A seminar on Nursing Profession Characteristics, Perspectives National & Global

Submitted By: Jasmine Ann Thomas 1st Yr M.Sc (N) The Oxford College of Nursing

Submitted To: Mr. Babu D HOD Medical Surgical Dept The Oxford College of Nursing

Submitted On:

MASTER PLAN
Subject: Advanced Nursing Practice Name of the Student: Jasmine Ann Thomas Evaluator : Mr. Babu D Unit: I Topic: Nursing Profession-Characteristics, Criteria, Perspectives- National & World Date: SL.NO 1 2 Content Introduction Terminology Nurse Professional Nurse Occupation Profession Accountability Altruism Autonomy 3 Definitions Nursing Profession Occupation 4 5 6 Differences in Profession & Occupation Concepts of a Profession Characteristics of a Profession Flexners Criteria Kellys Criteria Page No

7 8

Nursing as a Profession Role & Functions of a Professional Nurse Caregiver Communicator Teacher Counselor Decision Maker Leader/Manager Comforter Rehabilitator Protector & Advocator

Perspective of Nursing Profession a) Perspective of Nursing Profession in India Issues related to Nursing

services in India Impact of Migration Reversing the Problems Safeguards by TNAI b) Perspective of Nursing professionGlobal

10 11 12

Summary Conclusion Bibliography

INTRODUCTION What is a profession, & who can be called a professional? These terms are used loosely in everyday conversation. Historically, only medicine, law, & the ministry were accepted as professions. Today, however, professional is a term commonly used to identify many types of people ranging from wrestles & rock stars to college professors & archaeologists. Are all these individuals professionals? The answer to that question depends on how profession is defined. In sports, a professional is distinguished from an amateur by being paid. Amateur golfers, for example, cannot accept money; professional golfers compete for it. So in sports, making money is one characteristic of being a professional. Professionals are generally better at what they do than are others. Therefore, in most fields, expertise is also a part of being a professional. Being paid & having expertise, however, are not the only criteria for being professional. General agreement exists about what constitutes a profession, but not all people agree about which occupations are professional. How contemporary nursing stacks up as a profession can be discussed. TERMINOLOGIES NURSE- A person formally educated in the care of the sick or infirm PROFESSIONAL NURSE- Professional Nurse is a graduate of a recognized nursing school who has met the requirements for a registered nurse in a state in which she is licensed to practice. OCCUPATION- What occupies or engages ones time; employment. PROFESSION- A vacation requiring advanced training & usually involving mental rather than manual work. ACCOUNTABILITY- Responsibility ALTRUIM- Devotion to humanity AUTONOMY- Self governing.

DEFINITIONS NURSING- Nursing is the unique function of the nurse, that is to assist the individual (sick or well) in the performance of those activities contributing to health or its recovery that he would perform unaided if he had the necessary strength, will or knowledge.[International Council of Nurse]. PROFESSION- professions are those occupations based on specialized intellectual study & training the purpose of which is supply skilled service with ethical components to others, for a definite fee or salary.[ R. Louise McManur] OCCUPATION- Occupations are principle areas of work classified according to various features such as preparation, skills & knowledge required; the nature of work itself, supervision, motivation. DIFFERENCES IN PROFESION & OCCUPATION OCCUPATION 1. Training may occur in the job. PROFESSION Education takes place in a college Or university 2. Length of training varies 3. Values, beliefs & ethics are not Prominent factors of preparation 4. Commitment & personal identification Vary. 5. Workers Supervised 6. People often change job 7. Accountability rests with employer Education is prolonged Values, beliefs & ethics are an integral part of preparation Commitment & personal Identification strong. Workers are autonomous People unlikely to change Profession Accountability rests with an Individual.

Occupation is often used interchangeable with profession, but their definitions differ. These are some of the differences between occupation & profession in terms of their characteristics.

