I had a discussion with an anaesthetist in my theatre this week, an anaesthetist who I thought was well educated and well informed. I was very disappointed with the direction of our conversation and it made me think about this conversation as a topic for this post. I am not sure how the topic even came up now. He said to me – “nurse training should go back into hospitals don’t you think?” My reply was straight away “if you take it out of the universities nurses won’t be seen as a profession anymore”. The reply shocked me – “nursing isn’t really a profession anyway is it”. Now we did go on to debate this for quite a period of time. He is not much older than I am. I have often heard comments like this from older nurses and older medical professionals. I did try to inform him but I think in the end we agreed to disagree.
What do you think?
I argued for our profession because I feel that nursing has come a long way, that to become a profession was fought for by many nurses before me. That we should try to understand where they were coming from and see what they were trying to achieve for nursing as a whole. If we do not treat ourselves as the professionals that we are, how can we expect those around us to treat us as professionals? It is something that I just feel as well and take pride in. I take pride in being able to offer the best care that I can as a professional to my patients. Do you want someone who is professionally trained looking after you? Then you need to value that person as a professional. We need to be a profession to advocate for our patients. Once you start to water down nurses as a profession you water down the patients’ voice.
Nurses should not assume that all professionals have the same value system as they do. As nurses, we work to foster an environment in which the values of human dignity, truth, integrity, excellence, duty, and social responsibility are accepted and demonstrated by others.
I feel that nurses have a duty to support, demonstrate, and encourage the best professional behaviours for all staff members to ensure patients are receiving the highest-quality care.
Professionalism in nursing encompasses key elements that include a common body of knowledge, autonomous practice, self-regulation through education and licensure, a set code of ethics, and a commitment to altruism. Nurses also must embrace collaboration, vision, accountability, and patient and staff member advocacy based on established ethics, values, and standards of care. Nurses who are committed to professional development through the pursuit of higher degrees, application of evidence-based practice, collaboration with colleagues, and certiﬁcation show a strong commitment to their profession and serve as role models for staff members.
Nurses have specialised education training validated by professional registration with AHPRA (Australian Healthcare Practitioner Registration Agency). We have a code of ethics and established practice standards we are bound to adhere to, a violation of which can result in our registration being revoked or suspended. We have our own body of ongoing research that shapes and governs our practice. Nurses work autonomously within our scope of practice. We formulate and carry out our own plan of care for our patients; we apply judgment, use of critical thinking skills, and make a nursing diagnosis.
Concern for the welfare of others is a basic tenet of ethical behaviour for nursing professionals. Ideally, nurses make choices guided by foundational ethical principles and base their conduct on an established professional code. Guidelines, standards, and a code of conduct are available, but ethical practice requires a personal commitment to ensure that best practices occur. Personal and professional decisions are likely to result in positive outcomes when based on ethical practice.
Professional ethical behaviour requires making informed decisions. Nurses are responsible for their own decisions; however, they are also tasked with inﬂuencing other team members’ decisions in promoting professional practice.
Nurses must always keep patient safety in mind when making decisions. Adherence to promoting patient safety from an ethical stance is not only a moral issue or an issue of personal interest but is a legal requirement included in the main mission of health care. An ethical commitment to patient safety should involve
- Incorporating safety into all decision-making,
- participating in the development of collaborative practice,
- supporting all nurses,
- educating and training all personnel,
- making safety visible,
- applying and enforcing protocols,
- creating a climate of safety, and
- involving patients and their family members in the safety process and their care.
Nurses use their specialised knowledge, experience, and skill set to initiate life-saving measures, improve and promote the health and well-being of the planet, and ease pain, suffering, and loss. We are all united in that common mission. Healthcare in the future will involve greater health promotion, chronic disease monitoring and care of older patients. This situation has led to the recognition that general practice needs to evolve to cope with an increasing complexity in care.
Excellence in nursing practice involves nurses who “consistently use current knowledge and theory, integrate judgment and the patient perspective, challenge mediocrity, and work toward development of new knowledge.” Mediocrity could be the single most important contributor to increased patient risk of negative outcomes related to the surgical experience. Settling for mediocrity sends a negative message to personnel about the importance of education and knowledge of evidence-based standards. If team members are not challenged to participate in continuous professional development (CPD), the value of education is diminished.
If you want nurses who are reflective, intelligent and autonomous. Their education must stay in the tertiary sector. What we probably need is guaranteed graduate years that are funded. This makes our first year as nurses confident. By funding it, hospitals become excited to take on graduates, they are not a burden. The validation of the nursing profession in Australia is best recalled in Christine Duffield’s paper ‘Nursing in Australia comes of age’ (1986). It was seen as particularly significant that nurses, like their other healthcare counterparts, also needed to be trained in the higher education system. But this was a struggle that took 20 years to achieve. In the mid 80’s the first nurses started university training and by 1996 all nurses were hospital trained.
By having training in universities all criteria required by Greenwood (1957) are met to make nurses professional, meaning that it should be disputed. Nursing has its own
- Systemic body of theory
- Professional authority
- Code of ethics
The development of a code of practice, a code of conduct, and a competency-based framework under which all Australian nurses must be registered and which they must adhere to, further validate nursing as a regulated health profession. The competency framework was originally accepted in 1992 (AHPRA, 2012) and is regularly updated. It regulates the registration of registered nurses, enrolled nurses, and midwives. This competency framework consists of four key domains:
- professional practice
- critical thinking and analysis
- provision and coordination of care
- collaborative and therapeutic practice.
The international council of nurses defines nurse as:-
“Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.” (ICN, 2002)
Nurses have had a troubled relationship with the image of nursing. Public perception often reinforces the negative image as it is confusing and hard to define, where the public often viewed nursing work as dirty and unpleasant tasks, something that they were not capable of. The public perception of nursing was removed from the reality and was potentially damaging to the profession. Much of the real work of nursing is intangible. Our therapeutic relationships, our patient advocacy and our holistic approach to care are often unseen, although certainly understood by the patient and family. This relative invisibility, along with our continued affiliation with medical knowledge and practice, has compounded our struggle to legitimise our autonomy
Some people/nurses/other medical professionals see that hospital training brings “life skills”. It also brings that sense of belonging/loyalty to the hospital and colleagues. Everyone loves that feeling of belonging, and that feeling of being part of something successful.
Being a live-in nurse achieved the ultimate ideal, being that of loyalty. That is to the hospital, to your colleagues and to those in your care. The sense of belonging is most important. This cannot be taught at university. It needs to be fostered within the hospital culture within the hospital – but does that change the definition of nurses as a professional?
Professionalism in nursing is deﬁned by the standards for nursing practice. As perioperative leaders, it is important to model ethical and professional behaviours and support nursing personnel in their commitment to patient safety as facilitated by knowledge of and adherence to standards. Leaders also have a responsibility to educate staff members about professional standards, the scope of practice, current research and EBP standards, and to encourage professional growth.
Yes, there is no code billing code for what I do day to day – that is not what makes my job a profession. You cannot truly put a price on what I do each day.
AHPRA (2012). National Regulatory Boards.
Greenwood E “Attributes of a profession” Social Work, 2 (3) 44-55 (1957)
ICN. (2010). International Council of Nurses Conseil international http://www.icn.ch/who-we-are/icn-definition-of-nursing/