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Professionalism in NursingProfessionalism in Nursing
Nurses Week Nurses Week 20042004ByBy
Cheryl Donelan, R.N. BSNCheryl Donelan, R.N. BSN
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.
Nurses Week 2004Nurses Week 2004
The nursing profession began with a The nursing profession began with a genuine desire to serve and care for others, genuine desire to serve and care for others, combined with a sense of compassion and combined with a sense of compassion and commitment. Nurses are special people. It is commitment. Nurses are special people. It is with awe and reverence that the nation with awe and reverence that the nation pauses this week to celebrate and thank all pauses this week to celebrate and thank all those in the nursing profession for the those in the nursing profession for the tireless hours of giving and care bestowed tireless hours of giving and care bestowed upon the suffering. upon the suffering.
To be a nurse is a calling and difficult To be a nurse is a calling and difficult to describe in words. Who can say why to describe in words. Who can say why a person would want to do a nurses a person would want to do a nurses work, but those who do will tell you work, but those who do will tell you there is nothing as fulfilling or there is nothing as fulfilling or rewarding. Nurses stay by the side of rewarding. Nurses stay by the side of those they serve through the worst those they serve through the worst times and celebrate with patients and times and celebrate with patients and families in the best times. families in the best times.
There is an intimacy nurses and There is an intimacy nurses and patients share which is understood. patients share which is understood. The essence of nursing is an The essence of nursing is an unconditional love for mankind. To unconditional love for mankind. To be called a nurse is an honor – a be called a nurse is an honor – a profession of the highest realm.profession of the highest realm.
Founder of NursingFounder of Nursing
Florence Nightingale is called the mother of Florence Nightingale is called the mother of modern secular nursing. Born in 1820 in modern secular nursing. Born in 1820 in Florence, Italy, this intelligent, upper-class Florence, Italy, this intelligent, upper-class woman made dramatic and universal woman made dramatic and universal changes in health care. At age 16, changes in health care. At age 16, Nightingale was called by God to minister to Nightingale was called by God to minister to the sick. the sick.
With her social connections she was able to With her social connections she was able to secure an appointment as a healthcare secure an appointment as a healthcare professional at a hospital for women in professional at a hospital for women in London in 1853. Nightingale was asked to London in 1853. Nightingale was asked to bring nurses to care for the wounded British bring nurses to care for the wounded British soldiers in Scutari during the Crimea War in soldiers in Scutari during the Crimea War in 1854. 1854.
Nightingale viewed nursing as an art as well as a Nightingale viewed nursing as an art as well as a science. science.
““Nursing is an art, and, if it is to be made an art, Nursing is an art, and, if it is to be made an art, requires as exclusive a devotion, as hard a requires as exclusive a devotion, as hard a preparation, as any painter’s or sculptor’s work; for preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or cold what is the having to do with dead canvas or cold marble, compared with having to do with the living marble, compared with having to do with the living body- the temple of God’s spirit? It is one of the body- the temple of God’s spirit? It is one of the fine Arts; I had almost said, the finest of the Fine fine Arts; I had almost said, the finest of the Fine Arts” (Nightingale,1868).Arts” (Nightingale,1868).
The Florence Nightingale PledgeThe Florence Nightingale Pledge
I solemnly pledge myself before God I solemnly pledge myself before God and in the presence of this assembly to and in the presence of this assembly to pass my life in purity and to practice my pass my life in purity and to practice my profession faithfully.profession faithfully.
I will abstain from whatever is I will abstain from whatever is deleterious and mischievous and will not deleterious and mischievous and will not take or knowingly administer any harmful take or knowingly administer any harmful drug.drug.
(continued)(continued)
I will do all in my power to maintain and I will do all in my power to maintain and elevate the standard of my profession elevate the standard of my profession and will hold in confidence all personal and will hold in confidence all personal matters committed to my keeping and all matters committed to my keeping and all family affairs coming to my knowledge in family affairs coming to my knowledge in the practice of my calling. the practice of my calling.
With loyalty will I endeavor to aid With loyalty will I endeavor to aid the physician in his work and devote the physician in his work and devote myself to the welfare of those committed myself to the welfare of those committed to my care to my care (Nightingale,1860).(Nightingale,1860).
