As the nursing profession evolves and rises to meet modern demands, we are faced with growing complexities in our profession and in our workplaces. From the orientation and socialization of new nurses and managers, to the selection processes for preceptors and mentors, to continuing education, to legal and ethical issues, the modern nurse is faced with complicated situations and elaborate organizations that require his/her continuing dedication.
Examining the concepts included in "professionalism": a profession is a vocation, usually involving science or a unique education; the heart of professionalism per se is twofold: a professional has a distinct type of knowledge and a self-imposed responsibility to serve the community (Donelyn, 2004, Slide 16). Applying those concepts to the Nursing Profession, professionalism is the continual pursuit of knowledge, a self-imposed sense of responsibility for human concerns, development through our unique education, accountability to our peers, professional autonomy and self-regulation, and altruism (Donelyn, 2004, Slides 21-31). In terms of work, professionalism includes: knowledge; competence; professional appearance; teamwork. In terms of the person, professionalism includes: respect for others; integrity; a positive attitude; compassion (Donelyn, 2004, Slide 36).
b. The Orientation and Socialization of New Nurses and Managers
" New nurse" orientation and socialization may take several weeks or months and usually occurs for the entire facility and the unit. Socially, orientation is when the new nurse becomes acquainted with all the new hires in his/her orientation group and with as many of his/her coworkers as possible. Educationally, Orientation is the time when the new nurse should learn all he/she can; this is important not only for practice but also for getting along with coworkers who will expect the new nurse to learn important basics during orientation. Orientation is the time to work out as many "kinks" as possible, so the new nurse should take advantage of the "nurse educator's" expertise, learn as much as possible and assume nothing: he/she should take and review notes and handouts; learn as much as possible about the facility's policies and procedures, including the facility's documentation policies; immediately ask as many questions as needed; immediately ask for additional help as needed; learn the location of the Policy & Procedural Manual and the Standard of Care Manual; learn to use any required computers and their programs; make mental notes of the location of important items and become so familiar with them that he/she can reach for them without looking; learn about the medication cart's layout and system, whether or not the new nurse is allowed to dispense medications; learn how medications are computerized, how to get newly prescribed medications and how to get STAT medications in case they are needed; learn how to obtain procedure trays and central supplies, how to charge patients for the supplies used by the new nurse, and how to obtain a new sterile tray in case the existing one is contaminated; learn any charge-off procedures, how to order lab work, x-rays and other tests, how to access the lab and test results, IV procedures and personnel, where the IV sets are kept. Finally, orientation is the time when new nurses are shown how to use certain types of equipment, how to work on clinical issues and the time when the new nurse may be checked off on procedures (Quan).
Nurse Managers are educated in leadership and communication skills during their orientation. Some orientation programs for Nurse Managers have developed a checklist that is adapted to his/her experience level of management and organization. Those checklists are organized into sections such as: general information; human resources; process improvements (Lippincott, Williams & Wilkins, 2011).
c. Selection Process for Preceptors and Their Formal Educational Program
Preceptors are teachers or tutors who get new nurses ready and trained to work by ensuring that the new nurses' skills are up to par and ensuring that new nurses get a variety of patients so they are ready for whatever may come when they are on their own. (Briddon, 2008). An excellent description of the selection process for preceptors comes from Health Disciplines.ubc.ca. Preceptors are selected by: recruiting; selection from the pool of recruits and pairing/matching protocols. During recruiting, the selection committee lists the attributes of effective preceptors and preceptees, establishes a pool of acceptable candidates, selects the desired candidates, and then matches them with preceptees (Health Disciplines.ubc.ca, 2004). Other than the formal education required licensed nursing, their formal education program normally consists of workshops for first-time preceptors and refresher courses for experienced preceptors (Edmunds & Scudder, 2010).
