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
-American Nurses Association
Nursing includes the promotion of
health, prevention of illness, and the care
of ill, disabled and dying people.
Advocacy, promotion of a safe
environment, research, participation in
shaping health policy and in patient and
health systems management, and
education are also key nursing roles.
- International Council of Nurses
The unique function of the nurse is to assist the
individual, sick or well, in the performance of those
activities contributing to health or its recovery (or to
peaceful death) that he would perform unaided if he
had the necessary strength, will or knowledge.
-Virginia Avenel Henderson
Profession is a classic piece of educational literature
that provided the impetus for the much needed reform
of medical education.
–Abraham Flexner (1910)
Professionalism involves the application of knowledge
and skills, high standards of practice, leadership, self
regulation, professional commitment, social values
and self directed activity.
- Muller (1998)
Richard H Hall identified 5
indicators of individuals’
Use of a professional
organization as a primary
point of reference.
Belief in the value of public
Belief in self regulation.
Commitment to a
profession that goes
A sense of autonomy in
Characteristics of a Profession
A profession requires an extended education of its
members, as well as a basic liberal foundation.
A profession has a theoretical body of knowledge
leading to defined skills, abilities and norms.
A profession provides a specific service.
Members of a profession have autonomy in decision
making and practice.
The practice as a whole has a code of ethics.
Criteria of Nursing Profession
Body of Knowledge
Code of Ethics
Two terms related to Profession
Professionalism: It refers to the professional
character, spirit or methods. It is a set of attributes, a
way of life that implies responsibility and
Professionalization: It is the process of becoming
professional, that of acquiring characteristics
considered being professional.
Nursing: Occupation vs Profession
Occupation is defined as
“What occupies or engages one’s time; business;
- Webster (1996)
Profession is defined as
“A calling, vocation or form of employment that
provides a needed service to society, possesses
expertise, autonomy, long academic
preparation, commitment, & responsibility”
Five core competencies:
Provide patient-centered care
Work in interdisciplinary teams
Apply quality improvement principles
-IOM Summit in 2003
Commitment to their
profession is strong.
They deliver much of
their personal identity
from their work and
consider it as an integral
part of their life.
Characteristics of Profession vs.
On the job, trade school, community
Usually 4 or more years
Shorter preparation time
Values, beliefs, ethics always present
(code of ethics)
Values, beliefs, ethics not always
Commitment & personal ID always
Commitment & personal ID not
Supervised by others
Work stable, rarely change profession
Often change jobs
Accountability usually rests with
Nursing Pathway to
Nursing pathway to professionalism has not been
smooth. For decades an ongoing subject for discussion
in nursing circles has been the following question “is
nursing a profession”.
Miller’s Wheel of Professionalism in Nursing
A profession utilizes in its practice a well defined
and well organized body of specialized
knowledge which is on the intellectual level of
A profession constantly enlarges the body of
knowledge, its uses and improves its
techniques of education and service by the use
of scientific method.
A profession entrusts the education of its
practitioners to institutions of higher
A profession functions autonomously in the formulation
of professional policies and in the control of professional
activity there by.
A profession applies its body of knowledge in practical
services which are vital to human and social welfare.
A profession attracts individuals of intellectual
personal qualities who exalt service above personal
gain and who recognize their chosen occupation as a life
A profession strives to compensate its practitioners
providing freedom of action, opportunity for
continuous professional growth and economic
Services provided vital to humanity/society
There is a Specialized knowledge that continuously enlarged
The services involve Intellectual activities, accountability:
individual responsibility is a great feeling.
Education in higher learning institution
Autonomy - Practitioners are independent, control own policies
Altruism - Practitioners are motivated by service and consider
their work as an important part of their lives
There is a Code of ethics to guide decisions and conduct
There is an organization (association) that encourages and
supports high standards of practice
Miller’s Wheel of Professionalism
Center represents the
essential foundation of
Competence and Continuing
Adherence to the code of
Participation in professional
Theory and research
development and utilization
Self-regulation and autonomy
Professional Nursing Practice
Nurse Practice Acts
It regulates the licensure and practice of nursing.
