546422
research-article2014
NSQXXX10.1177/0894318414546422Nursing Science QuarterlyKarnick / Practice Applications
Practice Applications
The Elusive Profession Called Nursing
Nursing Science Quarterly 2014, Vol. 27(4) 292–293 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318414546422 nsq.sagepub.com
Paula M. Karnick, RN; PhD1
Abstract As a discipline, nursing continues the struggle to be recognized by others as a profession. Despite the fact that nursing has a unique body of knowledge with theory, scientific inquiry, practice, and a code of ethics, the litmus test for defining the profession remains elusive. The discipline is not valued. Much of the struggle is in part due to the criteria developed by nonnurses regarding what the nursing profession should be, not what it truly is. Keywords nursing, profession, valuing The discipline of nursing has a rich history, from before the era of Nightingale to the present day; yet nurses and others still cannot agree on what defines nursing as a profession. What constitutes a profession? Is nursing a profession? After over 100years of espousing nursing as a profession, where does nursing find itself? Since there is a lack of clarity surrounding what a profession is, let us begin with a comparison of several definitions. In the Oxford English Dictionary (2014) the word profession is defined as “a paid occupation, especially one that involves prolonged training and formal qualifications.” The International Council of Nurses views the nursing profession as “a well-defined body of knowledge, with a strong service orientation, recognized as an authority by a professional group and a code of ethics.” Similarly, Kirk (2007) wrote, At the root of professionalism is our profession (medicine). A profession requires acquisition and application of a body of knowledge and technical skills. The individuals of a profession are bound together by a shared commitment. Members of a profession regulate themselves. Those in a profession practice in accord with a code of ethics. Finally, a profession has a contract with society. (p. 13).
Meanwhile, business leaders identify characteristics rather than state a definition of a profession. In business, a person must look clean and polished, well dressed, and assertive. There is a set of ethical principles in business that is also important to a profession, but the business world appears to have many struggles with ethics and abiding by the rules surrounding practice. While Wuest (2013), clarified the history of nursing, it became unmistakable that although the discipline was defined by a woman, it was men who discerned criteria for the profession. The value of the discipline was cast upon nursing by men who used paternalistic patterns of
professionalism, mostly physicians. The perspective of what nursing is and is not was not brought to light as a unique science and profession. Thus over the course of nursing’s history, the mark of professionalism was not fully explored with the group who actually were involved in the work. However, since men generally did not practice nursing, it was only perceived notions of what nursing should be, in terms of men’s criteria. Hence, men’s priorities, and men’s ideal of what they thought nursing should be were identified, not what it actually was or should be. The measure of a nurse was developed through observation and preconceived notions of what women do, how they do it, and viewed as an extension of women’s functions in the home. These patriarchal priorities of the discipline were inaccessible and unrealized since nurses could not be measured against these standards. The journey to gender equality is not about measuring up to men, it is about women defining what they consider important. It is not a man’s world; it is a world for all. What one brings to the humanuniverse is unique. This uniqueness is the hallmark of every profession, of every connection; it is how one is with others. It cannot be judged or dictated by another outside the profession Therefore, the criteria for the discipline should not have been adopted but rather developed by persons with the expertise in the field, nurses and patients. Part of this adoption process left nurses under the purview of medicine thereby allowing physicians to dictate the terms of nursing. Nurses relinquished any semblance of power that they might have obtained. The power was lost since nurse 1
Director of the Institute of Nursing Education, Emergency Nurses Association, Desplaines, IL Contributing Editor: Paula M. Karnick, RN, PhD, Director, Institute of Nursing Education, Emergency Nurses Association, Desplaines, IL. Email: [email protected]
Downloaded from nsq.sagepub.com at WESTERN OREGON UNIVERSITY on May 28, 2015
293
