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Chapter 3: The Professionalization of Nursing


Title: Chapters 3, 6 and pages 395-401 Author: Bonnie Last modified by: Bonnie Created Date: 4/14/2010 1:39:41 PM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Chapter 3: The Professionalization of Nursing

Chapter 3 The Professionalization of Nursing
  • Bonnie M. Wivell, MS, RN, CNS

History of Professions
  • Historically only professions were
  • Ministry (first ever)
  • Medicine
  • Law
  • So how is profession defined?

Abraham Flexner
  • The Flexner Report provided the impetus for
    reform to medical education
  • Published a list of criteria that he believed
    were characteristic of all true professions
  • Basically intellectual accompanied by individual
  • Based on a body of knowledge that can be learned
    and refreshed and refined through research
  • Is practical as well as theoretical
  • Can be taught through specialized professional
  • Has a strong internal organization of members
    with group consciousness
  • Has practitioners who are motivated by altruism
    and are responsive to public interests

Richard H. Hall
  • Published work on professionalism in 1968
  • Described a professional model
  • 5 indicators of an individuals attitude toward
  • Recommended that each profession needed to
    develop its own methods of measuring

Major Similarities
  • 3 Criteria that consistently appear
  • Service/Altruism a sense of calling or mission
    responsibility to the public
  • Specialized knowledge special education
    including theory and skill
  • Autonomy/Ethics control over ones own practice
    having a code of ethics governing conduct

  • Perform full time work in the discipline
  • Determine work standards, ID a body of knowledge,
    and establish educational programs of higher
  • Promote organization into effective occupational
  • Legal protection that limits practice
  • Establish a code of ethics

Occupation to Profession
  • 9 characteristics identified by Houle (1980) that
    an occupation is developing a collective identity
  • Formal training
  • Credentialing
  • Creation of a subculture
  • Legal right to practice
  • Public acceptance
  • Ethical practice
  • Discipline of incompetent/unethical practitioners
  • Relationship to other practitioners
  • Relationship to users of services

Occupation vs.Profession
  • Occupation What occupies or engages ones time
    business employment (Webster)
  • Profession A calling, vocation or form of
    employment that provides a needed service to
    society, possesses expertise, autonomy, long
    academic preparation, commitment,
    responsibility (Huber)

5 Core Competencies
  • IOM Summit in 2003 identified core competencies
    that all health professions should acquire
  • Provide patient-centered care
  • Work in interdisciplinary teams
  • Employ EBP
  • Apply quality improvement principles
  • Utilize informatics

Characteristics of Profession vs. Occupation
  • Profession
  • College/university preparation
  • Usually 4 or more years
  • Values, beliefs, ethics always present (code of
  • Commitment personal ID always present
  • Independent, autonomous
  • Work stable, rarely change profession
  • Individual accountability
  • Occupation
  • On the job, trade school, community college prep
  • Shorter prep time
  • Values, beliefs, ethics not always present
  • Commitment personal ID not always present
  • Supervised by others
  • Often change jobs
  • Accountability usually rests with employer

Profession Overview
  • Preparation in college or university
  • Skills unique body of knowledge that grows with
  • Oriented to beliefs, values, and attitudes of its
  • Decisions are based on standards of practice with
    ethical considerations
  • Strong commitment to the profession, considered
    a calling

Barriers to Professionalism in Nursing
  • Variability in educational preparation no other
    profession allows entry at less than
    baccalaureate level
  • Gender issues perceived mainly as female
  • Historical connections with religious orders and
    military unquestioning obedience to orders run
    counter to autonomy
  • External conflicts with medicine, strive for
  • Internal conflicts among subgroups and rivalry
    among levels of educational preparation

Nursings Pathway to Professionalism
  • Bixler Bixler (1945, 1959)
  • 1. Well defined body of specialized knowledge,
  • 2. Enlargement of body of knowledge improves
    techniques of education service
  • 3. Education in institution of higher learning
  • 4. Applies body of knowledge vital to human
    social welfare
  • 5. Functions autonomously
  • 6. Attracts those who exalt service above
    personal gain
  • 7. Compensates its practitioners by providing
    freedom of action, opportunity for professional
    growth economic security.

Kellys Criteria
  • 8 Characteristics of a Profession
  • 1. Services provided vital to humanity/society
  • 2. Specialized knowledge enlarged with research
  • 3. Intellectual activities, accountability
  • 4. Education in higher learning institution
  • 5. Autonomyindependent, control own policies and
  • 6. Motivated by service important part of their
  • 7. Code of ethics guide decisions and conduct
  • 8. There is an organization (association) that
    encourages and supports high standards of practice