The nurse practice act of each state defines the practice
of nursing within that area.
The board of nursing in each states sets requirements
Professional Nursing Practice…..
Standards of Practice
As nursing became an independent profession, it began
to develop its own standards of practice.
It serves as a guideline for providing and evaluating
nursing care and serves as criteria in legal questions of
whether adequate care was given.
STANDARDS OF PROFESSIONAL
Association (ANA) 2010
1. ANA Standards of
2. ANA Standards of
ANA Standards of Care
Standard I: Assessment
The registered nurse collects comprehensive data pertinent
to the healthcare consumer’s health or the situation.
Standard II: Diagnosis
The registered nurse analyzes the assessment data to
determine the diagnoses or issues.
Standard III: Outcome Identification
The registered nurse identifies expected outcomes for a plan
individualized to the healthcare consumer or the situation.
Standard IV: Planning
The registered nurse develops a plan of care that prescribes
strategies and interventions to attain expected outcomes.
Standard V: Implementation
The nurse implements the interventions identified in the
Standard 5A - Coordination of Care
Standard 5B - Health Teaching and Health Promotion
Standard 5C - Consultation (Graduate Prepared Specialty
or Advanced Practice Nurse)
Standard 5D - Prescriptive Authority and Treatment
(Advanced Practice Nurse)
Standard VI: Evaluation
The registered nurse evaluates progress toward attainment of
ANA Standards of Professional
Standard VII: Ethics
The registered nurse practices ethically.
Standard VIII: Education
The registered nurse attains knowledge and competence that
reflects current nursing practice.
Standard IX: Evidence-Based Practice and Research
The registered nurse integrates evidence and research findings into
Standard X : Quality of Practice
The registered nurse contributes to quality nursing practice.
Standard XI: Communication
The registered nurse communicates effectively in a variety of
formats in all areas of practice.
Standard XII: Leadership
The registered nurse demonstrates leadership in the
professional practice setting and the profession.
Standard XIII: Collaboration
The registered nurse collaborates with the healthcare
consumer, family and others in the conduct of nursing
Standard XIV: Professional Practice Evaluation
The registered nurse evaluates her or his own nursing
practice in relation to professional practice standards and
guidelines, relevant statutes, rules and regulations.
Standard XV: Resource Utilization
The registered nurse utilizes appropriate resources to plan
and provide nursing services that are safe, effective and
Standard XVI: Environmental Health
The registered nurse practices in an environmentally safe and
Professional Responsibilities and
Roles of Nurses
Expanded roles of Nurse
Provide direct care, educate client & restore health
Advanced Practice Nurses (APN)
Independent functioning nurse with masters’ degree in nursing
Advanced education in pharmacology and physical assessment
Certification and expertise in a specialized area of practice.
Clinical Nurse Specialist (CNS)
Certified Nurse Midwife (CNM)
Certified Registered Nurse Anesthetist (CRNA)
Works in schools of nursing, staff development of health
care agencies and client education departments.
manages client care and the delivery of specific nursing
services within a health care agency.
begins her position such as the charge nurse or assistant
Attributes of Professionalism in
How do we stay
Involved in nursing
Continually seeking out
A professional nurse is
always curious to
having the ability to
carry out the
appropriate course of
having the capacity as a
nurse to determine
her/his own course of
Innovator and Visionary
Innovation: Bring in
new methods, ideas, etc.
Visionary: The act or
faculty of seeing, sight;
ability to plan or form
policy in a far-sighted
Admit mistakes and
learns from them
Keeps their word
Respectful of others
Understands the needs
of the patient
Recognizes that the
family members of the
patient are also their
Willingness to help
Honesty and Integrity
Does not gossip
Sets the tone
Should be positive
First impressions are
Can instill confidence or
Represents your pride in
yourself and your
Educational Preparations of
Professional Registered Nurse Education
Diploma in Nursing
Associate Degree in Nursing
Basic BSc Nursing
Post Basic Nursing:
Factors Influencing Contemporary
Greater financial support provided through public
and private health insurance programs has
increased the demand for nursing care.