CONCEPTS OF A PROFESSION A profession is an occupation with ethical components that is devoted to the promotion of human & social welfare. The services offered by a profession based on specialized knowledge & skills that have been developed in scientific & learned manner. Some occupation, organized around a professional core, also include an array of personal such as assistants, technicians who are not professionals by the accepted standards of preparation & responsibility. Profession mandate an advanced body of knowledge & skill & an organized value system, developed & transmitted through extensive academic preparation & professional socialization, along with the occupational structure to assure the required education & practice. CHARACTERISTICS OF A PROFESSION In general, to be a professional person, the person must; 1. Have a group of fundamental truth- a kind of truth that will make him free to think & act. 2. Have the ability to apply truth in dealing with new problem for which there is no precise answer at that moment. 3. Be able to remain uninhibited & unafraid under perplexities of changing basic knowledge, demands social conditions or personal upsets. Over the years, many thoughtful people have grappled with the meaning of professionalism. In the early 1900s, the Carnegie foundation issued a series of papers about professional schools. The first of these reports was based on sociologist Abraham Flexners 1910 study of medical education. The Flexner report, as it became known, is a classic piece of educational literature that provided the impetus for the much needed reform of medical education. level of

Later Flexner published a list of criteria that he believed were characteristic of all true professions (1915). Since Flexners original criteria were published , they have been widely used as a benchmark for determining the status of various occupations in terms of professionalism & have had profound influence on professional education is Several disciplines, including nursing. FLEXNERS CRITERIA (1915) Flexner believed that professional work: 1. Is basically intellectual (as opposed to physical) & is accompanied by a high degree of individual responsibility. 2. Is based on a body of knowledge that can be learned & is refreshed & refined through research. 3. Is practical, in addition to being theoretical. 4. Can be taught through a process of highly specialized professional education. 5. Has a strong internal organization of members & a well-developed group consciousness. 6. Has practitioners who are motivated by altruism (the desire to help others) & who are responsive to human interests. Many writers have listed the criteria of professionalism and a comparison of them to Flexners criteria reveals many similarities. KELLYS CRITERIA Kelly(1981) reiterated & expanded Flexners criteria in her 1981 listing of characteristics of a profession: 1. The services provided are vital to humanity & the welfare of the society. 2. There is a special body of knowledge research. that is continually enlarged through

3. The

services

involve

intellectual

activities;

individual

responsibility

(accountability) is a strong feature. 4. Practitioners are educated in institutions of higher learning. 5. Practitioners are relatively independent & control their own policies & activities(autonomy) 6. Practitioners are motivated by service (altruism) & consider their work an important component of their lives. 7. There is a code of ethics to guide the decisions & conduct of practitioners. 8. There is an organization (association) that encourage & supports high standards of practice. NURSING AS A PROFESSION An ongoing subject for discussion in nursing circles has been the questions: Is Nursing a Profession? Much has been written on both sides of this issue over the years. Nursing sociologists do not all agree that nursing is a profession. Some believes that it is, at best, an emerging profession. Other cite the progress nursing has made toward meeting the commonly accepted criteria for full fledged professional status. "The Services Provided Are-Vital to Humanity and the Welfare of Society." If 10 students were asked why they chose nursing, most would reply. To help people. Certainly nursing is a service that is essential to the well- being of people and to society as a whole. Nursing promotes the maintenance and restoration of health of individuals, groups, and communities. Assisting others to attain the highest level of wellness of which they are capable is the goal of nursing. Caring, meaning nurturing and helping others is a basic component of professional nursing. There is a Special Body of Knowledge that is Continually Enlarged Through Research. In the past, nursing was based on principles borrowed from the physical and social sciences and other disciplines. Today, however ways so the amount of

investigation and analysis of nursing care has expanded rapidly in the past 20 years. Nursing is no longer based on task orientation, intuition, or trial and error but increasingly relies on research as a basis for practice. The services involve intellectual Activities; Individual Responsibility (Accountability) is a strong Feature. Nursing has developed and refined its own unique approach to practice, called the nursing process. The nursing process is essentially a congnitive (mental) activity that requires both critical and creative thinking and serves as the basis for providing nursing care.

Individual accountability in nursing has become the hallmark of practice. Accountability, according to the American Nurses Associations (ANA) Code for Nurses is being answerable to someone for something one has done. It means providing an explanation to self, to the client, to the employing agency, and to the nursing profession. In the ANAs Standards of Nursing Practice. Through legal opinions and court cases, society has demonstrated that it, too, holds nurses individually responsible for their actions as well as for those of personnel under their supervision.