In 1859, Florence Nightingale wrote: “No In 1859, Florence Nightingale wrote: “No man, not even a doctor, ever gives any man, not even a doctor, ever gives any other definition of what a nurse should be other definition of what a nurse should be than this – “devoted and obedient” “ This than this – “devoted and obedient” “ This definition would do just as well for a porter. It definition would do just as well for a porter. It might even do for a horse. It would not do might even do for a horse. It would not do for a policeman” (Nightingale, 1860). for a policeman” (Nightingale, 1860).
Nursing has come a long way in 145 years. Nursing has come a long way in 145 years. Nightingale established the fundamentals of Nightingale established the fundamentals of patient management, care, and cleanliness patient management, care, and cleanliness that has been taught in nursing schools ever that has been taught in nursing schools ever since. Her true legacy is far greater, as she since. Her true legacy is far greater, as she elevated nursing to a higher degree of elevated nursing to a higher degree of respectability and professionalism than ever respectability and professionalism than ever before. As we celebrate Nurse’s Week, May before. As we celebrate Nurse’s Week, May 6-12, 2004 let us reflect on what 6-12, 2004 let us reflect on what professional nursing is and our vision for the professional nursing is and our vision for the future.future.
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 practical (2) The practice of nursing as a licensed practical nurse means the performance for compensation or nurse means the performance for compensation or gratuitously of tasks and responsibilities defined in gratuitously of tasks and responsibilities defined in part (1) which tasks and responsibilities are based part (1) which tasks and responsibilities are based on acceptable educational preparation within the on acceptable educational preparation within the framework of supportive and restorative care framework of supportive and restorative care under the direction of a registered professional under the direction of a registered professional nurse, a person licensed to practice medicine and nurse, a person licensed to practice medicine and surgery or a person licensed to practice dentistry surgery or a person licensed to practice dentistry (KSBN,2003). (KSBN,2003).
A profession is defined as a calling or A profession is defined as a calling or vocation, especially one that involves some vocation, especially one that involves some branch of advanced learning or science. The branch of advanced learning or science. The essence of professionalism is both having a essence of professionalism is both having a unique or special knowledge and the self-unique or special knowledge and the self-imposed obligation to serve the community. imposed obligation to serve the community.
Until recently this has been an unwritten Until recently this has been an unwritten contract. For these reasons, society holds contract. For these reasons, society holds the professional in higher esteem than it the professional in higher esteem than it does a technician, blue-collar worker, or does a technician, blue-collar worker, or businessman, people who traditionally are businessman, people who traditionally are interested in the benefits of their interested in the benefits of their employment rather than the occupation employment rather than the occupation itself.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 professionalism within In order to emphasize professionalism within nursing, each nurse needs to understand nursing, each nurse needs to understand the opportunities, responsibilities and the opportunities, responsibilities and concerns that are integral to the nursing concerns that are integral to the nursing profession. The Kansas State Nurses profession. The Kansas State Nurses Association, 2003, Association, 2003, Code of Ethics for Code of Ethics for Nurses with Interpretive StatementsNurses with Interpretive Statements defines defines these concepts: 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 through advancement of the profession through contributions to practice, education, contributions to practice, education, administration, and knowledge administration, and knowledge development.development.
7.1 Advancing the profession through 7.1 Advancing the profession through active involvement in nursing and in active involvement in nursing and in healthcare policyhealthcare policy..
Nurses should advance their profession by Nurses should advance their profession by contributing in some way to the leadership, contributing in some way to the leadership, activities, and the viability of their professional activities, and the viability of their professional organizations. Nurses can also advance the organizations. Nurses can also advance the profession by serving in leadership or mentorship profession by serving in leadership or mentorship roles or on committees within their places of roles or on committees within their places of employment. Nurses who are self-employed can employment. Nurses who are self-employed can advance the profession by serving as role models advance the profession by serving as role models for professional integrity. Nurses can also advance for professional integrity. Nurses can also advance the profession through participation in civic the profession through participation in civic activities related to health care or through local, activities related to health care or through local, state, national, or international initiatives. state, national, or international initiatives.
