1 Nursing as a Profession: Professionalism & Professionalization University of Maryland School of Nursing NURS 507
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Nursing as a Profession:Professionalism & Professionalization
University of Maryland School of Nursing
NURS 507
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Learning Objectives Identify the characteristics of a profession. Identify potential barriers to professionalism in
nursing. Explain the process of professional evolution in
relation to nursing practice, education, and research.
Describe the role of professional nursing organizations, particularly their role in formulation of practice standards and public policy.
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What is nursing?
Art of nursing “Nursing is an art, rooted in the needs of
humanity…” Science of nursing
“Disease prevention and health promotion arethe focus of nursing.”
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Early Definitions of Nursing Patient-centered and focused on:
Health restoration Nurses as giving service Patients as accepting nursing services The body and physical function
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Definition of Nursing in Mid-1950s Focused on:
Nursing as a process Science and humanism Educational opportunities Health promotion Holism Patients as participants
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Defining Nursing Today Nursing is concerned with caring for the person in
a variety of health-related situations. The concept of “caring” is well documented in
nursing literature. The role of the nurse also involves prevention of
illness, teaching, and case management. In all environments, nurses play a key role in
promoting higher standards of health.
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What is nursing?
Is it a profession? Is it an occupation?
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Historical Review
Abraham Flexner
1910 Flexner Report focused on medical education reform
1915 Flexner list of criteria characteristic of professions
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Characteristics of a Profession
Activities must be Intellectual (as opposed to physical)
with high degree of individual responsibility.
Based on a body of knowledge refined via research.
Practical, in addition to being theoretical.
Taught via highly specialized education.
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Characteristics of a Profession
A strong internal organization of members, a well-developed group consciousness (collective identity).
Practitioners motivated by altruism, responsive to public interests.
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Characteristics of a Profession: Richard H. Hall Sociologist, key work published in 1968. Professional organization a primary point of
reference Belief in value of public service Belief in self-regulation Commitment to profession goes beyond
economic incentives. Sense of autonomy
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Characteristics of a Profession: Kelly’s Criteria on Nursing
Lucie Kelly, RN, PhD, FAAN – nurse writer, teacher, influential leader
Editor of journal Nursing Outlook, President of Sigma Theta Tau International Honor Society
Spent much of her career exploring dimensions of professional nursing
Through her research she complied set of eight characteristics of a profession
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Kelly’s Criteria for Nursing Services provided are vital to humanity & welfare of society. Special body of knowledge continually enhanced via research. Services involve intellectual activities; individual responsibility
(accountability) a strong feature. Education via institutions of higher learning. Practitioners relatively independent & control own policies and
activities (autonomy). Motivated by service (altruism) and consider their work an important
component of their life. Code of ethics to guide decisions and conduct. Organization (association) that encourages & supports high standards
of practice.
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Characteristics of a Profession Many scholars have disagreed about the number
of criteria, types of behaviors and characteristics of a profession.
What are the true characteristics of a profession and how do we measure it?
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Characteristics of a Profession In the literature, 5 criteria consistently appear:
Service: a sense of calling to the discipline, mission, and responsibility to the public
Knowledge: specialized education, including both theoretical and techniques/skills
Practice autonomy: having control over one’s own practice.
Code of ethics governing standards of conduct within the profession.
Body of knowledge
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Most IMPORTANT Factor for Nursing:
AUTONOMY: control over work. “Within the health care delivery system, almost all
other occupations are organized around the the work of the physician.”
Wolinsky, 1988
“Thus, accordingly, all non-physician health care workers are employed in occupations, not professions.”
Freidson, 1988
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Evolution from Occupation to Profession
Professions usually evolve from occupations that originally consisted of tasks but developed more specialized educational status and publicly legitimized status
Professionalization – the process through which a occupation evolves to professional status
Professionalism – generally refers to the extent to which an individual reflects professional attributes
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Definitions Occupation – what occupies, or engages, one’s
time; business employment Profession – a calling, vocation, or form of
employment that provides a needed service to society and possesses characteristics of expertise, autonomy, long academic preparation, commitment, and responsibility
Profession different from occupation in two ways: Preparation Commitment
Webster's dictionary
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Professionalization Continuum Occupational groups can be envisioned as
moving along a continuum as they strive to attain professional status
What is the benchmark on the continuum beyond which groups are considered professions?
Occupation to Profession
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Nursing as a Profession
Where is nursing represented?
Occupations Professions X
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Barriers to Professionalism in Nursing
Variability in educational preparation Gender issues Historical influences External conflicts Internal conflicts
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Variability in Educational Preparation
Most obvious barrier to nursing’s achievement of professional status
No other profession allows entry into practice at less than a baccalaureate level
Many professions require postgraduate preparation for practice
Professional status and power increase with education – How do we achieve status when most nurses hold less than a baccalaureate degree?
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Gender Issues
Gender plays a major role in perceived value of female-dominated professions.
Number of men in nursing increasing; implications?
Devaluing of “woman’s work” in our society is a hindrance to men entering the profession.
