Profesionalismo en enfermeria

Professionalism in NursingProfessionalism in Nursing
Nurses WeekNurses Week
20042004
ByBy
Cheryl Donelan, R.N. BSNCheryl Donelan, R.N. BSN

Professionalism in NursingProfessionalism in Nursing
Learning ModuleLearning Module
 Purpose: Upon completion of this learningPurpose: Upon completion of this learning
module, the nurse will have an overview ofmodule, the nurse will have an overview of
nursing professionalism in practice. Thisnursing professionalism in practice. This
activity will explore what nursingactivity will explore what nursing
professionalism is, how it impacts nursingprofessionalism is, how it impacts nursing
practice, and how to advancepractice, and how to advance
professionalism in the community. Theprofessionalism in the community. The
module includes information on the Kansasmodule includes information on the Kansas
State Board of Nursing’s definition ofState Board of Nursing’s definition of
incompetence, The Code of Ethics from theincompetence, The Code of Ethics from the
Kansas State Nurses Association andKansas State Nurses Association and
accountability within the profession.accountability within the profession.

 Objectives: Upon completion of the learningObjectives: Upon completion of the learning
module, the nurse should be able to:module, the nurse should be able to:
– Define the meaning of nursingDefine the meaning of nursing
professionalism.professionalism.
– Describe three factors which enhanceDescribe three factors which enhance
professionalism.professionalism.
– Describe situations reflective ofDescribe situations reflective of
accountability in the nursing profession.accountability in the nursing profession.

Nurses Week 2004Nurses Week 2004
 The nursing profession began with aThe 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 andcombined with a sense of compassion and
commitment. Nurses are special people. Itcommitment. Nurses are special people. It
is with awe and reverence that the nationis with awe and reverence that the nation
pauses this week to celebrate and thank allpauses this week to celebrate and thank all
those in the nursing profession for thethose in the nursing profession for the
tireless hours of giving and care bestowedtireless hours of giving and care bestowed
upon the suffering.upon the suffering.

 To be a nurse is a calling and difficultTo be a nurse is a calling and difficult
to describe in words. Who can say whyto describe in words. Who can say why
a person would want to do a nursesa person would want to do a nurses
work, but those who do will tell youwork, but those who do will tell you
there is nothing as fulfilling orthere is nothing as fulfilling or
rewarding. Nurses stay by the side ofrewarding. Nurses stay by the side of
those they serve through the worstthose they serve through the worst
times and celebrate with patients andtimes and celebrate with patients and
families in the best times.families in the best times.

 There is an intimacy nurses andThere is an intimacy nurses and
patients share which is understood.patients share which is understood.
The essence of nursing is anThe essence of nursing is an
unconditional love for mankind. Tounconditional love for mankind. To
be called a nurse is an honor – abe 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 ofFlorence Nightingale is called the mother of
modern secular nursing. Born in 1820 inmodern secular nursing. Born in 1820 in
Florence, Italy, this intelligent, upper-classFlorence, Italy, this intelligent, upper-class
woman made dramatic and universalwoman 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 toNightingale was called by God to minister to
the sick.the sick.

 With her social connections she was able toWith her social connections she was able to
secure an appointment as a healthcaresecure an appointment as a healthcare
professional at a hospital for women inprofessional at a hospital for women in
London in 1853. Nightingale was asked toLondon in 1853. Nightingale was asked to
bring nurses to care for the wounded Britishbring nurses to care for the wounded British
soldiers in Scutari during the Crimea War insoldiers in Scutari during the Crimea War in
1854.1854.

 Nightingale viewed nursing as an art as well as aNightingale 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 arequires as exclusive a devotion, as hard a
preparation, as any painter’s or sculptor’s work; forpreparation, as any painter’s or sculptor’s work; for
what is the having to do with dead canvas or coldwhat is the having to do with dead canvas or cold
marble, compared with having to do with the livingmarble, compared with having to do with the living
body- the temple of God’s spirit? It is one of thebody- the temple of God’s spirit? It is one of the
fine Arts; I had almost said, the finest of the Finefine 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 GodI solemnly pledge myself before God
and in the presence of this assembly toand in the presence of this assembly to
pass my life in purity and to practice mypass my life in purity and to practice my
profession faithfully.profession faithfully.
 I will abstain from whatever isI will abstain from whatever is
deleterious and mischievous and will notdeleterious and mischievous and will not
take or knowingly administer anytake or knowingly administer any
harmful drug.harmful drug.