Nurse educators have a specific Nurse educators have a specific responsibility to enhance students’ responsibility to enhance students’ commitment of professional and civic commitment of professional and civic values. Nurse administrators have a values. Nurse administrators have a responsibility to foster an employment responsibility to foster an employment environment that facilitates nurses’ ethical environment that facilitates nurses’ ethical integrity and professionalism, and nurse integrity and professionalism, and nurse researchers are responsible for active researchers are responsible for active contribution to the body of knowledge contribution to the body of knowledge supporting and advancing nursing practice.supporting and advancing nursing practice.
7.2 Advancing the profession by 7.2 Advancing the profession by developing, maintaining, and implementing developing, maintaining, and implementing professional standards in clinical, professional standards in clinical, administrative, and educational practice.administrative, and educational practice.
Standards and guidelines reflect the practice Standards and guidelines reflect the practice of nursing grounded in ethical commitments of nursing grounded in ethical commitments and a body of knowledge. Professional and a body of knowledge. Professional standards and guidelines for nurses must be standards and guidelines for nurses must be developed by nurses and reflect nursing’s developed by nurses and reflect nursing’s responsibility to society. responsibility to society.
It is the responsibility of nurses to identify It is the responsibility of nurses to identify their own scope of practice as permitted by their own scope of practice as permitted by professional practice standards and professional practice standards and guidelines, by state and federal laws, by guidelines, by state and federal laws, by relevant societal values, and by the Code of relevant societal values, and by the Code of Ethics.Ethics.
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 autonomy and self regulation in Professional autonomy and self regulation in the control of conditions of practice are the control of conditions of practice are necessary for implementing nursing necessary for implementing nursing standards and guidelines and assuring standards and guidelines and assuring quality care for those whom nursing serves. quality care for those whom nursing serves.
The nurse educator is responsible for The nurse educator is responsible for promoting and maintaining optimum promoting and maintaining optimum standards of both nursing education and of standards of both nursing education and of nursing practice in any settings where nursing practice in any settings where planned learning activities occur. Nurse planned learning activities occur. Nurse educators must also ensure that only those educators must also ensure that only those students who possess the knowledge, skills, students who possess the knowledge, skills, and competencies that are essential to and competencies that are essential to nursing graduate from their nursing nursing graduate from their nursing programs.programs.
7.3 Advancing the profession through 7.3 Advancing the profession through knowledge development, dissemination, and knowledge development, dissemination, and application to practiceapplication to practice
The nursing profession should engage in The nursing profession should engage in scholarly inquiry to identify, evaluate, refine, scholarly inquiry to identify, evaluate, refine, and expand the body of knowledge that and expand the body of knowledge that forms the foundation of its discipline and forms the foundation of its discipline and practice.practice.
In addition, nursing knowledge is derived In addition, nursing knowledge is derived from the sciences and from the humanities. from the sciences and from the humanities. Ongoing scholarly activities are essential to Ongoing scholarly activities are essential to fulfilling a profession’s obligations to society. fulfilling a profession’s obligations to society. All nurses working alone or in collaboration All nurses working alone or in collaboration with others can participate in the with others can participate in the advancement of the profession through the advancement of the profession through the development, evaluation, dissemination, and development, evaluation, dissemination, and application of knowledge in practice. application of knowledge in practice.
However, an organizational climate and However, an organizational climate and infrastructure conducive to scholarly inquiry infrastructure conducive to scholarly inquiry must be valued and implemented for this to must be valued and implemented for this to occur. occur.
The nursing profession is characterized by The nursing profession is characterized by the continuing pursuit of knowledge, a sense the continuing pursuit of knowledge, a sense of responsibility for human concerns, of responsibility for human concerns, preparation through higher education, peer preparation through higher education, peer accountability, autonomy, and altruism. accountability, autonomy, and altruism.
Nursing theory provides knowledge to Nursing theory provides knowledge to improve practice by describing, explaining, improve practice by describing, explaining, predicting, and controlling phenomena. predicting, and controlling phenomena. Theory provides professional autonomy by Theory provides professional autonomy by guiding the practice, education, and guiding the practice, education, and research functions of the profession. Theory research functions of the profession. Theory also helps develop analytical skills, also helps develop analytical skills, challenge thinking, clarify values and challenge thinking, clarify values and assumptions, and determine purposes for assumptions, and determine purposes for nursing practice, education, and research nursing practice, education, and research (Tomey, 2002).(Tomey, 2002).
