4 unit 1 ■ Professionalism
Introduction
It is often said that you do not know where you
are going until you know where you have been.
More than 40
... [Show More] years ago, Beletz ( 1974 ) wrote
that most people thought of nurses in genderlinked, task-oriented terms: “a female who performs unpleasant technical jobs and functions as
an assistant to the physician” (p. 432). Interestingly, physicians in the 1800s viewed nursing as
a complement to medicine. According to Warrington ( 1839 ), “. . . the prescriptions of the best
physician are useless unless they be timely and
properly administered and attended to by the
nurse” (p. iv).
In its earliest years, most nursing care occurred
at home. Even in 1791 when the fi rst hospital
opened in Philadelphia, nurses continued to care
for patients in their own home settings. It took
almost another century before nursing moved into
hospitals. Th ese institutions, mostly dominated by
male physicians, promoted the idea that nurses
acted as the “handmaidens” to the better-educated,
more capable men in the medical fi eld.
Th e level of care diff ered greatly in these early
health-care institutions. Th ose operated by the
religious nursing orders gave high-quality care to
patients. In others, care varied greatly from good to
almost none at all. Although the image of nurses
and nursing has advanced considerably since then,
some still think of nurses as helpers who carry out
the physician ’ s orders.
It comes as no surprise that nursing and health
care have converged and reached a crossing point.
Nurses face a new age for human experience; the
very foundations of health practices and therapeutic interventions continue to be dramatically
altered by signifi cantly transformed scientifi c,
technological, cultural, political, and social realities
( Porter-O’Grady , 2003 ). Th e global environment
needs nurses more than ever to meet the healthcare needs of all.
Nursing sees itself as a profession rather than a
job or vocation and continues with this quest for its
place among the health-care disciplines. However,
what defi nes a profession? What behaviors are
expected from the members of the profession?
Chapter 1 discusses nursing as a profession with
its own identity and place within this new and
ever-changing health-care system.
Professionalism
Defi nition of a Profession
A vocation or calling defi nes “meaningful work”
depending on an individual ’ s point of view ( Dik
& Duff y, 2009 ). Nursing started as a vocation or
“calling.” Until Nightingale, most nursing occurred
through religious orders. To care for the ill and
infi rmed was a duty ( Kalisch & Kalisch, 2004 ). In
early years, despite the education required, nursing
was considered a job or vocation ( Cardillo, 2013 ).
Providing a defi nition for a “profession” or “professional” is not as easy as it appears. Th e term is
used all the time; however, what characteristics
defi ne a professional? According to Saks ( 2012 ),
several theoretical approaches have been applied
to creating a defi nition of a profession, the older
of these looking only at knowledge and expertise,
whereas later ones include a code of ethics, practice standards, licensure, and certifi cation, as well
as expected behaviors ( Post, 2014 ).
Nurses engage in specialized education
and training confi rmed by successfully passing
the National Council Licensure Examination
(NCLEX ®
) and receiving a license to practice
in each state. Nurses follow a code of ethics and
recognized practice standards and a body of continuous research that forms and directs our practice.
Nurses function autonomously within the designated scope of practice, formulating and delivering
a plan of care for clients, applying judgments, and
utilizing critical thinking skills in decision making
( Cardillo, 2013 ).
Professional Behaviors
According to Post ( 2014 ), professional characteristics or behaviors include:
■ Consideration
■ Empathy
■ Respect
■ Ethical and moral values
■ Accountability
■ Commitment to lifelong learning
■ Honesty
Professionalism denotes a commitment to carry
out specialized responsibilities and observe ethical
principles while remaining responsive to diverse
recipients ( Al-Rubaish, 2010 ). Communicating
chapter1 ■ Characteristics of a Profession 5
eff ectively and courteously within the work environment is expected professional behavior. State
boards of nursing through the nurse practice acts
elaborate expected behaviors in a registered nurse ’ s
professional practice and personal life (National
Council of State Boards of Nursing [ NCSBN],
2012, 2016 ). Nurses may lose their licenses for a
variety of actions deemed unprofessional or illegal.
For example, inappropriate use of social media,
posting emotionally charged statements in blogs or
forums, driving without a license, and committing
felonies outside of professional practice may be
cause for suspending or revoking a nursing license.
Commitment to others remains central to a
profession. In nursing, this entails commitment
to colleagues, lifelong learning, and accountability
for one ’ s actions. Professionalism in the workplace
means coming to work when scheduled and on
time. Coming to work late shows disrespect to your
peers and colleagues. It also indicates to your supervisor that this position is not important to you.
Always portray a positive attitude. Although
everyone experiences a bad day, projecting personal
feelings and issues onto others aff ects the work
environment. Many agencies and institutions have
dress codes. Dress appropriately per the employer ’ s expectations. Wearing heavy makeup, colognes,
or inappropriate hairstyles demonstrates a lack of
professionalism. Finally, always speak professionally to everyone in the work environment. A good
rule to follow should be, “If you wouldn ’ t say it
in front of your grandmother, do not say it in the
workplace” ( McKay, 2017 ).
Work politics often create an unfavorable environment. Stay away from gossip or engaging in
negative comments about others in the workplace.
Change the topic or indicate a lack of interest in
this type of verbal exchange. Negativity is contagious and aff ects workplace morale. Professionals
maintain a positive attitude in the work environment. If the environment aff ects this attitude, it is
time to look for another position ( McKay, 2017 ).
Lastly, professional behavior entails honesty
and accountability. If a day off is needed, take a
personal or vacation day; save sick days for illness.
Own up to errors. In nursing, an error may result
in injury or death. Th e health-care environment
should promote a culture of safety, not one of punishment for errors. Th is is discussed more in later
chapters.
Evolution of Nursing
as a Profession
Nursing Defi ned
Th e changes that have occurred in nursing are
refl ected in the defi nitions of nursing that have
developed through time. In 1859, Florence Nightingale defi ned the goal of nursing as putting the
client “in the best possible condition for nature to
act upon him” ( Nightingale, 1992/1859 , p. 79). In
1966, Virginia Henderson focused her defi nition
on the uniqueness of nursing:
Th e 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
to 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 possible. ( Henderson,
1966 , p. 21)
Martha Rogers defi ned nursing practiceas “the
process by which this body of knowledge, nursing
science, is used for the purpose of assisting human
beings to achieve maximum health within the
potential of each person” ( Rogers, 1988 , p. 100).
Rogers emphasized that nursing is concerned with
all people, only some of whom are ill.
In the modern nursing era, nurses are viewed
as collaborative members of the health-care team.
Nursing has emerged as a strong fi eld of its own
in which nurses have a wide range of obligations,
responsibilities, and accountability. Recent polls
show that nurses are considered the most trusted
group of professionals because of their knowledge, expertise, and ability to care for diverse
populations.
Nightingale ’ s concepts of nursing care became
the basis of modern theory development, and in
today ’ s language, she used evidence-based practice to promote nursing. Her 1859 book Notes on
Nursing: What It Is and What It Is Not laid the foundation for modern nursing education and practice.
Many nursing theorists have used Nightingale ’ s
thoughts as a basis for constructing their view of
nursing.
Nightingale believed that schools of nursing
must be independent institutions and that women
who were selected to attend the schools should be [Show Less]