(continued)(continued)
 I will do all in my power to maintain andI will do all in my power to maintain and
elevate the standard of my professionelevate the standard of my profession
and will hold in confidence all personaland will hold in confidence all personal
matters committed to my keeping and allmatters committed to my keeping and all
family affairs coming to my knowledge infamily affairs coming to my knowledge in
the practice of my calling.the practice of my calling.
 With loyalty will I endeavor to aid theWith loyalty will I endeavor to aid the
physician in his work and devote myselfphysician in his work and devote myself
to the welfare of those committed to myto the welfare of those committed to my
carecare (Nightingale,1860).(Nightingale,1860).

 In 1859, Florence Nightingale wrote: “NoIn 1859, Florence Nightingale wrote: “No
man, not even a doctor, ever gives anyman, not even a doctor, ever gives any
other definition of what a nurse should beother definition of what a nurse should be
than this – “devoted and obedient” “ Thisthan this – “devoted and obedient” “ This
definition would do just as well for a porter.definition would do just as well for a porter.
It might even do for a horse. It would not doIt 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 ofNightingale established the fundamentals of
patient management, care, and cleanlinesspatient management, care, and cleanliness
that has been taught in nursing schools everthat has been taught in nursing schools ever
since. Her true legacy is far greater, as shesince. Her true legacy is far greater, as she
elevated nursing to a higher degree ofelevated nursing to a higher degree of
respectability and professionalism than everrespectability and professionalism than ever
before. As we celebrate Nurse’s Week, Maybefore. As we celebrate Nurse’s Week, May
6-12, 2004 let us reflect on what6-12, 2004 let us reflect on what
professional nursing is and our vision for theprofessional nursing is and our vision for the
future.future.

Definition of Professional NursingDefinition of Professional Nursing
The Kansas State Board of Nursing provides this definitionThe 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 orregistered professional nurse for compensation or
gratuitously means the process in which substantialgratuitously 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 ofdiagnosis, treatment, counsel and health teaching of
persons who are experiencing changes in the normalpersons who are experiencing changes in the normal
health processes or who require assistance in thehealth processes or who require assistance in the
maintenance of health or the prevention or management ofmaintenance of health or the prevention or management of
illness, injury or infirmity; administration, supervision orillness, injury or infirmity; administration, supervision or
teaching of the process as defined in this section; and theteaching of the process as defined in this section; and the
execution of the medical regimen as prescribed by aexecution of the medical regimen as prescribed by a
person licensed to practice medicine and surgery or aperson 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 PracticalDefinition 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 ornurse means the performance for compensation or
gratuitously of tasks and responsibilities defined ingratuitously of tasks and responsibilities defined in
part (1) which tasks and responsibilities are basedpart (1) which tasks and responsibilities are based
on acceptable educational preparation within theon acceptable educational preparation within the
framework of supportive and restorative careframework of supportive and restorative care
under the direction of a registered professionalunder the direction of a registered professional
nurse, a person licensed to practice medicine andnurse, a person licensed to practice medicine and
surgery or a person licensed to practice dentistrysurgery or a person licensed to practice dentistry
(KSBN,2003).(KSBN,2003).

A profession is defined as a calling orA profession is defined as a calling or
vocation, especially one that involves somevocation, especially one that involves some
branch of advanced learning or science. Thebranch of advanced learning or science. The
essence of professionalism is both having aessence 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 unwrittenUntil recently this has been an unwritten
contract. For these reasons, society holdscontract. For these reasons, society holds
the professional in higher esteem than itthe professional in higher esteem than it
does a technician, blue-collar worker, ordoes a technician, blue-collar worker, or
businessman, people who traditionally arebusinessman, people who traditionally are
interested in the benefits of theirinterested in the benefits of their
employment rather than the occupationemployment rather than the occupation
itself.itself.

Professionals are expected to show aProfessionals are expected to show a
degree of special attainment, altruism, anddegree of special attainment, altruism, and
self-sacrifice in their dealings with the rest ofself-sacrifice in their dealings with the rest of
the community and in return receivethe community and in return receive
privileges both in the workplace and at largeprivileges both in the workplace and at large
(Bryan-Brown, et al. 2003).(Bryan-Brown, et al. 2003).

 In order to emphasize professionalismIn order to emphasize professionalism
within nursing, each nurse needs towithin nursing, each nurse needs to
understand the opportunities,understand the opportunities,
responsibilities and concerns that areresponsibilities and concerns that are
integral to the nursing profession. Theintegral to the nursing profession. The
Kansas State Nurses Association, 2003,Kansas State Nurses Association, 2003,
Code of Ethics for Nurses with InterpretiveCode of Ethics for Nurses with Interpretive
StatementsStatements defines these concepts:defines these concepts:

ANA Code Of EthicsANA Code Of Ethics
Provision 7Provision 7
 The nurse participates in theThe nurse participates in the
advancement of the profession throughadvancement of the profession through
contributions to practice, education,contributions to practice, education,
administration, and knowledgeadministration, and knowledge
development.development.
7.1 Advancing the profession through7.1 Advancing the profession through
active involvement in nursing and inactive involvement in nursing and in
healthcare policyhealthcare policy..

