Nursing as a profession

SMT. DAKUBEN SAREMALJI SANCHETI NURSING INSTITUTE, SUMERPUR
2020
Management of Nursing
Services & Education
Nursing as a Profession
Kuldeep Vyas M.Sc. CHN

Management of Nursing Services & Education 2020
Kuldeep Vyas M.Sc. CHN Page 2
Nursing as a Profession
INTRODUCTION
Nursing is a professional service devoted to promoting health care and social welfare, nursing care helps
to implement gained scientific knowledge and skills on the nursing care service for those who are sick
and require good quality health care, resulting in rejuvenation of health and eradication of illness.
PROFESSIONALISM AND THE NURSING PROFESSION
The concept of profession was described as early as 1915 and discussed by professional sociologists who
established certain criteria:
1. Using a body of specialized knowledge on the level of a practice
2. Constantly enlarging the body of Knowledge and improving its service through scientific
methods
3. Educating its practitioners in institutions of higher education.
4. Offering services that are vital to human and social welfare
5. Making policies and controlling its own activities
6. Attracting those who put service above personal gain and accept their occupation as their life
work
7. Striving to provide freedom of action and opportunity for continued professional growth and
economic well-being
Characteristics of Professionalism
Houle (1980) identified characteristics of professionalization:
1. A concept of deputation open to change
2. Mystery and thorough knowledge of nursing theory.
3. Ability to solve problems
4. Application of theoretical knowledge
5. Continued seeking of self-enrichment by its members.
6. Official training.
7. Authorization system to certify competence.
8. Development of a subculture.
9. Legal augmentation of professional standards,
10. Ethical practice
11. Penalties against incompetent or unethical practices.
12. Public acceptance.

ESSENTIAL QUALITIES OF A NURSE:
REGULATORY BODIES
Indian Nursing Council
The Central Government has established Indian Nursing Council (INC), by an act of parliament in 1917.
The INC is a self-governing body under the Government of India. Under Section 3(1). this INC under the
act of parliament in year 1917 has framed regulatory body of the Ministry of Health and Family Welfare,
which was constituted by the central government in order to establish a uniform standard of training for
nurses, midwives and health Visitors.
The main goals of the INC are as follows:
1. To accomplish and evaluate a fixed standard of nursing education for the nurse midwife, auxiliary
nurse-midwives and health visitors by performing regular appraisal of those institutions

2. To recognize registered nurses and midwives belonging to different nursing courses and their
qualifications under Section 10(2)(4) of the Indian Nursing Council Act, 1947 for the purpose of
registration and job placement in India and abroad
3. To provide approval for the registration of Indian and foreign nurses having foreign nursing
qualification under Section 11(2a) of the Indian Nursing Council Act, 1947.
4. To frame the nursing syllabus rules and regulations for nursing programmes
5. To provide guidelines to the state nursing councils.examining boards, state governments and
central government to upgrade the nursing education with good standards of nursing care.
The power to withdraw the recognition of qualifications under section 14 of the Act stands in case the
institution fails to maintain its standards under section 1461 Xb) that an institution recognized by a
State Council for the training of nurses, midwives auxiliary nurse-midwives or health Visitors does
not satisfy the requirements of the INC.
Purpose of INC
1. To formulate a national policy for training and practice of nursing depending mainly on the
culture and philosophy of the country
2. To prescribe the syllabus for the training of nurses of all levels
3. Nursing personnel have to be identified with an appropriate educational programme for each level
in the system of the country
4. The council has the authority to inspect the training institutions periodically to ensure that its
functioning follows the prescribed standards.
Amendment of the Act of INC
The steps or process to amend the INC Act are as follows:
1. A proposal is to be sent to the Government of India, Ministry of Health and Family Welfare
2. The above ministry will consult the Ministry of Law.
3. It will then go to the cabinet (legal cell),
4. When it is approved by the cabinet (legal cell), it will be placed before the Lok Sabha.
5. When the amendments are approved by the Rajya Sabha, then it will be gazetted and notified.
Functions of INC
1. Recognizes nurses as a separate branch in health services.
2. Regulates nursing training sets uniform standard or types of training for nurses throughout the
country
3. Recognizes qualifications (basic to higher). Any recognized qualifications shall be sufficient for
enrolment in any state register.
4. Seeks information on course of study and training and examination from any state from time to
time as required.
5. Inspect schools and colleges of nursing
6. Can withdraw recognition of nursing institutions.
7. Maintains Indian nurses' register.

