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The Forum > Article Comments > The money or the nurse? > Comments

The money or the nurse? : Comments

By Denise Bartlett, published 30/11/2004

Denise Bartlett argues that there is no simple solution to the dilemma facing health care workers.

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the nursing work force has long aspired to be recognised as a profession - I have never understood why. I have always considered it just a job. And there is nothing wrong with that at all. While it does command a discreet body of knowledge in many respects, with few exceptions, it is far from an autonomous form of practice.

Most nursing work is indeed dependant on medical work - doctors make a hole, take something out or put something in and the nurse manages the intricacies of the after care; after 5pm nurses undertake whatever physiotherapy regime may be prescribed by a physiotherapist or encourage a stroke victim with exercises prescribed by the spech pathologist. Doctors order medications and nurses administer them - via increasingly complex means and using increasingly complex technology. Nurses manage increasingly complex apparatus in intensive care units and undertake increasingly more critical work on behalf of the patient - those tasks are not done in isolation. Doctors get bored with various aspects or tasks of their function and give them over to other professions - urinary catheterisation, venepuncture, simple suturing, IV cannulation; the vast majority of nursing work with the exception of attending to the basic needs of elimination, hygeine and nutrition are either derivative of medical practice, inherited from medical practice, built up with the introduction of technology or legislated as part of their practice - nurse practitioners, those operating in rural and remote settings, independant midwives are obvious exceptions to this but they are in the minority. The list of activities now undertaken by nurses that were formerly the domain of doctors is extensive.

There certainly isnt anything wrong with nursing work when seen through the prism if interdepedence with the medical profession. There are however many that seem to cringe at this scenario. The "I'm not a hand maiden" arguement is often thrown up. So any down stream activity developed from medical practice is too often seen in that light; that however is often the nature of the beast. Nurses invariably need to respond to medical intervention. At the same time they should be responsive to the immediate declared needs of the patient most of which they have the skills to address.

Nursing is also fragmenting; with increasing degrees of specialisation and divisions of labour nursing as an entity becomes increasingly hard to define and the concept of "holism" becomes increasingly irrelevant to many fields of practice - where does a dedicated theatre nurse sit in the pantheon of nursing when thier working day consists of managing the instrumentation during operative procedures - some scrub nurse would rarely see a patient for more than a minute in anything but an unconscious state - how does a lactation consultant fit into the definition of nursing.

Nursing has struggled for decades with its identity and an inability to define itself; the strikes in Victoria were underscored by bans on non nursing duties; nurses readily abandoned what they considered non nursing but still struggle with what is nursing. Nursing can define itself but it will have no relevance until it recognises the organic nature of health delivery. A good health outcome is a sum of all the contributors simply fulfilling their responsibilties well. Its called getting on with the job - whatever that is.
Posted by inkeemagee, Tuesday, 1 February 2005 1:21:30 PM
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