 Nurses should advance their profession byNurses 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 professionalactivities, and the viability of their professional
organizations. Nurses can also advance theorganizations. Nurses can also advance the
profession by serving in leadership or mentorshipprofession by serving in leadership or mentorship
roles or on committees within their places ofroles or on committees within their places of
employment. Nurses who are self-employed canemployment. Nurses who are self-employed can
advance the profession by serving as role modelsadvance the profession by serving as role models
for professional integrity. Nurses can also advancefor professional integrity. Nurses can also advance
the profession through participation in civicthe 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 specificNurse educators have a specific
responsibility to enhance students’responsibility to enhance students’
commitment of professional and civiccommitment of professional and civic
values. Nurse administrators have avalues. Nurse administrators have a
responsibility to foster an employmentresponsibility to foster an employment
environment that facilitates nurses’ ethicalenvironment that facilitates nurses’ ethical
integrity and professionalism, and nurseintegrity and professionalism, and nurse
researchers are responsible for activeresearchers are responsible for active
contribution to the body of knowledgecontribution to the body of knowledge
supporting and advancing nursing practice.supporting and advancing nursing practice.

7.2 Advancing the profession by7.2 Advancing the profession by
developing, maintaining, and implementingdeveloping, maintaining, and implementing
professional standards in clinical,professional standards in clinical,
administrative, and educational practice.administrative, and educational practice.
 Standards and guidelines reflect theStandards and guidelines reflect the
practice of nursing grounded in ethicalpractice of nursing grounded in ethical
commitments and a body of knowledge.commitments and a body of knowledge.
Professional standards and guidelines forProfessional standards and guidelines for
nurses must be developed by nurses andnurses must be developed by nurses and
reflect nursing’s responsibility to society.reflect nursing’s responsibility to society.

 It is the responsibility of nurses to identifyIt is the responsibility of nurses to identify
their own scope of practice as permitted bytheir own scope of practice as permitted by
professional practice standards andprofessional practice standards and
guidelines, by state and federal laws, byguidelines, by state and federal laws, by
relevant societal values, and by the Code ofrelevant societal values, and by the Code of
Ethics.Ethics.

 The nurse as administrator or managerThe nurse as administrator or manager
must establish, maintain, and promotemust establish, maintain, and promote
conditions of employment that enableconditions of employment that enable
nurses within that organization ornurses within that organization or
community setting to practice in accord withcommunity setting to practice in accord with
accepted standards of nursing practice andaccepted standards of nursing practice and
provide a nursing and health care workprovide a nursing and health care work
environment that meets the standards andenvironment that meets the standards and
guidelines of nursing practice.guidelines of nursing practice.

 Professional autonomy and self regulationProfessional autonomy and self regulation
in the control of conditions of practice arein the control of conditions of practice are
necessary for implementing nursingnecessary for implementing nursing
standards and guidelines and assuringstandards and guidelines and assuring
quality care for those whom nursing serves.quality care for those whom nursing serves.

 The nurse educator is responsible forThe nurse educator is responsible for
promoting and maintaining optimumpromoting and maintaining optimum
standards of both nursing education and ofstandards of both nursing education and of
nursing practice in any settings wherenursing practice in any settings where
planned learning activities occur. Nurseplanned learning activities occur. Nurse
educators must also ensure that only thoseeducators must also ensure that only those
students who possess the knowledge, skills,students who possess the knowledge, skills,
and competencies that are essential toand competencies that are essential to
nursing graduate from their nursingnursing graduate from their nursing
programs.programs.

7.3 Advancing the profession through7.3 Advancing the profession through
knowledge development, dissemination,knowledge development, dissemination,
and application to practiceand application to practice
 The nursing profession should engage inThe nursing profession should engage in
scholarly inquiry to identify, evaluate, refine,scholarly inquiry to identify, evaluate, refine,
and expand the body of knowledge thatand expand the body of knowledge that
forms the foundation of its discipline andforms the foundation of its discipline and
practice.practice.

