Okay so, after reading a ton of books trying to find a definition of nursing that matched my experience, I fell asleep with no clear cut answer to my question, “What is a nurse?”

I mean it’s not that I haven’t been pondering that for a very long time, it’s just that nothing so far has satisfied me. I’ve seen brilliant bedside nurses–and I don’t mean nurses who only cared for patients with superb care and compassion– I mean smart, really smart diagnosticians. Nurses who doctors asked, “What do you think is going on with this patient?” And when they answered, there was true appreciation and respect from the doctor to that nurse. They were colleagues, no question there.

I’ve seen ICU nurses, who both doctors and patients trusted to look at a monitor, administer meds — both stat and with standing orders — who saved patients lives time and time again, before a doctor ever could get to the Unit.

I watched patients pour their hearts out to a nurse, the way children do to their mothers, tears flowing, nose running, sobbing, when they felt hurt and broken over news of a sickness that snuck up on them, and heard doctors sigh with relief and appreciation when nurses did the emotional heavy lifting. No one ever asked what degree the nurse had, or even where she went to school. If a nurse was good at her job, she was a “good nurse.”

But now with the corporate takeover of healthcare, with those businesses so afraid of liability, they’ve relegated a lot of the best nurses to desk duty and management. Both the corporations and nursing policy makers are beginning to require more and higher degrees in order to squeeze “the most” out of the nurses just in case the corporations choose to use nurses as “primary caregivers” because doctors will no longer put up with the bottom line abuse and lack of autonomy that nurses have for so many years.

New rules for a new time needed to be developed–so as we grew we had new rules for scope of practice, but not universal, not even statewide — in fact, those rules were as different as the corporations themselves–because corporations do help support both the organizations that write policy and the legislators who make the laws.

So what position does that leave the nurse in? Egads! And what position does that leave the patients in? Healthcare executives don’t have a clue what nurses can do, patients don’t know what nurses can do, and a lot doctors don’t even know what to do with a nurse in expanded or advanced practice.

So what if a nurse has a bachelor’s or a master’s degree now? Remember that nurse has spent a lot of years, done a lot of work, and invested a lot of money to get those degrees. The good news is that in some hospitals or healthcare systems in some states, under some conditions, that nurse is allowed to practice to the full extent of her/his talents and capabilities. So though she has a lot of responsibility and a lot of work, she finds nursing satisfying. She’s a professional after all and the whole healthcare team, including the patients, benefit.

But what if she finds a job in a healthcare system that needs her credentials and her help, but doesn’t want her to think or practice what she or he has learned? What if the execs running it don’t even know it’s a nurse’s job to practice advocating and educating a patient? What happens then? Where does she turn? Does the profession of nursing have a legal aid team that they will provide? Do professional nursing organizations offer counseling or emotional support and guidance for that nurse to get through the difficult times of being punished for doing a job she or he was educated to do? Or do those same organizations that wrote the policy just turn a blind eye and let her go down, alone? Will someone send out a press release to advocate for that nurse?

We should mention the evolution of the organizations that are trying to grow nursing up. Do those same organizations accept the responsibility and admit that they haven’t grown in the same way that they now require the nurses to grow?

What happens to that nurse who was advocating for the patient?
As important, what happens to the patient that the nurse is advocating for when the “bottom line” corporate execs and doctors who are “old school” egomaniacs from the time when doctors had all the power, try to punish her for treating patients as though they are grownups and intelligent, despite being sick and vulnerable human beings?

Well, as in the case of Amanda Trujillo, the powers that be fire her, put her under investigation, which stops her from earning a living, feeding her child, living her life because all the other corporations that run with a bottom line business model are afraid of being sued, so they aren’t going to hire that nurse. Then, they’ll pull one of the oldest power tricks of humankind. They’ll discredit her, and send her for a psychological exam to see if she’s competent. Is there a diagnosis for too competent?

Is this what we have to look forward to as nurses? Or should we forget our calling to help sick people, realize that the system we have now is not healthcare and stick with simple stuff like accounting, or being financial advisors or stockbrokers. At least in those professions you get respect, lots of money, and you’re not working with real things…
Sure we’ve all agreed money is real, because it’s easier than trading cattle or other merchandise but after all, most of the time, it’s not life and death! Except when you hit up against overwhelming fear, greed and corruption. Uh-oh, I’m beginning to see a pattern here.

Anyway, I told you when I started this whole rant or discussion or whatever…that I couldn’t figure out what a nurse was, is. But everyone says that great discoveries come in your dreams and so it was with me. Just before I opened my eyes this morning, my head was filled with Swiss Army knives. Very colorful ones, some with polka dots, some with tartan patterns, some pure gold. Still, I recognized them. Swiss Army knives!
“What has this got to do with nursing?” I asked myself.
“Everything,” is what I answered.

“Well,” I thought, “If it’s an issue of survival, it’s always better to have a Swiss Army Knife than not.
“Wait! Wait!” something inside me hollered, “What happens when there are no more Swiss Army Knives, what happens to all of us then?”
Clear as anything I heard a voice say, “Is it a matter of survival?”