The question “profession or not” has never been satisfactorily answered, not least because the definition of ‘profession’ is not exactly a fixed item.

However, some aspects of the definition might be considered ‘core items’.

A profession has a unique body of knowledge and values – and a perspective to go with it.
A profession has controlled entry to the group eg registration
A profession demonstrates a high degree of autonomous practice.
A profession has its own disciplinary system.
A profession enjoys the Recognition and Respect of the wider community.

1. Nursing DOES have a unique body of knowledge and values, but all too often adopts the medical perspective over its own; most acadamic nurses these days don’t try very hard to inject new nurses with any values other than the medical model (Yes, there are exceptions!). In that sense, nursing can only ever be a ‘profession allied to medicine’, not a true profession in its own right.

2. Nursing does have controlled entry – most countries have a legally-enforced registration. This is beyond doubt, but of questionnable value, to some degree, it’s a cheat – “Nursing is a profession because the law says it is”.

3. Nursing has a variable degree of autonomy, but for the most part (Yes, there are exceptions!), has very little real freedom; indeed, nursing management, with it’s ‘cost saving’ mentality, does its utmost to strangle any independent thought or action, for fear of expensive litigation; there are ‘protocols’ for everything, these days, and woe betide the nurse who dares to use initiative (Yes, there are exceptions!).

Nurse practitioners (etc.) usually take orders from docs and are accountable to them, because their specialties are branches of medicine. But in many areas, nurses are responsible for *nursing* and in that sense are (still) independent of doctors.

It is a shame – but historically beyond doubt, that nurses tend to give away the areas they are most expert in; physiotherapy and occupational therapy both grew out of a nursing role, respiratory therapy is going the same way. Stoma therapy is an area that utilizes many core nursing skills; how long before it breaks off to become a profession in its own right?

Perversely, wound management was, until recently, a medical responsibility, though nurses applied almost 100% of dressings. Now, specialist nurses are teaching others the principles of wound care.

4. In many countries, Nursing does have its own disciplinary system – but in many of them, this is being eroded in favour of making nurses “accountable to the public” – understandable, but reflecting a view that nurses “cannot be trusted” to deal with there own problems – this is a diminution of professional resect and value.

5. Nurses are recognized as ‘nice’, ‘deserving better’ and ‘sexy’ – the jury is out on whether any of those assist in the definition of ‘professional’.

External recognition is vital, just as the legal side is ‘so what’ – few people would ever argue with doctor and lawyers as ‘true’ professionals; when the ‘Church was one, united, catholic church’, priests were similarly respected – I’m not so sure that’s generally true any more; individual clergymen are respected by individuals, and by their own community; as are individual nurses. But both fall shy of general respect to the level required, sadly. (Though both are streets ahead of journalists, real estate agents and heating engineers!).

To conclude, part of the problem is the poor self respect of nursing; just twenty years ago, the Process of Nursing, care plans and nursing diagnosis looked set to sweep in an era of nursing confidence and a bright, professional future.

Why did it fail? This is not the place to discuss that in detail, but factors include:

Overconfidence and a needless challenge to medicine – little illustrates the power of language better than the blinding stupidity of the term “nursing diagnosis”. Nursing assessment, as a serious, conscious, methodical activity was in its infancy, when ‘nursing diagnosis’ was invented. this simple act guaranteed a fear reaction and backlash from doctors, themselves under attack from the accountants and litigators. From being our allies, doctors become distanced at best, enemies at worst. All that could have been avoided by a few minutes invested in Roget’s thesaurus or a good dictionary .

A too rapid flight to academia – it is hard to argue against developments in Nurse education; God knows, a bit more has to be a ‘good thing’; but talk of a graduate profession form a tiny graduate base in less than twenty years meant that many mediocre people were sucked into senior postions; many good people were seduced away from clinical nursing, and many clinical idiots became academic idiots. Sad; and bad because instead of supporting and defending clinical nursing, academia began to control it, and did not defend it.

Failure to resist the suits – The inexorable rise of the accountant, who knows the price of everything, and the value of nothing, probably could not be stopped; but it was allowed to ride roughshod over nursing, destroying confidence and stopping development dead in its tracks.