Career trajectory, in systems thinking, refers to Career trajectory, in systems thinking, refers to the series of successive states through which a the series of successive states through which a system or career proceeds over time. It may be system or career proceeds over time. It may be said to represent the long-term behavior of the said to represent the long-term behavior of the system. Nursing is often referred to as a young system. Nursing is often referred to as a young profession, in that it is around 150 years old. A profession, in that it is around 150 years old. A review of nursing’s history clearly shows growth in review of nursing’s history clearly shows growth in theory, evidence-based practice, image and theory, evidence-based practice, image and autonomy. autonomy.
VCRMC Survey on ProfessionalismVCRMC Survey on Professionalism
In the winter of 2003, a random survey of In the winter of 2003, a random survey of licensed nurses was conducted at Via licensed nurses was conducted at Via Christi Regional Medical Center. The survey Christi Regional Medical Center. The survey asked nurses throughout the organization to asked nurses throughout the organization to name three characteristics that expressed name three characteristics that expressed what professionalism was to them. what professionalism was to them.
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.
KnowledgeKnowledge
Participants in the Via Christi study Participants in the Via Christi study indicated that knowledge and continuing indicated that knowledge and continuing education were very important to them. The education were very important to them. The desire to continue learning is relevant to the desire to continue learning is relevant to the nurse’s ability to develop competence and nurse’s ability to develop competence and professionalism in the provision of nursing professionalism in the provision of nursing care. With knowledge acquired, nurses can care. With knowledge acquired, nurses can focus on the quality and performance of focus on the quality and performance of nursing care rather than merely successful nursing care rather than merely successful completion of tasks. completion of tasks.
Several factors enhance the utilization and Several factors enhance the utilization and acquisition of knowledge. These factors are:acquisition of knowledge. These factors are:
OrientationOrientation Preceptor/co-worker support Preceptor/co-worker support In-house educational programsIn-house educational programs Advanced certificationAdvanced certification Research evidence-based practice. Research evidence-based practice.
OrientationOrientation
Orientation generally includes a brief Orientation generally includes a brief employee orientation about the hospital’s employee orientation about the hospital’s mission, vision and values as well as mission, vision and values as well as organizational policies and procedures. organizational policies and procedures. Further orientation for licensed personnel is Further orientation for licensed personnel is focused on patient care policies and issues. focused on patient care policies and issues.
Specific orientation programs for varying Specific orientation programs for varying lengths of time are developed to address lengths of time are developed to address skills and expectations for patient care in skills and expectations for patient care in each department. Some nurses may require each department. Some nurses may require a longer orientation time than others a longer orientation time than others because learning is individualized. because learning is individualized.
Preceptoring/ Co-worker SupportPreceptoring/ Co-worker Support
Mentoring or precepting is a crucial activity Mentoring or precepting is a crucial activity that enhances the development of that enhances the development of professionals. Experienced practicing professionals. Experienced practicing nurses mentor others by being competent nurses mentor others by being competent role models and by providing a safety net as role models and by providing a safety net as nurses attempt to master new skills. nurses attempt to master new skills.
MentorsMentors
Strong mentors provide a positive Strong mentors provide a positive introduction to the nursing profession and, introduction to the nursing profession and, depending on their beliefs, can foster depending on their beliefs, can foster professionalism among those they guide professionalism among those they guide (Cameron-Jones & O’Hara, 1996; Ehrich, (Cameron-Jones & O’Hara, 1996; Ehrich, Tennent, & Hansford, 2002; Lo & Brown, Tennent, & Hansford, 2002; Lo & Brown, 2000). 2000).
MentorsMentors
Mentoring involves two parties and occurs Mentoring involves two parties and occurs when the senior person in terms of maturity when the senior person in terms of maturity and experience- the mentor- provides and experience- the mentor- provides information, advice, and emotional support information, advice, and emotional support for the junior person – the “mentee” or for the junior person – the “mentee” or protégé. Mentors are people with advanced protégé. Mentors are people with advanced job-related experience, knowledge, and job-related experience, knowledge, and power in their organizations. power in their organizations.
