Dr. Nora Ahmad PhD is Assistant Professor College of Nursing PAAET – Kuwait. In the celebrate of Nursing Day 2009, Indonesian National Nurses Association in Kuwait (INNA-K) made a seminar for their members in the Indonesian Embassy with topic Professionalism in Nursing.
What is Professionalism? Professionalism is a calling which requires specialized knowledge and often long and extensive academic preparation.
Professional Nursing is “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…” (ksbn, 2003).
What is Professional Responsibility? There are two big point they have to mention on their job regarding to the their profession :
- They should be responsible to the area of legal practice that encompasses the duties of an attorney to act in a professional manner, obey the law, avoid conflicts of interest, and put the interests of clients ahead of their own interests.
- All professionals in every field are expected to act in this legally binding manner in all their relationships with the client
As a Nurse, you should understand about responsibility of the Nursing Professional Body :
- Participates in determining individual members and group responsibilities and conduct
- Regulation of its members adherence to its own professional standards
What makes nursing a profession? There are many criteria which can makes the nursing become a profession :
- There is an educational background required to ensure safe and effective practice. A practitioners must complete Board certified educational programs or meet minimum criteria to be eligible for licensure.
- Members are accountable for continuing education and competency.
- Members of the profession adhere to a code of ethics.
- Members participate in professional organizations.
- members publish and communicate their knowledge and advances in the profession.
- Members of the profession are autonomous and self- regulating
- Members of the profession are involved in research They are involved in community service
- The profession develops, evaluates and uses theory as a basis for practice
So, the question is…. Do we meet the criteria(s) above?
Do we have the criteria of professional nursing values and behaviors?
- Professional Values ; Altruism (humanity), Equality, Aesthetic, Freedom/Autonomy, Human, dignity, Justice and Truth.
- Professional Behaviors ; Dependability, Professional presentation, Initiative, Empathy, Cooperation, Organization, Clinical reasoning, Supervisory process, Verbal and written Communication (Kasar, et al, 1996).
The challenges in Nursing Professionalism are :
- Changes in Nursing practice
- Diversity in the population
- Lack of autonomy
- Lack of leadership skills
- Nature of the job : long hours, health care risks, emotional load and undervalue by society.
- Shortage of the nurses
- Limited opportunities
Ok, Now we talk about Professionalism and Competency.
A. Professional Competencies
Professional competency is defined as the values, attitudes and practices that competent nurses embody and may share with members of other professions. Nursing care competency is defined as relationship capabilities that nurses need to work with clients and colleagues. the knowledge and skills of practicing the discipline and competencies that encompass understanding of the broader health care system.
B. Core Values of Nursing Competency
A competent nurse’s personal and professional actions are based on a set of shared core nursing values through the understanding that nursing is a humanitarian profession based on a set of core nursing values, including Social justice, Caring, Advocacy, Respect for self and others, Collegiality, and Ethical behaviour.
C. Foundations of Nursing Competency
Develops insight through reflection, self-analysis, and self-care through the understanding that by using ongoing reflection, critical examination and evaluation of one’s professional and personal life improves nursing practice.
Nurse engages in ongoing self-directed learning with the understanding that knowledge and skills are dynamic and evolving; in order to maintain competency one must continuously update the knowledge.
Demonstrates leadership in nursing and health care through the understanding that an effective nurse is able to take a leadership role to meet client needs, improve the health care system and facilitate community problem solving.
Collaborates as part of a health care team through the understanding that successful health care depends on a team effort, and collaboration with others in a collegial team is essential for success in serving clients.
Practices within, utilizes, and contributes to the broader health care system through the understanding that professional nursing has a legally defined standard of practice .
Each nurse has the responsibility and Accountability for effective and efficient management and utilization of health care resources.
Practices relationship-centered care through the understanding that the effectiveness of nursing interventions and treatment plans depends, in part, on the attitudes, beliefs and values of clients and these are influenced both by how professionals interact with clients and by the intervention.