 In addition, nursing knowledge is derivedIn addition, nursing knowledge is derived
from the sciences and from the humanities.from the sciences and from the humanities.
Ongoing scholarly activities are essential toOngoing 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 collaborationAll nurses working alone or in collaboration
with others can participate in thewith others can participate in the
advancement of the profession through theadvancement of the profession through the
development, evaluation, dissemination,development, evaluation, dissemination,
and application of knowledge in practice.and application of knowledge in practice.

 However, an organizational climate andHowever, an organizational climate and
infrastructure conducive to scholarly inquiryinfrastructure conducive to scholarly inquiry
must be valued and implemented for this tomust be valued and implemented for this to
occur.occur.

 The nursing profession is characterized byThe nursing profession is characterized by
the continuing pursuit of knowledge, athe continuing pursuit of knowledge, a
sense of responsibility for human concerns,sense of responsibility for human concerns,
preparation through higher education, peerpreparation through higher education, peer
accountability, autonomy, and altruism.accountability, autonomy, and altruism.

 Nursing theory provides knowledge toNursing 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 byTheory provides professional autonomy by
guiding the practice, education, andguiding the practice, education, and
research functions of the profession. Theoryresearch functions of the profession. Theory
also helps develop analytical skills,also helps develop analytical skills,
challenge thinking, clarify values andchallenge thinking, clarify values and
assumptions, and determine purposes forassumptions, and determine purposes for
nursing practice, education, and researchnursing practice, education, and research
(Tomey, 2002).(Tomey, 2002).

 Career trajectory, in systems thinking, refers toCareer trajectory, in systems thinking, refers to
the series of successive states through which athe series of successive states through which a
system or career proceeds over time. It may besystem or career proceeds over time. It may be
said to represent the long-term behavior of thesaid to represent the long-term behavior of the
system. Nursing is often referred to as a youngsystem. Nursing is often referred to as a young
profession, in that it is around 150 years old. Aprofession, in that it is around 150 years old. A
review of nursing’s history clearly shows growth inreview of nursing’s history clearly shows growth in
theory, evidence-based practice, image andtheory, evidence-based practice, image and
autonomy.autonomy.

VCRMC Survey on ProfessionalismVCRMC Survey on Professionalism
 In the winter of 2003, a random survey ofIn the winter of 2003, a random survey of
licensed nurses was conducted at Vialicensed nurses was conducted at Via
Christi Regional Medical Center. The surveyChristi Regional Medical Center. The survey
asked nurses throughout the organization toasked nurses throughout the organization to
name three characteristics that expressedname three characteristics that expressed
what professionalism was to them.what professionalism was to them.

The top eight responses of over 300The 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 theThe following discussion will focus on the
results and how nurses can build on theresults and how nurses can build on the
characteristics identified by peers tocharacteristics identified by peers to
exemplify professional nursing.exemplify professional nursing.

KnowledgeKnowledge
 Participants in the Via Christi studyParticipants in the Via Christi study
indicated that knowledge and continuingindicated that knowledge and continuing
education were very important to them. Theeducation were very important to them. The
desire to continue learning is relevant to thedesire to continue learning is relevant to the
nurse’s ability to develop competence andnurse’s ability to develop competence and
professionalism in the provision of nursingprofessionalism in the provision of nursing
care. With knowledge acquired, nurses cancare. With knowledge acquired, nurses can
focus on the quality and performance offocus on the quality and performance of
nursing care rather than merely successfulnursing care rather than merely successful
completion of tasks.completion of tasks.

Several factors enhance the utilization andSeveral factors enhance the utilization and
acquisition of knowledge. These factors are:acquisition of knowledge. These factors are:
 OrientationOrientation
 Preceptor/co-worker supportPreceptor/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 briefOrientation generally includes a brief
employee orientation about the hospital’semployee orientation about the hospital’s
mission, vision and values as well asmission, vision and values as well as
organizational policies and procedures.organizational policies and procedures.
Further orientation for licensed personnel isFurther orientation for licensed personnel is
focused on patient care policies and issues.focused on patient care policies and issues.

