Transcript Document 7143618

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.
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. 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 selfimposed obligation to
serve the community.
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
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
Knowledge (78)
Competence (53)
Appearance (48)
Teamwork (27)
Respect for others (51)
Integrity (35)
Positive Attitude (28)
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.


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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 experiencethe 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, selfsacrifice, 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, inhouse 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) 651120

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
 Level II
 Level III
 Level IV
Standard of care met
Standard of care not met, but
no reasonable probability of
causing injury
Reportable; standard of care
not met, with injury occurring
or reasonable probable.
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.