Karnick / Practice Applications administrators with perceived power were challenged to meet paternalistic ideals. This further moved the discipline from what it really was to what it could not be, directed at the business of moving patients in and out of institutions. The domain of nursing is unlike other professions and It should not be measured by unattainable standards imposed by others. A professional framework is identifiable in nursing. There is a specific body of nursing knowledge and science exclusive to the discipline. Although historically the domain central to nursing was based on borrowed principles from other professions; this is not inimitable to nursing. Medicine borrowed principles from biology, chemistry, and mathematics, and others. Certainly new knowledge from engineering and advancement in computer technology are currently informing the practice of medicine. As disciplinary theory, research, and practice become refined, knowledge development specific to any domain creates and underpins a solid foundation for a profession. However, as nursing moved forward with its development, the standards became more elusive. When a criterion defined by others was close to being met, another was put in its place. Professional nursing continues to be measured by men, usually in medicine, who keep their profession above all others. Even when women in nursing started to be included with other professionals, they moved away from nursing. Even though nurse scholars and scientists worked diligently to conceptualize and create theories, building the guiding principles of nursing, nurse administrators and executives took on the behavior and intent of other professionals. Moreover, feminism did more harm than good for the discipline. Wanting to be like men does not make us men. Women still are paid less than men. The value that others place on women’s roles IS incongruent with so-called equality. With the advancement of nurse administrators and executives, the goals and values of nursing were tossed away, and the goals of profitability and increased market share came to the forefront. Indeed, nurses with perceived power sold themselves to the highest bidder in order to please the patriarchy. Instead of developing the profession to stand on its own, nurses have continued to struggle. Simply, nurses throughout the world do not have a true voice. The focus is about confusing others by creating different levels of nurses. This confusion has created a difficult situation. Since the discipline cannot define itself and continues to create many levels of nursing without further explicating the profession of nursing, no progress can occur. Nursing has, for many reasons, not been true to its essence. Nurses do not use their power to challenge others’ authority in healthcare. Nurses have given away that power in exchange for a seat at the table with others who now control what nurses do. For example, recently a hospital attorney created a new way to save money and decrease activity in emergency departments. When a patient presents to the emergency room with complaints that are not deemed emergent by staff, the patient will be offered two options. The patient could stay and pay for care the patient would like or feel is needed or the patient
could to decide to go home and have a nurse visit and render care the next day. There was absolutely no nursing input into this proposal, yet this other professional proposed a solution for care without the guidance of the discipline with the end goal of cutting cost. Based on the previous definitions, the discipline of nursing should be viewed as a profession; however, the measure-ment of this profession is based on patriarchal ideals. Should these ideals continue to define nursing? The use of theory is an integral part of defining the profession of nursing. As with other professionals the glass ceiling still exists. The ideals that were defined by medicine are not, nor were they ever valid for defining the profession of nursing. The unique body of nursing knowledge is well established. It is up to nurse leaders to raise a clarion call to action for nurses to be recognized as professionals based on their discipline –specific knowledge. Patients depend on nurses to provide compassionate competent care based on best evidence. Caring and being with are part of professional practice. As nursing continues to evolve, the discipline must clarify how the profession is not only defined but measured. To refine what nursing is and what it is not. How can the discipline transform itself as the profession it wants to be? Nursing has a unique knowledge base, a code of ethics, education, research, and practice. Hiding behind or trying to meet others’ perceived values is not nursing. Nurses cocreated this circumstance by allowing others to take control of and define nursing. Nursing has relinquished its power by trying to be something else. Nurses must power onward and cocreate a different reality. If nursing is to continue and become the profession it wants to be, it must be valued and respected. Nurses must rise to the occasion and identify in certain terms what nursing is, what it believes, and of what the profession consists. Nurse leaders must be clear and informative, and must stand together to ensure that the message sent is strong and unequivocal. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this editorial.
Funding The author received no financial support for the research, authorship, and/or publication of this editorial.
References Kirk, L. M. (2007). Professionalism in medicine: Definitions and considerations for teaching. Baylor University Medical Center. http://www.ncbi.nlm.nih.gov\pmc\articles\PMC1769526\ Oxford American Dictionary. (2014). Wuest, J. (2013). Professionalism and the evolution of nursing as a discipline: A feminist perspective. (Original work published 1994). In W. K. Cody (Ed.), Philosophical and theoretical perspectives for advanced nursing practice (pp.239-255). Burlington, MA: Jones and Bartlett.