 Specific orientation programs for varyingSpecific orientation programs for varying
lengths of time are developed to addresslengths of time are developed to address
skills and expectations for patient care inskills and expectations for patient care in
each department. Some nurses may requireeach department. Some nurses may require
a longer orientation time than othersa 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 activityMentoring or precepting is a crucial activity
that enhances the development ofthat enhances the development of
professionals. Experienced practicingprofessionals. Experienced practicing
nurses mentor others by being competentnurses mentor others by being competent
role models and by providing a safety net asrole 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 positiveStrong mentors provide a positive
introduction to the nursing profession and,introduction to the nursing profession and,
depending on their beliefs, can fosterdepending on their beliefs, can foster
professionalism among those they guideprofessionalism 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 occursMentoring involves two parties and occurs
when the senior person in terms of maturitywhen the senior person in terms of maturity
and experience- the mentor- providesand experience- the mentor- provides
information, advice, and emotional supportinformation, advice, and emotional support
for the junior person – the “mentee” orfor the junior person – the “mentee” or
protégé. Mentors are people with advancedprotégé. Mentors are people with advanced
job-related experience, knowledge, andjob-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 elseadvanced learning and above all else
honesty are required in order to be ahonesty are required in order to be a
mentor and serve as a role-model for thementor and serve as a role-model for the
profession of nursing. To find a goodprofession of nursing. To find a good
mentor look for someone with a positivementor look for someone with a positive
attitude and caring approach to others. Theattitude and caring approach to others. The
individual should be a good communicatorindividual should be a good communicator
and someone trustworthy (Restifo, 2004).and someone trustworthy (Restifo, 2004).

PreceptorsPreceptors
Preceptors are key elements in thePreceptors are key elements in the
success of a nurse’s professionalsuccess 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 forA clearly stated set of expectations for
their performance.their performance.

– A clear delineation of their responsibilitiesA clear delineation of their responsibilities
to the preceptee.to the preceptee.
– A clear distinction for their responsibilitiesA clear distinction for their responsibilities
in relation to others who are involved inin relation to others who are involved in
the orientation program.the orientation program.

– A clear statement of all expectedA clear statement of all expected
outcomes for the orientation program.outcomes for the orientation program.
– Valid and reliable evaluation tools toValid and reliable evaluation tools to
appraise preceptee performance.appraise preceptee performance.
– The resources necessary to fulfill theirThe resources necessary to fulfill their
responsibilities.responsibilities.

– Continuing and responsive supportContinuing and responsive support
systems for fulfillment of theirsystems for fulfillment of their
responsibilities.responsibilities.
– Adequate preparation for integration ofAdequate 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 theirand attitudes necessary to fulfill their
responsibilities (Alspach, 2000).responsibilities (Alspach, 2000).

Preceptor Development Classes andPreceptor Development Classes and
programs help define and support theprograms help define and support the
preceptor role. With the increasedpreceptor role. With the increased
complexity of healthcare systems thiscomplexity of healthcare systems this
clearly is an identified need for the nursingclearly is an identified need for the nursing
profession.profession.

 Students and new nurses working closelyStudents and new nurses working closely
with experienced staff nurses have thewith experienced staff nurses have the
opportunity for role socialization as well asopportunity for role socialization as well as
increasing clinical skills, knowledge,increasing clinical skills, knowledge,
competence, and confidence.competence, and confidence.

Precepting student nurses and graduatePrecepting student nurses and graduate
nurses has shown to be effective innurses has shown to be effective in
reducing lengthy and costly orientationreducing lengthy and costly orientation
programs, enhancing recruitment andprograms, enhancing recruitment and
increasing retention.increasing retention.

In-house Educational ProgramsIn-house Educational Programs
 Nurses are required to maintain andNurses are required to maintain and
develop their professional knowledge anddevelop their professional knowledge and
competence in the many years of practicecompetence in the many years of practice
that may follow registration. They arethat may follow registration. They are
expected to have knowledge,expected to have knowledge,
communication skills and the ability to offercommunication skills and the ability to offer
effective, safe, evidence-based nursing ineffective, safe, evidence-based nursing in
their field of practice.their field of practice.

 In order to facilitate and encourage this levelIn order to facilitate and encourage this level
of professionalism, in-house educationalof professionalism, in-house educational
programs should be offered. Accordingly,programs should be offered. Accordingly,
higher education, certification in advancedhigher education, certification in advanced
practice, support for professionalpractice, support for professional
organizations and research should beorganizations and research should be
supported.supported.

Nursing CompetencyNursing Competency
Nursing competency ranked second inNursing competency ranked second in
the Via Christi survey. Some key features ofthe Via Christi survey. Some key features of
nursing competency are as follow:nursing competency are as follow:
 The ability to recognize common factors thatThe ability to recognize common factors that
contribute to, and adversely affect, thecontribute to, and adversely affect, the
physical, mental and social well-being ofphysical, mental and social well-being of
patients and clients, and be able to takepatients and clients, and be able to take
appropriate action.appropriate action.

 The use of relevant literature and researchThe 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 topolitical and cultural factors in relation to
health care.health care.

