Defining Nursing

1. Defining Nursing Joan Pollner, RN, BSN, CHPN October 18, 2006

2. Objectives • Identify characteristics of a profession. • Distinguish between the characteristics of professions and occupations. • Describe how professions evolve. • Evaluate nursing’s position on the professionalism continuum. • Explain the elements of nursing’s contract with society. • Recognize characteristic behaviors of professional nurses.

3. Objectives (continued) • Define the benefits of defining nursing and nursing’s scope of practice. • Recognize the evolutionary nature of definitions. • Compare early definitions of nursing with contemporary ones. • Recognize the impact of historical, social, economic, and political events on definitions of nursing and scope and standards of practice.

4. Objectives (continued) • Identify commonalities in existing definitions of nursing. • Develop personal definitions of nursing • Name four documents every professional nurse should possess and tell why they are important.

5. Characteristics of a Profession • Abraham Flexner – Early 1900’s • Richard H. Hall – 1968 • Task Force on Professionalism - 2000

6. Abraham Flexner • Intellectual (as opposed to physical) • Body of knowledge through research • Practical as well as theoretical • Highly specialized professional education • Strong internal organization of members

7. Richard H. Hall • Professional organization • Belief in value of public service • Belief in self regulation • Commitment beyond economic incentives • Sense of autonomy in practice

8. Task Force on Professionalism • Prolonged specialized training • Service orientation • Ideology based on original faith • Binding ethic • Unique body of knowledge • Technique formed by set of skills

9. Task Force on Professionalism (con’t) • Guild of those entitled to practice • Licensure or certification • Recognized setting • Theory of societal benefits

10. Major Similarities • Service/altruism • Specialized knowledge • Autonomy/ethics

11. Professions College or University Prolonged education Mental creativity Decisions based on science or theoretical constructs Values, beliefs & ethics integral part of preparation Strong commitment Autonomous Unlikely to change professions Commitment > $ reward Individual accountability Occupations On the job training Length varies Largely manual work Guided decision making Values, beliefs & ethics not part of preparation Commitment may vary Supervised Often change jobs Motivated by $ reward Employer is primarily accountable Professions vs Occupations

12. Evolution of a ProfessionProfessionalization • Practitioners perform full-time work in the discipline • Determine work standards, identify a body of knowledge and establish educational programs • Promote organization into effective occupational associations (licensure/certification) • Establish codes of ethics

13. Barriers to Professionalism • Variability in educational preparation • Gender issues • Historical influences • External conflicts • Internal conflicts

14. What about Nursing??? Profession or Occupation

15. What the experts say!! • Genevieve and Roy Bixler – 1945 • Lucie Kelly, RN, PhD, FAAN – 1981 • Barbara Miller – 1984 • Nurses themselves

16. Bixler & Bixler • Specialized knowledge • Expands knowledge by scientific method • Institutions of higher education • Services vital to human and social welfare • Autonomously forms professional policy • Intellectual and personal qualities • Compensation = freedom, professional growth and economic security

17. Lucie Kelly, RN, PhD, FAAN • Services vital to humanity and society • Knowledge continually enlarged through research • Individual accountability • Educated in institutions of higher education • Autonomy • Motivated by altruism • Code of ethics • Association = high standards of practice

18. Miller’s Wheel of Professionalism in Nursing Education in univ. & scientific background • Professional organization • Self-regulatory; autonomy • Research: development, use & evaluation • Continuing education; competence • Community service • Theory: development, use & evaluation • Adherence to Code of Ethics for Nurses • Publication and communication

19. Nurses Themselves • Nurses Social Policy Statement – 2003 • Code of Ethics for Nurses – American Nurses Association - 2001

20. Nurses Code of Ethics • American Nurses Association • 9 provisions • Fundamental values and commitments of the nurse • Boundaries of duty and loyalty • Duties beyond patient encounters • Entire document at: www.nursingworld.org/ethics/code/ethicscode150.htm

21. CollegialityStandard of ANA – Scope and Standards of Practice, 2004 According to Bruhn - 2001 • Be civil • Be ethical • Be honest • Be the best • Be consistent • Be a communicator • Be accountable

22. Collegiality (con’t) • Be collaborative • Be forgiving • Be current • Be involved • Be a model

23. Why define Nursing??? • Defines parameters of the profession • Clarifies purposed and functions of the work • Guides educational preparation • Guides research and theory development • Provides visibility and value to general public and policy makers

24. Evolution of Definitions of Nursing • Florence Nightingale • Early twentieth-century definitions • Post-World War II definitions • Professional association definitions • Developing definitions

25. Florence Nightingdale • Notes on Nursing: What It Is and What It Is Not (1859) “And what nursing has to do…is put the patient in the best condition for nature to act upon him” • Recognized the difference between a nurse providing care and a layperson providing care.

26. Early Twentieth-century Definitions • Shaw’s Textbook of Nursing – 1907 • Harmer’s Textbook of the Principles and Practice of Nursing – 1922 • Influence of Henderson with Harmer - 1939

27. Post-World War II Definitions • Hildegard Peplau – 1952 Active collaborator • Dorothea Orem – 1959 Self-care • Virginia Henderson – 1960 Adopted by International Council of Nurses • Martha Rogers – 1961 Maximum health potential

28. Professional Association Definitions • American Nurses Association • Royal College of Nursing • International Council of Nursing

29. American Nurses Association2003 • Caring relationship • Human experiences and responses • Objective data • Scientific knowledge • Advancement of professional knowledge • Influence on social and public policy

30. Royal College of Nursing2003 • Core statement: “Nursing is the use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.”

31. How do you define Nursing?? Mary Ally Rob Judy Liam Terry Jane Bill Mike Sue Tracey John Claudia Michelle Brenda Nancy Florence Andy Beth Suzanne

32. International Council of Nurses2003 • Autonomous and collaborative care • Promotion of health, prevention of illness • Care of ill, disabled and dying • Advocacy • Research • Health policy shaping • Education

33. Four document nurses should possess and READ • State Nurse Practice Act • Nursing’s Social Policy Statement (ANA) • The Code of Ethics for Nurses (ANA) • Scope and Standards of Clinical Practice (area specific or ANA)

34. Additional Resources • Take this self test http://davisplus.fadavis.com/catalano/Assessment_Tools/Assessment_Professionalism.pdf • Royal College of Nursing http://davisplus.fadavis.com/catalano/Assessment_Tools/Assessment_Professionalism.pdf • Royal College of Nursing http://www.rcna.org.au/content/professional_self-regulation_march_03_-_under_review_-_25nov04.pdf • University of Utah – College of Nursing http://www.rcna.org.au/content/professional_self-regulation_march_03_-_under_review_-_25nov04.pdf

35. Reference • Chitty, K.K. (2005). Professional nursing: Concepts and challenges. 4th ed. Philadelphia: Saunders.