Increased cost of health care
Current health care industry is shifting its
emphasis from inpatient to outpatient care
People are better educated and have more knowledge about
health and illness.
The publics’ concept about health and nursing also changed
Consumer has become an active participant in making
decisions about health care.
More people are living away from the extended family
and the nuclear family.
Many single men and women rear children and in many
two parent families both parents work.
Adolescent mothers also need specialized nursing
services, both while they are pregnant and after their
babies are born.
Science and Technology
Nurses will need to expand their knowledge base and
technical skills as they adapt to meet the new needs of
More nurses are using collective bargaining to deal with
The ANA participates in collective bargaining on behalf
of nurses through its economic and general welfare
Provides leadership that affects many areas of nursing.
Accreditation of nursing programs is given by
associations which are regulatory bodies.
Information and Telecommunications
Nurses may need to interpret internet sources of
information for clients and their families.
Nurses has to help client to access high quality, valid
websites; interpret information and then help to
evaluate the information.
Legislation about nursing practice and health matters
affect both the public and nursing.
E.g. Patient Self Determination Act (PSDA)
From demographic data, needs of the population for
nursing service can be assessed.
1. Aging nurses workforce
Number of nurses under 30 decreasing
Number of nurses age 40-49 increasing with 40% older than
50 by 2010
New graduates entering workforce at an older age and will
have fewer years to work.
2. Aging of nursing faculty
As nursing faculty retire, nursing program may have fewer
faculty to educate further nurses.
3. Reduced entry of younger population into nursing
4. Aging population
Increased health needs
5. Increased demands for nurses
Increased need for specialized nurses
Shorter hospital stay resulting in transfer of clients to long
term care and community setting creating increased demand
for nurses in the community.
6. Workplace issues
Lack of sufficient support staff
Difficult recruiting and retaining nurses
Impacts of nursing shortage on healthcare:
Increased nurses’ patient workloads
Increased risk for error, thereby compromising patient
Increased risk of spreading infection to patients and
Increased risk for occupational injury
Increase in nursing turnover, thereby leading to greater
costs for the employer and the health care system
Increase in nurses' perception of unsafe working
conditions, contributing to increased shortage and
hindering local or national recruitment efforts
International Council of Nursing
American Nurses Association
National League for Nursing
American Association of Colleges of Nursing
National Student Nurses Association
The Indian Nursing Council
Trained Nurses Association Of India
The Student Nurses Association
TRENDS AND ISSUES IN CURRENT
AND FUTURE NURSING
Influence of today’s health care settings
Expansion of Employment opportunities
Nursing’s public perception
Nursing impact on Politics and Health policy
Trends in India
Changes in society
Intensive efforts of government to meet the health needs of
Gradual improved literacy level of the people with the
growing awareness of health needs.
Advanced scientific technology
The changing role of women and the continuing growth of
Changes in other professions
Growing specialization in medical field is resulting in a trend
towards increased specialization in nursing.
The development of new diagnostic procedure and
equipments make specialization even more necessary.
Patients’ Bill of Rights
The nurses are also accountable for patients care and have
legal responsibilities for the patient.
Developments in other discipline
Nursing is moving towards more specific
Leadership within the profession
Leadership within the profession also influences the
trends in nursing.
Nursing is moving towards professionalism due to the
untiring efforts of nurses who have been dedicated to
achieve the aim
Working and studying in abroad
Shortage of nurses in other countries, higher salary paid
in abroad is the main causes for the working of Indian
nurses in abroad.
Greater specialization in nursing education and practice
Greater specialization in nursing education and practice is a
trend related to that in the medical profession and the
growing amount of scientific knowledge available.
Working conditions for nurses are also changing.
There is a gradual change towards shorter and more
convenient hours of duty, better accommodations and higher
Trends in other countries
Trends in other country also influence the trends in the
nursing profession in India.
The rapid development of the degree25 programme has
promoted the same emphasis and development here for
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