I agree with Diana Mason in her January Editorial "Blinded by Degrees." The nursing profession has a social responsibility to advocate better long-term care and prevent the sickening situation described in "Dying with a Stage IV Pressure Ulcer," also in January. A related article, "Contrasts in Long-Term Care," shows what can be done if we respect employees, encourage career advancement, require appropriate education, provide ongoing training, and pay competitive salaries.

But I have a problem with Mason's saying that Bridget Siljander "began her nursing career" when she took a job caring for a person with quadriparesis. She may have provided good care, but it wasn't nursing. Competent, able-bodied people who can perform their own activities of daily living can assist someone else with theirs. Anyone can learn to observe skin condition and color, breathing, and mental acuity. But it's only when a nurse decides that those observations require intervention that you have nursing. Prior to that, it's just care, often custodial care. To call all caregiving nursing perpetuates the myth that nursing is only a series of tasks that can be performed by almost anyone.

We certainly need direct care workers, but they should be required to complete the 75 hours (minimum) of training the federal government requires of certified nursing assistants. And whether it's provided in the home or in an assisted living or long-term care facility, care should be planned, delegated, and supervised by a nurse. Then we can call it "nursing" care.

Omaha, NE