8. Has the power to make regulations
9. Permits title, badge and uniform for registered nurses
10. Upholds the standard of profession
11. Brings out publications.
State Nursing Council (SNC)
The SNC is constituted in respective states. The main purpose is to regulate better training for nurses,
midwives and health visitors.
Salient Features
1. Has provision for autonomous body, comprising the majority of nurses, and is endowed with
decision-making powers
2. Carries out compulsory registration for all nurses and midwives practising within the state
3. Has provision for nurses, midwives and public health nurses to elect their own represents tives to
the respective state
4. Has a power to regulate nursing education through prescribed curriculum and to enunciate
examination policies
5. Has provision for recognition of educational institutions of nursing and withdrawal of such
recognition if necessary
6. Different types of basic as well as post basic nursing training programmes are conducted by some
of the SNCs.
Functions of SNC
1. Registration carries out student registration after admission to a basic nursing programme And
final registration after completing the course.
2. Exotirations are conducted for the different courses throughout the year
3. Changing surname after marriage, the surname of the trained nurses are changed if wanted
4. Inspection of training institution and granting recognition or withdrawal of recognition
5. Maintenance of different register for different categories of nurses.
6. Change of address of the trained nurse if wanted by the nurse.
7. Issue of duplicate certificate for loss of original certificates
8. Additional qualifications registration for up-to-date statistics for higher qualifications
9. Renewal of registration
10. Reciprocal registration
11. Abroad verification
12. Publication
13. Construction of syllabus including required courses in state.
14. In-service education programme.
15. Research.

CURRENT TRENDS AND ISSUES IN NURSING
A number of forces that have affected the development of professional nurse till continue to affect
significant issues these include:
1. Societal images and expectations of nurses
2. Degree of the nursing profession.control over the quantity and quality of practitioners
3. Impact of technology and theory on nursing practice its roles and setting
4. Professional self images of nurses.
5. Source of financing for health care services
The changes that seem likely to occur in due course will be in the demographic the deteriorating
environment, risky lifestyle, economics of health care and governmental regula tion of health care. These
will affect changes in both nursing practice and nursing education.
Issues Affecting Nursing Practice
1. Demographical changes: The trends important to the future of nursing include the rising number
of elderly people continuing increase in poverty, increasing cultural diversity in the population
and a continuing urbanization. Each has implications for nursing.
1) Many older persons a healthy, but the likelihood ut illness becomes greater as people age.
it indicates clearly that nurses of the future must be prepared to work effectively with a
rising number of elderly persons.
2) The number of people living below the poverty line is increasing, particularly among
children and elderly. When basic needs for food clothing and shelter are unmet or uncer
tain, health care becomes a luxury.
3) Immunization for children care for pregnant women, nutritious meals and other health
maintaining factors are neglected even though some development has been made on these
issues.
4) Poor people tend to put otf seeking care until illness is advanced and thus harder to treat.
5) Preventable cnditions are often not prevented due to lack of education, lack of sanita-
tion, and crowded living condition, improper shelter, homelessness and a host of other
poverty-related factors.
6) Nursing as an protesion is committed to provide care to all people, regardless of social
and economic factors
2. Environment changes: Major environmental tragedies such as nuclear power plant accidents
burning oil wells tsunamis gradual decline in the purity of the air, water, deteriorating plant and
animal life of the universe lead to many social and health problems.
3. Changes to healthy practices: Obesity is a predisposing cause for a number of illnesses and is
due to unhealthy dietary habits, lack of exercise and stress Other causes include having contact

with multipartners for sex, which leads to HIV/AIDS. Substance abuse is another unhealthy habit.
Given the predominance of these undesirable lifestyle factors, it is clear that nurses will play an
increasingly important role in educating people about wellness and self- care.
4. Emerging bioethical issues:
Issus related to birth involves processes that prevent conception or terminate pregnancy
prematurely as well as processes that enable conception and pregnancy to occur through invasive
technological interventions Development sterilization contraception and aborton on the one hand,
and test tube conception and artificial insemination on the other evoke strong feelings from
various groups and individuals
Nursing Education
In the future nurses will need broad-based education, assessment skills, technical competence And the
ability to deal with rapid change. The knowledge base and technology used in providing nursing care will
continue to increase as well as the nurse's need for skill and ability in:
1. intensely acute aspects of care,
2. diagnostics and decision-making
3. patient teaching,
4. coordination of less-skilled workers and
5. Collaboration with patient and health care professionals to improve the quality of health.
In the earlier days, the entry level for the profession was certificate level and diploma level Now, in the
changing circumstances people are thinking of no less than undergraduate (B.Se Nursing degree) as the
entry level of professional nursing Entry to a nursing course could conceivably occur at one of the four
levels: diploma (D.GIN.M.), bachelor's degree (UG-BSc. Nursing), master's degree (PO MSc Nursing) or
the doctoral degree (Ph.D. Nursing).
The current pattern, entry at diploma level, with professional education at the UG level (bach bachelor's
degree) might be perpetuated There are some who propose that education for entry to professional nursing
be moved to the master's level rather than the basic bachelor degree level This level of education would
prepare the student for a combination of specialized and generalized practice appropriate for developing
the health care delivery system. All students would need prior general education and possible a bachelor's
degree for entry into nursing which would strengthen the liberal arts and science base for practice.
So it is better that after PUC science, students can join a BSc. nursing degree course. After a few years of
experience in bedside nursing or community health nursing, they can join the Master's degree course in
nursing. After that they can think of doing a doctoral degree course in nursing in their respective interest
in the field.
Professional Ethics: Ethics means a set of laws or principles that gover the right conduct or behaviour.
Nursing ethics means a set of principles that govern the nursing behaviour, which leads to a healthy
profession.
1. At international level, the nurse’s code was first established by the International Council for
Nurses (ICN) at Sao Paulo, Brazil, in the year 1953. The code of ethics was revised in Frank furt,

