Professional and Educational Development in Nursing

Fall, 2012

At the end of this discussion, the student will be able to:

Explain the difference between an occupation and a profession (this is one of the questions) Define characteristics of a profession Analyze barriers to professionalism Use models to examine nursing professionalism Name key people and events that influenced the development of nursing education. Describe current educational pathways of nursing. Examine challenges of nursing education and professional development.

I Want a Job!
Why did you enter the nursing program? What did you do before becoming a nursing student? (Do you even remember back that far?)

Who are you now?

Occupation Defined as what a person does to make a living or how one spends time. Task-oriented (mindless, something very repetitive without any thought process) Most of work is manual Trained on-the-job No specific value-system associated No specific career path Accountability lies with supervisor/employer

Profession -requires a specialized knowledge

Develops from an occupation that specializes in
Service (advocating for your patient) Knowledge (a specialized knowledge is what separates you) Autonomy (you dont have to go back to your supervisor when a decision has to be made)

Professions develop a collective identity

Formal education Evidence based practice Integrated value-system (code of ethics, same familiar value system) Legal protection (protecting your license)

Professionals are different from workers in an occupation

1. Preparation

College setting Prolonged education, specialized Orientation (socialization) to beliefs/values

Calling Part of personal identity Im a nurse! Transcends expectation of material reward

2. Commitment

Barriers to Professionalism in Nursing (question on test)

Variability of educational background (see later discussion) Historical issues
Gender (1901 men banned from nursing in military) Obedience (1868 AMA/Hospital Admin promoted training.persisted through 1960s) Altruism (less expectation of monetary compensation) Power of other organizations (AMA, legislation)

Public perception
The nurse does what the doctor says The nurse helps the doctor

Kellys Criteria of a Profession

Accountability (personal integrity) Autonomy (still under development in nursing) Altruistic (motivated by service) Associations (advocates for the profession)

Body of knowledge (specialized)

College (higher learning Caring (vital to humanity) Code (guide to decisions/conduct)

Millers Wheel of Professionalism

Code Publication Theory

Organization

University education and Science background

Community Service Continuing Education

Self-regulatory Research

Professionalism in Nursing

Professional Nursing Documents

ANA published books (3) (Foundation of Nursing package) Nursing Social Policy Statement (a published contract outlining nurses obligations to society) Nursing: Scope and Standards of Practice (what a reasonable and prudent nurse would do) Code of Ethics for Nurses With Interpretative Statements (see back cover of your Chitty and Black text) *These publications are available for purchase from ANA website, e-versions only $3.95*

Collegiality
What does this mean to you? Treating you as equals, shared understanding, shared purpose Do you think nursing has a reputation for this? No they dont (nurses eat their young) Why? b/c it was passed down Why not? it was miserable for me and so I will make it miserable for you What are ways we can promote collegiality in the nursing profession? (further discussion week 4)

Nursing Education History 1800s

(1860-1899) Training schools affiliated with hospitals (Nightingale suggested administration separate from nursing education, and public funds to be used for nursing education) U.S. at turn-of-century was focused on hospitalbased training. *Note different mind-set between training and education *Primary reason for nurse training structure was to staff the hospitals with free labor*

Nursing Education History 1900s

Main concerns of nursing leaders:
Training not well-regulated Need for leadership and scholarship
1899 ANA founded (professionals getting together creating the structure) 1900 International Council of Nurses formed 1901 American Journal of Nursing first published (created the literacy)

1907 Mary Adelaide Nutting, worlds 1st nursing professor (Teachers College, New York)

Nursing Education History

Famous studies: 1912 (Nutting) nationwide study of nursing students training 1923 (Goldmark Report) advocated for education at collegiate level rather hospital-based training 1934, 1937 (NLN) recommend college education, but also outlined 3 year diploma curriculum (hospital based, but with college courses included) they create the standards (what should we be teaching)

Early Studies Consensus

College for nurses Students NOT to be used to staff hospitals Standards are needed Minimum qualifications for graduation identified

Nursing History set the stage

Registration required
1903, North Carolina passed 1st nurse practice act By 1921, 48 states had laws regulating nursing practice (but note that women did not receive the right to vote in this country until 1920, so laws made by non-nurse men!*) *problem with early laws is that people could function as caregivers, for less pay, as long as they did not use the title nurse.

LPN (LVN) Pathway

Started in 1930s in response to shortage due to WW II Technical degree 1 year program Limited scope of practice by law
(question: What has your experience been as an LPN in the area of scope of practice by law, and scope of practice by facility administration demand?)

