professional and educational development in nursing

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    Professional and Educational

    Development in NursingFall, 2012

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    At the end of this discussion, thestudent will be able to:

    Explain the difference between an occupationand a profession (this is one of the questions)

    Define characteristics of a profession Analyze barriers to professionalism Use models to examine nursing professionalism Name key people and events that influenced the

    development of nursing education. Describe current educational pathways of nursing. Examine challenges of nursing education and

    professional development.

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    I Want a Job!

    Why did you enter the nursing program?

    What did you do before becoming anursing student? (Do you even rememberback that far?)

    Who are you now?

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    Occupation-

    Defined as what a person does to make a living orhow one spends time.

    Task-oriented (mindless, something very repetitivewithout any thought process)

    Most of work is manual

    Trained on-the-job

    No specific value-system associated

    No specific career path

    Accountability lies with supervisor/employer

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    Profession -requires a specialized knowledge Develops from an occupation that specializes in

    Service (advocating for your patient)

    Knowledge (a specialized knowledge is what separates

    you)

    Autonomy (you dont have to go back to your supervisor

    when a decision has to be made)

    Professions develop a collective identity

    Formal education

    Evidence based practice Integrated value-system (code of ethics, same familiar value

    system)

    Legal protection (protecting your license)

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    Professionals are different fromworkers in an occupation

    1. Preparation

    College setting

    Prolonged education, specialized

    Orientation (socialization) to beliefs/values

    2. Commitment

    Calling

    Part ofpersonal identityIm a nurse!

    Transcends expectation of material reward

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    Barriers to Professionalism in

    Nursing (question on test) Variability of educational background (see later

    discussion) Historical issues

    Gender (1901 men banned from nursing in military)

    Obedience (1868 AMA/Hospital Admin promotedtraining.persisted through 1960s)

    Altruism (less expectation of monetary compensation) Power of other organizations (AMA, legislation)

    Public perception The nurse does what the doctor says The nurse helps the doctor

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    Kellys Criteria of a Profession

    Accountability (personalintegrity)

    Autonomy (still under

    development innursing)

    Altruistic (motivated byservice)

    Associations(advocates for theprofession)

    Body of knowledge

    (specialized)

    College (higher learning

    Caring (vital tohumanity)

    Code (guide todecisions/conduct)

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    Millers Wheel of Professionalism

    Publication

    Organization

    Self-regulatory

    Research

    Continuing

    Education

    CommunityService

    Theory

    Code

    University educationand

    Science background

    Professionalism in Nursing

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    Professional Nursing Documents

    ANA published books (3)

    (Foundation of Nursing package)Nursing Social Policy Statement (a published

    contract outlining nurses obligations to society)Nursing: Scope and Standards of Practice (what a

    reasonable and prudent nurse would do)Code of Ethics for Nurses With Interpretative

    Statements (see back cover of your Chitty and

    Black text)*These publications are available for purchase

    from ANA website, e-versions only $3.95*

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    Collegiality What does this mean to you? Treating you as

    equals, shared understanding, shared purpose Do you think nursing has a reputation for this?

    No they dont (nurses eat their young)

    Why? b/c it was passed down Why not? it was miserable for me and so I will

    make it miserable for you

    What are ways we can promote collegiality inthe nursing profession?

    (further discussion week 4)

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    Nursing Education History 1800s

    (1860-1899)Training schools affiliated with hospitals(Nightingale suggested administration separatefrom nursing education, and public funds to beused for nursing education)U.S. at turn-of-century was focused on hospital-based training.

