Nursing: a degree that honors the profession is not the evidence of competence

(A Red Cross nurse in France)

Today is the last day of my second week in the BSN online program at GCU.  Tonight after 14 hours at work I submitted the first collegiate paper I've written in 17 years.  The assignment:  A formal 750-1000 word paper discussing the difference in competency between the associates prepared nurse and the  baccalaureate prepared nurse, as well as identifying a patient care situation where approaches to nursing care or decision making might differ in having a BSN versus a diploma or associates degree in nursing.  In my initial attempt I wrote 500 words without thinking twice and found all I had was an impassioned argument for why the RN, BSN isn't any more competent than the RN, ADN.  It hit a nerve.  But what developed I think was a pretty well thought out paper which addressed the subject matter the instructor wanted while pointing out that the perspective taken in writing this paper all depends on how you view competency.  The main difference in competency is not clinical skills for bedside nursing.  The main difference is competency in being seen as a professional amongst other health care professionals, and in honoring the leading role nursing is in health care with a degree which is fitting.  Nurses with BSN degrees can move into leadership positions and be seen by their cohorts as professionals.  Nurses with BSN degrees raise the bar for how nursing is viewed.

Nursing has evolved over it history from a job seen only fitting for, "an ignorant woman, who was not fit for anything else," (Draper, 1893/1949) where nurses blindly obeyed doctors orders without questions.  Nurses in American history strove to get nursing to be seen as a profession with a unique perspective on health care.  And they weren't wrong to strive for that.  Nursing is a profession.  It isn't mindless task work.  Nurses today have to manage the health care of acutely complexly ill patients while collaborating with doctors, therapists, and other health care professionals.  The truth is nurses are professional health care providers.  But that truth is being pushed to light in a system that is still trying to work in the dark with nurses as medicine delivery technicians. Nurse's are expected to have the knowledge of their professional cohorts while working in environments that continue to expect timed tasked work.  Other health care professionals in the health care system aren't expected to answer call-lights, take patent's trays, empty trays, pass medications, take vital signs, answer phones, call referrals, enter orders into computer system, clean their own equipment, file repair reports, make beds, move beds, order patent's meals, draw labs, draw blood, communicate with pharmacy, IT, management, CNA's, family members, case managers, cafeteria staff, PPS coordinators, doctors, nurse practitioners, PA's, patients, maintenance, housekeeping, central supply, linen services, etc.   Nurse's are expected to do all that, plus do extensive documentation and assess, plan, coordinate and carryout a plan of care for their patients as well as educate their patients and the families all in a 12 hour shift.

If the system is going to push nursing to be seen as the profession it is, as equals among health care professionals, the system has to stop treating nurses like waitresses.

The truth is nursing is a service-oriented profession.  Good nurse's will always do the "dirty work"of lowering themselves to help someone else. That is not beneath the profession of nursing.  But the pressure to do more tasks in a 12 hour period as well as the pressure to be seen as a professional by getting a higher degree are pressing hard on nurses so that the ones who do get higher degrees are moving away from bedside nursing beyond their first year as nurses.

The work of a nurse historically is honorable, no matter what society thought of them.  Whether doctor's respected nurse's or bullied them, nurses have been advocates of health and people in need of health care for centuries. The work of practical nursing does not require a bachelor's degree. And that does not mean nursing is a job vs. a profession.  But nurses do have a unique way of approaching health care that is distinct from doctors.  Doctors treat disease.  Nurses approach people wholistically  for their health and well being. Nurses should be seen as health care professionals. And I'm glad to honor the profession of nursing with a fitting degree.  I just wish the system would honor the profession of nursing not just with pressure to attain a higher degree, but with a role in health care (I'm especially thinking of acute health care, a.k.a. the hospital) that honors the profession.

At work today I parked a patient with severe brain injury next to me at the nurse's station for his safety and my convenience.  I had about four hours of charting to do and he couldn't communicate or control his body safely with attached tubes and lines.   As I assessed his needs through facial expressions, the way he held a pencil and the tears welling up in his eyes while he squeezed my arm and pointed to the coffee cup he couldn't drink out of, I decided he was communicating his despair.  I put my hand on his back and gently scratched while assuring him he was in a good place and we were going to do all we could to help him get better.   He arched his back and made an expression of relief, enjoying the back rub. A lot of problems get solved with a back rub (and a cup of coffee if the patient can have it).  It doesn't take a BSN to make an aphasic man feel comforted.  But it does take the kind of compassion that rubs a back to make a professional nurse.