The majority of programs offering basic nursing education are now associate degree and baccalaureate programs located in colleges and unive1'sities, There are master's and doctoral programs in nursing, although the number of graduates is small compared with other health professions. Because professional status and power increase with postgraduate education, a legitimate question is: "How can nursing take its place as a peer among the professions, when most nurses currently in practice hold less than a baccalaureate degree? The differentiation between professional nursing and technical nursing is a challenging issue that nursing has not yet resolved, Diversity ", within the ranks of nursing has slowed the progress toward acceptance of the baccalaureate or higher degree as the prerequisite fur professional practice. Lack of resolution of these differences threatens to undermine nursing's development as a profession.

"Practitioners Are Relatively Independent and Control Their Own Policies and Activities (Autonomy)." Autonomy, or control over ones practice, is another controversial area fur nursing. Although many nursing actions are independent, most nurses are employed in hospitals, where authority resides in one's position. One's place in the hierarchy, rather than expertise, confers or denies power and status. Physicians are widely regarded as gatekeepers, and their authorization or supervision is required before many activities can occur. Nurse practice acts in must states reinforce nursing's lack of self-determination by requiring that nurses perform certain actions only when authorized by supervising physicians or hospital protocols.

There a e at least three groups who wish to control nursing practice: organized medicine, health service administration, and organized nursing, Both the medical profession and health service administration are attempting to maintain control of nursing because they believe it is in their best interest to keep nurses dependent on them, Both are well organized and have powerful lobbies at state and national levels. Organized nursing promotes independence and autonomy, but its power is fragmented by subgroups and dissension. Rivalry between diploma-educated, associate degree-educated and

baccalaureate-educated nurses saps the energy of the profession. The proliferation of nursing organizations (see for a partial list of nursing organizations) and competition among them also diminish nursing's potential. Only 10 percent of the 2.2 million registered nurses in the United States are members of the ANA (Little, 1992), The fact that most nurses are not members of any professional organization impairs nursing's ability to lobby effectively. These are major challenges for nursing if it is to realize its potential collective professional power and autonomy.

"Practitioners Are Motivated by Service (Altruism) and Consider Their Work an Important Component of Their Lives." As a group, nurses are dedicated to the ideal of service to others, which is also known as altruism. This ideal has sometimes become

intertwined with economic issues and historically has been exploited by employers of nurses, No one questions the right of other professionals to charge reasonable fees for the services they render; when nurses want higher salaries, however, others sometimes call their altruism into question. Nurses must take responsibility for their own financial wellbeing and for the health of the profession. This will, in turn, ensure its continued attractiveness to those who might chose nursing as a career, If there are to be adequate numbers of nurses to meet society's needs, salaries must be comparable with those in competing disciplines. Being concerned with salary issues does nothing to diminish a Nurses altruism.

Another issue, consideration of work as a primary component of life, has been a thornier problem for nurses. Commitment to a career is not a value equally shared by all nurses. Some still regard nursing as a job and drop in and out of practice depending on economic and family needs. This approach, although appealing to many female nurses and conducive to traditional family management. has retarded the development of professional attitudes and-behaviors for the profession as a whole.

"There Is a Code of Ethics to Guide the Decisions and Conduct of Practitioners." An ethical code does not stipulate how an individual should act in a specific situation; rather, it provides professional standards and a framework for decision making, The trust placed in the nursing profession by the public requires that nurses act with integrity. To aid them in doing so, both the' International Council of Nurses (ICN) and the ANA have established codes of nursing ethics through which standards of practice are established, promoted and refined. In 1893, long before these codes were written. The Florence Nightingale Pledge was created by a committee headed by Lystra Eggert Gretter and presented to the Farrand Training School for Nurses located at Harper Hospita1 in Detroit, Michigan (Pillitteri, 1991). The Nightingale pledge can be considered nursing's first code of ethics.

BOX 6-1 The Florence Nightingale Pledge I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affair's coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work and devote my self to the welfare of those committed, to my care.