RN Nursing Education Pathways 1

Diploma
Hospital-based Most popular 1900-1960s Used to be 3 years, now 2 years (question: Health care more complicated now, so what is left out in a 2 year education? Currently offers college credit (didnt previously) Least used path at this time

RN Nursing Education Pathways 2

Associate Degree
1952 Mildred Montags doctorial dissertation Originally a technical degree, 2 years *Main reason was nursing shortage* (question: Is shortage an adequate reason to lessen the educational standard?) Montags model was changed from a technical degree to a pathway to RN (includes leadership, decision-making education, etc.) Usually 3 years for completion

RN Nursing Education Pathways 3

BSN
Recommended by every major study and organization since early 1900s as the minimum preparation for professional nursing. ANA position papers
1965 BSN minimum for professional practice and ADN for technical practice (LPN not recommended) 1979 dates emphasized (by 1985, BSN, and only 2 levels of practice by 1980) (questions: How many levels of practice for nurse do we have in the United States? Does this title matter? Does the public know the educational levels of its nursing caregivers? Does that matter?)

Questions
Do you believe classes not directly related to clinical practice are less important, equally important or more important than additional clinical classes? How would you structure a nursing curriculum to cover what is important in nursing education?

How do we solve the problems of Nursing Pathways?

Promote Articulated Programs Decide by legislation the minimum qualifications Cooperation needed between ANA, NLN, AACN, bedside nurses, facility administrators, the public, legislators, educators, and all other stakeholders Promote acceptance into BSN/MSN programs (students with other degrees, ADNs wishing to further education, fast-track to MSN, etc.)

Certification Programs
Certification comes AFTER License Differs from licensure in that license is stateregulated and certification is given by a discipline-recognized accrediting organization Applies to area of specialty Validates proficiency in practice (remember Benners novice to expert theory?) youhave different areas based on your knowledge base. Novice, beginner, expert http://www.testprepreview.com/nursing_certificatio ns.htm

Certification Programs.Problems?
Who decides the standards of all the certifications? American Association of Colleges of Nursing (AACN) 2008 Consensus Model http://www.nursecredentialing.org/APRNFAQ.aspx#Q25 This is gold-standard in organizing standards and focus for advanced practice nursing. Can be used as model for organizing standards in other areas of certification.

Graduate Programs
1950s/1960s Masters viewed as terminal degree 1970s/1980s focus: clinical specialization
CNS very popular, not a Masters degree PhD was educator track ND phased to DNP for clinical practice

1990s/2000s Masters for Nurse Practitioner very popular 2010s Consensus Model Implemented

Continuing Education
Means post-licensure education State of OHIO 24 hours every 2 years See Code of Ethics provision # 5 Some states require continuing education for re-licensure. Some do not! (see page 165 in Chitty and Black text as well as updated website) http://ce.nurse.com/state-nurse-cerequirements

Continuing Education Notes

Continuing Education (CE) is counted in number of contact hours
(1 50-60 minute hour = 1 CE)

13 states still have NO continuing education requirements (click on website names of states to find out which ones) 2 states do not have CE requirement stated in number of hours, but the practice acts specifically list continued competency and personal self-regulation as law!

Interesting CE examples
New York
4 hours every 4 years on infectious disease 2 hours on child abuse (1 time only)

Oklahoma
1 of 5 options for re-licensure is 24 CEs

Washington
531 hours of clinical nursing practice every 3 years (for a part timer need to work at least 177 hours/year on average) 45 hours of CE, to include self-assessment and reflection!

Oregon
Nothing needed except 7 hours of pain management (question: Why only just pain management?)

Ohio Continuing Education

CE Requirements for RNs: Each person licensed as an RN in Ohio must complete twenty-four (24) contact hours of approved CE to renew their license. A nurse who has been licensed by endorsement for less than or equal to one (1) year must complete twelve (12) contact hours. At least one (1) of the required contact hours must be Category A. The contact hours must be completed within two (2) years prior to renewal. ALL licensee and certificate holders are required to complete at least one contact hour related to Chapters 4723,1-23 of the Ohio nurse practice code and rules.
ref: http://ce.nurse.com/state-nurse-ce-requirements/ohio

Also see FAQ:

http://www.nursing.ohio.gov/PDFS/education/CE%20FAQ%203.12.pdf

Current/Future Challenges
Diversity issues Critical thinking Collaboration Health promotion issues Informatics Health care costs Faculty shortage expected