    *Note different mind-set between training and

    education*Primary reason for nurse training structure

    was to staff the hospitals with free labor*

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    Nursing Education History 1900s

    Main concerns of nursing leaders: Training not well-regulated

    Need for leadership and scholarship

    1899 ANA founded (professionals getting togethercreating the structure)

    1900 International Council of Nurses formed

    1901 American Journal of Nursing first published

    (created the literacy) 1907 Mary Adelaide Nutting, worlds 1st

    nursing professor (Teachers College, New

    York)

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    Nursing Education History

    Famous studies:

    1912 (Nutting) nationwide study of nursingstudents training

    1923 (Goldmark Report) advocated for educationat collegiate level rather hospital-based training

    1934, 1937 (NLN) recommend college education,

    but also outlined 3 year diploma curriculum(hospital based, but with college coursesincluded) they create the standards (what shouldwe be teaching)

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    Early Studies Consensus

    College for nurses

    Students NOT to be used to staff

    hospitals Standards are needed

    Minimum qualifications for graduation

    identified

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    Nursing History set the stage

    Registration required 1903, North Carolina passed 1st nurse

    practice act

    By 1921, 48 states had laws regulatingnursing practice (but note that women did notreceive the right to vote in this country until1920, so laws made by non-nurse men!*)

    *problem with early laws is that people couldfunction as caregivers, for less pay, as longas they did not use the title nurse.

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    LPN (LVN) Pathway

    Started in 1930s in response to shortagedue to WW II

    Technical degree

    1 year program Limited scope of practice by law

    (question: What has your experience been as

    an LPN in the area of scope of practice bylaw, and scope of practice by facilityadministration demand?)

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    RN Nursing Education Pathways 1

    Diploma

    Hospital-based

    Most popular 1900-1960s

    Used to be 3 years, now 2 years

    (question: Health care more complicated now,so what is left out in a 2 year education?

    Currently offers college credit (didntpreviously)

    Least used path at this time

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    RN Nursing Education Pathways 2

    Associate Degree 1952 Mildred Montags doctorial dissertation

    Originally a technical degree, 2 years

    *Main reason was nursing shortage*(question: Is shortage an adequate reason to

    lessen the educational standard?)

    Montags model was changed from atechnical degree to a pathway to RN (includesleadership, decision-making education, etc.)

    Usually 3 years for completion

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    RN Nursing Education Pathways 3

    BSN Recommended by every major study and

    organization since early 1900s as the minimumpreparation for professional nursing.

    ANA position papers 1965 BSN minimum for professional practice and ADN for

    technical practice (LPN not recommended)

    1979 dates emphasized (by 1985, BSN, and only 2 levels ofpractice by 1980)

    (questions: How many levels of practice for nurse do we havein the United States? Does this title matter? Does the publicknow the educational levels of its nursing caregivers? Doesthat matter?)

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    Questions

    Do you believe classes not directly relatedto clinical practice are less important,equally important or more important than

    additional clinical classes?

    How would you structure a nursingcurriculum to cover what is important in

    nursing education?

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    How do we solve the problems ofNursing Pathways?

    Promote Articulated Programs

    Decide by legislation the minimum qualifications

    Cooperation needed between ANA, NLN,

    AACN, bedside nurses, facility administrators,the public, legislators, educators, and all otherstakeholders

    Promote acceptance into BSN/MSN programs(students with other degrees, ADNs wishing to

    further education, fast-track to MSN, etc.)

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    Certification Programs

    Certification comes AFTER License Differs from licensure in that license is state-

    regulated and certification is given by adiscipline-recognized accrediting organization

    Applies to area of specialty

    Validates proficiency in practice

    (remember Benners novice to expert theory?)

    youhave different areas based on yourknowledge base. Novice, beginner, expert

    http://www.testprepreview.com/nursing_certifications.htm

    http://www.testprepreview.com/nursing_certifications.htmhttp://www.testprepreview.com/nursing_certifications.htmhttp://www.testprepreview.com/nursing_certifications.htmhttp://www.testprepreview.com/nursing_certifications.htm
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    Certification Programs.Problems?

    Who decides the standards of all thecertifications?