"There Is an Organization (Association) That Encourages and Supports High Standards of Practice." As shown in Chapter 4, nursing has a number of professional associations that were formed to promote the improvement of the profession. Foremost among these is the ANA, the purposes of which are to foster high standards bf nursing practice promote professional and educational advancement of nurses, and promote the welfare or nurses to the end that all people have better nursing care(American Nurses association, 1970). The ANA is also the official voice of nursing and therefore is the primary advocate for nursing interests in general. Unfortunately, fewer than I out of 10 nurses belongs to the official professional organization. The political power that could be derived from the unified efforts of 2.2 million registered nurses nationwide would be impressive; that goal has not yet been realized.

ROLES & FUNCTIONS OF NURSE Traditionally, the role of the nurses was to provide care & comfort as they carried out specific nursing function, but changes in nursing of the day have expanded the role to include increased emphasis on health promotion & illness prevention as well as concern

for the client as a whole. At present nurse functions in the inter related roles as given below. CAREGIVER Care giving role is a primary role of the nurse. The provision of care to clients that combines both the art & science of nursing in meeting physical, emotional, intellectual, socio- cultural, & spiritual needs. As a caregiver, the nurse addresses the holistic health care needs of the client & family set goals with minimum cost of time & energy. As a caregiver, the nurse interrogates other roles to promote wellness through activities that prevent illness, restore health & facilitate coping with disability or death.

COMMUNICATOR The role communicator is central to other nursing roles. The quality of communication is a critical factor in meeting the needs of the client, without clear communication effective nursing care is impossible. The use of effective interpersonal & therapeutic communication skills to establish & maintain helping relationships with clients of all ages in a wide variety of health care settings.

TEACHER The use of communication skills is to assess, implement & evaluate individualized teaching plans to meet learning needs of clients & their families. As a teacher, the nurse explaining to clients concepts & facts about health, demonstrates procedures such as self care activities, determines that the client fully understands, reinforces learning or client behavior, and evaluates progress in learning. Teaching may be planned or journal (eg. responding to a question while conversation) or planned or mere formal (eg. teaching diet plan for diabetes).

COUNSELOR The use of therapeutic interpersonal communication skills to provide information, make appropriate referrals, & facilitate the clients problem solving & decision making skills.

DECISION To provide effective care, the nurse uses decision making skills, throughout the nursing process. Before undertaking any nursing intervention, whether it is assessing the clients condition, giving care or evaluating the results of care, the nurse plans the action by deciding the best approach for each client, by using decision making skills.

LEADER/MANAGER The assertive, self confident practice of nursing, when providing care, effective change & functioning with group. Nurses co-ordinate the activities of other members of the health care team, such a dietician, & Physiotherapist, when managing client needs & nurses also direct their subordinates for quality of nursing care. Nurses must also manage their own time & the resources of the practice settings when concurrently providing care to several clients. As managers/ leader, nurses co-ordinate & delegate care responsibilities & supervise other health care workers.

COMFORTER The role of comforter, caring for the client as a person, is a traditional & historical one in nursing & has continued to be important as nurses have assumed new roles. Because nursing care must be directed to the whole person rather than simply the body comfort & emotional support often help give the client strength to recover, while carrying out nursing activities, nurses can provide comfort by demonstrating care of the client as an individual with unique feelings & needs.

REHABILITATOR Rehabilitation is the process by which individuals return to maximal levels of functioning after illness, accidents or other disabling events. Usually the clients experience some improvements & all aspects of health, the nurse helps them to adapt as fully as possible, by using her/his knowledge & skill of many concepts which she/he learned.

PROTECTOR & ADVOCATER The protection of human or legal rights & the securing of care for all clients based on the belief that clients have the right to make informed decision about their own health & lives. As a protector the nurse helps to maintain in safe environment for the client & takes steps to prevent injury & protect the client from possible adverse effect of diagnostic or treatment measures. For example, confirming that a client does not have an allergy to medication. As an advocate, the nurse protects the clients human & legal rights & provides assistance in asserting those rights of the need arises eg. providing additional information to accept treatment.

