Nursing Defined (self-plagiarism)

About a week ago, I sat down & whipped out a short essay for a 1-credit class, in response to two articles we had to read regarding nursing. I didn't do a fabulous job, but because of the self-referential nature of the assignment, it seems worth re-posting here.
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Nursing Defined

Defining is a process that involves deciding upon criteria for inclusion and exclusion. Providing a definition of nursing, or listing the criteria that one must meet to be called a nurse, reminds me somewhat of the activity of declaring who is a Christian. Any licensed practical nurse (LPN) or non-bachelor-prepared registered nurse (RN) would be insulted—and rightly so—were I to tell them that Luther Christman (1998) thinks that what they spend their time doing cannot, or should not, properly be called nursing, since they were not prepared by a four-year university education. While most of the Southern Baptists in the Alabama town where I was raised would swear up and down that Mormons are not Christians, Mormons I know say that they are. The members of a group make up the group’s inclusion and exclusion criteria, and outsiders, those who do not think of themselves as belonging, usually could not care less about such internecine controversy.

I agree with Christman that nurses’ image in the public eye could be better (1998), and a combination of the public’s experience with point-of-care delivery and what they see on television is likely the source of this image. Nonetheless, the “solution” he offers to this problem is impractical and naïve, not merely because there are so many entrenched interests opposed to it. Demanding that all nurses spend even more time and money on their educations will simply mean that Christman’s “real nurses” will be more expensive to hire, so current trends will continue: Certified Nursing Assistants and LPNs will be trained to stretch the bounds of their scope of practice in ever-more creative ways so that they can take over most of the tasks that RNs do, and healthcare facilities won’t have to budget so much for personnel [1]. And their patients still won’t keep straight who can properly be called a nurse, because they won’t care. Patients will only know or notice who is caring for them at bedside, and whether this person does so in a way that makes them happy. As for Christman’s complaint that more educated nurses eventually move out of the realm of patient care (1998), this could be solved in a number of ways that do not involve his never-to-be-realized pipe dream of a 100% BSN-prepared nursing staff, including “lateral” promotion whereby someone gets meaningful salary increases without being asked to leave bedside nursing. Likewise, his important critique of nursing instructors often being many years out of practice of bedside nursing could be accomplished by having educating institutions require that faculty spend a minimum number of hours per month working in bedside nursing, which presumably many of them require already.

Rozella Schlodtfeldt’s (1986) description of nursing seems nearly orthogonal to Christman’s. She barely touches upon nurses’ education or preparation. Rather, she addresses nursing practice and scholarly inquiry. She fears that the American Nursing Association’s definition of nursing in its 1985 Social Policy Statement, and nursing diagnoses themselves, will induce nurses to focus on human sickness and abnormality, rather than human health and health-seeking behaviors. This seems unreasonable to me, given that the _Nursing Diagnosis Handbook_ contains plenty of diagnoses that relate to wellness and health-seeking behaviors, and “deficient knowledge” diagnoses that require assessing what the client already knows and treating them as a health-seeking agent. Her definition of nursing as “the appraisal and the enhancement of the health status, health assets, and health potentials of human beings” (Schlodtfeldt, 1987, p. 67) certainly approaches sickness and health from the direction of health, but I do not think it would cause a change in the diagnoses present in the Handbook, unless someone took the time to tortuously reword them to provide for this slight change in emphasis at the cost of clarity.

When I studied comparative religion, I approached religion from an anthropological perspective. I was much less interested in what a particular religion’s canon declared that the religious practitioner was, or should be or do, or could not be or do. Rather, I was interested in the actions of those who called themselves believers and practitioners. Likewise, while I find studies of what practices and medications prove effective in healthcare settings interesting, I am far more interested in when, how, and why these evidence-based procedures are and are not implemented. I think the entire field of healthcare would benefit from relatively more research on factors that affect the (non)implementation of interventions proven to be effective, rather than looking for new interventions.

A nurse, to me, is someone who has undergone a specific amount of training to become a nurse, and who calls herself a nurse, as do her coworkers and clients. She engages in tasks that touch upon human dignity and are often quite high stakes, require an enormous amount of organizational ability, can employ analysis but don’t necessarily, and likely has to work hard. This is different from an ideal nurse. An ideal nurse is an effortless multi-tasker and communicator, endlessly compassionate, intellectually curious, intolerant of inefficiency in the healthcare system while tolerant of the humans who create the inefficiencies, prompt to adopt evidence-based changes in practice, a tireless worker, and kind and sociable without imposing her own emotions on any situation. Much like Jesus, the ideal nurse is a model we can carry in our heads and hearts as we carry out the tasks we have to do, and to which we can compare ourselves, hopefully with compassion, as we fail to do exactly what the Ideal Nurse would have done in the same situation. Certainly I hope that a drive for self-improvement, and for improving the system in which humans experience sickness and health, is a part of every nurse, but even this cannot be declared the sine qua non that makes a nurse a nurse.


[1]
As a teaching “assistant” at University XXX, I taught 300-level Spanish courses on my own. I was far cheaper to UX than faculty or even assistant professors would have been. I was a competent and well-prepared instructor, but I could not have been, and UX still would have been saving money. As a further example of outsiders’ indifference to rank and role inside groups they don’t belong to, students often called me professor and were confused when I corrected them.

References

Ackley, B., & Ladwig, C. (2011). Nursing diagnosis handbook: A guide to planning care ( 9th ed.). St. Louis: Mosby.

Christman, L. (1998). Who is a nurse? Image: Journal of Nursing Scholarship, 30 (3), 211-14.

Schlotfeldt, R. (1987). Defining nursing: A historic controversy. Nursing Research, 36(1), 64-
67.