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October 23, 2000

Image is everything

I agree that nursing is a profession ("Profession or Trade?" Editor’s Note, Oct. 9) and am proud to tell others that I am an RN. I think nursing needs to be portrayed well in the media on a large scale and portrayed well individually on a "small" scale.

Plenty of nursing students were in school when I applied in 1990. I’m wondering if RNs are "out there" but not practicing because of fear or disappointment. If nurses fear that they will harm patients (i.e., medication errors) instead of helping them, this could keep an RN from wanting to practice. Some nurses may not be able to function well at certain hours or under certain conditions (i.e., noc shift or poor staffing), and if their facility demands that they work noc shifts, they may be forced to leave (and rightly so, knowing that they may accidentally harm patients if working at night).

Flexibility in nursing hours can be a draw to RNs out there. Forget about required nocs/days rotations. If someone can only work weekends, then let them work weekends. If someone wants to work all the holidays, let them. Encourage new graduates and share the "tricks of the profession" with them, rather than giving them a hard time, which will only encourage them to get out of the profession.

Treating patients, families and other nurses with respect can be challenging at times, but I think it is essential in how nurses are portrayed.

Lisa Marchi, RN
San Francisco

Not a profession

I disagree that nursing meets all the criteria to be considered a profession. Lawyers, doctors, architects, dentists and teachers do not have someone giving direct orders. If there were no doctor’s orders, what would nurses do? Lawyers, doctors, dentists, teachers and architects act independently in practice.

Recently, I returned to the acute care environment after an absence of 12 years. The other day, I was on a med/surg floor, where a pulmonary specialist removed a chest tube from a patient, dropped it on the floor and left the bedside to go write progress notes. The RN was left to clean up after the doctor. This was a young doctor. There was no excuse for this degrading and unsafe behavior.

When medical school teaches doctors to treat nurses as partners in patient care, then nurses will be thought of as professionals and the public will view us differently. Until then, we will remain subservient to their disgusting, rude, arrogant and belittling behavior toward us. What doctors do not realize is that we are the ones who care for and save their patients when they are not around. They need to treat us with respect and even gratitude.

Patients will see this and then treat us as professionals, too. I think we have a ways to go.

Barbara Peurifoy, MSN, RN
San Jose, Calif.

Direct billing missing

I must applaud your efforts in establishing and confirming nursing as a profession. However, a certain fact remains: Nursing is not able to bill directly for services provided.

Sure, certain advanced nurses can now bill independently for the services they provide, but most are still limited by their collaboration with other professionals. If I am not mistaken, every profession that meets the definition provided in your article (and some that don’t) are able to bill independently for the service(s) provided. This fundamental difference influences the community’s view and the status of nursing as a profession; therefore, nursing as an autonomous entity is not possible due to its reliance on other institutions or practitioners for compensation and acknowledgement.

Nursing cannot be a true profession without these factors:

• Legal title of practice (done)
• Legal requirements for services provided (variable)
• Ability to get reimbursed independently (nonexistent)

As a clinical nurse, I would starve if hospitals or doctors stopped paying me for the services I provide, or could find another non-RN practitioner to perform that role. (What other practitioner would meet legal requirements and perform these services as cheaply as a nurse?) I don’t think the other "professionals" (lawyers, doctors, architects, dentists and teachers) have such a codependency on others. They can set up shop, bill for services and demand payment without depending on another profession or institution for their revenue.

Once nurses obtain the ability to bill independently and obtain a legal definition of services that can be performed only as nursing services with the title of RN, then we can recognize and the community will recognize RNs as professionals. Until then we can talk, research, write, publish, profess, demand and self-proclaim all we want, it still does not make us a profession (to all) – even if we deserve it.

James Blount, RN, RRT
Los Angeles

Where the anger is

I am an RN and have worked in a skilled nursing facility for 13 years. I am 60 and have many health problems, but I have a family to support, so I am still working.

I read with interest your article in the Oct. 9 issue of NurseWeek regarding nursing homes ("Medi-cuts Hit Home"), the staffing problems in particular.

We are plagued by problems of short staffing. Most of us are working much more than we should, with the result that many staff members are becoming ill or injured. I am writing this and working in spite of having my right hand in a splint (and I am right-handed).

I disagree with the statement that people aren’t willing to work with the elderly – actually people no longer are willing to work where wages are so low that they can’t take care of their families. Pay a reasonable wage and there will be no problem getting enough staff.

I was angered by the suggestion that employees would take out their frustrations on the residents. Believe me, our anger is pointed in a totally different direction!

Judith Parks-Stevens, RN
Meadow Valley, Calif.

Difference of opinion

I must respond to a particular letter you published ("Opposing view," Readers Respond, Oct. 9) regarding endorsements of Democratic candidates for office.

The first point made by an RN from Bakersfield was about how nurses could endorse late-term abortions, which Democratic candidates usually prefer not to forbid. The usual position by the Democrats is to allow physicians and the patient to make the decision based on medical need. Most nurses know that the few late-term abortions are for severe fetal anomalies or serious health problems of the mother.

Vice President Al Gore has said that he would sign a bill outlawing the procedure if the bill included the provisions for the life and health of the mother. If the writer believes that "health care professionals who pour their heart and souls into helping others should determine health care," shouldn’t those health care professionals have some say in determining when the need for late-term abortion is necessary? Or should the government determine that on an unconditional "no" in any and all cases?

Finally, the writer believes that what is happening today is first lady Hillary Clinton’s fault. The truth is that the problems we have today have been created by the free market. Insurance industries (remember Harry and Louise?) want to make a sizable profit out of health care delivery. Many large corporations have gotten out of the business (Aetna) because they cannot make a profit and keep their shareholders happy.

Whether health care can be made to fit the free market mechanisms is questionable. Health care is not the same as manufacturing a product. So far, the only people going to the bank are the pharmaceutical companies and they are working hard to defeat Gore. The drug plan envisioned by the Democrats would set prices for Medicare patients (a huge market) and force drug companies to lower their prices – something they do not want. Now do you understand?

Anne Spanier, RN
Oakland, Calif.

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