Communicates effectively through the understanding that effective use of therapeutic communication, to establish a caring relationship, to create a positive environment, to inform clients, and to advocate is an essential part of all interventions
Makes sound clinical judgments through the understanding that effective nursing judgment is not a single event, but concurrent and recurrent processes that include assessment (data collection, analysis and diagnosis), community and client participation in planning, implementation, treatment, ongoing evaluation, and reflection
In making practice decisions, locates, evaluates and uses the best available evidence, coupled with a deep understanding of client experience and preferences, through the understanding that there are many sources of knowledge, including research evidence, standards of care, community perspectives, practical wisdom gained from experience, which are legitimate sources of evidence for decision-making
What we can do to promote Professionalism?
- Provide strategic directions and programs that enhance the competencies of nurses to be globally competitive.
- Passionately sustain the quality work life and collegial interactions with and among nurses.
- Encourage staff to develop their knowledge and skills by participating in a wide variety of both formal and informal activities.
- Enthusiastically explore possibilities of collaboration.
- Maintain nursing educational standards
- Promote professional behaviour in the professional nurse
- Practice evidence-based care delivery
1. Kim-Godwin Y, Baek H, Wynd C. Factors Influencing Professionalism in Nursing among Korean American Registered Nurses. J Prof Nurs. 2010;26:242–9.[PubMed]
2. Demirkasimoğlu N. Defining Teacher Professionalism from different perspectives. Procedia Soc Behav Sci. 2010;9:2047–51.
3. Adams D, Miller B. Professionalism in nursing behaviors of nurse practitioners. J Prof Nurs. 2001;17:203–10.[PubMed]
4. McCloskey J, McCain B. Satisfaction, commitment, and professionalism of newly employed nurses. J Nurs Sch. 1987;19:20–4.[PubMed]
5. Manojlovich M, Ketefian S. The effects of organizational culture on nursing professionalism: Implications for health resources planning. Can J Nurs Res. 2002;33:15–34.[PubMed]
6. Calder D. Professional images and stereotypes in nursing. Assignment. 1997;3:1–2.
7. Castledine G. Nursing professionalism: Is it declining? Br J Nurs. 1998;7:352.[PubMed]
8. Kinnear J. The professionalization of Canadian nursing, 1924-1932: Views in the Canadian Nurse and the CMAJ. Bull Can History Med. 1994;11:153–74.[PubMed]
9. Reverby S. New York: Cambridge University Press; 1989. Ordered to care: The dilemma of American nursing, 1850-1945.
10. Rutty JE. The nature of philosophy of science, theory and knowledge relating to nursing and professionalism. J Adv Nurs. 1998;28:243–50.[PubMed]
11. Ozbilgin M, Woodward D. ‘Belonging’ and ‘otherness’: Sex equality in banking in Turkey and Britain’ Gend Work Organ. 2004;11:668–88.
12. Su-Mei H. Does higher education enhance the professionalism of nursing? Prof Nurse. 1997;24:20–2.
13. Weller B. Whither professionalism? J Neonatal Nurs. 1998;4:5.
14. Etzioni A. New York: McMillan; 1969. The Semi-Professions and Their Organizations.
15. Wynd CA. Current factors contributing to professionalism in nursing. J Prof Nurs. 2003;19:251–61.[PubMed]
16. Chinn PL, Kramer MK. St. Louis: Mosby; 1999. Theory and nursing: Integrated knowledge development.
17. Rodgers BL, Knafl KA. Philadelphia: Saunders; 2000. Concept development in nursing: Foundations, techniques, and applications.
18. Kennedy A. Continuing professional development (CPD) policy and the discourse of teacher professionalism in Scotland. Res Pap Educ. 2007;22:95–111.
19. Walker LO, Avant KC. Norwalk, CT: Appleton and Lange; 1988. Strategies for theory construction in nursing.
20. Rodgers BL. 2nd ed. Saskatchewan, US: W.b. Saunders; 2000. Concept development in nursing: Foundations, techniques, and applications; pp. 77–102.
21. Hupcey JE, Penrod J. Concept analysis: Examining the state of the science. Res Theory Nurs Pract. 2005;19:197–208.[PubMed]
22. Kumar K, Bullard K, Liu T, Harken A. Case-based multimedia programs enhance the maturation of surgical residents’ concepts of professionalism. J Am Coll Surg. 2006;203:75.
23. Snell L. Teaching professionalism and fostering professional values during residency: The McGill experience. In: Cruess RL, Cruess SR, Steiner Y, editors. Teaching Medical Professionalism. UK: Kambridge University press; 2009.
