Nursing as a Profession and Development of Professional Identity
Characteristics of Nursing as a Profession
Nursing is defined as a lifelong vocation requiring extensive education, special knowledge, skill, and a commitment to service.
Six core characteristics distinguish a profession from an occupation:
Standardized formal education.
A systematic body of knowledge pertinent to the role performed.
A commitment to providing a service that benefits individuals and the community.
A guiding code of ethics for professional activities.
Demonstration of autonomy, responsibility, and accountability.
A commitment of its members to professional organizations and activities.
Standardized Formal Education and Lifelong Learning
Educational Entry Pathways:
Multiple pathways exist for entry into professional nursing practice (e.g., Associate's Degree in Nursing [ADN], Bachelor's Degree of Science in Nursing [BSN]).
Schools of nursing may configure educational content in varied ways.
Standardized consistency across educational programs is maintained through categories tested on the National Council Licensure Examination (NCLEX / NCLEX-RN).
Continuing Education and Academic Progression:
Professional practice requires continuous lifelong learning beyond entry-level preparation.
Nurses often navigate a "new nurse reality shock" after initial graduation before pursuing further degree advancement.
Motivations for advancing education include expanding specialized knowledge, opening doors for future career opportunities, and assuming leadership roles rather than immediate monetary pay raises.
Systematic Body of Knowledge and Service Commitment
Systematic Body of Knowledge:
Knowledge is grounded in conceptual frameworks that guide practice and define nursing skills, abilities, and norms.
Nursing research has expanded drastically since its early stages of development in the 1940s.
Research contributes directly to understanding nursing education and practice-related issues.
Service Commitment and Altruism:
Nursing is deeply rooted in service to others.
Altruism—defined as a selfless concern for the welfare of others—guides nursing policies and ethical codes.
Nursing maintains a formal social contract with society, as articulated in the American Nurses Association (ANA) Social Policy Statement.
Regulatory Autonomy, Responsibility, and Public Protection
State Boards of Nursing:
Each state's Board of Nursing regulates nursing practice within its jurisdiction.
Responsible for implementing and enforcing state laws pertaining to nursing, including licensure, practice regulations, nursing schools, and educational programs.
The primary goal of State Boards of Nursing is protecting the public.
Autonomy and Accountability:
Nurses are autonomous, responsible, and accountable for their practice outcomes and for demonstrating professional values to themselves, peers, and society.
Nursing continues to build autonomy in policy formation and practice control, supported significantly by professional associations.
Professional Organizations and Workplace Advocacy
Role of Professional Organizations:
Professional organizations aim to influence social, political, and economic conditions affecting nursing practice.
Members demonstrate professional commitment through active participation in organizational activities.
The American Nurses Association (ANA):
Advances the profession by fostering high standards of nursing practice.
Promotes the rights of nurses in the workplace.
Projects a positive and realistic public image of nursing.
Lobbies Congress and regulatory agencies on healthcare issues affecting nurses and the public.
Sources and Development of Professional Identity
Definition of Professional Identity:
A set of beliefs, attitudes, and understandings regarding one's role as a nurse.
Involves internalizing how one views oneself as a nurse and how one is perceived by others.
Key Sources of Professional Identity Formation:
Early Contact: Interactions with relatives, friends, and coworkers who are nurses.
Classroom Learning: Formal expectations presented by nursing professors.
Clinical Practice: Unofficial expectations observed during everyday clinical practice.
Personal Integration: Blending social expectations of nursing with personal identity.
Attributes of the Ideal Professional Nurse:
Technical competence.
Interpersonal skills.
Strong work ethic.
High moral standards.
Concern for the welfare of others.
Core Professional Nursing Values:
Altruism.
Integrity (doing what is right and maintaining ethical standards).
Human dignity (valuing the inherent worth of all individuals).
Social justice.
Respect for autonomy.
Historical Context:
Nursing originated from humble roots involving acts of charity for the less fortunate.
Historically viewed as an unpleasant occupation before resilient individuals transformed it into a respected profession.
Public trust remains high due to nursing's sustained commitment to client needs.
Professional Resources and Guiding Statements
Primary ANA Resources for Registered Nurses (RNs):
Code of Ethics for Nurses with Interpretive Statements.
Nursing's Social Policy Statement.
Scope and Standards of Practice.
Primary NAPNES Resource for Licensed Practical/Vocational Nurses (LPN/LVNs):
National Association of Practical Nurse Education and Service (NAPNES) document: Standards of Practice and Educational Competencies of Graduates of Practical Vocational Nursing Programs.
Provisions of the ANA Code of Ethics for Nurses
Fundamental Commitments to Society (Provisions 1–3):
Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person, honoring human dignity across all client and colleague interactions.
Provision 2: The nurse's primary commitment is to the client, whether an individual, family, group, community, or population.
Provision 3: The nurse promotes, advocates for, and protects the rights, health, and safety of the client.
Duty and Loyalty Commitments (Provisions 4–6):
Provision 4: The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal client care, including appropriate task delegation.
Provision 5: The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
Provision 6: The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment conducive to safe, quality health care.
Duties Beyond Individual Client Encounters (Provisions 7–9):
Provision 7: The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
Provision 8: The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities (e.g., addressing hunger and lack of healthcare access).