Downloaded from nsq.sagepub.com at WESTERN OREGON UNIVERSITY on May 28, 2015
research-article2014
NSQXXX10.1177/0894318414546422Nursing Science QuarterlyKarnick / Practice Applications
Practice Applications
The Elusive Profession Called Nursing
Nursing Science Quarterly 2014, Vol. 27(4) 292–293 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318414546422 nsq.sagepub.com
Paula M. Karnick, RN; PhD1
Abstract As a discipline, nursing continues the struggle to be recognized by others as a profession. Despite the fact that nursing has a unique body of knowledge with theory, scientific inquiry, practice, and a code of ethics, the litmus test for defining the profession remains elusive. The discipline is not valued. Much of the struggle is in part due to the criteria developed by nonnurses regarding what the nursing profession should be, not what it truly is. Keywords nursing, profession, valuing The discipline of nursing has a rich history, from before the era of Nightingale to the present day; yet nurses and others still cannot agree on what defines nursing as a profession. What constitutes a profession? Is nursing a profession? After over 100years of espousing nursing as a profession, where does nursing find itself? Since there is a lack of clarity surrounding what a profession is, let us begin with a comparison of several definitions. In the Oxford English Dictionary (2014) the word profession is defined as “a paid occupation, especially one that involves prolonged training and formal qualifications.” The International Council of Nurses views the nursing profession as “a well-defined body of knowledge, with a strong service orientation, recognized as an authority by a professional group and a code of ethics.” Similarly, Kirk (2007) wrote, At the root of professionalism is our profession (medicine). A profession requires acquisition and application of a body of knowledge and technical skills. The individuals of a profession are bound together by a shared commitment. Members of a profession regulate themselves. Those in a profession practice in accord with a code of ethics. Finally, a profession has a contract with society. (p. 13).
Meanwhile, business leaders identify characteristics rather than state a definition of a profession. In business, a person must look clean and polished, well dressed, and assertive. There is a set of ethical principles in business that is also important to a profession, but the business world appears to have many struggles with ethics and abiding by the rules surrounding practice. While Wuest (2013), clarified the history of nursing, it became unmistakable that although the discipline was defined by a woman, it was men who discerned criteria for the profession. The value of the discipline was cast upon nursing by men who used paternalistic patterns of
professionalism, mostly physicians. The perspective of what nursing is and is not was not brought to light as a unique science and profession. Thus over the course of nursing’s history, the mark of professionalism was not fully explored with the group who actually were involved in the work. However, since men generally did not practice nursing, it was only perceived notions of what nursing should be, in terms of men’s criteria. Hence, men’s priorities, and men’s ideal of what they thought nursing should be were identified, not what it actually was or should be. The measure of a nurse was developed through observation and preconceived notions of what women do, how they do it, and viewed as an extension of women’s functions in the home. These patriarchal priorities of the discipline were inaccessible and unrealized since nurses could not be measured against these standards. The journey to gender equality is not about measuring up to men, it is about women defining what they consider important. It is not a man’s world; it is a world for all. What one brings to the humanuniverse is unique. This uniqueness is the hallmark of every profession, of every connection; it is how one is with others. It cannot be judged or dictated by another outside the profession Therefore, the criteria for the discipline should not have been adopted but rather developed by persons with the expertise in the field, nurses and patients. Part of this adoption process left nurses under the purview of medicine thereby allowing physicians to dictate the terms of nursing. Nurses relinquished any semblance of power that they might have obtained. The power was lost since nurse 1
Director of the Institute of Nursing Education, Emergency Nurses Association, Desplaines, IL Contributing Editor: Paula M. Karnick, RN, PhD, Director, Institute of Nursing Education, Emergency Nurses Association, Desplaines, IL. Email: [email protected]
Downloaded from nsq.sagepub.com at WESTERN OREGON UNIVERSITY on May 28, 2015
293
