janet
    Janet

    September 3, 2006 at 12:51 pm

    Amen! Tell it, Kim!
    IMHO contemporary nursing education has become way too prissy! There has been too much emphasis on being a “profession” and too little on basic patient care. Nursing CARE involves wiping butts, catching vomit, holding hands, and millions of other activities that will never be codified in the textbooks. To be a good nurse one has to be REAL, willing to get down and dirty, not locked in some ivory intellectual tower giving orders. Just what is Ms.Ima Bigshot trying to prove with all the letters behind her name?


  • Peggy
    Peggy

    September 3, 2006 at 3:06 pm

    Three months ago I fell and broke my hip, went to the emergency room, have no primary doctor and haven’t seen a doctor for fifteen years. I was heavily drugged and only remember the nurse’s voice getting info. She sounded like an angel. My next awareness was waking in my room with nurses coming and going. They were wonderful! So efficient, professional and kind. I slept mostly. I knew the surgeon who’d been assigned to pin the bone-ends together was good because the nurses all liked him. That was obvious. He was so respectful of everyone, including me! I take extremely good care of my health so am recovering perfectly. I cannot tell you how many letters those nurses strung out after their names, but to me every one of them was the best in their profession. God bless all of you.


  • DisappearingJohn
    DisappearingJohn

    September 3, 2006 at 3:27 pm

    Yep, NANDA’s are pretty dumb.

    I agree with you on the equality of nurses, despite their educational status, as far as bedside nursing is concerned. If anything, in my experience, ADN nurses are better at bedside care than BSN nurses as new grads, as their schooling was much more fcused on nursing practice rather than nursing “theory” and research.

    That being said, I just started back to earn my BSN because my ultimate goal is to eventually teach, although I don’t ever see myself leaving the bedside. Its one thing I love about ED nursing; there doesn’t sem to be the class warfare I see in other departments. Sometimes it seems some nurses judge you by the alphabet soup after your name, rather than the care you provide…


  • Kj
    Kj

    September 3, 2006 at 4:15 pm

    Hey.
    Thanks for saying publicly what a lot of nurses are thinking.

    As for the Rolex, Don’t drop it in the autoclave while loading.
    Yours cracked in a steamy room, mine disintegrated in an autoclave!! It wasn’t covered by the warrantee.

    Cheers


  • Linda
    Linda

    September 3, 2006 at 7:43 pm

    Oh Kim…if any of my nursing professors read this they would keel over. While I totally agree with you, I’ll never be able to repeat any of it until I get my degree because everything you’ve typed is the exact OPPOSITE of what they teach in nursing school these days. So sad 🙁


  • Cassie
    Cassie

    September 3, 2006 at 8:45 pm

    I love you Kim!


  • Medical Librarian
    Medical Librarian

    September 4, 2006 at 10:41 am

    Yay Kim! I work in another profession with deeply-seated hang-ups about being recognized and regarded as “professionals” — librarians.

    I work in a hospital (in fact, it may be the very one you refered to in SJ) where I get respect from the doctors, the nurses and the administrators I work with because I *do my job* and I do it well. It’s not because I tag all sorts of letters behind my name, it’s not because I come to work in a suit, and, lord knows, it’s not becasue I hold myself up above anyone else. I’m a cog in this healthcare wheel, and if I can get some information for a doc (or anyone else) that helps patient care, then I’m doing my job.

    And I know my limits. I do research, I don’t interpret clinical information. (Though I’ve had the occassional doc come to the library with a list of symptoms asking ME to come up with a differential. Hello? You want the *librarian* to diagnose your patient? I don’t THINK so!)

    Anyway, back to the point. Degrees and credentials don’t make the professional. Knowing your stuff, and doing it, does. That goes for nurses, librarians, and everyone else out there.


  • beastarzmom
    beastarzmom

    September 4, 2006 at 12:39 pm

    One of my biggest pet peeves are those initials nurses feel compelled to put after their name. I don’t see other professions do it – at least not to the same degree. I don’t freakin’ care what initials you posess if you can do the job competently!
    I moved to IT many years ago (and I LOVE the schedule despite the harried go-lives), and find it frustrating that I still have to use “RN” after my name to get respect from the physician community. I do use it, but it gripes me every time.
    Maybe someday…


  • […] A comment on this recent post started me thinking about the other side of nursing education. […]


  • Candy
    Candy

    September 17, 2006 at 11:54 am

    RN doesn’t always give you respect, but it does give you entre, and that’s a good place to start.

    I agree that diploma or ADN nurses usually come to the floor better prepared clinically, simply because that’s the focus of their program. BSN RNs also focus on other areas, including public health, that 2- or 3-year programs done have time for. They also spend more time on critical thinking exercises. I think it’s important for nurses to keep learning all the time; completing a BSN (especially since so many programs are available online now) is good direction to go. Aren’t you curious about all the other stuff you don’t know? There’s a huge need for nursing faculty across the country, and they have to come from our ranks. You can be an adjunct clinical faculty person with a BSN at a ADN program and still work on the floor if you want. Or, you can add an MSN program (also online, lots of financing available) to your already busy schedule, do it at your own pace, and transition to full-time nursing faculty when your feet tell you it’s time to leave the bedside.

    I think credentials are important — for the nurse who worked hard to earn them, and for the patients and other members of the healthcare team (including docs). Seeing CEN or CCRN after the RN following a nurse’s name doesn’t mean she (or he) thinks they’re better than another person (nurse or not) — it means they’ve gone the extra mile to earn certification in their chosen nursing field. No one bitches or thinks it’s “uppity” when a doc lists his or her credentials (like FAAP or FACS).

    These are not honorifics, like FAAN (which I also think is pretty special), and nurses who earn them should list them with pride. I would.


  • Dawn
    Dawn

    September 22, 2006 at 11:33 am

    While I was taking a break from trying to understand my “Nursing Theory” class in order to develop MY own nursing theory for an assignment/paper/concept map that is due, I ran across your blog.

    Here Here. I so agree. I don’t understand the nursing diagnoses push, in fact, while at a dinner with a few physician friends – they were laughing about them and said their favorite was the Spiritual one. Interestingly enough, they thought the current attempts at earning respect were demeaning nursing…just one small groups opinion.

    I’m a new nurse, just passed the NCLEX and ready to venture into my new job and work on my NP. Not sure I will “over” initialize myself since I used to be an electrical engineer and teacher – seems silly to put all those letters. it would be, BSEE, PE, MSEd, BSN, RN….then MSN, NP….then command respect by demonstration not by throwing letters after you name!

    What do you think the direction is going be?


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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