Reasons why nursing is not a profession

CHAPTER 1: Philosophy, Science, and Nursing
Melanie McEwen

Largely due to the work of nursing scientists, nursing theorists, and nursing scholars over the past five decades, nursing has been recognized as both an emerging profession and an academic discipline. Crucial to the attainment of this distinction have been numerous discussions regarding the phenomena of concern to nurses and countless efforts to enhance involvement in theory utilization, theory generation, and theory testing to direct research and improve practice.

A review of the nursing literature from the late 1970s until the present shows sporadic discussion of whether nursing is a profession, a science, or an academic discipline. These discussions are sometimes pleading, frequently esoteric, and occasionally confusing. Questions that have been raised include: What defines a profession? What constitutes an academic discipline? What is nursing science? Why is it important for nursing to be seen as a profession or an academic discipline?

Nursing as a Profession

In the past, there has been considerable discussion about whether nursing is a profession or an occupation. This is important for nurses to consider for several reasons. An occupation is a job or a career, whereas a profession is a learned vocation or occupation that has a status of superiority and precedence within a division of work. In general terms, occupations require widely varying levels of training or education, varying levels of skill, and widely variable defined knowledge bases. In short, all professions are occupations, but not all occupations are professions (Finkelman & Kenner, 2013).

Professions are valued by society because the services professionals provide are beneficial for members of the society. Characteristics of a profession include (1) defined and specialized knowledge base, (2) control and authority over training and education, (3) credentialing system or registration to ensure competence, (4) altruistic service to society, (5) a code of ethics, (6) formal training within institutions of higher education, (7) lengthy socialization to the profession, and (8) autonomy (control of professional activities) (Ellis & Hartley, 2012; Finkelman & Kenner, 2013; Rutty, 1998). Professions must have a group of scholars, investigators, or researchers who work to continually advance the knowledge of the profession with the goal of improving practice (Schlotfeldt, 1989). Finally, professionals are responsible and accountable to the public for their work (Hood, 2010). Traditionally, professions have included the clergy, law, and medicine.

Until near the end of the 20th century, nursing was viewed as an occupation rather than a profession. Nursing has had difficulty being deemed a profession because many of the services provided by nurses have been perceived as an extension of those offered by wives and mothers. Additionally, historically, nursing has been seen as subservient to medicine, and nurses have delayed in identifying and organizing professional knowledge. Furthermore, education for nurses is not yet standardized, and the three-tier entry-level system (diploma, associate degree, and bachelor’s degree) into practice that persists has hindered professionalization because a college education is not yet a requirement. Finally, autonomy in practice is incomplete because nursing is still dependent on medicine to direct much of its practice.

On the other hand, many of the characteristics of a profession can be observed in nursing. Indeed, nursing has a social mandate to provide health care for clients at different points in the health–illness continuum. There is a growing knowledge base, authority over education, altruistic service, a code of ethics, and registration requirements for practice. Although the debate is ongoing, it can be successfully argued that nursing is an aspiring, evolving profession (Finkelman & Kenner, 2013; Hood, 2010; Judd, Sitzman, & Davis, 2010). See Link to Practice 1-1 for more information on the future of nursing as a profession.

Link to Practice 1-1: The Future of Nursing

The Institute of Medicine (IOM, 2011) recently issued a series of sweeping recommendations directed to the nursing profession. The IOM explained their “vision” is to make quality, patient-centered care accessible for all Americans. Recommendations included a three-pronged approach to meeting the goal.

The first “message” was directed toward transformation of practice and precipitated the notion that nurses should be able to practice to the full extent of their education. Indeed, the IOM advocated for removal of regulatory, policy, and financial barriers to practice to ensure that “current and future generations of nurses can deliver safe, quality, patient-centered care across all settings, especially in such areas as primary care and community and public health” ( p. 30 ).

A second key message related to the transformation of nursing education. In this regard, the IOM promotes “seamless academic progression” ( p. 30 ), which includes a goal to increase the number and percentage of nurses who enter the workforce with a baccalaureate degree or who progress to the degree early in their career. Specifically, they recommend that 80% of RNs be BSN prepared by 2020. Last, the IOM advocated that nurses be full partners with physicians and other health professionals in the attempt to redesign health care in the United States.