Professionalism: Creating a Nurse Barbara Cherry, DNSc, MBA, RN
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Transcript Professionalism: Creating a Nurse Barbara Cherry, DNSc, MBA, RN
Professionalism:
Creating a Nurse
Barbara Cherry, DNSc, MBA, RN, NEA-BC
MARYLAND ASSOCIATION OF
ASSOCIATE
DEGREE NURSING DIRECTORS
ANNUAL CONFERENCE
OCTOBER 14, 2011
Maryland Association for Associate Degree
Nursing Directors
THE BENEFITS OF ASSOCIATE DEGREE NURSING – THE FOUR A’S
ACCOUNTABLE:
ACCESSIBLE:
Provide access to nursing education for students from broad socio-economic strata
Flexible scheduling options such as evening, weekend programs.
Part-time educational opportunities to meet student needs
AFFORDABLE:
60% of all Maryland’s registered nurses graduate from AD programs
Maryland AD grads consistently perform above the national average on NCLEX
90% of graduates are employed in Maryland
Mainly publicly funded: cost is approximately $7,000-$9,000.
Commands a starting salary range from $40,000 to $50,000
Graduates who continue their education may earn while they learn
ARTICULABLE:
Articulation models exist to facilitate educational mobility
LPN to AND, ADN to BSN, ADN to MSN, EMT-P to RN
Program Objectives
Analyze professionalism as an explicit set of behaviors and
values that require ongoing learning and development.
Examine characteristics of today’s college student and their
impact on the development of professional behaviors.
Outline academic infrastructure requirements to support
the development of professional behavior among students.
Implement strategies to promote professional behavior in
the classroom and clinical setting.
Treat professional development as an ongoing process of
learning and development.
Today’s Agenda
Today’s college student
What is “professionalism”?
The evidence for teaching professionalism
Model for “creating a nurse”
Program standards – Leadership support
Evidence-based teaching strategies
Innovative programs and curricula
Student responsibilities
National League for Nursing:
Excellence in Nursing Education
Program
Standards –
Leadership
Support
Innovative
Programs &
Curricula
EvidenceBased
Teaching
Methods
Questions to Consider
Professionalism: What is it and how can it be
meaningful to students?
Professional development: How do students come to
value and improve their professional behavior?
Teaching strategies: What strategies can be used in
the classroom or clinical setting to promote
professional behavior?
You are doing a great job!
“Nursing education is very strong in the
pedagogies….that are effective in helping students
develop a deep sense of professional identify,
commitment to the values of the profession, and to
act with ethical comportment”
(Benner et al, 2010, p. 11)
Benner, P., Sutphen, M., Leonard, V. & Day, L. Educating Nurses: A Call
for Radical Transformation. San Francisco: Jossey-Bass.
Getting Started: What is the Problem?
What are the common unprofessional
behaviors you observe in your students?
TODAY’S COLLEGE
STUDENTS
HTTP://WWW.YOUTUBE.COM/WATCH?V
=DGCJ46VYR9O
Generational Differences
Millennials:
Generation X:
Baby Boomers:
Traditionalists:
Born 1982 – 2002
Born 1965 – 1982
Born 1946 - 1964
Born 1900 – 1946
Millennials
Grew up in a time of great prosperity
Most protected generation in history
Highly scheduled and sheltered in childhood
Often indulged and protected from the concept of
“losing”
Generally optimistic and strive for a work-life
balance
Millennials
Maintain constant social contact via text, social
media, etc..
Regularly use digital devices to interact with the
world
Find information on-line rather than using a book
Multitasking is a way of life
Tend to be collaboratively, team-oriented and
prefer group work
Millennials
Today’s Students (Group Work!)
What are the positives and strengths about
today’s students?
How can you capitalize on those strengths to
improve their educational journey and
promote professionalism?