24. Arnold EL, Stern DT. What is medical professionalism? In: Stern DT, editor. Measuring medical professionalism. New York: Oxford University Press; 2006.
25. Walton J, Chute E, Ball L. Negotiating the role of the Professional Nurse: The pedagogy of Simulation: A grounded theory study. J Prof Nurs. 2011;27:299–310.[PubMed]
26. Hisar F, Karadağ A, Kan A. Development of an instrument to measure professional attitudes in nursing students in Turkey. Nurse Educ Today. 2010;30:726–30.[PubMed]
27. Stephenson A, Higgs R, Sugarman J. Teaching professional development in medical schools. Lancet. 2001;357:867–70.[PubMed]
28. Van Zanten M, Boulet JR, Norcini JJ, McKinley D. Using a standardised patient assessment to measure professional attributes. Med Educ. 2005;39:20–9.[PubMed]
29. Fryer-Edwards K, Wilkins MD, Baernstein A, Braddock CH., 3rd Bringing ethics education to the clinical years: Ward ethics sessions at the University of Washington. Acad Med. 2006;81:626–31.[PubMed]
30. Jones JW, McCullough LB, Richman BW. Ethics and professionalism: Do we need yet another surgeons’ charter? J Vasc Surg. 2006;44:903–6.[PubMed]
31. Stern DT. In search of the informal curriculum: When and where professional values are taught. Acad Med. 1998;73:28–30.[PubMed]
32. Lempp H, Seale C. The hidden curriculum in undergraduate medical education: Qualitative study of medical students perceptions of teaching. BMJ. 2004;329:770–3.[PMC free article][PubMed]
33. Wilkes M, Raven BH. Understanding social influence in medical education. Acad Med. 2002;77:481–8.[PubMed]
34. Wear D. On white coats and professional development: The formal and the hidden curricula. Ann Intern Med. 1998;129:734–7.[PubMed]
35. Stern DT. Values on call: A method for assessing the teaching of professionalism. Acad Med. 1996;71:37–9.[PubMed]
36. Sierles F, Hendrickx I, Circle S. Cheating in medical school. J Med Educ. 1980;55:124–5.[PubMed]
37. Simpson DE, Yindra KJ, Towne JB, Rosenfeld PS. Medical students› perceptions of cheating. Acad Med. 1989;64:221–2.[PubMed]
38. Baldwin DC, Jr, Daugherty SR, Rowley BD, Schwarz MD. Heating inmedical school: A survey of second-year students at 31 schools. Acad Med. 1996;71:267–73.[PubMed]
39. Van Mook W, de Grave W, Wass V. Professionalism: Evolution of the concept. Eur J Int Med. 2009;20:81–4.
40. Edelstein SB, Stevenson JM, Broad KM. Teaching professionalism during anesthesiology training. J Clin Anesth. 2005;17:392–8.[PubMed]
41. Brown LA. Maintaining professional practice-is continuing education the cure or merely a tonic? Nurse Educ Today. 1998;8:251–7.[PubMed]
42. Jarvis P. Lifelong education and its relevance to nursing. Nurse Educ Today. 1987;2:49–55.[PubMed]
43. Altschul A. How far should further education go? Nursing Mirror July. 1982:29–30.[PubMed]
44. Houle C. San Francisco/London/Washington: Jossey Bass; 1982. Continuing learning in the professions.
45. Jarvis P. London/Canberra: Croom Helm; 1983. Professional education.
46. Altun I. Burnout and nurses’ personal and professional values. Nursing Ethics. 2002;9:269–78.[PubMed]
47. Weis D, Schank MJ. Toward building an international consensus in professional values. Nurse Educ Today. 1997;17:366–9.[PubMed]
48. Bang KS, Kang JH, Jun MH, Kim MH, Son HM, Yu SJ, et al. Professional values in Korean undergraduate nursing students. Nurse Educ Today. 2011;31:72–5.[PubMed]
49. Weis D, Schank MJ. An instrument to measure professional nursing values. J Nurs Scholarsh. 2000;32:201–4.[PubMed]
50. Creasia JL, Parker BJ. 4th ed. USA: Elsevier Publisher; 2007. Conceptual foundations: The bridge to professional nursing practice; p. 58.
