Professionalism: Creating a Nurse Barbara Cherry, DNSc, MBA, RN, NEA-BC

1. Professionalism:Creating a NurseBarbara Cherry, DNSc, MBA, RN, NEA-BC Maryland Association of Associate Degree Nursing Directors Annual Conference October 14, 2011

3. Maryland Association for Associate DegreeNursing Directors THE BENEFITS OF ASSOCIATE DEGREE NURSING – THE FOUR A’S • ACCOUNTABLE: • 60% of all Maryland’s registered nurses graduate from AD programs • Maryland AD grads consistently perform above the national average on NCLEX  • 90% of graduates are employed in Maryland • ACCESSIBLE:   • Provide access to nursing education for students from broad socio-economic strata • Flexible scheduling options such as evening, weekend programs.  • Part-time educational opportunities to meet student needs • AFFORDABLE: • Mainly publicly funded: cost is approximately $7,000-$9,000. • Commands a starting salary range from $40,000 to $50,000 • Graduates who continue their education may earn while they learn • ARTICULABLE: • Articulation models exist to facilitate educational mobility • LPN to AND, ADN to BSN, ADN to MSN, EMT-P to RN

4. Program Objectives • Analyze professionalism as an explicit set of behaviors and values that require ongoing learning and development. • Examine characteristics of today’s college student and their impact on the development of professional behaviors. • Outline academic infrastructure requirements to support the development of professional behavior among students. • Implement strategies to promote professional behavior in the classroom and clinical setting. • Treat professional development as an ongoing process of learning and development.

5. Today’s Agenda • Today’s college student • What is “professionalism”? • The evidence for teaching professionalism • Model for “creating a nurse” • Program standards – Leadership support • Evidence-based teaching strategies • Innovative programs and curricula • Student responsibilities

6. National League for Nursing: Excellence in Nursing Education

15. Professionalism

16. Questions to Consider • Professionalism: What is it and how can it be meaningful to students? • Professional development: How do students come to value and improve their professional behavior? • Teaching strategies: What strategies can be used in the classroom or clinical setting to promote professional behavior?

17. You are doing a great job! “Nursing education is very strong in the pedagogies….that are effective in helping students develop a deep sense of professional identify, commitment to the values of the profession, and to act with ethical comportment” (Benner et al, 2010, p. 11) Benner, P., Sutphen, M., Leonard, V. & Day, L. Educating Nurses: A Call for Radical Transformation. San Francisco: Jossey-Bass.

18. Getting Started: What is the Problem? What are the common unprofessional behaviors you observe in your students?

19. Today’s College Students http://www.youtube.com/watch?v=dGCJ46vyR9o

20. Generational Differences • Millennials: Born 1982 – 2002 • Generation X: Born 1965 – 1982 • Baby Boomers: Born 1946 - 1964 • Traditionalists: Born 1900 – 1946

21. Millennials • Grew up in a time of great prosperity • Most protected generation in history • Highly scheduled and sheltered in childhood • Often indulged and protected from the concept of “losing” • Generally optimistic and strive for a work-life balance

22. Millennials • Maintain constant social contact via text, social media, etc.. • Regularly use digital devices to interact with the world • Find information on-line rather than using a book • Multitasking is a way of life • Tend to be collaboratively, team-oriented and prefer group work

23. Millennials

24. Today’s Students (Group Work!) • What are the positives and strengths about today’s students? • How can you capitalize on those strengths to improve their educational journey and promote professionalism?

25. Professionalism

26. Program Standards and Leadership Support

27. Foundational Support to Promote Professionalism • Commitment to promote professionalism “from the top” • Consistent expectations across all courses and clinical experiences • Consistent consequences across all courses and clinical experiences supported by policies • Inclusion of professionalism in the formal curriculum • Commitment to faculty development http://www.nursing.iupui.edu/students/professionalism.shtml

28. Policy Implementation • Increasing the chances for successful policy implementation • VALUES: Views about what should be • BELIEFS: Assumptions about what is • INTERESTS: Responses to incentives and rewards

29. Primary Goals for Students To become a skilled and serious professional who knows how to dress and act the part To engage in the desire to become a respected member of their chosen profession

30. Keys to Student Development Faculty must be vested in the student’s success though role-modeling Create a sense of pride and excitement in the student’s chosen profession

31. Faculty Expectations • Role model professional behavior • Be aware and responsible for your own behavior • One study found observed faculty (Clark, 2007): • Belittling students • Changing policies and procedures • Demonstrating bias and discrimination • Prevalence is estimated to be 50% of faculty Clark, C. & Springer, P. (2007). Thoughts on incivility: Student and faculty perceptions of uncivil behavior in nursing education. Nursing Education Perspectives, 26(2), 93-97.