MentorsMentors
The beliefs of altruism, self-sacrifice, The beliefs of altruism, self-sacrifice, advanced learning and above all else advanced learning and above all else honesty are required in order to be a honesty are required in order to be a mentor and serve as a role-model for the mentor and serve as a role-model for the profession of nursing. To find a good profession of nursing. To find a good mentor look for someone with a positive mentor look for someone with a positive attitude and caring approach to others. The attitude and caring approach to others. The individual should be a good communicator individual should be a good communicator and someone trustworthy (Restifo, 2004).and someone trustworthy (Restifo, 2004).
PreceptorsPreceptors
Preceptors are key elements in the Preceptors are key elements in the success of a nurse’s professional success of a nurse’s professional development. Alspach (2000) published adevelopment. Alspach (2000) published 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 A clearly stated set of expectations for their performance.their performance.
– A clear delineation of their responsibilities A clear delineation of their responsibilities to the preceptee.to the preceptee.
– A clear distinction for their responsibilities A clear distinction for their responsibilities in relation to others who are involved in in relation to others who are involved in the orientation program.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, skills, Adequate training in the knowledge, skills, and attitudes necessary to fulfill their and attitudes necessary to fulfill their responsibilities (Alspach, 2000). responsibilities (Alspach, 2000).
Preceptor Development Classes and Preceptor Development Classes and programs help define and support the programs help define and support the preceptor role. With the increased preceptor role. With the increased complexity of healthcare systems this complexity of healthcare systems this clearly is an identified need for the nursing clearly is an identified need for the nursing profession. profession.
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.
Precepting student nurses and graduate Precepting student nurses and graduate nurses has shown to be effective in reducing nurses has shown to be effective in reducing lengthy and costly orientation programs, lengthy and costly orientation programs, enhancing recruitment and increasing enhancing recruitment and increasing retention. retention.
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 and encourage this level In order to facilitate and encourage this level of professionalism, in-house educational of professionalism, in-house educational programs should be offered. Accordingly, programs should be offered. Accordingly, higher education, certification in advanced higher education, certification in advanced practice, support for professional practice, support for professional organizations and research should be organizations and research should be supported. supported.
Nursing CompetencyNursing Competency
Nursing competency ranked second in Nursing competency ranked second in the Via Christi survey. Some key features of the Via Christi survey. Some key features of nursing competency are as follow: nursing competency are as follow:
The ability to recognize common factors that The ability to recognize common factors that contribute to, and adversely affect, the contribute to, and adversely affect, the physical, mental and social well-being of physical, mental and social well-being of patients and clients, and be able to take patients and clients, and be able to take appropriate action.appropriate action.
The use of relevant literature and research The use of relevant literature and research to inform the practice of nursing.to inform the practice of nursing.
An appreciation of the influence of social, An appreciation of the influence of social, political and cultural factors in relation to political and cultural factors in relation to health care.health care.
An understanding of the ethics of health An understanding of the ethics of health care and the nursing profession and the care and the nursing profession and the responsibilities these impose on the nurse’s responsibilities these impose on the nurse’s professional practice.professional practice.
The ability to identify the physical, The ability to identify the physical, psychological, social and spiritual needs of psychological, social and spiritual needs of the patient or client.the patient or client.
The use of appropriate channels of referral The use of appropriate channels of referral for matters not within the nurse’s sphere of for matters not within the 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 involving failure to 2) repeated instances involving failure to adhere to the applicable standard of care to adhere to the applicable standard of care to a degree which constitutes ordinary a degree which constitutes ordinary negligence, as determined by the board; ornegligence, as determined by the board; or
3) a pattern of practice or other behavior 3) a pattern of practice or other behavior which demonstrates a manifest incapacity or which demonstrates a manifest incapacity or incompetence to practice nursing.incompetence to practice nursing.
It is every nurses responsibility to It is every nurses responsibility to understand the definition of incompetent understand the definition of incompetent proactice. In addition, it is the responsibility proactice. In addition, it is the responsibility of those within the profession to monitor and of those within the profession to monitor and report acts of incompetence. report acts of incompetence.
