The
question "profession or not" has never been satisfactorily answered,
not least because the definition of 'profession' is not exactly a fixed item. However,
some aspects of the definition might be considered 'core items'. - 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. Nursing DOES have a unique body
of knowledge and values, but all too often adopts the medical perspective over
its own; most acadamic nurses these days don't try very hard to inject new nurses
with any values other than the medical model (Yes, there are exceptions!). In
that sense, nursing can only ever be a 'profession allied to medicine', not a
true profession in its own right. 2. Nursing does have controlled entry
- most countries have a legally-enforced registration. This is beyond doubt, but
of questionnable value, to some degree, it's a cheat - "Nursing is a profession
because the law says it is". 3. Nursing has a variable degree of autonomy,
but for the most part (Yes, there are exceptions!), has very little real freedom;
indeed, nursing management, with it's 'cost saving' mentality, does its utmost
to strangle any independent thought or action, for fear of expensive litigation;
there are 'protocols' for everything, these days, and woe betide the nurse who
dares to use initiative (Yes, there are exceptions!). Nurse practitioners
(etc.) usually take orders from docs and are accountable to them, because their
specialties are branches of medicine. But in many areas, nurses are responsible
for *nursing* and in that sense are (still) independent of doctors. It is
a shame - but historically beyond doubt, that nurses tend to give away the areas
they are most expert in; physiotherapy and occupational therapy both grew out
of a nursing role, respiratory therapy is going the same way. Stoma therapy is
an area that utilizes many core nursing skills; how long before it breaks off
to become a profession in its own right? Perversely, wound management was,
until recently, a medical responsibility, though nurses applied almost 100% of
dressings. Now, specialist nurses are teaching others the principles of wound
care. 4. In many countries, Nursing does have its own disciplinary system
- but in many of them, this is being eroded in favour of making nurses "accountable
to the public" - understandable, but reflecting a view that nurses "cannot
be trusted" to deal with there own problems - this is a diminution of professional
resect and value. 5. Nurses are recognized as 'nice', 'deserving better'
and 'sexy' - the jury is out on whether any of those assist in the definition
of 'professional'. External recognition is vital, just as the legal side
is 'so what' - few people would ever argue with doctor and lawyers as 'true' professionals;
when the 'Church was one, united, catholic church', priests were similarly respected
- I'm not so sure that's generally true any more; individual clergymen are respected
by individuals, and by their own community; as are individual nurses. But both
fall shy of general respect to the level required, sadly. (Though both are streets
ahead of journalists, real estate agents and heating engineers!). To conclude,
part of the problem is the poor self respect of nursing; just twenty years ago,
the Process of Nursing, care plans and nursing diagnosis looked set to sweep in
an era of nursing confidence and a bright, professional future. Why did
it fail? This is not the place to discuss that in detail, but factors include:
- Overconfidence and a needless challenge to medicine - little illustrates
the power of language better than the blinding stupidity of the term "nursing
diagnosis". Nursing assessment, as a serious, conscious, methodical activity
was in its infancy, when 'nursing diagnosis' was invented. this simple act guaranteed
a fear reaction and backlash from doctors, themselves under attack from the accountants
and litigators. From being our allies, doctors become distanced at best, enemies
at worst. All that could have been avoided by a few minutes invested in Roget's
thesaurus or a good dictionary
- A too rapid flight to academia -
it is hard to argue against developments in Nurse education; God knows, a bit
more has to be a 'good thing'; but talk of a graduate profession form a tiny graduate
base in less than twenty years meant that many mediocre people were sucked into
senior postions; many good people were seduced away from clinical nursing, and
many clinical idiots became academic idiots. Sad; and bad because instead of supporting
and defending clinical nursing, academia began to control it, and did not defend
it.
- Failure to resist the suits - The inexorable rise of the accountant,
who knows the price of everything, and the value of nothing, probably could not
be stopped; but it was allowed to ride roughshod over nursing, destroying confidence
and stopping development dead in its tracks.
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