32. Evidence-Based Teaching Methods

33. Evidence-Based Teaching • Theoretical framework • Situational learning theory • Cognitive learning combined with real-world activities or experiential learning • Explicitly teach the cognitive base of professionalism • Knowledge and ability to articulate the concept is essential • Provide a list of traits and characteristics expected of the professional

34. Promoting Professionalism Cognitive Learning + Experiential Learning = Development of Professionalism

35. Professionalism: Exactly what is it? • Basic Professional Behaviors • Honesty and integrity • Reliability and dependability • Accountability • Respect and courtesy towards others • Professional appearance • Neat, well-dressed conveys a higher level of knowledge • Appearance cannot guarantee success but it can ensure failure

36. Professionalism: Exactly what is it? • Basic Professional Behaviors (continued) • Discretion and confidentiality • Professional communication • Compassion • Maintain appropriate boundaries • Believe in and support colleagues • Commitment to personal health

37. Development of Professionalism as a Continuum • Advanced Professional Behaviors • Cultural humility • Avoid introducing irrelevant and destructive bias into clinical practice and professional relationships • Nonjudgmental behavior • Commitment to excellence • Clinical excellence • Personal standard of excellence – be the best that you can be

38. Development of Professionalism as a Continuum • Advanced Professional Behaviors • Willingness to examine one’s own behavior and take responsibility for actions and reactions • Commitment to lifelong learning • Patient advocacy • Involvement in professional organizations • Pursuit of advanced education

39. Development of Professionalism as a Continuum • “Partnership with the public” to provide safe patient care “Excellence in nursing is not just about kindness. It’s about providing thoughtful, complex intellectually-demanding care with compassion” Diana J. Mason Fashioning the Right Impression Imprint, February/March 2009, page 29

40. How do professional behaviorslook in practice? • Guide students to visualize how professional behaviors are actually practiced in classroom & clinical setting: • Discusses patients in a respectful manner and only when appropriate • Takes responsibility for being on-time and prepared for class • Seeks help and guidance from instructors, preceptors, and/or other health care professionals • Maintains composure during difficult interactions • Shows initiative for own learning • Focuses on healthy behaviors – eating right, exercise and adequate sleep

41. What does unprofessional behavior look like? • Sloppy, unkempt appearance with violations of the dress code • Failure to be prepared for class or clinical assignments • Requires continual reminders about responsibilities to fellow students or to patient care assignments • Lack of conscientiousness – failure to fulfill responsibilities – doing only the minimum • Lack of effort towards developing and improving clinical skills • Failure to accept responsibility for errors and to learn from mistakes • Poor interactions and/or a lack of respect for fellow students, instructors, patients and families • Chronic fatigue and sleep deprivation • Arrogant and demeaning behavior

42. Skills for Professionalism • Specific skills needed by the novice professional • Clinical skills • Interpersonal skills • Professional communication • Self-control to manage difficult encounters • Time management skills • Planning • Organizing • Delegating • Priority setting • Personal health and energy management

43. Consequences of Unprofessional Behaviors • Inability to get hired • Inability to keep a job • Failure to be promoted • Lack of respect from clients and colleagues • Potential legal consequences

44. Innovative Programs & Curricula

45. What would you do to promote professionalism among your students?

46. Teaching Activities • Exposure to expert, highly respected role models • Role models across several levels from student leaders, staff, faculty and practicing professionals • Story Telling • Address negative role modeling • Provide opportunities to discuss professional issues in a safe environment • Tell about a time when a coworker or fellow student showed true professionalism

47. Teaching Activities • Encourage self-reflection through journaling • Keep a log of experiences and reflect on the professional behaviors experienced or reinforced • Learning from lapses in professionalism • Internet Exercises – Social Media • Involvement in professional activities outside the classroom or clinical setting • Journal clubs • National Student Nurses Association • Seminars with local, state and national nurse leaders

48. Free from the National Student Nurses Association Diana J. Mason: Fashioning the Right Impression. February/March 2009 Donna Cardillo: Projecting Your Professionalism, February/March 2009 Kathleen Pagana: Your Professional Presence: Advice on Dress and Appearance. February/March 2009

49. Teaching Activities • Make expectations and consequences completely clear and CONSISTENT • Ground rules for conduct, dress and behavior in clinical and classroom settings • Learning contracts for individual students • Clear communication about how the student is or is not meeting professional expectations

50. Teaching Activities • Use case scenarios • Example: During lunch, a student makes demeaning remarks about a patient he has seen in the clinic today; Discussion questions • What do you think of this behavior? Is the student acting professionally? • Is the student breaching confidentiality by describing details about the patient to other students who are not directly involved in the patient’s care? • How would you respond to the student’s remarks? • Student experiences • Scenarios from popular TV shows