Karnick / Practice Applications administrators with perceived power were challenged to meet paternalistic ideals. This further moved the discipline from what it really was to what it could not be, directed at the business of moving patients in and out of institutions. The domain of nursing is unlike other professions and It should not be measured by unattainable standards imposed by others. A professional framework is identifiable in nursing. There is a specific body of nursing knowledge and science exclusive to the discipline. Although historically the domain central to nursing was based on borrowed principles from other professions; this is not inimitable to nursing. Medicine borrowed principles from biology, chemistry, and mathematics, and others. Certainly new knowledge from engineering and advancement in computer technology are currently informing the practice of medicine. As disciplinary theory, research, and practice become refined, knowledge development specific to any domain creates and underpins a solid foundation for a profession. However, as nursing moved forward with its development, the standards became more elusive. When a criterion defined by others was close to being met, another was put in its place. Professional nursing continues to be measured by men, usually in medicine, who keep their profession above all others. Even when women in nursing started to be included with other professionals, they moved away from nursing. Even though nurse scholars and scientists worked diligently to conceptualize and create theories, building the guiding principles of nursing, nurse administrators and executives took on the behavior and intent of other professionals. Moreover, feminism did more harm than good for the discipline. Wanting to be like men does not make us men. Women still are paid less than men. The value that others place on women’s roles IS incongruent with so-called equality. With the advancement of nurse administrators and executives, the goals and values of nursing were tossed away, and the goals of profitability and increased market share came to the forefront. Indeed, nurses with perceived power sold themselves to the highest bidder in order to please the patriarchy. Instead of developing the profession to stand on its own, nurses have continued to struggle. Simply, nurses throughout the world do not have a true voice. The focus is about confusing others by creating different levels of nurses. This confusion has created a difficult situation. Since the discipline cannot define itself and continues to create many levels of nursing without further explicating the profession of nursing, no progress can occur. Nursing has, for many reasons, not been true to its essence. Nurses do not use their power to challenge others’ authority in healthcare. Nurses have given away that power in exchange for a seat at the table with others who now control what nurses do. For example, recently a hospital attorney created a new way to save money and decrease activity in emergency departments. When a patient presents to the emergency room with complaints that are not deemed emergent by staff, the patient will be offered two options. The patient could stay and pay for care the patient would like or feel is needed or the patient
could to decide to go home and have a nurse visit and render care the next day. There was absolutely no nursing input into this proposal, yet this other professional proposed a solution for care without the guidance of the discipline with the end goal of cutting cost. Based on the previous definitions, the discipline of nursing should be viewed as a profession; however, the measure-ment of this profession is based on patriarchal ideals. Should these ideals continue to define nursing? The use of theory is an integral part of defining the profession of nursing. As with other professionals the glass ceiling still exists. The ideals that were defined by medicine are not, nor were they ever valid for defining the profession of nursing. The unique body of nursing knowledge is well established. It is up to nurse leaders to raise a clarion call to action for nurses to be recognized as professionals based on their discipline –specific knowledge. Patients depend on nurses to provide compassionate competent care based on best evidence. Caring and being with are part of professional practice. As nursing continues to evolve, the discipline must clarify how the profession is not only defined but measured. To refine what nursing is and what it is not. How can the discipline transform itself as the profession it wants to be? Nursing has a unique knowledge base, a code of ethics, education, research, and practice. Hiding behind or trying to meet others’ perceived values is not nursing. Nurses cocreated this circumstance by allowing others to take control of and define nursing. Nursing has relinquished its power by trying to be something else. Nurses must power onward and cocreate a different reality. If nursing is to continue and become the profession it wants to be, it must be valued and respected. Nurses must rise to the occasion and identify in certain terms what nursing is, what it believes, and of what the profession consists. Nurse leaders must be clear and informative, and must stand together to ensure that the message sent is strong and unequivocal. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this editorial.
Funding The author received no financial support for the research, authorship, and/or publication of this editorial.
References Kirk, L. M. (2007). Professionalism in medicine: Definitions and considerations for teaching. Baylor University Medical Center. http://www.ncbi.nlm.nih.gov\pmc\articles\PMC1769526\ Oxford American Dictionary. (2014). Wuest, J. (2013). Professionalism and the evolution of nursing as a discipline: A feminist perspective. (Original work published 1994). In W. K. Cody (Ed.), Philosophical and theoretical perspectives for advanced nursing practice (pp.239-255). Burlington, MA: Jones and Bartlett.
Downloaded from nsq.sagepub.com at WESTERN OREGON UNIVERSITY on May 28, 2015