51. Chitty KK. 2nd ed. Philadelphia: W.B. Saunders Company; 1997. Professional nursing.
52. Karadağ A, Hisar F, Elbas¸ NÖ. A behavioural inventory for professionalism in nursing. Hemşirelik Forumu. 2005;7:14–22.
53. Kelly LY, Joel LA. 7th ed. New York: McGraw-Hill; 1995. Dimension of professional nursing.
54. McGhee G. Professionalization and the health promotion officer. Health Educ. 1995;5:26–32.
55. Miller BK. Amodel for professionalismin nursing. Todays OR Nurse. 1988;10:18–23.[PubMed]
56. Kim C, Lim B. Modernized education of traditional medicine in Korea: Is it contributing to the same type of professionalization seen in Western medicine? Soc Sci Med. 2004;58:1999–2008.[PubMed]
57. Horton K, Tschudin V, Forget A. The value of nursing: A literature review. Nurs Ethics. 2007;14:716–40.[PubMed]
58. Hall RH. Professionalism and bureaucratization. Am Sociol Rev. 1968;63:92–104.
59. Hall RH. Kansas City: American Nurse Association; 1982. The professions, employed professionals, and the professional association. [PubMed]
60. Hall RH. Some organizational considerations in the professional-organizational relationship. Adm Sci Q. 1967;12:461–78.
61. Booth J, Tolson D, Hotchkiss R, Schofield I. Using action research to construct national evidence-based nursing care guidance for gerontological nursing. J Clin Nurs. 2007;16:945–53.[PubMed]
62. Arthur D. Measuring the professional self-concept of nurses: A critical review. J Adv Nurs. 1992;17:712–9.[PubMed]
63. Arthur D, Thorne S. Professional self-concept of nurses: A comparative study of four strata of nursing students in a Canadian university. Nurse Educ Today. 1998;18:380–8.[PubMed]
64. Fagermoen MS. Professional identity: Values embedded in meaningful nursing practice. J Adv Nurs. 1997;25:434–41.[PubMed]
65. Gunter M, Alligood MR. A discipline-specific determination of high quality nursing care. J Adv Nurs. 2001;38:353–9.[PubMed]
66. Witz A, Annandale E. The Challenge of nursing. The Challenge of Nursing. In: Gabe J, Kelleher D, Williams G, editors. Challenging medicine. London: Routledge; 2006. pp. 24–39.
67. Cant S, Watts P, Ruston A. Negotiating competency, professionalism and risk: The integration of complementary and alternative medicine by nurses and midwives in NHS hospitals. Soc Sci Med. 2011;72:529–36.[PubMed]
68. Barber B. Some problems in the sociology of the Professions. In: Lynn KS, editor. The Professions in America. Boston: Houghton Mifflin; 1965. pp. 669–88.
69. Lui M, Lam LW, Lee I, Chien WT, Chau J, Ip WI. Professional nursing values among baccalaureate nursing students in Hong Kong. Nurse Educ Today. 2008;28:108–14.[PubMed]
70. Washington, DC: American Nurses Association; 2001. [Last accessed on 2012 Apr 6]. American Nurses Association. Code of Ethics For Nurses With Interpretive Statements. Available from: http://nurisngworld.org/ethicscode150.htm .
71. Geneva, Switzerland: International Council of Nurses; 2000. [Last accessed on 2012 Apr 6]. International Council of Nurses. ICN Code of ethics for nurses. Available from: http://www.icn.ch/ethics.htm .
72. Hampton GM, Hampto DL. Relationship of professionalism, rewards, market orientation and job satisfaction among medical professionals: The case of Certified Nurse–Midwives. J Bus Res. 2004;57:1042–53.
73. Mayer MM. Professional management. Brookings Rev. 1997;15:48.
74. Yoder LH. Staff nurses’ career development relationships and self-reports of professionalism, job satisfaction, and intent to stay. Nurs Res. 1995;44:290–7.[PubMed]
75. Martin P, Yarbrough S, Alfred D. Professional values held by baccalaureate and associate degree nursing students. J Nurs Scholarsh. 2003;35:291–6.