Professionalism in Nursing. Professionalism in Nursing Learning Module Purpose: Upon completion of this learning module, the nurse will have an overview.

Professionalism in NursingProfessionalism in Nursing

Professionalism in NursingProfessionalism in NursingLearning ModuleLearning Module

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

Objectives: Upon completion of the learning Objectives: Upon completion of the learning module, the nurse should be able to: module, the nurse should be able to: – Define the meaning of nursing Define the meaning of nursing

professionalism.professionalism.– Describe three factors which enhance Describe three factors which enhance

professionalism.professionalism.– Describe situations reflective of Describe situations reflective of

accountability in the nursing profession.accountability in the nursing profession.

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

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

Founder of NursingFounder of Nursing

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

With her social connections she was able to secure an With her social connections she was able to secure an appointment as a healthcare professional at a hospital for appointment as a healthcare professional at a hospital for women in London in 1853. Nightingale was asked to bring women in London in 1853. Nightingale was asked to bring nurses to care for the wounded British soldiers in Scutari nurses to care for the wounded British soldiers in Scutari during the Crimea War in 1854. during the Crimea War in 1854.

Nightingale viewed nursing as an art as well as a science. 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 Nursing is an art, and, if it is to be made an art, requires

as exclusive a devotion, as hard a preparation, as any as exclusive a devotion, as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with painter’s or sculptor’s work; for what is the having to do with dead canvas or cold marble, compared with having to do dead canvas or cold marble, compared with having to do with the living body- the temple of God’s spirit? It is one of 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” the fine Arts; I had almost said, the finest of the Fine Arts” (Nightingale,1868).(Nightingale,1868).

Definition of Professional NursingDefinition of Professional Nursing The Kansas State Board of Nursing provides this definition The Kansas State Board of Nursing provides this definition

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

Definition of Licensed Practical Definition of Licensed Practical NurseNurse

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

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

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

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

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

ANA Code Of EthicsANA Code Of Ethics

Provision 7Provision 7 The nurse participates in the The nurse participates in the

advancement of the profession advancement of the profession through contributions to practice, through contributions to practice, education, administration, and education, administration, and knowledge development.knowledge development.

7.1 Advancing the profession 7.1 Advancing the profession through active involvement in nursing through active involvement in nursing and in healthcare policyand in healthcare policy..

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

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

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

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

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

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

The top eight responses of over 300 The top eight responses of over 300 surveys were as follows:surveys were as follows:

ProfessionalProfessional PersonalPersonal Knowledge (78) Respect for others (51)Knowledge (78) Respect for others (51) Competence (53)Competence (53) Integrity (35) Integrity (35) Appearance (48)Appearance (48) Positive Attitude (28) Positive Attitude (28) Teamwork (27)Teamwork (27) Compassion (18) Compassion (18)

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

Several factors enhance the Several factors enhance the utilization and acquisition of utilization and acquisition of knowledge. These factors knowledge. These factors are:are:

OrientationOrientation Preceptor/co-worker support Preceptor/co-worker support In-house educational In-house educational

programsprograms Advanced certificationAdvanced certification Research evidence-based Research evidence-based

practice. practice.

OrientationOrientation

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

Preceptoring/ Co-worker SupportPreceptoring/ Co-worker Support

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

MentorsMentors

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

MentorsMentors

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

MentorsMentors

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

PreceptorsPreceptors Preceptors are key elements in the success of a Preceptors are key elements in the success of a

nurse’s professional development. Alspach (2000) nurse’s professional development. Alspach (2000) published apublished a

Preceptor’s Bill of Rights which follows.Preceptor’s Bill of Rights which follows.

Preceptors have the right to:Preceptors have the right to:– A clear definition of their role.A clear definition of their role.– A clearly stated set of expectations for their A clearly stated set of expectations for their

performance.performance.– A clear delineation of their responsibilities to the A clear delineation of their responsibilities to the

preceptee.preceptee.– A clear distinction for their responsibilities in relation A clear distinction for their responsibilities in relation

to others who are involved in the orientation program.to others who are involved in the orientation program.

– A clear statement of all expected A clear statement of all expected outcomes for the orientation program.outcomes for the orientation program.

– Valid and reliable evaluation tools to Valid and reliable evaluation tools to appraise preceptee performance. appraise preceptee performance.

– The resources necessary to fulfill their The resources necessary to fulfill their responsibilities.responsibilities.

– Continuing and responsive support Continuing and responsive support systems for fulfillment of their systems for fulfillment of their responsibilities.responsibilities.

– Adequate preparation for integration of Adequate preparation for integration of the preceptor role.the preceptor role.

– Adequate training in the knowledge, Adequate training in the knowledge, skills, and attitudes necessary to fulfill skills, and attitudes necessary to fulfill their responsibilities (Alspach, 2000). their responsibilities (Alspach, 2000).

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

In-house Educational ProgramsIn-house Educational Programs

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

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

Nursing CompetencyNursing Competency

Nursing competency ranked second in the Via Nursing competency ranked second in the Via Christi survey. Some key features of nursing Christi survey. Some key features of nursing competency are as follow: competency are as follow:

The ability to recognize common factors that The ability to recognize common factors that contribute to, and adversely affect, the physical, contribute to, and adversely affect, the physical, mental and social well-being of patients and mental and social well-being of patients and clients, and be able to take appropriate action.clients, and be able to take appropriate action.

The use of relevant literature and research to The use of relevant literature and research to inform the practice of nursing.inform the practice of nursing.