A standard is an authoritative statement A standard is an authoritative statement defined and promoted by the profession by defined and promoted by the profession by which the quality of practice, service, or which the quality of practice, service, or education can be evaluated. education can be evaluated.
These standards are used by Peer Review These standards are used by Peer Review Committees to evaluate peer practice and Committees to evaluate peer practice and determine if certain situations meet the determine if certain situations meet the criteria of a reportable incident according to criteria of a reportable incident according to the Kansas Risk Management laws.the Kansas Risk Management laws.
The Kansas State Board of Nursing The Kansas State Board of Nursing provides standard of care determinations provides standard of care determinations which are based on the following criteria:which are based on the following criteria:
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
AppearanceAppearance
The nursing survey identified appearance as The nursing survey identified appearance as important as professionalism. The issue of important as professionalism. The issue of appearance and attire is important in appearance and attire is important in creating a positive perception and creating a positive perception and communicating an attitude of competence communicating an attitude of competence and professionalism (Huber, 2000).and professionalism (Huber, 2000).
Research has shown that consumers Research has shown that consumers prefer white uniforms with a skirt and a cap prefer white uniforms with a skirt and a cap as a nurse’s uniform. This has possibly as a nurse’s uniform. This has possibly occurred because of the persistence of occurred because of the persistence of traditional views and images of nursing. As traditional views and images of nursing. As the health care field becomes more the health care field becomes more competitive some institutions may begin to competitive some institutions may begin to implement dress codes which capitalize on implement dress codes which capitalize on the preference of “the customer”. the preference of “the customer”.
While caps and white starched uniforms are While caps and white starched uniforms are not functional, nurses must realize that the not functional, nurses must realize that the way one dresses symbolizes role identity, way one dresses symbolizes role identity, authority, professional image, and authority, professional image, and confidence - as well as the way the nurse confidence - as well as the way the nurse feels about themselves (Mangum, et al., feels about themselves (Mangum, et al., 1991). 1991).
Clothing is a form of nonverbal Clothing is a form of nonverbal communication that stimulates judgmental communication that stimulates judgmental responses from others and as a professional responses from others and as a professional nurse it is inappropriate to dress casual, nurse it is inappropriate to dress casual, soiled, disheveled or seductive. Dressing soiled, disheveled or seductive. Dressing with a professional image in mind is a with a professional image in mind is a simple act which carries the power to simple act which carries the power to advance professionalism. advance professionalism.
An institutional policy on nursing dress code An institutional policy on nursing dress code is as follows:is as follows:
Nurses are asked to set an example of Nurses are asked to set an example of neatness and cleanliness in personal neatness and cleanliness in personal appearance during work hours/shifts. Daily appearance during work hours/shifts. Daily grooming and appropriate appearance are grooming and appropriate appearance are essential and set the image of the hospital. essential and set the image of the hospital.
Nurses customarily dress in uniform Nurses customarily dress in uniform specified by the departments. Hair, beards, specified by the departments. Hair, beards, and sideburns must be neatly groomed, and sideburns must be neatly groomed, clean and present a professional clean and present a professional appearance. Excessive use of cosmetics, appearance. Excessive use of cosmetics, fragrances and other accessories should be fragrances and other accessories should be avoided. Facial jewelry, such as eye, nose, avoided. Facial jewelry, such as eye, nose, lip or tongue jewelry is prohibited. lip or tongue jewelry is prohibited.