Program
Standards –
Leadership
Support
Innovative
Programs &
Curricula
EvidenceBased
Teaching
Methods
PROGRAM STANDARDS
and
LEADERSHIP SUPPORT
Foundational Support to Promote
Professionalism
Commitment to promote professionalism
“from the top”
Consistent expectations across all courses and clinical
experiences
Consistent consequences across all courses and clinical
experiences supported by policies
Inclusion of professionalism in the formal curriculum
Commitment to faculty development
http://www.nursing.iupui.edu/students/professionalism
.shtml
Policy Implementation
Increasing the chances for successful policy
implementation
VALUES: Views about what should be
BELIEFS: Assumptions about what is
INTERESTS: Responses to incentives and rewards
Primary Goals for Students
To become a skilled and serious
professional who knows how to
dress and act the part
To engage in the desire to become a
respected member of their chosen
profession
Keys to Student Development
Faculty must be vested in the student’s
success though role-modeling
Create a sense of pride and excitement in
the student’s chosen profession
Faculty Expectations
Role model professional behavior
Be aware and responsible for your own behavior
One study found observed faculty (Clark, 2007):
Belittling students
Changing policies and procedures
Demonstrating bias and discrimination
Prevalence is estimated to be 50% of faculty
Clark, C. & Springer, P. (2007). Thoughts on incivility: Student and
faculty perceptions of uncivil behavior in nursing education. Nursing
Education Perspectives, 26(2), 93-97.
EVIDENCE-BASED
TEACHING METHODS
Evidence-Based Teaching
Theoretical framework
Situational learning theory
Cognitive learning combined with real-world activities
or experiential learning
Explicitly teach the cognitive base of professionalism
Knowledge and ability to articulate the concept is
essential
Provide a list of traits and characteristics expected of
the professional
Promoting Professionalism
Cognitive Learning + Experiential
Learning = Development of
Professionalism
Professionalism: Exactly what is it?
Basic Professional Behaviors
Honesty
and integrity
Reliability and dependability
Accountability
Respect and courtesy towards others
Professional appearance
Neat,
well-dressed conveys a higher level of
knowledge
Appearance cannot guarantee success but it can
ensure failure
Professionalism: Exactly what is it?
Basic Professional Behaviors (continued)
Discretion and confidentiality
Professional communication
Compassion
Maintain appropriate boundaries
Believe in and support colleagues
Commitment to personal health
Development of Professionalism
as a Continuum
Advanced Professional Behaviors
Cultural
humility
Avoid
introducing irrelevant and destructive bias into
clinical practice and professional relationships
Nonjudgmental behavior
Commitment
Clinical
to excellence
excellence
Personal standard of excellence – be the best that you
can be
Development of Professionalism
as a Continuum
Advanced Professional Behaviors
Willingness
to examine one’s own behavior and
take responsibility for actions and reactions
Commitment to lifelong learning
Patient advocacy
Involvement in professional organizations
Pursuit of advanced education
Development of Professionalism
as a Continuum
“Partnership with the public” to provide safe
patient care
“Excellence in nursing is not just about kindness. It’s
about providing thoughtful, complex
intellectually-demanding care with compassion”
Diana J. Mason
Fashioning the Right Impression
Imprint, February/March 2009, page 29
How do professional behaviors
look in practice?
Guide students to visualize how professional behaviors
are actually practiced in classroom & clinical setting:
Discusses patients in a respectful manner and only when
appropriate
Takes responsibility for being on-time and prepared for class
Seeks help and guidance from instructors, preceptors, and/or
other health care professionals
Maintains composure during difficult interactions
Shows initiative for own learning
Focuses on healthy behaviors – eating right, exercise and
adequate sleep
What does unprofessional
behavior look like?
Sloppy, unkempt appearance with violations of the dress code
Failure to be prepared for class or clinical assignments
Requires continual reminders about responsibilities to fellow
students or to patient care assignments
Lack of conscientiousness – failure to fulfill responsibilities –
doing only the minimum
Lack of effort towards developing and improving clinical skills
Failure to accept responsibility for errors and to learn from
mistakes
Poor interactions and/or a lack of respect for fellow students,
instructors, patients and families
Chronic fatigue and sleep deprivation
Arrogant and demeaning behavior
Skills for Professionalism
Specific skills needed by the novice professional
Clinical skills
Interpersonal skills
Professional communication
Self-control to manage difficult encounters
Time management skills
Planning
Organizing
Delegating
Priority setting
Personal health and energy management
Consequences of Unprofessional Behaviors
Inability to get hired
Inability to keep a job
Failure to be promoted
Lack of respect from clients and colleagues
Potential legal consequences
INNOVATIVE
PROGRAMS &
CURRICULA
What would you do to promote
professionalism among your
students?
