1. Cardin, Suzette RN, DNSc, FAAN, Guest Editor

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I had a novel experience the other day. My 13-year-old daughter asked me to explain the difference between a job and a profession. I thought to myself: How insightful! I seized the opportunity and explained to her how nursing has always been a profession for me and that it has never been a job. She looked at me and I could tell it didn't make sense to her, so I clarified the difference. I explained that a job involves going to and doing the required work, getting paid, and that is all you put into it.


You have probably asked yourself-Why is this guest editor elaborating on this specific topic? The answer for me is 33 years in scope-that is the length of time that I've been a nurse and it now spans more than half my life. I've never thought of being a nurse as just a job; I know now that I am in the profession of nursing in the business of healthcare. Years ago I thought the business I was in was nursing, but once I realized nursing is really one of the major components within the business of healthcare it all made sense to me. As soon as I realized what business I was in, my life actually became easier; I began to understand some of the decisions that need to be made at an executive level and what it means to the large array of healthcare givers who comprise today's workforce.


Few nurses think they are in the business of healthcare and that the bottom line really matters. The term business implies dollars and cents and the big bad word that nurses hate-budget-is for someone else to worry about. The terms business and budget also imply a workplace to practice the art and science of nursing as a professional nurse. The challenge for nurses today is to create a balance between a caring approach to the business of healthcare and the actual business prospective of healthcare. Many staff nurses feel it is the manager's job to worry about the so called bottom line. While true, we each need to realize that we are in the business of healthcare and our welfare and being as a profession is dependent on this realization. The difference for nurses is that we do think differently and our thinking is based on what we actually do in the profession of nursing. The perspective that we bring to the workplace setting is based on several assumptions:


* our business is taking care of people, not things;


* our business involves the continuum of a person's life;


* our business is a 24-hour/365-day operation;


* our business never ends, it just repeats itself; and


* our business skills are knowledge and skill based.



The challenge all nurses face today is how to interface both the work that needs to be done and the professional aspect of nursing. Nurses possess a specific body of knowledge based on science; interwoven into the body of knowledge is the art of being a nurse. Many of the skills that are required to care successfully for a patient can be done by someone who is very skillful; a nurse, however, has a breath and depth of nursing knowledge that sets he/she apart from the person who can do the skills and do them well.


There is a dichotomy in the profession that most nurses face today when they start to think about where the profession is going and what it means for them. Do we care for a patient or a customer? Many nurses were educated to care for a patient and the word consumer was not mentioned until just recently (now I'm really showing my age). The essence of nursing as an integral part of the business of healthcare lies in the realization that the consumer is now the patient and the concepts need to be viewed together, not as separate entities but as a whole continuum. The terms patient and consumer can no longer be separated out. The continuum is one in which the clinical condition is at one end and the healthy perspective is at the other. Often both are one and the same. The challenge is very apparent in critical care nursing where patients and the consumer are clearly one and the same. The goal in critical care nursing is to return the patient to his/her optimal state of health; however, it is at times very stressful for nurses today to keep both the patient and consumer perspective intact when faced with life and death decisions and experiences. Successful critical care units in the business of healthcare view the patient and consumer as one entity; all care is centered on the needs of the patient with the consumer perspective as the underlying foundation for the practice of the profession of nursing.


How does this all relate to the answer to my daughter's question? Now more than ever nurses need to realize what our product is and how we are a critical component of the business of healthcare. Our product is ourselves, what we do on a daily basis, and what we do well. The problem is how the term is defined in the world of healthcare business. Staff nurses, managers, nurse executives, and faculty members all view the term professional nursing from a different lens. My challenge to all of you, and to answer the question that was posed to me by my daughter, is this: We need to know the business we are in and what is it that we do well so everyone knows what a professional nurse does and what our business is.


I hope this editorial has been enlightening to you and that you can impart some of the wisdom I have shared with you. When you are asked what is the difference between a job and a profession, I hope you will answer the question by thinking of what you do as a nurse that makes a difference and what business you are in. Good luck, think hard before you answer the question-you may be talking to a future nurse.