Other attire considered Other attire considered inappropriateinappropriate includes: includes:
Stained, wrinkled, tight, frayed, or revealing Stained, wrinkled, tight, frayed, or revealing clothingclothing
JeansJeans ShortsShorts Leggings, stretch pants, or caprisLeggings, stretch pants, or capris Sweatpants/tops or wind suitsSweatpants/tops or wind suits
T-shirts, tank tops, tube tops, crop tops or T-shirts, tank tops, tube tops, crop tops or halter topshalter tops
HatsHats Sleeveless clothingSleeveless clothing Shirts with inappropriate slogans and/or Shirts with inappropriate slogans and/or
designs. designs. Artificial nailsArtificial nails Open-toed shoesOpen-toed shoes
TeamworkTeamwork
The last characteristic identified through to The last characteristic identified through to 2003 survey relates to teamwork. Nurses 2003 survey relates to teamwork. Nurses work in multidisciplinary professional teams work in multidisciplinary professional teams with doctors and therapists. The goal of with doctors and therapists. The goal of these teams is to promote and provide these teams is to promote and provide treatments which improve patient outcomes. treatments which improve patient outcomes. Nurses have been working with doctors for Nurses have been working with doctors for many years attempting to strengthen mutual many years attempting to strengthen mutual understanding of each other professionalism understanding of each other professionalism and ability. and ability.
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 As nurses have expanded their roles in the community, it is important to understand the 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 to upon us, the nursing profession may need to divide labor with unlicensed staff, 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.
As professionals, nurses must not forget the As professionals, nurses must not forget the greatest consideration – that of the patient greatest consideration – that of the patient rather than the provider. We cannot function rather than the provider. We cannot function without our unlicensed assistants and owe without our unlicensed assistants and owe them mutual respect and courtesy. Their job them mutual respect and courtesy. Their job is also to provide comfort, care, love and is also to provide comfort, care, love and compassion to the sick.compassion to the sick.
Teamwork Improves SafetyTeamwork Improves Safety
As stated in the As stated in the Hallmarks of the Hallmarks of the Professional Nursing Practice EnvironmentProfessional Nursing Practice Environment (2002), in 1999, the Institute of Medicine (2002), in 1999, the Institute of Medicine (IOM) issued a comprehensive report, (IOM) issued a comprehensive report, To To Err is Human; Building a Safer Health Err is Human; Building a Safer Health System,System, summarizing problems of patient summarizing problems of patient safety in the U.S. health system (IOM, safety in the U.S. health system (IOM, 1999). 1999).
One important recommendation was to One important recommendation was to create improved safety systems inside create improved safety systems inside health care through implementation of safe health care through implementation of safe practices at the delivery level, including practices at the delivery level, including interdisciplinary clinical practice among interdisciplinary clinical practice among health professionals. health professionals.
Attributes of interdisciplinary collaboration Attributes of interdisciplinary collaboration include trust, knowledge, mutual respect, include trust, knowledge, mutual respect, good communication, cooperation, good communication, cooperation, coordination, share responsibility, and coordination, share 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:
>Reluctance or refusal to answer your questions, >Reluctance or refusal to answer your questions, return phone calls or pages: 39% three to 10 return phone calls or pages: 39% three to 10 times, and 21% more than 10 times.times, and 21% more than 10 times.
>Condescending language or voice intonation: >Condescending language or voice intonation: 40% three to 10 times, and 30% more than 10 40% three to 10 times, and 30% more than 10 times.times.
>Impatience with questions: 42% three to 10 >Impatience with questions: 42% three to 10 times, and 27% more than 10 times.times, and 27% more than 10 times.
>”Just give what I ordered”: 24% three to 10 times, >”Just give what I ordered”: 24% three to 10 times, and 10% more than 10 times (Ulrich, 2004). and 10% more than 10 times (Ulrich, 2004).
This data identifies the problem of This data identifies the problem of intimidating behavior in regard to clarifying intimidating behavior in regard to clarifying orders and answering questions. Many orders and answering questions. Many professional education programs for professional education programs for medical, nursing, and allied health students medical, nursing, and allied health students now require curricula that support now require curricula that support interdisciplinary practice in a variety of interdisciplinary practice in a variety of clinical settings. clinical settings.
These programs should emphasize These programs should emphasize teamwork, conflict resolution, and the use of teamwork, conflict resolution, and the use of informatics to promote collaboration in informatics to promote collaboration in patient care planning and implementation patient care planning and implementation (Wakefield & O’Grady, 2000). (Wakefield & O’Grady, 2000).
AccountabilityAccountability
Though problems of intimidation exist, the Though problems of intimidation exist, the registered nurse is personally accountable registered nurse is personally accountable for his/her own practice – not a senior for his/her own practice – not a senior member of staff, physician or other health member of staff, physician or other health care professional. Remember the saying care professional. Remember the saying “but he/she told me to do it” is never “but he/she told me to do it” is never justification for poor practice. justification for poor practice.