d. Mentoring for Managers and Staff
Mentors are trusted counselors or guides who can be anyone in the new nurse's working unit but they are usually experienced and "well-seasoned" nurses. The new nurse's mentor may or may not also be the preceptor (Briddon, 2008). According to Health Disciplines.ubc.ca, mentors are chosen in the same way as preceptors are chosen. Formal education consists of a baseline of normal nursing education and licensing, plus classroom/internet/discussion opportunities (PB Works, 2009).
e. Continuing Education Efforts for Staff and Managers
One facet of continuing nursing education involves "Best Practice" issues sharing with staff. Exact procedures may vary from institution to institution but one effective method of issues sharing involves: contacting experts to discuss their recommendations of best practice; obtaining additional advice from national, state and local resource centers; discussing the issues with nursing colleagues to reach a consensus on the best practice for your facility's unique circumstances. There should also be support for formal continuing education in the forms of tuition reimbursement, grants, scholarships, government loan forgiveness under the Nurse Reinvestment Act of 2002, assistance in student loan repayment under the federal Nursing Education Loan Repayment Program, webinars and conferences and flexible scheduling (Allnurses.com, 2003), (American Nurses Association, 2011).
f. Types of Development Afforded to Nursing Staff Leadership
Nursing staff leadership is vigorously supported by the American Nurses Association, through leadership workshops, seminars, webinars, web site toolkits for effective communication and delegation of duties, a "Magnet Recognition" program and social networking (American Nurses Association, 2011).
g. Organizational Support for Legal and Ethical Dimensions of Nursing
Legal dimensions of Nursing are organizationally supported by ANA-PAC, The American Nurses Association's Political Action Committee, by supporting candidates for federal office who have demonstrated "belief in the legislative and regulatory agenda of the American Nurses Association" (American Nurses Association, 2011). In addition, individual nurses are organizationally supported by the ANA by defining and supporting a "Nurses' Bill of Rights regarding working conditions and the ability to freely "advocate for themselves and their patients" (American Nurses Association, 2011). Finally, nurses' ethical considerations are also supported by the ANA's efforts to maintain, refine and explain the Code of Ethics for Nurses with Interpretive Statements (Nursingworld.org, 2011).
h. Process for Managing Ethical Dilemma Identified by Nursing
Our code of ethics gives a methodical, practical framework for ethical decision-making as we perform our healthcare duties. First, we must identify the ethical issue; then we must clarify our personal and professional values, using the professional code of ethics, with our interpretation and position reflecting our underlying value system. The next step is to clarify the influencing factors or barriers, gathering information from professional literature, applying at least the first 4 principles of W.D. Ross' prima faci theory: respect for autonomy, beneficence, non-maleficence and justice. While using prima faci, we must define our guiding principles, following the professional code of ethics whenever possible. Our next step is to analyze the alternatives, knowing that usually at least 2 courses of action will develop and examining each argument for and against each action plus their outcome and checking for the validity of the each argument. We must also find common ground, knowing that dilemmas may lead to disputes, that communication is important, and that our strategies for finding common ground may include collaboration, compromise, accommodation, coercion and avoidance. The next step is to decide and act, ideally with consistency between personal values and the values of others, consistently with legal and professional standards, and aware of the guiding principles behind the decision to justify our decision. After acting, we must assess the outcome, evaluating both the process and the results, and learning from the experience to improve our approach to ethical dilemmas. While taking every step of this decision process, we are to remain aware that the code of professional conduct is the guide that directs, coordinates and assists us day-to-day; consequently, we are to consistently abide by the code while respecting our patients' autonomy and dignity.
Each ethical issue is unique and the code offers specific actions for several ethical dilemmas. For example, Section 3.6 of the Code addresses the steps a nurse must take to protect "the patient, the public and the profession from potential harm when a colleague's practice…appears to be impaired" (Nursingworld.org, 2011). In that situation, the nurse should begin by consulting supervisors and may also confront the impaired colleague. The Code encourages nurses to follow policies and guidelines laid out by the facility. If the workplace has no…