    American Association of Colleges of Nursing

    (AACN) 2008 Consensus Modelhttp://www.nursecredentialing.org/APRN-FAQ.aspx#Q25

    This is gold-standard in organizing standards

    and focus for advanced practice nursing. Can beused as model for organizing standards in otherareas of certification.

    http://www.nursecredentialing.org/APRN-FAQ.aspxhttp://www.nursecredentialing.org/APRN-FAQ.aspxhttp://www.nursecredentialing.org/APRN-FAQ.aspxhttp://www.nursecredentialing.org/APRN-FAQ.aspxhttp://www.nursecredentialing.org/APRN-FAQ.aspx
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    Graduate Programs

    1950s/1960s Masters viewed as terminaldegree

    1970s/1980s focus: clinical specialization

    CNS very popular, not a Masters degree PhD was educator track

    ND phased to DNP for clinical practice

    1990s/2000s Masters for NursePractitioner very popular

    2010s Consensus Model Implemented

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    Continuing Education

    Means post-licensure education

    State of OHIO 24 hours every 2 years

    See Code of Ethics provision # 5 Some states require continuing education

    for re-licensure.

    Some do not! (see page 165 in Chitty andBlack text as well as updated website)

    http://ce.nurse.com/state-nurse-ce-

    requirements

    http://ce.nurse.com/state-nurse-ce-requirementshttp://ce.nurse.com/state-nurse-ce-requirementshttp://ce.nurse.com/state-nurse-ce-requirementshttp://ce.nurse.com/state-nurse-ce-requirementshttp://ce.nurse.com/state-nurse-ce-requirementshttp://ce.nurse.com/state-nurse-ce-requirementshttp://ce.nurse.com/state-nurse-ce-requirementshttp://ce.nurse.com/state-nurse-ce-requirementshttp://ce.nurse.com/state-nurse-ce-requirements
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    Continuing Education Notes

    Continuing Education (CE) is counted in numberof contact hours(1 50-60 minute hour = 1 CE)

    13 states still have NO continuing educationrequirements (click on website names of statesto find out which ones)

    2 states do not have CE requirement stated in

    number of hours, but the practice actsspecifically list continued competency andpersonal self-regulation as law!

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    Interesting CE examples

    New York4 hours every 4 years on infectious disease

    2 hours on child abuse (1 time only)

    Oklahoma

    1 of 5 options for re-licensure is 24 CEs Washington

    531 hours of clinical nursing practice every 3 years

    (for a part timer need to work at least 177 hours/year on average)

    45 hours of CE, to include self-assessment and reflection!

    OregonNothing needed except 7 hours of pain management

    (question: Why only just pain management?)

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    Ohio Continuing Education

    CE Requirements for RNs:Each person licensed as an RN in Ohio must complete twenty-four(24) contact hours of approved CE to renew their license. A nursewho has been licensed by endorsement for less than or equal to one(1) year must complete twelve (12) contact hours. At least one (1) ofthe required contact hours must be Category A. The contact hours

    must be completed within two (2) years prior to renewal. ALLlicensee and certificate holders are required to complete at least onecontact hour related to Chapters 4723,1-23 of the Ohio nursepractice code and rules.

    ref: http://ce.nurse.com/state-nurse-ce-requirements/ohio

    Also see FAQ:

    http://www.nursing.ohio.gov/PDFS/education/CE%20FAQ%203.12.pdf

    http://ce.nurse.com/state-nurse-ce-requirements/ohiohttp://www.nursing.ohio.gov/PDFS/education/CE%20FAQ%203.12.pdfhttp://www.nursing.ohio.gov/PDFS/education/CE%20FAQ%203.12.pdfhttp://ce.nurse.com/state-nurse-ce-requirements/ohiohttp://ce.nurse.com/state-nurse-ce-requirements/ohiohttp://ce.nurse.com/state-nurse-ce-requirements/ohiohttp://ce.nurse.com/state-nurse-ce-requirements/ohiohttp://ce.nurse.com/state-nurse-ce-requirements/ohiohttp://ce.nurse.com/state-nurse-ce-requirements/ohiohttp://ce.nurse.com/state-nurse-ce-requirements/ohio
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    Current/Future Challenges

    Diversity issues

    Critical thinking

    Collaboration Health promotion issues

    Informatics

    Health care costs Faculty shortage expected