Professionalism in Nursing

Professionalism in Nursing Learning Module Purpose: Upon completion of this learning module, the nurse will have an overview of nursing professionalism in practice. This activity will explore what nursing professionalism is, how it impacts nursing practice, and how to advance professionalism in the community. The module includes information on the Kansas State Board of Nursing’s definition of incompetence, The Code of Ethics from the Kansas State Nurses Association and accountability within the profession.

Objectives: Upon completion of the learning module, the nurse should be able to: Define the meaning of nursing professionalism. Describe three factors which enhance professionalism. Describe situations reflective of accountability in the nursing profession.

To be a nurse is a calling and difficult to describe in words To be a nurse is a calling and difficult to describe in words. Who can say why a person would want to do a nurses work, but those who do will tell you there is nothing as fulfilling or rewarding. Nurses stay by the side of those they serve through the worst times and celebrate with patients and families in the best times.

There is an intimacy nurses and patients share which is understood There is an intimacy nurses and patients share which is understood. The essence of nursing is an unconditional love for mankind. To be called a nurse is an honor – a profession of the highest realm.

Founder of Nursing Florence Nightingale is called the mother of modern secular nursing. Born in 1820 in Florence, Italy, this intelligent, upper-class woman made dramatic and universal changes in health care. At age 16, Nightingale was called by God to minister to the sick.

With her social connections she was able to secure an appointment as a healthcare professional at a hospital for women in London in 1853. Nightingale was asked to bring nurses to care for the wounded British soldiers in Scutari during the Crimea War in 1854. Nightingale viewed nursing as an art as well as a science. “Nursing is an art, and, if it is to be made an art, requires as exclusive a devotion, as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or cold marble, compared with having to do with the living body- the temple of God’s spirit? It is one of the fine Arts; I had almost said, the finest of the Fine Arts” (Nightingale,1868).

Definition of Professional Nursing The Kansas State Board of Nursing provides this definition on professional nursing: (1) The practice of professional nursing as performed by a registered professional nurse for compensation or gratuitously means the process in which substantial specialized knowledge derived from the biological, physical, and behavioral sciences is applied to: the care, diagnosis, treatment, counsel and health teaching of persons who are experiencing changes in the normal health processes or who require assistance in the maintenance of health or the prevention or management of illness, injury or infirmity; administration, supervision or teaching of the process as defined in this section; and the execution of the medical regimen as prescribed by a person licensed to practice medicine and surgery or a person licensed to practice dentistry (KSBN, 2003).

Definition of Licensed Practical Nurse (2) The practice of nursing as a licensed practical nurse means the performance for compensation or gratuitously of tasks and responsibilities defined in part (1) which tasks and responsibilities are based on acceptable educational preparation within the framework of supportive and restorative care under the direction of a registered professional nurse, a person licensed to practice medicine and surgery or a person licensed to practice dentistry (KSBN,2003).

A profession is defined as a calling or vocation, especially one that involves some branch of advanced learning or science. The essence of professionalism is both having a unique or special knowledge and the self-imposed obligation to serve the community.

Until recently this has been an unwritten contract Until recently this has been an unwritten contract. For these reasons, society holds the professional in higher esteem than it does a technician, blue-collar worker, or businessman, people who traditionally are interested in the benefits of their employment rather than the occupation itself.

Professionals are expected to show a degree of special attainment, altruism, and self-sacrifice in their dealings with the rest of the community and in return receive privileges both in the workplace and at large (Bryan-Brown, et al. 2003).

In order to emphasize professionalism within nursing, each nurse needs to understand the opportunities, responsibilities and concerns that are integral to the nursing profession. The Kansas State Nurses Association, 2003, Code of Ethics for Nurses with Interpretive Statements defines these concepts:

ANA Code Of Ethics Provision 7 The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. 7.1 Advancing the profession through active involvement in nursing and in healthcare policy.

Nurse educators have a specific responsibility to enhance students’ commitment of professional and civic values. Nurse administrators have a responsibility to foster an employment environment that facilitates nurses’ ethical integrity and professionalism, and nurse researchers are responsible for active contribution to the body of knowledge supporting and advancing nursing practice.