Provision 9: The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
ANA Social Policy Statement
Formal Definition of Nursing:
The protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations.
Four Essential Characteristics of Nursing Practice:
Human Responses: Phenomena related to how individuals respond to actual or potential health problems.
Theory Application: Understanding and applying nursing theory through evidence-supported interventions.
Nursing Actions: Theoretically derived, evidence-based interventions aimed at protecting and promoting health.
Outcomes: Beneficial health results produced for the client as a direct result of nursing actions.
ANA Scope and Standards of Practice
Scope of Practice Architecture:
Single Scope: The nursing profession possesses one overarching scope encompassing the full range of practice from generalist to specialty practice.
Specific engagement in actions depends on education level, population served, practice role, and experience level.
State Boards of Nursing retain primary statutory authority for legal licensure and practice authorization.
Two Major Content Areas:
Standards of Practice: Competencies based on the standard phases of the nursing process:
Assessment
Diagnosis
Outcomes Identification
Planning
Implementation
Evaluation
Standards of Professional Practice: Expected professional role performance behaviors across ten domain areas:
Ethics
Education
Evidence-Based Practice and Research
Quality of Practice
Communication
Collegiality
Collaboration
Professional Practice Evaluation
Resource Utilization
Environmental Health
Five Tenets of Professional Nursing Practice:
Individualized Care: Nursing care is tailored to respect client diversity and specific needs.
Care Coordination: Care is coordinated through established partnerships and shared goals.
Centrality of Caring: Caring forms the core of practice, encompassing self-care, client care, society, and the environment.
Evidence-Based Practice: Evidence-based knowledge guides assessment, diagnosis, outcome identification, planning, implementation, and evaluation.
Work Environment Link: A direct connection exists between the quality of the professional work environment and the nurse's ability to achieve optimal client outcomes.
Work Environment Responsibilities:
Nurses must maintain and improve healthy work environments through skilled communication, true collaboration, and effective decision-making.
Practical Nurse Guidance (NAPNES Standards)
NAPNES Role and Purpose:
Document Title: Standards of Practice and Educational Competencies of Graduates of Practical Vocational Nursing Programs.
Goal: Improve educational achievement for Licensed Practical/Vocational Nurses (LPN/LVNs) and elevate care quality for citizens.
Clarification: Enhances understanding of LPN capabilities, legal rights, clinical responsibilities, and collaborative relationships with other healthcare providers.
Six Defined Outcome Domains:
Professional Behaviors
Communication
Assessment
Planning
Caring Interventions
Managing
Clinical Scenarios and Dialogue Analysis
Media Portrayal vs. Professional Reality:
Critique of Medical-Surgical Television Shows: Television dramas frequently misrepresent nursing by highlighting negative behaviors (e.g., nurses refusing client assignments, throwing tantrums over homeless or HIV-positive clients, spending time on personal vanity, talking to attractive doctors, or stealing pain medications).
Professional Reality: Authentic nursing involves complex critical thinking, profound empathy, advocating for human dignity, health promotion, clinical interventions, and assisting terminal clients to die with dignity.
Case Study: Care of Mr. Hawthorne (End-of-Life Advocacy):
Client Context: Mr. Hawthorne chose to discontinue chemotherapy treatment that caused severe illness, electing instead to experience a peaceful death.
Conflict: Mr. Hawthorne's family became distressed over his decision, and Dr. Jacobson expressed a desire to continue chemotherapy.
Nurse Action: Sally advocated for Mr. Hawthorne's autonomous rights and choices, facilitating family and physician understanding.
Ethical Alignment: Exemplified Provision 1 (honoring human dignity with compassion/respect) and Provision 3 (advocating for client rights and safety).
Recognition: Mr. Hawthorne's family submitted a positive inpatient survey review, and Dr. Jacobson nominated Sally for the unit's Client Advocacy Award (to be presented at the annual hospital banquet).
Case Study: Delegation and Accountability (Mandy, Richard, and Dr. Williams):
Situation: Mandy was requested by her unit lead to attend a hospital-wide committee meeting on her day off due to unit staffing constraints.
Clinical Request: Dr. Williams requested vital sign measurements for client Miss Kelly.
Delegation: Mandy delegated vital sign collection to Richard, an Assistant Personnel (AP).
Accountability Action: Mandy reviewed the charted data prior to lunch and observed that Miss Kelly's vital signs were outside the reference range.
Outcome: Demonstrating Provision 4 accountability, Mandy personally re-checked Miss Kelly's vital signs rather than ignoring the abnormal findings.
Case Study: Professional Stress, Workload, and Continuing Education:
Stress and Shift Delegation: Mandy experienced high clinical stress and considered delegating unfinished tasks to the oncoming shift.
Peer Support: A colleague offered to stay past shift to assist Mandy prior to attending an scheduled 05:00 in-service.
Continuing Education Motivation: The colleague attended the optional in-service out of professional curiosity and interest in learning, despite already possessing all required Continuing Education Units (CEUs) for state license renewal.
Reflective Academic Discussion:
Student-to-Nurse Transition: Transitioning requires willingness to pursue lifelong learning, positive professional attitudes, and application of systematic knowledge.
Nursing School Experience: Standardized core curricula, NCLEX-RN preparation courses, frequent examinations, challenging academic questions, and intense clinical experiences empower nursing students to internalize professional identity.