MARYLAND ASSOCIATION OF ASSOCIATE

DEGREE NURSING DIRECTORSANNUAL CONFERENCE

OCTOBER 14, 2011

Professionalism:Creating a Nurse

Barbara Cherry, DNSc, MBA, RN, NEA-BC

Maryland Association for Associate Degree

Nursing Directors

THE BENEFITS OF ASSOCIATE DEGREE NURSING – THE FOUR A’S

ACCOUNTABLE: 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

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: 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 studentWhat is “professionalism”?The evidence for teaching professionalismModel 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

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 COLLEGESTUDENTS

HTTP://WWW.YOUTUBE.COM/WATCH?V=DGCJ46VYR9O

Generational Differences

Millennials: Born 1982 – 2002Generation X: Born 1965 – 1982

Baby Boomers: Born 1946 - 1964Traditionalists: Born 1900 – 1946

Millennials

Grew up in a time of great prosperityMost protected generation in historyHighly scheduled and sheltered in

childhoodOften 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 lifeTend 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 STANDARDSand

LEADERSHIP SUPPORT

Foundational Support to Promote Professionalism

Commitment to promote professionalism “from the top”Consistent expectations across all courses and

clinical experiencesConsistent consequences across all courses and

clinical experiences supported by policiesInclusion 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 behaviorBe aware and responsible for your own behaviorOne 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 to excellence

Clinical 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 ImpressionImprint, February/March 2009, page 29

How do professional behaviorslook 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 hiredInability to keep a jobFailure to be promotedLack of respect from clients and colleaguesPotential 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 MediaInvolvement 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 hopeBlame selfBlame othersDenial“Somebody should do

something”

Take action and learnFind solutionsAccept ownershipAcknowledge

situation“It starts with me”“It starts with me”

Complex WorkGlouberman, 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/ComplicatedAndComplexSystems-ZimmermanReport_Medicare_reform.pdf

Simple: Following a Recipe Complicated: Sending a Rocket to the Moon

Complex: Raising a Child

The recipe is essential Formulae are critical and necessary Formulae have a limited application

Raising one child provides experience

Recipes are tested to assure easy replication

Sending one rocket increases assurance that the next will be OK

No assurance of success with the next child

No particular expertise is required. But cooking expertise increasessuccess rate

High levels of expertise in a variety of fields are necessary for success

Expertise can contribute but is neither necessary nor sufficient to assuresuccess

Recipes produce standardized products

Rockets are similar in critical ways

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