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Professionalism:
Creating a Nurse
Barbara Cherry, DNSc, MBA, RN, NEA-BC
MARYLAND ASSOCIATION OF
ASSOCIATE
DEGREE NURSING DIRECTORS
ANNUAL CONFERENCE
OCTOBER 14, 2011
Maryland Association for Associate Degree
Nursing Directors
THE BENEFITS OF ASSOCIATE DEGREE NURSING – THE FOUR A’S
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ACCOUNTABLE:
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ACCESSIBLE:
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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:
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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
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:
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Articulation models exist to facilitate educational mobility
LPN to AND, ADN to BSN, ADN to MSN, EMT-P to RN
Program Objectives
 Analyze professionalism as an explicit set of behaviors and
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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.
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
National League for Nursing:
Excellence in Nursing Education
Program
Standards –
Leadership
Support
Innovative
Programs &
Curricula
EvidenceBased
Teaching
Methods
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?
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.
Getting Started: What is the Problem?
What are the common unprofessional
behaviors you observe in your students?
TODAY’S COLLEGE
STUDENTS
HTTP://WWW.YOUTUBE.COM/WATCH?V
=DGCJ46VYR9O
Generational Differences
 Millennials:
 Generation X:
 Baby Boomers:
 Traditionalists:
Born 1982 – 2002
Born 1965 – 1982
Born 1946 - 1964
Born 1900 – 1946
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
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
Millennials
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?
Program
Standards –
Leadership
Support
Innovative
Programs &
Curricula
EvidenceBased
Teaching
Methods
PROGRAM STANDARDS
and
LEADERSHIP SUPPORT
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
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
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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
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
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.
EVIDENCE-BASED
TEACHING METHODS
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
Promoting Professionalism
Cognitive Learning + Experiential
Learning = Development of
Professionalism
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
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
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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
 Clinical
to excellence
excellence
 Personal standard of excellence – be the best that you
can be
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
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
How do professional behaviors
look in practice?
 Guide students to visualize how professional behaviors
are actually practiced in classroom & clinical setting:
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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
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
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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
Skills for Professionalism
 Specific skills needed by the novice professional
 Clinical skills
 Interpersonal skills
Professional communication
 Self-control to manage difficult encounters
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Time management skills
Planning
 Organizing
 Delegating
 Priority setting
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Personal health and energy management
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
INNOVATIVE
PROGRAMS &
CURRICULA
What would you do to promote
professionalism among your
students?
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
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
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Journal clubs
National Student Nurses Association
Seminars with local, state and national nurse leaders
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
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
Teaching Activities
 Use case scenarios
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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
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Professional Code of Conduct
 Sample statements from the Code of Conduct for Student
Nurses (from the National Student Nurses Association)
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Advocate for the rights of all clients.
Maintain client confidentiality.
Take appropriate action to ensure the safety of clients, self, and others.
Provide care for the client in a timely, compassionate and professional manner.
Communicate client care in a truthful, timely and accurate manner.
Actively promote the highest level of moral and ethical principles and accept
responsibility for our actions.
Promote excellence in nursing by encouraging lifelong learning and professional
development.
Treat others with respect and promote an environment that respects human rights,
values and choice of cultural and spiritual beliefs.
Strive to achieve and maintain an optimal level of personal health.
What Now? Start on the Right Side
 Wait and hope
 Take action and learn
 Blame self
 Find solutions
 Blame others
 Accept ownership
 Denial
 Acknowledge situation
 “Somebody should do
 “It starts with me”
something”
 “It starts with me”
Complex Work
Glouberman, S. & Zimmerman, B. (2001). Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like? Available
online at http://www.plexusinstitute.org/resource/collection/6528ED29-9907-4BC7-8D00-8DC907679FED/ComplicatedAndComplexSystemsZimmermanReport_Medicare_reform.pdf
Simple: Following a
Recipe
The recipe is essential
Recipes are tested to
assure easy replication
No particular expertise is
required. But cooking
expertise increases
success rate
Recipes produce
standardized products
Complicated: Sending a
Rocket to the Moon
Formulae are critical and
necessary Formulae have a
limited application
Sending one rocket increases
assurance that the next will be
OK
High levels of expertise in a
variety of fields are necessary
for success
Rockets are similar in critical
ways
Complex: Raising a Child
Raising one child provides
experience
No assurance of success
with the next child
Expertise can contribute
but is neither necessary
nor sufficient to assure
success
Every child is unique and
must be understood as an
individual
The best recipes give good
results every time
There is a high degree of
certainty of outcome
Uncertainty of outcome
remains
Optimistic approach to
problem possible
Optimistic approach to
problem possible
Optimistic approach to
problem possible