Putting the Professionalism back into the nursing profession

From the Floor

Putting the professionalism back into the nursing profession.

By

Geneviève M. Clavreul, RN, Ph.D.

Several nurses had gathered in the corridor of their unit and were carrying on a very animated discussion. What, my friend thought could have initiated such an animated discussion, could it be a patient care issues, union talk (contract negotiations were eminent)? Ever curious my friend decided to eaves drop and imagine his surprise to learn that what had the nurses so invigorated was comparing break times and length of said breaks, and when their next scheduled time off would be. They were so engrossed in discussing when their next scheduled break would be that they were unaware that their hallway discussion was being heard by everyone around them, fellow nurses, visitors and patients. Were these nurses aware that their behavior was unprofessional? Unlikely, otherwise they would have chosen to hold this type of conversation behind the closed doors of the nurse’s lounge rather then the very public hallway.
Over the years, while working as a beside nurse and even as a Director of Nursing I have seen nurse behaving in the most professional of manners under the most challenging of circumstances; and of course I have seen the contrary, nurses behaving in the most un-professional of manner disgracing themselves and our profession. Many of us so-called old-timers often bemoan what appears to be a growing lack of professionalism in nursing. Some point to the abandonment of the traditional white uniform as the start of this disintegration of professionalism, others blame the unionization of nursing as the cause, and still others blame the “me-generation” pointing out that this generation has little appreciation of societal norms and the meaning of manners, etc. So what is the state of professionalism in the nursing profession? In my opinion I believe that in many hospitals professionalism is in serious trouble and where there is a lack of professionalism you will often find nurse dissatisfaction, burnout and turnover. As with any good discussion we should always start with a “common point” and in this case it would be the “what does professionalism mean?” For the purpose of this article, I choose to rely on the dictionary. When looking up the definition of professionalism in the Merriam-Webster online dictionary, the search refers you to “professional” and its definition to further define the word and that definition is:
1 a : of, relating to, or characteristic of a profession b : engaged in one of the learned professions c (1) : characterized by or conforming to the technical or ethical standards of a profession (2) : exhibiting a courteous, conscientious, and generally businesslike manner in the workplace
There are occasions when I think good and caring nurses often feel as though professionalism is out of style in the nursing profession, and I would respond that like chivalry, professionalism is not dead – yet. All too often, for a variety of reasons nurses often fail to meet the definition of a “professional”. This lack of “professionalism” usually starts small, the occasional tardy nurse, or “have to leave early to pick up the kids”, leaving their duty station a mess because of the new admission admitted minutes before the end of shift, and so forth are common trends that if not “nipped in the bud” can quickly spread to other susceptible members of the nursing team. The leadership and other members of the nursing team often overlook this behavior when it first manifest itself, and when the nursing team is comprised of strong, motivated, and yes, professional members the behavior is an exception to the rule and does not become the new “norm” of the unit. However, where the nursing team is working under continuous stress (real or perceived), constant short staffing, lacking of strong internal (head/charge nurse) or external (Director of Nursing [DON]/Chief Nursing Officer [CNO]) leadership then unprofessional behavior can subsume what professionalism is left.
If nurses were to be honest with themselves, many would agree that nursing today in many hospitals sit at this very brink, the thin line between the professional versus the unprofessional. We saw it not that long ago when two nurses chose to take out their frustrations on the evening shift by intentionally feeding the patients under their care excessive doses of exlax. Thank goodness their plot was found out and they are now facing criminal charges. We see it with the continuous battle for supremacy, diploma/A.D.N. prepared nurse versus B.S.N. prepared nurse and the jockeying to be recognized as the only “real” nurse. We see it when strikes (rare as they are) occur and nurses feel driven to extreme behavior such as locking out relief nurses from much needed life saving equipment by altering codes, misplacing instruction books, etc. Though these examples are the “extreme” of the unprofessional meter, they can and do grow out of the lesser “offensive” unprofessional behavior. Sleeping or eating at the bedside, arriving late or leaving early from the shift, arriving unkempt to work, gossiping in public areas, carrying on a conversation in a language not understood by all present are just some examples of more common unprofessional behavior.
When we began to accept mediocre nursing behavior, care, and practices we lay the ground work for even greater acts of unprofessional behavior that is exhibited not by a few but by the many. When this occurs then nursing has become devoid of professionalism, and one can only think that Florence Nightingale must be doing “jumping jacks” in her grave (or as my children remind me “mom, that’s rolling over in her grave”). Nursing does not ask us to be perfect (except within our practice), but it does demand that we behave as role models not only to other nurses, but healthcare professionals and those that look to us. Consistent lack of professional behavior can and does drive away good nurses, leaving the “bad” and mediocre nurses behind. Most of the time it is the lack of social skills that is often the main culprit. We all know that individuals rise, or sink as the case may be, to the occasion. Where professionalism is stressed and expected nurses, even the mediocre ones strive to excel because such excellence is rewarded and recognized. On the contrary where there is little expectation of excellence then the mediocre and “I don’t give a darn” nurse will find safe haven and thrive. Like with parenting keeping expectations high takes work and effort, and as with parenting many don’t put the energy forth as it is so much easier to just shrug your shoulders and say “well what can I do” – there is a nursing shortage after all and I need the body.
I used to say that whether I was head nurse or DON I never had to fire anyone (place individuals on suspension yes, but that’s for a different article). There were two reason why I never had to fire any one, the first I kept excellent documentation (I see another article in this) and I always modeled and expected the highest. Nurses that were just in it for the paycheck, or “putting in their time” either rose to the occasion and began exhibiting the new behavior or quietly left for other pastures. This process cost in the short run a loss of some nurses, but it didn’t take long for the remaining nurses to “advertise” the new professional atmosphere at work and I often made up the loss of a few nurses, with a waiting list of nurses who wanted to join our nursing team.