The nurse as administrator or manager must establish, maintain, and promote conditions of employment that enable nurses within that organization or community setting to practice in accord with accepted standards of nursing practice and provide a nursing and health care work environment that meets the standards and guidelines of nursing practice.

Professional autonomy and self regulation in the control of conditions of practice are necessary for implementing nursing standards and guidelines and assuring quality care for those whom nursing serves.

However, an organizational climate and infrastructure conducive to scholarly inquiry must be valued and implemented for this to occur.

The nursing profession is characterized by the continuing pursuit of knowledge, a sense of responsibility for human concerns, preparation through higher education, peer accountability, autonomy, and altruism.

Career trajectory, in systems thinking, refers to the series of successive states through which a system or career proceeds over time. It may be said to represent the long-term behavior of the system. Nursing is often referred to as a young profession, in that it is around 150 years old. A review of nursing’s history clearly shows growth in theory, evidence-based practice, image and autonomy.

The top eight responses of over 300 surveys were as follows: Professional Personal Knowledge (78) Respect for others (51) Competence (53) Integrity (35) Appearance (48) Positive Attitude (28) Teamwork (27) Compassion (18)

The following discussion will focus on the results and how nurses can build on the characteristics identified by peers to exemplify professional nursing.

Several factors enhance the utilization and acquisition of knowledge Several factors enhance the utilization and acquisition of knowledge. These factors are: Orientation Preceptor/co-worker support In-house educational programs Advanced certification Research evidence-based practice.

Orientation Orientation generally includes a brief employee orientation about the hospital’s mission, vision and values as well as organizational policies and procedures. Further orientation for licensed personnel is focused on patient care policies and issues.

Preceptoring/ Co-worker Support Mentoring or precepting is a crucial activity that enhances the development of professionals. Experienced practicing nurses mentor others by being competent role models and by providing a safety net as nurses attempt to master new skills.

Mentors Strong mentors provide a positive introduction to the nursing profession and, depending on their beliefs, can foster professionalism among those they guide (Cameron-Jones & O’Hara, 1996; Ehrich, Tennent, & Hansford, 2002; Lo & Brown, 2000).

Mentors Mentoring involves two parties and occurs when the senior person in terms of maturity and experience- the mentor- provides information, advice, and emotional support for the junior person – the “mentee” or protégé. Mentors are people with advanced job-related experience, knowledge, and power in their organizations.

Mentors The beliefs of altruism, self-sacrifice, advanced learning and above all else honesty are required in order to be a mentor and serve as a role-model for the profession of nursing. To find a good mentor look for someone with a positive attitude and caring approach to others. The individual should be a good communicator and someone trustworthy (Restifo, 2004).

Preceptors Preceptors are key elements in the success of a nurse’s professional development. Alspach (2000) published a Preceptor’s Bill of Rights which follows. Preceptors have the right to: A clear definition of their role. A clearly stated set of expectations for their performance. A clear delineation of their responsibilities to the preceptee. A clear distinction for their responsibilities in relation to others who are involved in the orientation program.

A clear statement of all expected outcomes for the orientation program. Valid and reliable evaluation tools to appraise preceptee performance. The resources necessary to fulfill their responsibilities. Continuing and responsive support systems for fulfillment of their responsibilities. Adequate preparation for integration of the preceptor role. Adequate training in the knowledge, skills, and attitudes necessary to fulfill their responsibilities (Alspach, 2000).

Students and new nurses working closely with experienced staff nurses have the opportunity for role socialization as well as increasing clinical skills, knowledge, competence, and confidence.

In-house Educational Programs Nurses are required to maintain and develop their professional knowledge and competence in the many years of practice that may follow registration. They are expected to have knowledge, communication skills and the ability to offer effective, safe, evidence-based nursing in their field of practice.

In order to facilitate and encourage this level of professionalism, in-house educational programs should be offered. Accordingly, higher education, certification in advanced practice, support for professional organizations and research should be supported.

Nursing Competency Nursing competency ranked second in the Via Christi survey. Some key features of nursing competency are as follow: The ability to recognize common factors that contribute to, and adversely affect, the physical, mental and social well-being of patients and clients, and be able to take appropriate action. The use of relevant literature and research to inform the practice of nursing. An appreciation of the influence of social, political and cultural factors in relation to health care.

