Is Nursing a Profession - Essay Example

Is Nursing a Profession? The dis of the nursing profession has always been seen in the context of an organized group of persons who are all engaged in nursing. But professionalism is beyond this quality alone. There are other criteria involved in the discourse of the concept of professionalism, those that would distinguish whether an area or an occupation, which in this case is nursing, is just an occupation or whether it is a profession. Background For the better part of the 20th century, nursing is considered to be a semi-profession, just an appendage of the medical field, with subsidiary function of medicine that is proscribed by doctors’ orders. Interest in professionalizing the nursing occupation emerged in healthcare organizations in 1970s. This stemmed from the need to provide a substitute motivation for workers with blocked access to structures of mobility and that the ideological draw of professionalism offered the promise of higher degree of control. (Barker 2008, p. 9) Here, it is important to underscore that profession through their scientific credibility becomes a source of power and prestige. Indeed, it arises out of self-interest and provides a means by which occupational groups exert influence to advance their own interest in society. By professionalizing the nursing profession, it was expected that traditional collective action such as unionism would be countered and that nurses, being educated as professionals in colleges and universities, were expected to exercise their knowledge and skills without bureaucratic constraint. Professionalism Criteria The classical criteria that make a field or profession professional were posited in 1915 by Abraham Flexner, an imminent sociologist, who outlined several qualities. The most important of which follows: A profession utilizes in its practice a well-defined and well-organized body of knowledge that is intellectual in nature; A profession constantly enlarges such knowledge and subsequently imposes on its members the lifelong obligation to remain current in order to do no harm; one that entrusts education of its practitioners to institution of higher education; A profession that applies its body of knowledge in practical services that are vital to human welfare; It functions autonomously in the formulation of professional policy and in monitoring its practice and practitioners; it is guided by a code of ethics that regulates the relationship between professional and client; distinguished by specific culture, norms and values that are common among members; (Joel 2005, p. 167) Flexner’s qualities for professionalism stressed rationalism, scientific standards and objectivity. These criteria were addressed by the model that conceptualized nursing professionalism, the Miller’s Wheel. In the wheel model, the center represents the essential foundation of nursing education in an institution of learning and, according to Miller: Each of the eight spokes represents other behaviors deemed necessary in maintaining or increasing nurses’ professionalism. They are competence and continuing education; adherence to the code of ethics; participation in the primary and referent professional organizations, i.e., ANA and state constituent member associations; publication and communication; orientation toward community services; theory and research development and utilization; and self-regulation and autonomy. (Chitty 2005, p. 174-175) With the above factors considered, there are three very important arguments that support existence of the nursing profession. First is the tertiary education devoted to the nursing field. The nursing schools legitimated nursing work not just as an occupation but a profession as well. Secondly, there is the existing of collegiality as a result of the promotion for collaboration, cooperation and the recognition of interdependence among members of the nursing profession. This attribute is demonstrated, wrote Chitty, by sharing with, supporting, assisting, and counseling other nurses and nursing students. (p. 177) The professional organizations formed to this end serve to strengthen such collegiality. They influence the nursing practice by defining the structural and contextual environment in which nurses practice. For example, the structural dimensions of organizations shape nursing practice by having policies related to nurses’ roles, workload, and working environment, while the contextual aspects of the organizations shape the amount of control over practice. (Huber 2006, p. 63) An example of this organization is the American Nurses Association (ANA). According to its bylaws, the purposes of the organization are to work for the improvement of health standards and the availability of health care services for all people, to foster high standards of nursing, and to stimulate their economic and general welfare. (Chitty, p. 174) Finally, there are the nursing standards set up by the profession itself. There are two major documents that guide nurses in their professional commitments: the Nursing Policy Statement published in 2003 and the Code of Ethics for Nurses with Interpretative Statements by the American Nurses Association. The most recent Nursing Policy Statement define itself as “a framework for understanding professional nursing relationship with society and nursing’s obligation to those who receive professional nursing care.” (ANA 2003, p. 1) In regard to professionalism, this is the policy have to say: Professional nursing, like other professions, is an essential part of the society from