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Q: Is it OK if we keep saying that only nurses who currently work at the bedside are "real nurses?" Demonizing everyone else helps us fight for workers' rights!

A: That's totally fine, unless, of course, you'd like nursing to be considered an autonomous, scientific profession. It's understandable that bedside nurses and their advocates resent what they believe to be the disregard for their concerns about staffing and other key issues on the part of some nursing executives, academics, policy-makers and consultants. Good bedside nursing requires an extraordinary combination of intellect, skill, courage, and strength, and when other nurses seem not to appreciate that, it is especially distressing. The same is true when nurse executives make television ads suggesting that because they do not favor certain staffing legislation, "nurses" in general do not. But to say that nurses are not "real" nurses simply because they do not currently provide direct care will suggest to many members of the public that nursing is not a real profession whose members might actually be senior health policymakers, executives, and scholars, but a category of rank-and-file workers who happen to provide custodial care to patients. In fact, by the "real nurse" standard, Florence Nightingale would not have been considered a nurse for most of her career.

Claiming that only bedside nurses are "real nurses" suggests that nursing is not a "real profession," because it is characterized only by physical work and mental work that is done at the bedside. Of course bedside nurses are responsible for countless far-reaching changes to health systems, but the message most people will receive from the "not a real nurse" tactic is that the minute a nurse is not ethically bound to care for patient X today, he is not a nurse--even if he did bedside nursing yesterday and for the past 20 years. It suggests that nurses can only address individual patients who are right in front of them, that nurses are not concerned with broader health policy issues. This also excludes "real nurses" from significant managerial and policy positions, and many academic positions, ensuring that the profession continues to be considered by many to be a "lower skilled" job that does not require significant college training. Would anyone suggest that a physician working in basic research, or one who also holds a management position as chief of surgery, is no longer a "real physician?" In fact, the "real nurse" argument can sound sadly like self-loathing; if you're not being oppressed, you're not a real nurse. But why would you cease to be part of a profession once you start managing members of that profession, or become an advanced policy or academic figure within that profession? US Surgeon General Richard Carmona is a physician and a nurse. Is he not a "real physician?" Or just not a "real nurse?"

At the most basic level, the "only bedside nurses are real nurses" argument suggests that nurses can never wield significant economic, policymaking or academic power--they can only oppose or resent those who do have it. Of course, the irony for the profession of Florence Nightingale is extreme. Nightingale did provide bedside care, but later in her life spent many years researching, thinking and writing, launching reforms that changed the face of hospital care and nursing practice. If only she had been a "real nurse," she might have done something of "real importance."

last updated January 6, 2006

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