An appreciation of the influence of social, political An appreciation of the influence of social, political and cultural factors in relation to health care.and cultural factors in relation to health care.

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

The ability to identify the The ability to identify the physical, psychological, physical, psychological, social and spiritual needs social and spiritual needs of the patient or client.of the patient or client.

The use of appropriate The use of appropriate channels of referral for channels of referral for matters not within the matters not within the nurse’s sphere of nurse’s sphere of competence competence

Professional Incompetence DefinedProfessional Incompetence Defined

Professional Incompetence is defined in Professional Incompetence is defined in the Kansas Nurse Practice Act (2004) 65-the Kansas Nurse Practice Act (2004) 65-11201120

e. Professional incompetence defined; e. Professional incompetence defined; As used in this section, “professional As used in this section, “professional incompetence” means:incompetence” means:

1) one or more instances involving 1) one or more instances involving failure to adhere to the applicable standard of failure to adhere to the applicable standard of care to a degree which constitutes gross care to a degree which constitutes gross negligence, as determined by the board;negligence, as determined by the board;

2) repeated instances 2) repeated instances involving failure to adhere to involving failure to adhere to the applicable standard of care the applicable standard of care to a degree which constitutes to a degree which constitutes ordinary negligence, as ordinary negligence, as determined by the board; ordetermined by the board; or

3) a pattern of practice or 3) a pattern of practice or other behavior which other behavior which demonstrates a manifest demonstrates a manifest incapacity or incompetence to incapacity or incompetence to practice nursing.practice nursing.

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

Standard of Care DeterminationsStandard of Care Determinations

Level I Standard of care metLevel I Standard of care met Level II Standard of care not met, but Level II Standard of care not met, but

no reasonable probability of no reasonable probability of causing injury causing injury

Level III Reportable; standard of care Level III Reportable; standard of care not met, with injury occurring not met, with injury occurring or reasonable probable.or reasonable probable.

Level IV Reportable; grounds for Level IV Reportable; grounds for disciplinary action by the disciplinary action by the appropriate licensing agencyappropriate licensing agency

Other attire considered Other attire considered inappropriateinappropriate includes: includes:

Stained, wrinkled, tight, Stained, wrinkled, tight, frayed, or revealing clothingfrayed, or revealing clothing

JeansJeans ShortsShorts Leggings, stretch pants, or Leggings, stretch pants, or

capriscapris Sweatpants/tops or wind Sweatpants/tops or wind

suitssuits

T-shirts, tank tops, tube tops, crop tops or halter T-shirts, tank tops, tube tops, crop tops or halter topstops

HatsHats Sleeveless clothingSleeveless clothing Shirts with inappropriate slogans and/or designs. Shirts with inappropriate slogans and/or designs. Artificial nailsArtificial nails Open-toed shoesOpen-toed shoes

Definition of TeamworkDefinition of Teamwork

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

Today’s best integrated health delivery Today’s best integrated health delivery systems are evolving toward a model of systems are evolving toward a model of care in which interdisciplinary teams of care in which interdisciplinary teams of providers manage the care of complex providers manage the care of complex patients.patients.

As nurses have expanded their roles in the As nurses have expanded their roles in the

community, it is important to understand community, it is important to understand the contributions of unlicensed assistive the contributions of unlicensed assistive personnel. As the nursing shortage looms personnel. As the nursing shortage looms upon us, the nursing profession may need upon us, the nursing profession may need to divide labor with unlicensed staff, to divide labor with unlicensed staff, particularly in non-acute care where team particularly in non-acute care where team working has existed for many years. working has existed for many years.

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

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

The Fear FactorThe Fear Factor

The Institute for Safe Medication Practices The Institute for Safe Medication Practices recently released a report on a survey recently released a report on a survey concerning the role that intimidation plays in the concerning the role that intimidation plays in the safe administration of medications. safe administration of medications.

75% of the survey participants were nurses. 75% of the survey participants were nurses. The questions were inquiring of how frequently The questions were inquiring of how frequently problems were encountered regarding problems were encountered regarding intimidating behaviors:intimidating behaviors:

AccountabilityAccountability

Though problems of intimidation exist, the Though problems of intimidation exist, the registered nurse is personally accountable for registered nurse is personally accountable for his/her own practice – not a senior member of his/her own practice – not a senior member of staff, physician or other health care professional. staff, physician or other health care professional. Remember the saying “but he/she told me to do it” Remember the saying “but he/she told me to do it” is never justification for poor practice. is never justification for poor practice.

Nurses cannot blame anyone else for mistakes – Nurses cannot blame anyone else for mistakes – they are accountable, answerable, and liable for they are accountable, answerable, and liable for their own actions, the completion of the assigned their own actions, the completion of the assigned task, and acts of delegation. task, and acts of delegation. Accountability Accountability cannot be delegated.cannot be delegated.

Respect, Integrity and Positive Respect, Integrity and Positive AttitudeAttitude

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

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

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

Future of NursingFuture of Nursing As nurses embrace the future, what is your vision for the As nurses embrace the future, what is your vision for the

nursing profession? This author believes it will be nursing profession? This author believes it will be interactions that nourish our human spirits in the places we interactions that nourish our human spirits in the places we live and work. Nurses must be deliberate with time, energy live and work. Nurses must be deliberate with time, energy and resources as the profession works toward the goal of and resources as the profession works toward the goal of quality nursing care.quality nursing care.