which it grew and within which it continues to evolve… Professional nursing can be said to be owned by society in the sense that a profession acquires recognition, relevance, and even meaning in terms of its relationship to that society, its culture and institutions, and its other members. (ANA, p. 1-2) The policy statement also contains the definition of the nursing functions in broad and specific terms. Traditionally, for instance, the common elements have included maintaining and restoring normal life function; observing and reporting signs of actual or potential change in physiologic or psychosocial status; formulating and carrying out a plan for the provision of nursing care consistent with the regimen of other treating disciplines; among others. (Joel and Kelly 2003, p. 198) Furthermore, the policy also outlines the professional, legal, and self-regulation of nursing practice. The Code of Ethics, on the other hand, functions as a framework that guides the nurses as a group toward professional self-definition and that it provides evidence of professional legitimacy. The International Council of Nurses and the American Nurses Association, among others have established this framework wherein profession-wide standards of practice were established, promoted and refined. The 2001 Code is consisted of nine provisions: the first three describe the fundamental values and commitments of the nurse; the next three address boundaries of duty and loyalty; and the last three provisions address aspects of duties beyond individual patient encounters. (Nursing World 2001) The nursing of Code of Ethics has been updated throughout the years as the nursing profession and its social context have evolved. In addition, there now exists a body of statutory and case law that governs nursing practice, holding nursing practitioners accountable to a definition of practice that recognizes and codifies practice in accordance with current nursing knowledge and clinical practice standards. If one examines objectively the standard criteria as espoused by Flexner, it is clear that nursing does not satisfy all of them. Particularly, the nursing profession still lack significantly in regard to autonomy. Sociologists, wrote (nursing as a profession), have long contended that an occupation does not become a profession unless the members of that occupation are the ones who make the final decisions about the services they provide. (p. 193) Here, a line is drawn to distinguish the kind of autonomy characterized by decision-making relative to the client and/or patient care from the autonomy from the employing institution. The latter is about autonomous practice wherein practitioners have direct lines of access to clients, peers and professional organizations, as well as to the courts, for their conduct. There is a struggle in the nursing profession in regard to this area because nurses are still subordinated to the authority of organizations such as hospitals. In recent years, however, the challenge in regard to autonomy is being continually addressed and as a result, the freedom to make decisions particularly in patient care has achieved a high degree of recognition. This is because it proves to beneficial not only for the nursing profession but for the health care industry as a whole. For instance, a recent research that studied the integration of the concept of nursing autonomy found that increasing nursing autonomy and control over the practice setting was associated with improved patient care outcomes. (Aiken, Clarke, Sloane, Sochalski, and Silber 2002, p. 1992) Conclusion As cited by this paper, the nursing profession is no longer considered as a mere subsidiary to the medical field. With the Miller’s Wheel model, it is easier to understand how nursing care came to be characterized by a patient-centered approach that is based on a specific nursing theory and is shaped by a nursing process of reasoning. The three arguments, specifically, cited in this paper - education, collegiality and the codes and laws that regulate the profession both among themselves and state laws – they are what make nursing a profession. Despite the fact that there are qualities that are lacking, especially in reference to the standards set for professionalism, the fact is the more fundamental and important elements were satisfied. In light of this, it is also helpful to underscore that there are only few occupations that can claim pure professionalism because of the permeation of corporate and institutional control over most sectors of the economy. References Aiken, L.H., Clarke, S., Sloane, D., Sochalski,J. and Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. The Journal of the American Medical Association, 288:16 1987-1993. American Nurses Association (ANA). (2003). Code of Ethics for nurses with interpretative statements. Washington D.C.: Author. Barker, A. (2008). Advanced Practice Nursing: Essential Knowledge for the Profession. Jones and Bartlett Publishers. Chitty, K. (2005). Professional nursing: concepts & challenges. Elsevier Health Sciences. Huber, D. (2006). Leadership and nursing care management. Elsevier Health Sciences. Joel, L. (2005). The nursing experience: trends, challenges, and transitions. McGraw-Hill Professional. Joel, L., and Kelly, L. (2003). Kellys Dimensions of professional nursing. McGraw-Hill Professional. Nursing World. (2001). Code of Ethics for Nurses with Interpretative Statements. American Nurses Association Online. Retrieved 29 Nov. 2009 < http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses.aspx >. Read More