An understanding of the ethics of health care and the nursing profession and the responsibilities these impose on the nurse’s professional practice.

The ability to identify the physical, psychological, social and spiritual needs of the patient or client. The use of appropriate channels of referral for matters not within the nurse’s sphere of competence

Professional Incompetence Defined Professional Incompetence is defined in the Kansas Nurse Practice Act (2004) 65-1120 e. Professional incompetence defined; As used in this section, “professional incompetence” means: 1) one or more instances involving failure to adhere to the applicable standard of care to a degree which constitutes gross negligence, as determined by the board;

2) repeated instances involving failure to adhere to the applicable standard of care to a degree which constitutes ordinary negligence, as determined by the board; or 3) a pattern of practice or other behavior which demonstrates a manifest incapacity or incompetence to practice nursing.

It is every nurses responsibility to understand the definition of incompetent proactice. In addition, it is the responsibility of those within the profession to monitor and report acts of incompetence.

Standard of Care Determinations Level I Standard of care met Level II Standard of care not met, but no reasonable probability of causing injury Level III Reportable; standard of care not met, with injury occurring or reasonable probable. Level IV Reportable; grounds for disciplinary action by the appropriate licensing agency

Other attire considered inappropriate includes: Stained, wrinkled, tight, frayed, or revealing clothing Jeans Shorts Leggings, stretch pants, or capris Sweatpants/tops or wind suits

T-shirts, tank tops, tube tops, crop tops or halter tops Hats Sleeveless clothing Shirts with inappropriate slogans and/or designs. Artificial nails Open-toed shoes

Definition of Teamwork Teamwork in nursing practice refers to interdisciplinary practice or collaboration defined as a joint decision-making and communication process with the goal of satisfying the needs of the patient. This includes respecting the unique abilities of each professional involved in the care.

Today’s best integrated health delivery systems are evolving toward a model of care in which interdisciplinary teams of providers manage the care of complex patients. As nurses have expanded their roles in the community, it is important to understand the contributions of unlicensed assistive personnel. As the nursing shortage looms upon us, the nursing profession may need to divide labor with unlicensed staff, particularly in non-acute care where team working has existed for many years.

One important recommendation was to create improved safety systems inside health care through implementation of safe practices at the delivery level, including interdisciplinary clinical practice among health professionals.

Attributes of interdisciplinary collaboration include trust, knowledge, mutual respect, good communication, cooperation, coordination, share responsibility, and optimism.

The Fear Factor The Institute for Safe Medication Practices recently released a report on a survey concerning the role that intimidation plays in the safe administration of medications. 75% of the survey participants were nurses. The questions were inquiring of how frequently problems were encountered regarding intimidating behaviors:

Accountability Though problems of intimidation exist, the registered nurse is personally accountable for his/her own practice – not a senior member of staff, physician or other health care professional. Remember the saying “but he/she told me to do it” is never justification for poor practice. Nurses cannot blame anyone else for mistakes – they are accountable, answerable, and liable for their own actions, the completion of the assigned task, and acts of delegation. Accountability cannot be delegated.

Respect, Integrity and Positive Attitude Respect for others, integrity and a positive attitude also ranked high in the nursing survey. This finding is not surprising, as it correlates to Gallup’s 2003 annual survey in which nurses were on the top for honesty and ethics among various professions, followed by other medical professionals like doctors, pharmacists, veterinarians and dentists.

Americans, in the November 14-16, 2003 CNN/USA Today/Gallup Poll, were asked to rate the honesty and ethical standards of people in 23 different professions as very high, high, average, low, or very low.

As has been the case in four out of the five times they have been included in the poll, nurses ranked higher than any other profession, with 83% of respondents saying honesty and ethical standards of nurses are “very high” or “high” (Carroll, 2003).

Future of Nursing As nurses embrace the future, what is your vision for the nursing profession? This author believes it will be interactions that nourish our human spirits in the places we live and work. Nurses must be deliberate with time, energy and resources as the profession works toward the goal of quality nursing care.