Germany, in the year 1965, where it was named as The ICN Code of Ethics. The INC adopted the
ICN code of ethics for nurses in the year 1973.
2. Importance of ethics:
Nurses and People
1. The most important duty of a nurse is to provide care for those who require nursing care
2. Nunheild always respect patient's rights, values, customs and spiritual beliefs while providing
care
3. Nurse should provide adequate information about patient's treatment to the patient through out the
care
4. Nurse should be very much confidential about patient's details and documents
5. Nurse should meet the needs of the society, and organize and support the actions to do the same
6. Nurse is ultimately responsible and should take actions to sustain and protect our environ ment
from all kinds of destruction, pollution, depletion and degradation
Nurses and Professional Practice
1. The nurse carries personal responsibility. She or he is always accountable for the nursing
practice.
2. The nurse should maintain her/his own standardized personal health in order to provide good
quality of care.
3. The nurse should use her/his own intelligence to ascertain accepting and rejecting the re
sponsibilities
4. The nurse should follow standardized principles of nursing care, which will ultimately create
public respect towards the nursing profession.

5. The nurse plays an important role in planning and implementing critical nursing care, and
maintaining acceptable standards of care in management, education and research
6. Nurse should be active and alert in using reports and findings of research to develop new
nursing practice.
7. A nurse, acting with the help of professional organizations, establishes equitable social and
economic working conditions in his or her nursing practice.
Nurses and Co-workers
1. Nurse always maintains a healthy and smooth relationship with co-workers
2. Nurse also ensures and safeguards the patient from any danger created by the co-workers
CODES OF NURSING ETHICS:
The International Code of Nursing Ethics:
1. The fundamental responsibility of a nurse is to conserve life and to promote health. Every
nurse is a teacher of health by example.
2. A Nurse must be adequately prepared to practise nursing and be willing to continue to learn
new ideas by reading and attending meetings
3. The nurse must learn to respect authority.
4. The nurse must carry out the doctor's orders accurately and sustain confidence in the doctor,
and all members of the health team.
5. The nurse should report any unusual condition or symptoms to the doctor or the in-charge
nurse.
6. The religious beliefs of a patient should be respected.
7. The nurse should hold confidential all information given to her/him.
8. When a patient requires continued nursing care, the nurse must remain with the patient until
adequate relief is available.
9. The nurse has the obligation to give conscientious service and, in return, is entitled to just
remuneration.
10. A patient should always be called by his/her full name.
11. Punctuality is very important for every nurse.
12. Obedience is very important in observing rules and regulations.
PRACTICE STANDARDS FOR NURSING:
Standards ensure practising things the right way and doing things how they should actually be done
Standard and quality go hand in hand, and standard of care is bound by ethical values A standard has its
own scientific background for any type of nursing care.
Sources of Nursing Care Standards
There are many nursing Associations that strictly establish the standards of nurse ing care.
1) The ICN