How does nursing measure up?
  • Commitment stronga calling, caring
  • Nursing education higher learning institutions
  • Nursing unique knowledge, researchreliance on
    evidence-based practice.
  • Nursing process of critical creative thinking
    that standardizes nursing diagnoses,
    interventions, outcomes
  • Code of ethics regularly updated (Hallmark is
  • Accountability--each nurse responsible for own
  • Autonomy of nurses is controversial. Remains
    dependent on medicine in many areas. Nursing
    scope of practice defined by nursing practice act
    of each state and varies
  • Majority of nurses are not members of any
    professional organization which impedes progress
    for the profession and reduces political
    influence (encourage and support higher standards
    of practice)

Millers Wheel of Professionalism
  • Center represents the essential foundation of
    nursing education
  • Eight spokes
  • Competence and Continuing Education
  • Adherence to the code of ethics
  • Participation in professional organization
  • Community Service
  • Publication and Communication
  • Theory and research development and utilization
  • Self-regulation and autonomy

Nursings Contract with Society
  • Obligation to those who receive nursing
    careNursings Social Policy Statement (2003)
    addresses social context of nursing, values
    assumptions of support, definition of nursing,
    knowledge base for nursing practice, scope of
    practice, and professional, legal, and
    self-regulation of nursing practice.
  • Code of Ethics (2001)written public document
    outlines professional responsibilities of nurse,
    values, commitment, boundaries of duty and
    loyalty to patient profession. (See back cover
    of text)

Behaviors of a Professional Nurse
  • Develops own philosophy of nursing
  • Uses self-determination
  • Uses critical thinking
  • Collaborates communicates with other
  • Demonstrates accountability for self others
  • Committed to life long learning
  • Active in professional organizations
  • Mentors aspiring professionals
  • Recognizes own limitations seeks necessary help

Behaviors of a Professional Nurse
  • Contributes to expansion of nursings body of
  • Provides leadership
  • Uses principles of time management
  • Delegates responsibility wisely
  • Represents the profession to the public
  • Models altruism
  • Possesses self-awareness
  • Demonstrates commitment to the profession
  • Models healthy coping behaviors
  • Demonstrates collegiality

  • Which characteristics do you already possess?
  • Which characteristics do you think will be easily
    gained during the educational process?
  • Which characteristics do you think will be
    somewhat difficult to achieve?
  • (Check out Box 3-2)

Chapter 6 Becoming a Nurse Defining Nursing
Socialization into Professional Practice
  • Bonnie M. Wivell, MS, RN, CNS

Defining Nursing Harder than it Seems
  • Why define nursing? What are the benefits?
  • Provides framework for nursing practice
    curriculum development
  • Identifies boundaries and clarifies purpose and
    function of nursing
  • Guides nursing research and theory development
  • Differentiates nursing from allied health
    professions and unlicensed assistive personnel
  • Policymakers need to understand role of nursing
    to make health care policy decisions

Norma Langs Quote
  • If we cannot name it, we cannot control it,
    finance it, research it, teach it, or put it into
    public policy. Its just that blunt!

Early Nursing vs Contemporary Definitions
  • Florence Nightingale
  • Put the patient in the best condition for nature
    to act upon him.
  • Her definition of nursing foreshadowed
    contemporary nursings focus on
  • Therapeutic environment
  • Health promotion
  • Health maintenance
  • Virginia Henderson (1939) Nursingservice to an
    individual that helps him to attain or maintain a
    healthy state of mind or body.

Early Nursing vs Contemporary Definitions
  • Hildegard Peplau (1952) Nursing is a
    significant, therapeutic, interpersonal
    processan educative instrumentthat aims to
    promote forward movement of personality
  • Patient seen as active collaborator in his/her
    own care
  • Dorothea Orem (1959) Nursinggiving of direct
    assistance to a person because of inabilities in

Virginia Henderson (1960)
  • Adopted by International Council of Nurses
  • The unique function of the nurse is to assist
    the individual, sick or well, in the performance
    of those activities contributing to health or its
    recovery (or peaceful death) that he would
    perform unaided if he had the necessary strength,
    will or knowledge. And to do this in such a way
    as to help him gain independence as rapidly as

Other Nursing Definitions
  • Martha Rogers Nursing aims to assist people in
    achieving their maximum health potential.
  • American Nurses Association Nursing encompasses
    the prevention of illness, alleviation of
    suffering, and the protection, promotion, and
    restoration of health in the care of individuals,
    families, groups, and communities.
  • ANA Six features of caring relationship,
    response to health illness, integrate objective
    and subjective data, apply scientific knowledge,
    scholarly inquiry, influence social and public
    policy to promote social justice.
  • Definition of nursing is defined in Nurse
    Practice Act of each state and constitutes the
    legal definition of nursing in that state.

Commonalities in Definitions of Nursing
  • Patient-centered holisitic
  • Caring-oriented
  • Combination of science and humanism (caring)
  • Therapeutic interpersonal process
  • Concerned with patient responses to illness and
  • Practice-based profession
  • Focused on enhancing patients health
  • Collaborative, with nurses sharing responsibility
    for care

Shaping Your Professional Identity
  • Initial images idealized expect to work with
    sick patients immediately, make things better for
    patients, be treated with respect
  • May expect to easily adopt nursing roles
    behaviors and instead find new behaviors
    challenging or difficult
  • Necessity of prerequisite courses before
    clinical, expected to defer to experienced
    nurses, patient cannot always be cured, and may
    experience anxiety discomfort while learning
    new roles

Formal Informal Socialization
  • Formal socialization lessons taught in nursing
    program, skills, communication, nursing theorists
  • Informal socialization lessons that occur
    incidentally by observing other professionals and
    absorbing the culture of nursing.