Teaching Activities
Exposure to expert, highly respected role models
Role models across several levels from student leaders, staff,
faculty and practicing professionals
Story Telling
Address negative role modeling
Provide opportunities to discuss professional issues in a safe
environment
Tell about a time when a coworker or fellow student showed
true professionalism
Teaching Activities
Encourage self-reflection through journaling
Keep a log of experiences and reflect on the professional
behaviors experienced or reinforced
Learning from lapses in professionalism
Internet Exercises – Social Media
Involvement in professional activities outside the
classroom or clinical setting
Journal clubs
National Student Nurses Association
Seminars with local, state and national nurse leaders
Free from the National
Student Nurses
Association
Diana J. Mason: Fashioning
the Right Impression.
February/March 2009
Donna Cardillo: Projecting
Your Professionalism,
February/March 2009
Kathleen Pagana: Your
Professional Presence: Advice
on Dress and Appearance.
February/March 2009
Teaching Activities
Make expectations and consequences
completely clear and CONSISTENT
Ground
rules for conduct, dress and behavior
in clinical and classroom settings
Learning contracts for individual students
Clear communication about how the student is
or is not meeting professional expectations
Teaching Activities
Use case scenarios
Example: During lunch, a student makes demeaning
remarks about a patient he has seen in the clinic today;
Discussion questions
What
do you think of this behavior? Is the student acting
professionally?
Is the student breaching confidentiality by describing
details about the patient to other students who are not
directly involved in the patient’s care?
How would you respond to the student’s remarks?
Student experiences
Scenarios from popular TV shows
Professional Code of Conduct
Sample statements from the Code of Conduct for Student
Nurses (from the National Student Nurses Association)
Advocate for the rights of all clients.
Maintain client confidentiality.
Take appropriate action to ensure the safety of clients, self, and others.
Provide care for the client in a timely, compassionate and professional manner.
Communicate client care in a truthful, timely and accurate manner.
Actively promote the highest level of moral and ethical principles and accept
responsibility for our actions.
Promote excellence in nursing by encouraging lifelong learning and professional
development.
Treat others with respect and promote an environment that respects human rights,
values and choice of cultural and spiritual beliefs.
Strive to achieve and maintain an optimal level of personal health.
What Now? Start on the Right Side
Wait and hope
Take action and learn
Blame self
Find solutions
Blame others
Accept ownership
Denial
Acknowledge situation
“Somebody should do
“It starts with me”
something”
“It starts with me”
Complex Work
Glouberman, S. & Zimmerman, B. (2001). Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like? Available
online at http://www.plexusinstitute.org/resource/collection/6528ED29-9907-4BC7-8D00-8DC907679FED/ComplicatedAndComplexSystemsZimmermanReport_Medicare_reform.pdf
Simple: Following a
Recipe
The recipe is essential
Recipes are tested to
assure easy replication
No particular expertise is
required. But cooking
expertise increases
success rate
Recipes produce
standardized products
Complicated: Sending a
Rocket to the Moon
Formulae are critical and
necessary Formulae have a
limited application
Sending one rocket increases
assurance that the next will be
OK
High levels of expertise in a
variety of fields are necessary
for success
Rockets are similar in critical
ways
Complex: Raising a Child
Raising one child provides
experience
No assurance of success
with the next child
Expertise can contribute
but is neither necessary
nor sufficient to assure
success
Every child is unique and
must be understood as an
individual
The best recipes give good
results every time
There is a high degree of
certainty of outcome
Uncertainty of outcome
remains
Optimistic approach to
problem possible
Optimistic approach to
problem possible
Optimistic approach to
problem possible