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Historical Influences
Connection with religious orders & military: positive & negative influences
Liability: unquestioning obedience Runs counter to professional values of autonomy,
self-determination, and undermines fair economic valuation of nursing work
Stifles creative thinking and problem-solving Liability: Altruism
Resist pressure to feel guilty or greedy for expecting to be paid well for complex & demanding work
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External Conflicts Conflict with medical profession over “turf”
Do nurses have “true” autonomy to practice? Nurses must continue to lobby in an effort
to protect and enhance their scope of nursing practice
Nurses must also strive for collaboration, not competition with physicians and other health care professionals
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External Conflicts Does nursing really have its own body of
knowledge? Critics state that nursing borrows from
biological and medical science, and combines them with nursing concepts and practical skills to define nursing.
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Internal Conflicts Nurse power is fragmented by subgroups
and dissension Rivalry among differently educated nurses Proliferation of nursing organizations & their
competition for members, resources Small number of nurses are members of
professional organizations - impairs nursing’s ability to lobby effectively
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Other factors to think about… Socialization
Medical student versus nursing student Educational process
Medical students: why something happens and why a certain treatment is preferred.
Nursing: What treatment is used in which situation.
Scholar-scientists versus technicians.
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Enhancing the Nursing Profession Significant changes in nursing education
BSN as entry level Supported by ANA and AONE
Dual degrees Nursing research
Have we REALLY studied why we do things? Why do we “turn and position”
every two hours??
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Enhancing The Profession: Nursing Standards Two major documents that guide nurses in
their professional commitments: Nursing’s Social Policy Statement Code of Ethics for Nurses
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Nursing’s Social Policy Statement All professions have one criterion in common: an
obligation to the recipients of their services This policy statement is a framework for
understanding professional nursing’s relationship with society and nursing’s obligation to those who receive professional nursing care
Addresses a broad array of topics including the social context of nursing, a definition of nursing, its knowledge base, and other professional, legal and self regulation issues.
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The Nurses’ Code of Ethics Written, public document that reminds practitioners and
the public they serve of the specific responsibilities and obligations accepted by the profession’s practitioners
Guided first by ethical standards promoted by Florence Nightingale and thereafter by nursing groups.
Modified over the years as nursing and its social context has evolved.
Exists to strengthen and guide nurses' decision making and to empower nurses to maintain their focus on the patient as the center of health care
(www.nursingworld.org/ethics/code/ethicscode150.htm)
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Factors Enhancing Nursing Profession More men in nursing Women’s rights movement More political efforts of the ANA Nursing shortage
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Professional Organizations
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Whom Do Professional Associations Serve?
Nursing associations serve 3 major constituents:
The public by establishing a code of ethics and standards of practice
The nursing profession by being a vehicle for collective action
Individual members by providing continuing education, recognizing skills in practice by offering certification, and encouraging mechanisms for a professional workplace
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Benefits of Belonging to Professional Associations
Developing leadership Professional association recognition via
certification Legislative lobbying power Access to publications Networking with peers Continuing educational opportunities
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Types of Nursing AssociationsGeneral American Nurses Association (ANA)Specialty American Association of Critical Care Nurses (AACN) American Association of Managed Care Infusion Nurses Society Oncology Nursing Society (see Chitty & www.nursingworld.org for full list
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American Nurses Association (ANA) Only full service professional organization
representing the nation’s entire RN population Strongest voice for the nursing profession Represents the interests of 2.9 million RNs Advances practice by fostering high standards of
nursing practice, promoting economic & general welfare of nurses in the workplace, and by lobbying Congress & regulatory agencies on health care issues affecting nurses and the general public
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American Nurses Association At forefront of policy initiatives pertaining to
health care reform Political & legislative programs take firm
positions on Medicare reform, patient’s rights, appropriate staffing, access to health care, etc
Helps to enhance nursing practice via workplace advocacy, nurses’ compensation and other issues
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Where Do We Go From Here? To some, professionalism in nursing
simply means getting an education, graduating, giving the best care possible but…
To others, it also means GETTING INVOLVED, helping shape our health care environment, the laws and regulations that influence it
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Nursing Frameworks & Their Impact on Nursing
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Importance of Frameworks in Nursing Helps to build a body of evidenced-based
practice. Useful in developing reasoning, critical
thinking, and decision-making skills.
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Types of Nursing Frameworks Nursing Philosophies
A broad, general view of nursing helps clarify values, address broad questions.
What is nursing? What is the nature of human caring?
Nightingale’s Philosophy Notes on nursing: What it is and what it is not (1859) Health of patients is related to their surroundings. Observation of patients Recording of information
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Types of Nursing Frameworks cont’d Conceptual Models An example: Bette Neuman’s System Model
Involves the person, health, environment and nursing The person is viewed as an open and dynamic system
constantly interacting with internal and external environments.
Nursing is viewed as chiefly concerned with maintaining client system stability via primary, secondary, and tertiary care
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Types of Nursing Frameworkscont’d A few other conceptual models
Orem’s Self-Care Model Rogers Science of Unitary Human
Beings Roy’s Adaptation Module
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Types of Nursing Frameworkscont’d
Theories---link conceptsSome examples of nursing theories
Ida Jean Orlando’s Nursing Process Theory Madeleine Leininger’s Cultural Care Theory Margaret Newman’s Model of Health Theory
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Use of Nursing Frameworks Education Practice Research
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Something to think about….. As nursing evolves, frameworks are
updated. Are new frameworks needed to take into
account our complex health care system?