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I have researched the attributes related to professions and nursing as a profession for the past 15 years. This is what I can add to your debate.
By compiling the information of all the theorist relating to the attributes of professions, there are 14 which stand out; advanced knowledge (usually accepted to be a baccelaureate degree or higher), theoretical base, altruism, code of ethics, autonomy, service, competence, commitment, professional association, prestige, authority, and trustworthiness. Assuming nursing to be a discussion of the RN role only, it is generally accepted that nurses are mostly altruistic, their actions serve the greater good, they are competent, and they are trustworthy. As nursing has developed there has been significant development in nursing theories, so a theoretical base is accepted, and the board of nursing ensure that a code of ethics is maintained. Furthermore, the role of the RN has changed over the years and there is increasing authority over the nursing process (though many people in society in general still see nurses as performing the orders of the physician), and society has given the RN a much greater prestige in the past few decades.
The issues which are considered problematic in those who look at nursing in the spectrum of professions and occupations are:
There is a limited body of knowledge which has been tested and identified as purely underlying nursing practice.
The occupation continues to be comprised of segmented groups who have varying amounts of education, hold varying sets of values, and express varying concerns about the issues which impact on nursing.
The occupation possesses no common mode of thought in viewing its work
The educational base is not extensive enough to warrant professional status.
There is not a consistent participation in the professional associations. (Despite there being 3 million nurses in the US there are only 150,000 member in the American Nurses Association)
There are significant issues related to autonomy in nursing. There are however, some segments of nursing which demonstrate high levels of autonomy.
Some segments of nursing seem to have met the standards of a profession, to a greater degree, and are generally considered professionals, though in some cases, not as nurses.
The RNs in the active military, in a study were found to have higher demonstrated professional attributes, higher scores on professional attitude scales, and higher levels of autonomy on the Nursing Autonomy Tools. It was felt that this was due to several reasons; all RNs in the active military have a BSN or higher degree. Almost all RNs in the military with the rank of Major or above have at least one graduate degree. Military nurses are highly encouraged, and therefore have a high level of participation in professional associations. A significant issue is the quarterly professional counseling and goal setting which each officer receives, and the stress military nursing leadership puts on being assertive with physicians and other health care staff to improve patient outcomes. Nurses in the military frequently outrank the physicians who are working in their area. There is considered to be a higher level of autonomy for those nurses in the military, generally due to their dual role as officers. In fact, when asked what they do for a living, most military nurses will tell you their rank and branch of service, not that they are a nurse. Society perceives these nurses as professional officers and soldiers first, and then nurses. Another factor which probably affects the military nurses, is their monthly pay system. In a study of salary vs hourly wage involving nurses it was found that the hourly wage common to most RNs produced a blue collar mentality and productivity model which causes a loss of autonomy and professionalism.
Studies have also shown that there is a direct relationship between the autonomy and professional attitude scores and the level of education, and that without increasing education length of experience has a negative effect on autonomy and professionalism.
The highest levels have been found in nurses with graduate degrees, especially administrators, and advanced practice nurses. The lowest levels are seen in associate degree nurses who have worked in units or the operating room for extended periods and have not moved into management.
The American Nurses Association and the National League for Nursing have both recommended that the BSN be the minimum degree for RNs. This would be a significant change, and would indicate that nursing is controlling it's own criteria. There was a significant loss of status for nursing as a profession when one of the states changed it's law to make the BSN the state minimum standard, and then lost in a legal dispute with the AFL-CIO nurses union, and had to lower the standard.
For the reasons discussed above, and several others, which I could discuss for hours, if not days, sociologist consider that nursing is at worst not a profession. However, some have been seen to classify nursing as a semi-profession, marginal profession or more recently an emerging profession.
Nursing should be a profession, and if RNs understood that while everyone in nursing considers all RNs to be excellent nurses and providers of care, it is in the best interest of the occupation as a whole, to increase the educational standard. Pharmacist increased their education from a BS to a PharmD. Physical Therapist now require a Master’s or doctorate rather than a BS. We were able to achieve these goals with advanced practice nurses, as now all new APRNs in the US have graduate degrees. There are even now new DNP programs developing (Doctor of Nursing Practice) where after a BSN a nurse will go straight to a doctoral program as a nurse practitioner. It is reasonable to understand that as health care changes, and there are additional techniques, drugs, and procedures, there will be a need for longer educational programs.
In a world where there are associate degree programs to be an LPN or a Medical Assistant, and the 2 year RN programs now take 3 years for most students to complete, it is about time to change the education level.
EDIT: The response from Spongebob is an example of the issues in nursing today. The fragmenting of degrees and professional associations, the unionization and blue collar mentality which will insure it remains an occupation and is never a profession.
If 5% of garbagemen had doctorates would it be a profession? The fact is the largest percentage of RNs are educated in a program which provides less than a baccalaureate degree, and do not bother to seek higher degrees once working.
While it is true there are professional associations in addition to the ANA, there are in most occupations professions. Physicians have multiple professional associations but still manage to support their main national organization the AMA. Lawyers have state and specialty organizations but still support the National Bar. Nurses in California chose not to supporet the ANA, and the CNA which was a part of the ANA left because they wanted to form a union, which was not supported by the national association, as it does not lead to professionalism in nursing.
Yes there are specialty organizations and certifications, but the average RN in the US is not a member of a specialty organization, nor is he/she certified in any specialty.
Licensure is not something which nursing has developed in and of itself, but is partially a function of the state government, and in some states still falls under the pervue of the state medical board.
Thank you Spongebob for making my point!
RN, Ph.D., CFNP
Information from numerous studies and theorist collected over the course of 15 years.
The Profession of nursing is however made up of general and specialized jobs.
When people use the term Nursing Jobs they simply mean jobs available within the nursing profession and in the profession are a huge variety of jobs.
For the individual, however, nursing is a calling to service. Just like you would hear a missionary, a pastor (other religious leader), or a teacher say, nurses are called to do what they do.
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