489158

research-article2013
NSQXXX10.1177/0894318413489158Nursing Science QuarterlyKarnick / Practice Applications

Practice Applications

Nursing Science Quarterly

Is Nursing Its Own Worst Enemy?

26(3) 236­–237
© The Author(s) 2013
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DOI: 10.1177/0894318413489158
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Paula M. Karnick, RN; PhD1

Abstract
In a thought-provoking interview, one nurse theorist poses a question related to nurses. She asks nurses to defend their
profession as a profession rather than as a trade. This question should give rise to a resounding response that nursing is a
professional discipline. Over the years many nurses have fought to be recognized as a profession by doing the real work of
building a foundation to ensure nursing’s future. Unfortunately, over the last few decades, the building of nursing science
has taken a back seat to other concerns such as creating more layers of practice, continuing to confuse the public and our
patients about who nurses really are and what nursing really does.

Keywords
nursing discipline, Fawcett, nursing education, nursing practice

In a recent interview, Fawcett said, “If people do not accept
that there is a body of knowledge that constitutes nursing that
is distinctive and different from other disciplines, then they
do not have the right to say that they are practicing a profes-
sion or that they are members of a professional discipline.
Instead, they are functioning as trades people” (Lee &
Fawcett, 2013, p.97).
Do nurses view themselves as professionals or as trades
people? The debate is clear. How should nursing be defined?
Is nursing a professional discipline or is it merely a trade?
For many years, groups of nurses have sought to advance
nursing by enhancing discipline-specific knowledge unique
to healthcare and different from other disciplines. Has that
really happened? There are quite a few professionals who
have created a unique body of nursing knowledge, and this
has been disseminated; but who uses this knowledge?
Certainly the dissemination of the unique underpinnings
of nursing are available in books and other literature, but
what have nurses done with such knowledge? How is it used
in present day practice? Has it become a trade in which
nurses teach others skills and tasks without the underpin-
nings of nursing theory and research?
Surely some nurses will protest the use of nursing theory-
based practice, but most will readily admit that they under-
stand nothing of theory or what theory has to do with practice.
Everyone thinks they understand evidence-based research,
but simply said, this information is merely a translation of
the evidence into a protocol-driven practice. Students abhor
the question, “What is your personal meaning of nursing?”
Most cannot relate it to theory or even to the thinking and
problem solving done every day in professional practice.
They instead relate only to a list of tasks that they perform or
list other things that do not define nursing.
Case in point: many nursing schools do not include nurs-
ing theory, a specific body of knowledge unique to nursing,
in their curricula. This is notable in the multitude of Doctor
of Nursing Practice (DNP) and Nurse Practitioner (NP) pro-
grams established all over the United States. Where is the
unique body of knowledge that underpins the foundation of
nursing in these programs? From the lack of educational con-
sistency to the medical model being taught, one could argue
these are not nursing degrees. Even the word nursing in their
titles confuses the general public. Can nurses speak to the
differences in a way that others can understand? This is the
age-old question: What is a nurse?
The tide is turning unfavorably for nursing as a discipline.
The scholars of the profession are fading away; people who
have given their life’s work to the discipline are being
replaced by trades people. Nursing cannot have it both ways.
It cannot pretend to be a profession while teaching only tasks
and protocols as the means for taking care of patients. There
is a lack of clear understanding of what a professional nurse
knows and does. Many nurses ask: “Why do I need to know
about nursing theory? We don’t use it anyway”.
If nursing is a unique discipline, the answer should be
obvious. Nurses should respond by acknowledging that the
purpose of nursing theory is to guide, support, and even create
professional practice. However, if nursing continues on this
slippery slope of focusing on completing tasks, body
1
Associate Professor, Lewis University, Chicago, IL, USA
Contributing Editor:
Paula M. Karnick, RN, PhD, Associate Professor,
Lewis University, 5023 N. Busse, Chicago, Illinois, 60656
Email: pmkarnick@aol.com

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Karnick / Practice Applications 237
mechanics, and other minutia, the profession has indeed lost
the battle. The discipline has not taken ownership of what
nurses know, what they do, or what kind of profession nursing
should be. Instead, it has allowed physicians, financial depart-
ments, and chief operating officers, among others, to mandate
who nurses are. To date, there has been no one to confront this
infringement on nursing. Instead nursing allows itself to be
manipulated into what others want it to be, with no recourse.
Over the past 40 years, nursing has been degraded, demor-
alized, and defined by others in the healthcare arena. Is there
time to change this downward spiral? Not much. The time is
now to define the nursing profession as it should be, in a way
that recognizes and allows others to see what nurses really
contribute through the substantial knowledge that grounds
nursing in its knowledge base. It is not too late to change the
course of nursing, but it will take the effort of every nurse to
believe in what nursing stands for and see how nurses use
their own knowledge to guide practice. This means that
nurses must clearly articulate the unique knowledge the pro-
fession of nursing contains, what it does with that knowl-
edge, and how it translates into patient care. Yes, that means
explicating nursing theory, incorporating it into our beings,
showing others how nursing is different and what nursing
brings to the interdisciplinary table. Nurse theorists paved
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the way for nurses to stand up and be counted alongside other
professionals. Nursing is a power to be reckoned with —if
and only if nurses rise to the occasion.
Fawcett may be correct. The further nursing removes
itself from the foundational premises upon which it was
founded, the chances increase that nursing will not be seen as
a professional discipline. Nurses will be the plumbers and
electricians of healthcare, completing tasks and working
scheduled shifts and walking away from one of the most
needed professions in the world.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to
the authorship and/or publication of this column.
Funding
The author received no financial support for the authorship and/or
publication of this column.
Reference
Lee, R., & Fawcett, J. (2013). The influence of the metaparadigm of
nursing on professional identity development among RN-BSN
students. Nursing Science Quarterly, 26, 97.