Professionalism, Interprofessionalism, and Leadership: Commitment
Professional practice, interprofessionalism, leadership, commitment
By the end of this chapter, readers will be able to:
1. Differentiate between the terms professional and being professional
2. Apply the principles of interprofessionalism to the professional practice of nursing
3. Evaluate how the professional practice of leadership is tied to nursing professional practice models (PPMs)
4. Examine individual and leadership commitment to professional nursing practice
THE PROFESSIONAL PRACTICE OF NURSING
The practice of nursing is grounded by the American Nurses Association’s (ANA) seminal documents: Code of Ethics for Nurses With Interpretive Statements (ANA, 2015), Nursing: Scope and Standards of Practice (ANA, 2010a), and Nursing’s Social Policy Statement (ANA, 2010b) and further influenced by individual state nurse practice acts. These documents define nursing and nursing practice, describe how nursing practice fulfills society’s mandate, present standards and competencies that influence the professional role of nursing, explain regulations that guide professional practice, and establish the ethical base for all nurses regardless of setting. Furthermore, the documents highlight the mutually beneficial relationship between society and the nursing profession (i.e., nursing’s response to societal needs). Thus, individual professional nurses are responsible not only for their own behaviors but also to the needs of society or the community served. This “contract” that exists between nursing and society provides the authority to practice professional nursing.
In Nursing’s Social Policy Statement (ANA, 2010b), theory application and use of research serve as the basis for nursing actions (or interventions) whose aims are to “protect, promote, and optimize health; to prevent illness and injury; to alleviate suffering; and to advocate for individuals, families, communities, and populations” (p. 10), leading to beneficial outcomes. Throughout these various documents, elements of accountability, including current licensure, delegation issues, continuous improvement, and leadership, are repeatedly presented. Understanding the content of these professional documents and “applying” them to everyday practice, however, are two different phenomena.
The shifting focus toward health system value (the Triple Aim; Institute for Healthcare Improvement [IHI], 2007) demands sophisticated application of professional nursing behaviors (e.g., being professional). Being professional relates to behaving in a manner that is expected of a professional (e.g., acting in accordance with the seminal documents previously described) as well as sustaining effective interactions, reliable behaviors, and autonomous commitment to continuous improvement (Wilkinson, Wade, & Knock, 2009).
In fact, being professional is hard work that some would say does not occur at a single point in time (e.g., during an educational program) but develops over time, maturing with knowledge, experience, and ongoing self-awareness.
Being professional encompasses specialized knowledge and skills, collaborative interpersonal approaches, responsiveness and revision of how one is perceived by others (e.g., physical appearance, stance, displays of human respect and compassion), ongoing improvement, and informed decision making. The term professional comportment has been used to describe this phenomenon and is defined as a “dignified manner or conduct” (Clicker & Shirey, 2013, p. 107) that is equal in importance to technical tasks.
Being professional is associated with knowledge of one’s work (Drucker, 1994, 1999), which is important not only because it is tied to disciplinary ideals, but also because it adds value to those served as well as to the associated organizations. For example, how is a patient or family’s experience shaped by a disheveled nurse with a passive stance versus a professional-looking nurse with an optimistic stance? Although anecdotal, many patients have reported to this author a remarkable difference in their willingness to disclose, adhere to the plan of care, or to trust health care providers based on their appearance and behavior alone. Thus, professional comportment must be developed and nurtured in health systems in order to successfully deliver care aligned with patients’ preferences and values.
In the Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit (Johns Hopkins University School of Nursing and the Berman Institute of Bioethics, 2014), nurse leaders acknowledged the ethical challenges that nurses face in everyday practice, but also committed to strengthen nursing’s ethical foundation in order to meet the challenges facing health systems. In particular, they spoke to strengthening the context, clinical practice, education, research, and policy related to professional practice. Ideas, such as more intentional practice, accountability and personal responsibility, interdisciplinary efforts, acknowledging moral distress among nurses, the availability of adequate resources, and building on existing work—all features of professional practice models (PPMs)—were advocated.
Although most health professionals value their own disciplinary expertise and judgment, and display this through independent actions, working as a collaborative team member is also part of professional practice. It is only recently, however, that health professionals have embraced interprofessional practice to the extent that it is a crucial element of training programs. Fostering interprofessionalism through collegial actions that ultimately enhance patient outcomes is an expectation of professional nursing practice (Interprofessional Education Collaborative Expert Panel, 2011).
Interprofessional collaboration is crucial for meeting society’s expectations for enhancing health. The World Health Organization (WHO) defines interprofessional collaborative practice as a process whereby multiple health workers from different professional backgrounds provide comprehensive services by working with patients, families, caregivers, and communities to deliver the highest quality of care across settings (WHO, 2010, p. 13). Interprofessional teamwork, on the other hand, refers to the quality of the team process and its goals, collaboration, mutual aims, and optimal communication (Thistlethwaite & Dallest, 2014). In other words, interprofessional teamwork is undergirded by the relational attributes of team members, the appreciation of others’ goals, and mutual communication.
Several studies have demonstrated a link between interprofessional practice and improved patient outcomes (Reeves et al., 2009). Current delivery systems, however, frequently persist in organizing health professionals by discipline; staff work in separate clinical departments (Kline, Willness, & Ghali, 2008) that practice independently. Yet, the problems encountered by today’s patients are often so great that well-intentioned health professionals cannot resolve them alone. For example, Mazzocco, Pettiti, and Fong (2009) found that patients whose surgical teams exhibited fewer teamwork behaviors were at a higher risk for death or complications, even after adjusting for patient risk.
Despite the renewed interest in the academic preparation for interprofessional practice, translation into health systems has been slow. Cashman notes, “absent structures and systems that support interprofessional practice, professionals run the risk of reverting to old, traditional modalities of parallel practice” (Cashman, Reidy, Cody, & Lemay, 2004, p. 184). Health professionals increasingly indicate the need to collaborate but changing long-established systems has been challenging.
Carefully insisting on the inclusion of interprofessionalism in PPMs is an ethical responsibility. Building relationships through role modeling interprofessionalism and empowering others to develop flexible and effective relationships that add value (e.g., enhance patient outcomes) contributes to interprofessionalism. Helping others to identify aspects of practice that require collaboration, to accept multiple perspectives, and to continually monitor and improve practice fosters the overall goal of “what’s best for the patient,” an ideal of all health professionals.
LEADING A PROFESSION
The Institute of Medicine’s (IOM) report The Future of Nursing (IOM, 2010) advocated for nurses to take on greater roles in leading change to advance health care in America. This report called for leadership at all levels of nursing, and personal accountability for ongoing professional development, including interprofessional collaboration and coordination. More specific, the report called for transformative leadership that advances nursing’s role as a full partner. Leading in this context calls for a more actionable approach that considers patient welfare as primary, and its continued improvement over time, essential. Although all nurses are considered leaders, some have organizational responsibility for leading groups of nurses in the delivery of patient-centered care. Through repeated evidence-based work experiences, acquisition of new knowledge, and ongoing reflection, leadership proficiency evolves, supporting the hard work of health professionals in meeting society’s needs for health and wellness. As such, leadership is a lifelong process of learning, performing, pondering, and performing again.
Leadership is a practice in its own right that complements clinical practice; it enjoys an evidence base and an associated body of knowledge.
As leaders of a profession, nurses are called to consider the patient (and by extension, the family) as their first priority and rehearse (over and over again) the practice they have been prepared to advance.