 An understanding of the ethics of healthAn understanding of the ethics of health
care and the nursing profession and thecare and the nursing profession and the
responsibilities these impose on the nurse’sresponsibilities 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 ofpsychological, social and spiritual needs of
the patient or client.the patient or client.
 The use of appropriate channels of referralThe use of appropriate channels of referral
for matters not within the nurse’s sphere offor matters not within the nurse’s sphere of
competencecompetence

Professional Incompetence DefinedProfessional Incompetence Defined
 Professional Incompetence is defined inProfessional 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, “professionalAs used in this section, “professional
incompetence” means:incompetence” means:
 1) one or more instances involving failure1) one or more instances involving failure
to adhere to the applicable standard of careto adhere to the applicable standard of care
to a degree which constitutes grossto a degree which constitutes gross
negligence, as determined by the board;negligence, as determined by the board;

 2) repeated instances involving failure to2) repeated instances involving failure to
adhere to the applicable standard of care toadhere to the applicable standard of care to
a degree which constitutes ordinarya degree which constitutes ordinary
negligence, as determined by the board; ornegligence, as determined by the board; or
 3) a pattern of practice or other behavior3) a pattern of practice or other behavior
which demonstrates a manifest incapacitywhich demonstrates a manifest incapacity
or incompetence to practice nursing.or incompetence to practice nursing.

 It is every nurses responsibility toIt is every nurses responsibility to
understand the definition of incompetentunderstand the definition of incompetent
proactice. In addition, it is the responsibilityproactice. In addition, it is the responsibility
of those within the profession to monitor andof those within the profession to monitor and
report acts of incompetence.report acts of incompetence.

 A standard is an authoritative statementA standard is an authoritative statement
defined and promoted by the profession bydefined and promoted by the profession by
which the quality of practice, service, orwhich the quality of practice, service, or
education can be evaluated.education can be evaluated.
 These standards are used by Peer ReviewThese standards are used by Peer Review
Committees to evaluate peer practice andCommittees to evaluate peer practice and
determine if certain situations meet thedetermine if certain situations meet the
criteria of a reportable incident according tocriteria of a reportable incident according to
the Kansas Risk Management laws.the Kansas Risk Management laws.

 The Kansas State Board of NursingThe Kansas State Board of Nursing
provides standard of care determinationsprovides 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, butLevel II Standard of care not met, but
no reasonable probability ofno reasonable probability of
causing injurycausing injury
 Level III Reportable; standard of careLevel III Reportable; standard of care
not met, with injury occurringnot met, with injury occurring
or reasonable probable.or reasonable probable.
 Level IV Reportable; grounds forLevel IV Reportable; grounds for
disciplinary action by thedisciplinary action by the
appropriate licensing agencyappropriate licensing agency

AppearanceAppearance
 The nursing survey identified appearanceThe nursing survey identified appearance
as important as professionalism. The issueas important as professionalism. The issue
of appearance and attire is important inof appearance and attire is important in
creating a positive perception andcreating a positive perception and
communicating an attitude of competencecommunicating an attitude of competence
and professionalism (Huber, 2000).and professionalism (Huber, 2000).

Research has shown that consumersResearch has shown that consumers
prefer white uniforms with a skirt and a capprefer white uniforms with a skirt and a cap
as a nurse’s uniform. This has possiblyas a nurse’s uniform. This has possibly
occurred because of the persistence ofoccurred because of the persistence of
traditional views and images of nursing. Astraditional views and images of nursing. As
the health care field becomes morethe health care field becomes more
competitive some institutions may begin tocompetitive some institutions may begin to
implement dress codes which capitalize onimplement dress codes which capitalize on
the preference of “the customer”.the preference of “the customer”.

 While caps and white starched uniforms areWhile caps and white starched uniforms are
not functional, nurses must realize that thenot functional, nurses must realize that the
way one dresses symbolizes role identity,way one dresses symbolizes role identity,
authority, professional image, andauthority, professional image, and
confidence - as well as the way the nurseconfidence - 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 nonverbalClothing is a form of nonverbal
communication that stimulates judgmentalcommunication that stimulates judgmental
responses from others and as aresponses from others and as a
professional nurse it is inappropriate toprofessional nurse it is inappropriate to
dress casual, soiled, disheveled ordress casual, soiled, disheveled or
seductive. Dressing with a professionalseductive. Dressing with a professional
image in mind is a simple act which carriesimage in mind is a simple act which carries
the power to advance professionalism.the power to advance professionalism.

An institutional policy on nursing dress codeAn institutional policy on nursing dress code
is as follows:is as follows:
 Nurses are asked to set an example ofNurses are asked to set an example of
neatness and cleanliness in personalneatness and cleanliness in personal
appearance during work hours/shifts. Dailyappearance during work hours/shifts. Daily
grooming and appropriate appearance aregrooming and appropriate appearance are
essential and set the image of the hospital.essential and set the image of the hospital.