2) The INC SNCs and the Medical Council Of India-the regulatory bodies that control the in
institutions to follow the ethical laws and regulations
3) Professional organizations like Trained Nurses Association of India (TNAI), Government Nurses
Association of Karnataka (BANK) and American Nurses Association (ANA)
4) Directorate of Health and Family Welfare Ministry of Health and Family Welfare--report sible
for health for all
5) Universities and institutes, e.g. Rajiv Gandhi University of Health Sciences (RGUHS), Na- tonal
Institute of Health and Family Welfare (NIHFW), etc.
Classification of Standards
Standards of nursing can be classified into the following
1) Ends standards
2) Means standards
1) End standards: This means that it is always oriented to the patient. This describes the change in
the expected behaviour of the patient or desirable change of behaviour as expected
2) Means standards: This explains performance of the nurse or care given by the nurse to the
patient: how good and effective was it and the best way in which it could have been deliv ered.
Standards in nursing care are established to evaluate and improve the care; therefore, standards of
nursing care will always be understandable, measurable and achievable.
Main components of standard of care are as follows
1) Structure standard
2) Process standard
3) Outcome standard
1. Structure standard: It means the blueprint of the organization or the entire set up of the in
stitution. The goals objectives and philosophy of the institution am the main components. It also
means the quality that is maintained in constructing the institution, materials used, ta cilitic
provided to the patient and all equipment, et Entire institution in bounded and fully equipped with
standard resources to provide a high-quality care
2. Process standard It includes the performance of nurses functions and rule leech quality care has
been followed by the nurses in all procedures towards patient care The nurses completely assess
the patient, collect data required from patients relative family and friends, record the collected
details, frame nursing diagnosis plan goals for nursing action, complete doctor's order in time and
implement the core efficiently keep ing in mind the scientific principles In this process, standard
degree of practice skills estimated
In this process standard, there is an important competent of professional judgment that has been
used to evaluate the standarde and the extent of skills in implementation of fun ing care
3. Outcome standard: This involves determining the results of the patient care how effectively the
care was given what is the improvement in patient's health, etc. The outcome standard measure
the change or improvement in patient in health due to effective nursing care.

CONSUMER PROTECTION ACT
The Consumer Protection Act (CPA) was implemented by the parliament in the year 1986 to protect the
interests of the consumers. This act concentrates on justice through consumer council authorities that
finalize the related disputes. The scope of the act is wide enough to include avast variety of services.
Under this act the consumer can complain in a redressal forum Pa patients can also make a complaint to a
redressal forum in respect of defective service provided in their care
Rights of a Consumer/Patient
1. Rights to ensure safety
2. Rights to be intimated
3. Rights to be selected
4. Rights to get listened to
5. Rights to get relief
6. Rights for the person who trades money for goods
The Act
Litigation to get redressal of grievances for negligence and claims of damages is time consumed ing It is
also expensive
This act provides accomplishment of consumer council to create awareness among the public and settle
the financial disputes regarding the same. Consumer Protection Act does not confer any new right to the
patient for the relatives The Act is designed to provide for a quicker and cheaper remedy when there is
deficiency in service and claims for damages are made arising from such deficiency in service
According to Section 2(1) (d(ii) of the Act a consumer in a person who gets the service or work for which
he/she has been paid or promised to be paid or partly paid and partly promised or is under any other
system of deferred payment.
Salient Features
1. Through CPA, services rendered by medical practitioner for consultation and treatment are kept
free of charge
2. Under CPA, service charges are borne by the insurance company where relevant and claimed by
the affected person.
3. CPA is not applicable in case of free health care service where no charge is made to any per son,
whether rich or poor.
District forum:
1. District judge who will be the president of the forum
2. Two members, who are specialists in law, commerce, economics, accounting industry or ad
ministration. At least one of them must be a woman.
Functions of district forum are as follows:

1. Welcomes filing of complaints by consumers and tries to get compensation for the affected party.
The compensation claimed must not be more than 5 lakh INR.
2. Appeal against the order of the district forum must be made to the state commission within 30
days from the date of the order
State Commission:
1. High court judge, who will be the president of the state commission
2. Two members (at least one of them should be a woman who is specialists in industry commerce
law, accounting, administration or economics
Duties of the state commission include accepting complaints and providing compensation to al affected
persons in case of cars between 5 and 20 lakh INR. Appeal against the judgment of the state commission
must be made within 30 days and can be made by the national commission.
National Commission:
1. A Supreme Court judge, who will be the president of the commission
2. Four members who are specialists in economics, commerce, law, accounting administration or
industry. At least one of them should be a woman
LEGAL ASPECTS IN NURSING: Assignment for Student.
ATTRIBUTES OF PROFESSIONAL CARING: (The Five Cs)
1. Compassion: It means the capability of the nurse to empathize with the sensation of pain and
weakness in the patient and to understand the patient's illness and suffering and plan the nursing
care effectively.
Student Activities

2. Competence: Possessing enough knowledge and developing good attitude towards nursing care,
evaluating skills and interest and getting enough exposure to the nursing practice in order to
respond adequately to the needs and demands of the nursing care.
3. Confidence: It is a kind of courage that each nurse has to develop, with strong faith in the
application of nursing knowledge integrated with scientific principles that foster a trusting
relationship.
4. Conscience: It is possessing good morality and abiding by the ethical principles of nursing care
that is nurtured along with the exposure to nursing practice.
5. Commitment: It is a kind of selfless sincere dedication towards provision of nursing care that
explains the attributes towards providing satisfactory quality nursing care.

Nursing as a profession

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