PERSPECTIVE OF NURSING PROFESSION

PERSPECTIVE OF NURSING PROFESSION IN INDIA
According to TNAI about 8.6 lacks trained nursing manpower is present in the country. About 30,000 nurses are trained annually but only 45% are in active service at anytime. Issues related to Nursing Services in India Inadequate infrastructure living condition Inadequate manpower resulting in disproportionate nurse-patient ratio Lack of autonomy in decision making & planning. Non uniformity in pay structure at all levels. Limited scope for career development. Inadequate protective measures to safeguard nursing personnel at work place Lack of recognition / status in society

Why Migration? all human being irrespective of race, creed, or sex, have the right to pursue their well being. Every nurse has a right to have his/her personal & professional development. ICN

Each nurse is a member of the society & is entitled to the same individual rights, privileges, goals of physical, mental, economic & social development as are available to other members of the society. TNAI

Impact of Migration. Global shortage of nurse leading to more & more nurses heading to foreign shores. Further pressure on the existing manpower & health system. Indian health sector unable to tap the potential of the nursing personnel leading to brain drain.

Reversing the brain Drain Urgent need to revamp the health care system & address every issue related to nursing services. Create conducive working environment so that brain drain is replaced by brain gain.

Safeguards. Till such a system becomes available migration is inevitable. TNAI takes leading role in educating the nurses to take decision to migrate based on careful scrutinity of agencies. Safety & Security Financial purity with local counterparts Non discrimination Equal opportunities Sensitive to Cultural differences.

PERSPECTIVE OF NURSING PROFESSION-GLOBAL

Using evidence to influence policy Both health care professionals & the system are faced with a number of ongoing challenges, which may require a shift in organizational policy. The nursing profession including researchers & practitioners, must continue to work together & share experiences, evidence & data. A unified effort is necessary to further influence the health care system & changes that directly affect the profession.

Global Issues & Concerns Migration of Nurses is not a recent phenomenon, the nature of migration is changing. Nurse migration further exacerbates the existing nursing shortages in some countries. Subsequently limits the type of health care services that can be provided to population. Personal safety and violence in the workplace is a growing concern for the nursing profession. Nurses are exposed to physical & biological risks in their daily practice & there are an increasing number of reports on nurses as victims of violence. As a result of shortages, nurses are reporting increasingly heavy workloads, leading to burnouts & stress. Heavy workloads may also be linked to an increased in medication errors & possible visits to patient safety. The feature of nursing is in jeopardy. Given the impending shortages, it is imperative that the profession continue to recruit personnel into all nursing roles, practice, education, research & administration.

Changing Nursing Practice. Technology information and evidence continue to influence & change the way nurses practice. Nurses must be aware of the potential for technology & evidence to change the way care is provided.

Nurses must have the skill & equipment required to adopt & utilize these valuable resources, which will enable them to access the information needed to provide evidenceinformed care.

New Health care Provider Roles. To combat the current nursing shortages, governments are creating new roles for health care providers. Nurses must think critically about what these ides mean to nursing practice & their impact on nurses work.

Knowledge Transfer & Exchange International forums such as the NHSRU conference enable nurse from around the world to share knowledge & research findings, & network with their colleagues. These events provide an opportunity for knowledge transfer & exchange on a globel level. Evidence & strategies are shared & relationships develop, which nurses can maintain up on returning to their work environment.

SUMMARY Commitment to a profession is different from commitment to a job or an occupation. People that there are several characteristics that all true professions have in common. A body of knowledge, specialized education, service to society, accountability, autonomy & ethical standards are a few hall marks of professions. Although nursing is dealing with autonomy, preparation & commitment issues, great progress has been make in moving nursing toward full professional status. An awareness of the characteristics of professions & professional behavior helps nurses to assume leadership in continuing that progress.

CONCLUSION An empowering work environment can bring out the best in a profession & true leadership transforms a work culture through charisma, intellectual stimulation & individual consideration. A nurse is deprived of all these most of the time. What recognition a nurse is getting from her own health to be thought of. Even if the nurses image of angels doing selfless service has taken a beating, with commercialization of the profession, most nurses swear they would continue their profession irrespective of recognition. It is important to remember that being a professional is a dynamic process, not a condition or state of being. Professional growth evolves throughout the different stages of nurses career.

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