 Nurses customarily dress in uniformNurses 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 professionalclean and present a professional
appearance. Excessive use of cosmetics,appearance. Excessive use of cosmetics,
fragrances and other accessories should befragrances 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 consideredOther attire considered inappropriateinappropriate includes:includes:
 Stained, wrinkled, tight, frayed, or revealingStained, 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 orT-shirts, tank tops, tube tops, crop tops or
halter topshalter tops
 HatsHats
 Sleeveless clothingSleeveless clothing
 Shirts with inappropriate slogans and/orShirts with inappropriate slogans and/or
designs.designs.
 Artificial nailsArtificial nails
 Open-toed shoesOpen-toed shoes

TeamworkTeamwork
 The last characteristic identified through toThe last characteristic identified through to
2003 survey relates to teamwork. Nurses2003 survey relates to teamwork. Nurses
work in multidisciplinary professional teamswork in multidisciplinary professional teams
with doctors and therapists. The goal ofwith doctors and therapists. The goal of
these teams is to promote and providethese teams is to promote and provide
treatments which improve patient outcomes.treatments which improve patient outcomes.
Nurses have been working with doctors forNurses have been working with doctors for
many years attempting to strengthen mutualmany years attempting to strengthen mutual
understanding of each otherunderstanding of each other
professionalism and ability.professionalism and ability.

Definition of TeamworkDefinition of Teamwork
 Teamwork in nursing practice refers toTeamwork in nursing practice refers to
interdisciplinary practice or collaborationinterdisciplinary practice or collaboration
defined as a joint decision-making anddefined as a joint decision-making and
communication process with the goal ofcommunication process with the goal of
satisfying the needs of the patient. Thissatisfying the needs of the patient. This
includes respecting the unique abilities ofincludes respecting the unique abilities of
each professional involved in the care.each professional involved in the care.

 Today’s best integrated health deliveryToday’s best integrated health delivery
systems are evolving toward a model ofsystems are evolving toward a model of
care in which interdisciplinary teams ofcare in which interdisciplinary teams of
providers manage the care of complexproviders manage the care of complex
patients.patients.

 As nurses have expanded their roles inAs nurses have expanded their roles in
the community, it is important to understandthe community, it is important to understand
the contributions of unlicensed assistivethe contributions of unlicensed assistive
personnel. As the nursing shortage loomspersonnel. As the nursing shortage looms
upon us, the nursing profession may needupon us, the nursing profession may need
to divide labor with unlicensed staff,to divide labor with unlicensed staff,
particularly in non-acute care where teamparticularly in non-acute care where team
working has existed for many years.working has existed for many years.

 As professionals, nurses must not forget theAs professionals, nurses must not forget the
greatest consideration – that of the patientgreatest consideration – that of the patient
rather than the provider. We cannot functionrather than the provider. We cannot function
without our unlicensed assistants and owewithout our unlicensed assistants and owe
them mutual respect and courtesy. Their jobthem mutual respect and courtesy. Their job
is also to provide comfort, care, love andis also to provide comfort, care, love and
compassion to the sick.compassion to the sick.

Teamwork Improves SafetyTeamwork Improves Safety
 As stated in theAs stated in the Hallmarks of theHallmarks 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, ToTo
Err is Human; Building a Safer HealthErr is Human; Building a Safer Health
System,System, summarizing problems of patientsummarizing 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 toOne important recommendation was to
create improved safety systems insidecreate improved safety systems inside
health care through implementation of safehealth care through implementation of safe
practices at the delivery level, includingpractices at the delivery level, including
interdisciplinary clinical practice amonginterdisciplinary clinical practice among
health professionals.health professionals.

 Attributes of interdisciplinary collaborationAttributes of interdisciplinary collaboration
include trust, knowledge, mutual respect,include trust, knowledge, mutual respect,
good communication, cooperation,good communication, cooperation,
coordination, share responsibility, andcoordination, share responsibility, and
optimism.optimism.

The Fear FactorThe Fear Factor
The Institute for Safe Medication PracticesThe Institute for Safe Medication Practices
recently released a report on a surveyrecently released a report on a survey
concerning the role that intimidation plays in theconcerning 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 frequentlyThe questions were inquiring of how frequently
problems were encountered regardingproblems 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 10return 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 1040% 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 ofThis data identifies the problem of
intimidating behavior in regard to clarifyingintimidating behavior in regard to clarifying
orders and answering questions. Manyorders and answering questions. Many
professional education programs forprofessional education programs for
medical, nursing, and allied health studentsmedical, nursing, and allied health students
now require curricula that supportnow require curricula that support
interdisciplinary practice in a variety ofinterdisciplinary practice in a variety of
clinical settings.clinical settings.