Nurses cannot blame anyone else for Nurses cannot blame anyone else for mistakes – they are accountable, mistakes – they are accountable, answerable, and liable for their own actions, answerable, and liable for their own actions, the completion of the assigned task, and the completion of the assigned task, and acts of delegation. acts of delegation. Accountability cannot Accountability cannot be delegated.be delegated.
Past studies of environments that support Past studies of environments that support collaboration among physicians, nurses and allied collaboration among physicians, nurses and allied health professionals have shown evidence of health professionals have shown evidence of improved outcomes for both acutely and improved outcomes for both acutely and chronically ill patients. The professional nurse chronically ill patients. The professional nurse should always remain calm and respectful of should always remain calm and respectful of others. Perhaps the best advice is to remember others. Perhaps the best advice is to remember the golden rule “do unto others as you would have the golden rule “do unto others as you would have them do unto you.”them do unto you.”
The most common dilemma regarding The most common dilemma regarding accountability is created by the assignment of accountability is created by the assignment of responsibility and the granting of authority. Some responsibility and the granting of authority. Some common examples of a mismatch of authority to common examples of a mismatch of authority to responsibility is when nurses are placed in what responsibility is when nurses are placed in what they consider inadequate staffing situations, they consider inadequate staffing situations, disagreements with physician orders which may disagreements with physician orders which may not reflect best practice or instructions to carry out not reflect best practice or instructions to carry out tasks outside the scope of practice or the nurses’ tasks outside the scope of practice or the nurses’ competency base. competency base.
Suggestions for avoiding the mismatch of Suggestions for avoiding the mismatch of authority to responsibility include clear and authority to responsibility include clear and explicit communication, coupled with explicit communication, coupled with negotiation strategies (Huber, 2000). Every negotiation strategies (Huber, 2000). Every nurse has a responsibility to know the chain nurse has a responsibility to know the chain of command and the person to turn to when of command and the person to turn to when these occasions occur. these occasions occur.
Respect, Integrity and Positive Respect, Integrity and Positive AttitudeAttitude
Respect for others, integrity and a positive Respect for others, integrity and a positive attitude also ranked high in the nursing attitude also ranked high in the nursing survey. This finding is not surprising, as it survey. This finding is not surprising, as it correlates to Gallup’s 2003 annual survey in correlates to Gallup’s 2003 annual survey in which nurses were on the top for honesty which nurses were on the top for honesty and ethics among various professions, and ethics among various professions, followed by other medical professionals like followed by other medical professionals like doctors, pharmacists, veterinarians and doctors, pharmacists, veterinarians and dentists. dentists.
Americans, in the November 14-16, 2003 Americans, in the November 14-16, 2003 CNN/USA Today/Gallup Poll, were asked to CNN/USA Today/Gallup Poll, were asked to rate the honesty and ethical standards of rate the honesty and ethical standards of people in 23 different professions as very people in 23 different professions as very high, high, average, low, or very low. high, high, average, 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 As nurses embrace the future, what is your vision for the nursing profession? This vision for the nursing profession? This author believes it will be interactions that author believes it will be interactions that nourish our human spirits in the places we nourish our human spirits in the places we live and work. Nurses must be deliberate live and work. Nurses must be deliberate with time, energy and resources as the with time, energy and resources as the profession works toward the goal of quality profession works toward the goal of quality nursing care.nursing care.
New modalities of delivering care are yet New modalities of delivering care are yet to be envisioned and coordinated – not only to be envisioned and coordinated – not only for patients being served, but for each other. for patients being served, but for each other. Fundamental to the nursing professions’ Fundamental to the nursing professions’ future is our ability to honor, respect and future is our ability to honor, respect and value each other, as well as the inter-value each other, as well as the inter-personal and inter-professional personal and inter-professional relationships.relationships.
To know even one life has breathed To know even one life has breathed easier because you have lived – this easier because you have lived – this is to have succeededis to have succeeded ( (unknown authorunknown author). ).
Happy Nurses Week!Happy Nurses Week!
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