Professionalism and Leadership in Nursing

Nursing as a Scholarly Profession

  • Nursing is categorized as a scholarly profession.
  • Its foundation is built upon two distinct yet integrated pillars:
    • The Art of Caring: The empathetic and humanistic approach to patient care.
    • Scientific Evidence: The empirical data and research that guide clinical practice.
  • Professionalism serves as the guiding concept for nurses throughout their everyday practice.

Defining Professionalism

  • Professionalism encompasses the actions, behaviors, and attitudes of an individual that reflect the following:
    • Core values of the nursing profession.
    • Ethical principles.
    • Regulatory guidelines of the profession.
  • It involves a deep commitment to both the individual self and the profession as a whole.
  • It establishes an obligation to practice with absolute integrity and honesty.
  • It requires an unselfish devotion to the welfare of others.
  • Pause and Think Inquiry: Is it our professional responsibility to provide hand hygiene prior to caring for clients? (Implied: Yes, as it aligns with evidence-based safety and professionalism).

Standards and Public Perception

  • Americans consistently rate nursing as the profession with the highest standards and the highest levels of honesty.

Unprofessionalism and Misconduct

  • Definition: Unprofessionalism refers to conduct that fails to adhere to established standards of practice or the nursing code of ethics.
  • Conduct Unbecoming of a Nurse: This is a specific term for misconduct. It means to dishonor, disgrace, or harm the standing and reputation of the nursing profession in the public eye.
  • Correction Requirement: Any instance of unprofessionalism requires corrective action.
  • Cognitive Rehearsal: The transcript prompts reflection on what cognitive rehearsal means to the individual in a professional context.
  • Unprofessionalism and Informed Consent Roles:
    • Physician Responsibility: The physician is responsible for informing the client about the procedure and answering any specific questions the client may have.
    • Nurse Responsibility (Witness): The nurse acts as a witness to the client's signature on the consent form.
    • Nurse Responsibility (Verification): The nurse must verify that the client’s consent is voluntary and has not been coerced.
    • Nurse Responsibility (Competence): The nurse must ensure the client is legally and mentally competent to give and sign the consent form.

The Novice to Expert Developmental Model

  • The transition from a student to a newly licensed nurse is often recognized as difficult.

  • Acquiring the necessary skills and experience to reach the level of an expert occurs in five distinct stages:

  • Stage 1: Novice

    • The individual is a beginner.
    • They have little to no experience.

  • Stage 2: Advanced Beginner

    • The individual demonstrates basic skills.
    • They continue to require the support and guidance of a mentor.

  • Stage 3: Competent

    • The individual is capable of planning.
    • They make decisions and perform job duties responsibly and efficiently.

  • Stage 4: Proficient

    • The individual demonstrates advanced decision-making skills.
    • They exhibit knowledge, resourcefulness, flexibility, and strong problem-solving abilities.

  • Stage 5: Expert

    • The individual serves as a role model with deep knowledge and high-level skills.
    • They teach others.
    • They multitask effortlessly and with fluency.

Professional Identity

  • Definition: A nurse’s sense of self as influenced by the values, beliefs, and attributes associated with the nursing discipline.
  • This includes the personal view, self-concept, or self-image an individual maintains in their professional role.
  • It incorporates their specific beliefs, values, attributes, traits, and life experiences.

Accountability in Nursing

  • Definition: A legal obligation combined with a moral and ethical commitment to do the right thing every time and in every situation.
  • It involves taking ownership of decisions and actions.
  • It requires being responsible and answerable for actions and the resulting consequences.
  • Example: Medication Errors
    • Accountability involves taking responsibility for medication errors.
    • Considerations: What would be the course of action? Would the error have occurred if the "rights of medication administration" were followed strictly?

Responsibility in Nursing

  • Definition: An obligation to perform work, duties, or specific tasks using sound professional judgment.
  • Being responsible means being reliable, dependable, and persistent in following through with all commitments.
  • It involves thinking things through, completing tasks to an acceptable level of quality, and accepting consequences for what is said or done.
  • Delegation: As nurses, individuals are responsible for ensuring that any delegated task is successfully completed.
  • Clinical Scenarios for Responsibility:
    • Scenario A: A patient’s blood pressure is suddenly elevated. The nurse must determine their specific responsibility in this acute change.
    • Scenario B: A nurse administers an analgesic to a patient. The nurse must identify their ongoing responsibility (e.g., monitoring for effect or adverse reactions).

Best Practice and Innovation

  • Nurses investigate innovative interventions to achieve the following:
    • Change practice to improve patient outcomes.
    • Improve patient satisfaction.
    • Decrease costs to both the patient and the healthcare facility.
  • Critical Thinking: Critical thinking is required where the nurse applies knowledge and experience to analyze and solve practice-related or patient-centered problems.

Leadership Styles in Nursing

  • Transactional Leaders

    • Focus squarely on results.
    • Prioritize company needs over individual needs.
    • Require clear communication lines.
    • Understand the team’s current skillset.
    • Thrive on rules, guidelines, and standards.
    • Implement practical, immediate solutions.
    • Excel at daily operations.
    • Outline clear expectations and prefer measurable goals.
    • Are generally averse to change.
    • Concentrate on monitoring behaviors and use rewards or punishments based on task completion.
    • Encourage compliance by making others focus on responsibilities and expectations.

  • Transformational Leaders

    • Establish a common mission and vision.
    • Encourage employees to heighten their level of performance.
    • Relay trustworthiness and voice an attractive, hopeful future.
    • Provide meaning and challenge the best within people.
    • Are passionate about causes and display compassion and understanding toward team members.

  • Laissez-Faire Leaders

    • Adhere to a ‘hands-off’ approach.
    • Encourage team members to work independently.
    • Provide very little direct control over decision-making.
    • Relinquish power and responsibility to others.
    • Facilitate independent goal setting and solution-finding.
    • Make minimal decisions while providing the necessary resources and tools for employees to be self-sufficient.

  • Bureaucratic Leaders

    • A ‘by-the-book’ leader relying on consistency and rule adherence.
    • Operate within a top-down decision-making structure.
    • Pay great attention to detail to bring control and clarity to situations.
    • Ensure employees follow procedures precisely and meet expectations.
    • Strictly enforce rules to maintain compliance.
    • Are rule-based and not open to creativity.

  • Situational Leaders

    • Transition and move between different leadership styles depending on circumstances.
    • Style choice depends on the specific situation, the task at hand, the nature of the group, and organization requirements.
    • Focus on short-term goals and remain flexible to the group's needs.
    • Adjust quickly to changing circumstances.

Organizational Structure

  • Chain of Command:

    • An organizational hierarchy that identifies the lines of authority within an organization.
    • Confirms that appropriate leaders are notified and involved in problem-solving, starting with those closest to the event.
    • Example Path: Licensed Vocational Nurse (LVN) → Charge Nurse → Clinical Manager.

  • Shared Governance:

    • A shared-decision structure that provides nurses with control over their own professional practice.
    • Bases itself on the premise that nurses will have access to information, resources, data, and growth opportunities.
    • Nurses act as contributing partners in decisions impacting nursing practice.
    • Promotes collaboration, autonomy, professional development, accountability, and empowerment for nurses.