 These programs should emphasizeThese programs should emphasize
teamwork, conflict resolution, and the use ofteamwork, conflict resolution, and the use of
informatics to promote collaboration ininformatics to promote collaboration in
patient care planning and implementationpatient care planning and implementation
(Wakefield & O’Grady, 2000).(Wakefield & O’Grady, 2000).

AccountabilityAccountability
 Though problems of intimidation exist, theThough problems of intimidation exist, the
registered nurse is personally accountableregistered nurse is personally accountable
for his/her own practice – not a seniorfor his/her own practice – not a senior
member of staff, physician or other healthmember of staff, physician or other health
care professional. Remember the sayingcare 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 forNurses 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, andthe completion of the assigned task, and
acts of delegation.acts of delegation. Accountability cannotAccountability cannot
be delegated.be delegated.

 Past studies of environments that supportPast studies of environments that support
collaboration among physicians, nurses and alliedcollaboration among physicians, nurses and allied
health professionals have shown evidence ofhealth professionals have shown evidence of
improved outcomes for both acutely andimproved outcomes for both acutely and
chronically ill patients. The professional nursechronically ill patients. The professional nurse
should always remain calm and respectful ofshould always remain calm and respectful of
others. Perhaps the best advice is to rememberothers. Perhaps the best advice is to remember
the golden rule “do unto others as you would havethe golden rule “do unto others as you would have
them do unto you.”them do unto you.”

 The most common dilemma regardingThe most common dilemma regarding
accountability is created by the assignment ofaccountability is created by the assignment of
responsibility and the granting of authority. Someresponsibility and the granting of authority. Some
common examples of a mismatch of authority tocommon examples of a mismatch of authority to
responsibility is when nurses are placed in whatresponsibility is when nurses are placed in what
they consider inadequate staffing situations,they consider inadequate staffing situations,
disagreements with physician orders which maydisagreements with physician orders which may
not reflect best practice or instructions to carry outnot 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 ofSuggestions for avoiding the mismatch of
authority to responsibility include clear andauthority to responsibility include clear and
explicit communication, coupled withexplicit communication, coupled with
negotiation strategies (Huber, 2000). Everynegotiation strategies (Huber, 2000). Every
nurse has a responsibility to know the chainnurse has a responsibility to know the chain
of command and the person to turn to whenof command and the person to turn to when
these occasions occur.these occasions occur.

Respect, Integrity and PositiveRespect, Integrity and Positive
AttitudeAttitude
 Respect for others, integrity and a positiveRespect for others, integrity and a positive
attitude also ranked high in the nursingattitude also ranked high in the nursing
survey. This finding is not surprising, as itsurvey. This finding is not surprising, as it
correlates to Gallup’s 2003 annual survey incorrelates to Gallup’s 2003 annual survey in
which nurses were on the top for honestywhich nurses were on the top for honesty
and ethics among various professions,and ethics among various professions,
followed by other medical professionals likefollowed by other medical professionals like
doctors, pharmacists, veterinarians anddoctors, pharmacists, veterinarians and
dentists.dentists.

 Americans, in the November 14-16, 2003Americans, in the November 14-16, 2003
CNN/USA Today/Gallup Poll, were asked toCNN/USA Today/Gallup Poll, were asked to
rate the honesty and ethical standards ofrate the honesty and ethical standards of
people in 23 different professions as verypeople 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 fiveAs 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 othernurses ranked higher than any other
profession, with 83% of respondents sayingprofession, with 83% of respondents saying
honesty and ethical standards of nurses arehonesty 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 yourAs nurses embrace the future, what is your
vision for the nursing profession? Thisvision for the nursing profession? This
author believes it will be interactions thatauthor believes it will be interactions that
nourish our human spirits in the places wenourish our human spirits in the places we
live and work. Nurses must be deliberatelive and work. Nurses must be deliberate
with time, energy and resources as thewith time, energy and resources as the
profession works toward the goal of qualityprofession works toward the goal of quality
nursing care.nursing care.

 New modalities of delivering care are yetNew modalities of delivering care are yet
to be envisioned and coordinated – not onlyto 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 andfuture 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-professionalpersonal and inter-professional
relationships.relationships.

 To know even one life has breathedTo know even one life has breathed
easier because you have lived – thiseasier 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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