Factors that Influence Professional Socialization
  • External values, beliefs, and behaviors of
    significant people (faculty, practicing nurses)
    possess around the new professional and what they
    project as being important
  • Internal personal feelings and beliefs that
    influence the individual (religion, personal
    beliefs, moral values, ethics, and beliefs about
    social and health matters).

Cohens Model
  • Stage I Unilateral dependence Reliant on
    external authority limited questioning or
    critical analysis
  • Stage II Negativity/independence students
    ability to engage in critical thinking expands
    and may begin to question authority cognitive
  • Stage III Dependency/mutuality students learn
    to test concepts, ideas, models and to accept
    some and reject othersability to share jointly
    with others reasoned appraisal
  • Stage IV Interdependence students develop
    capacity to make decision collaboratively
    develop a professional role identity that is
    professionally acceptable

Benners Stages of Nursing Proficiency
  • Novice/Stage I students enter nursing school
    have little background. They depend on rules
    expectations because practical skills limited
  • Advanced Beginner/Stage II learners have become
    marginally competent, can use theory
    principles, may have difficulty setting
  • Competent Practitioners/Stage III learners have
    2-3 years experience, begin to feel organized
    efficient most of the time. Mastered planning
    goal-setting skill, think abstractly
    analytically. Able to coordinate several complex
    demands simultaneously.
  • Proficient Practitioners/Stage IV learners begin
    to view patients holistically, recognize subtle
    changes in patient condition, set priorities with
    ease, focus on long term goals, not merely task
    at hand
  • Expert Practitioners/Stage V learners perform
    fluidly, grasp patient needs automatically,
    responses are integrated with actions, expertise
    comes naturally, have a sense of what needs to
    be done based on knowledge and prior experience.

Purpose of Models
  • These models are aids to student awareness during
    socialization to the profession
  • Change and growth to be expected and may not
    always be comfortable.
  • Awareness of anxiety-producing aspects of
    socialization assists to recognize it for what it
    isa predictable processand make decisions as
    how to cope

Whose responsibility?
  • Nursing Programplan, implement, evaluate the
    program of formal socialization and provide for
    good role models.
  • Studentsparticipate actively in the
    socialization process, know what to expect
    (models), select role models, practice the roles
    behaviors of nurses, become proficient in
    skills, develop knowledge base necessary to meet
    course objectives, develop values ethics
    expected by the profession

Strategies to Ease Transition
  • Recognize schools cannot provide enough clinical
    experience to make graduates comfortable the
    first days as new nurses
  • Obtain additional practical work experience
    outside of school without jeopardizing academic
  • Enter the preceptor program if available. Seek
    out experiences in employment that pair new grad
    with experienced nurses
  • Work on time management skills
  • Seek out a mentor
  • Continue to read and learn
  • Take care of yourself, stay strong healthy in
    body, mind, and spirit.
  • Recognize that you are responsible for your
    lifelong professional growth and development.

How do you define nursing?
  • Write a definition of nursing
  • Write what you expect of the DSN nursing
  • Write why you think is it important for you to
    understand the process of socialization in the
    profession of nursing
  • How do you plan to increase your comfort and
    facilitate your socialization into nursing?

Chapter 15 (Pages 363-366) Professional
  • Bonnie M. Wivell, MS, RN, CNS

Why Join?
  • Network with colleagues
  • Pursue continuing education
  • Certification opportunities
  • Stay informed on professional issues
  • Develop leadership skills
  • Influence health policy
  • Practice guidelines and position statements

Why Nurses Dont Join
  • High cost of dues
  • Lack of time
  • Lack of interest
  • Different expectations and interests amon the

Types of Associations
  • Broad purpose professional associations
  • ANA professional organization for all nurses
    regardless of practice setting or level of
  • NSNA for student nurses
  • Specialty practice associations
  • Focus only on standards of practice or
    professional needs of the particular specialty
  • 66 are represented in the Nursing Organizations
  • Special interest associations
  • Sigma Theta Tau International
  • The Honor Society of Nursing
  • Must be invited to join

Mission Statements
  • Organizational activities are derived from the
    mission statement
  • Defines the associations area of focus as
  • Practice standards
  • A code of ethical conduct
  • Continuing education and conferences
  • Collective action around workplace issues

Role Associations Play
  • Serve society Standards of practice code of
    ethics and enforce these
  • Serve members of the profession Provide
    political power by collective action
  • Keep standards high credentialing support
    for impaired nurses
  • Communicate Newsletters, journals.
  • Computer access via databases