Nursing in Canada: a profession

The headlines scream out: "Hospitals alarmed as disgruntled nurses flee profession". "Living with death; the strains of daily tragedy feed chronic shortage of nurses". "Ministry should encourage alternative health care". "BC nurses set to withdraw services". As the provincial health care system falters and nurses, the very core of health care, flee the profession, politicians scramble to find answers. And so is Janice Kopinak, who takes a deep look at the current nurses' revolution and sees a glimmer of hope for change.     

A conceptual analysis of professional commitment

Professional Commitment is an attitude, and it is the core and spirit of professionalism. In addition to increasing personal stability in the profession, it also enables individuals to reach their professional goals in general. Because nurses usually have more opportunities than other health care professionals to be in contact with patients, patients receive most of their information about health care from nurses. If nurses accept professional commitment as early as possible, the quality of patient-care will be improved. That is the reason why professional commitment is regarded as the hallmark of quality in professional care. This paper will use the conceptual analysis framework developed by Walker and Avant (1995) to examine and analyze professional commitment and establish its relationship with nursing. The authors hope that it can provide nurses with the opportunity to understand this concept more fully, to support their own profession, to raise the position of the nursing profession and to guarantee the health of the general public.     

The need for nursing leadership in uncertain times

Background The world today is changing and being affected by advances in technology and communication, as well as changes in the political, economic, demographic and social environment. These changes also effect the delivery of health care services.
Aim A review of the literature was conducted to examine how the profession of nursing can ensure that it is involved in shaping the health care system of the future.
Key Issues to Emerge The nursing profession requires leadership which empowers nurses, enabling them to lead the profession into the next millennium. Pressures for change in health care delivery make the move from bureaucratic management to effective leadership essential. Development of an appropriate model of leadership will ensure that nurses play a pivotal role in the process of change.
Conclusion Transformational leadership is the model that will assist nursing to develop into an empowered profession with the potential to be a dominant voice in reshaping the health care system of the future.     

The professional doctorate: rationale and characteristics.

The position that it is time for the nursing profession to develop programs leading to the N.D. degree, or professional doctorate, (for the college graduates) derives from consideration of the nature of nursing, the contributions that nurses can make to development of an exemplary health care system, and from the recognized need for nursing to emerge as a full-fledged profession. It derives from pride in the accomplishments made by nurses of the past; from discontent with the meager influence that nurses now have; and from anticipation of a future that will be created when a critical mass of nurses are provided opportunities for completing pre-service doctoral study. It derives from confidence that those nurses can and will so influence the health care system that all persons will be properly served with care that promotes their health, restores their function,, and enhances their independence in knowledgeably exploiting their own health-seeking behaviors.     

Nursing and politics: a South African perspective

The purpose of this paper is to provide a general introduction to politics, and to describe some political changes which have affected the rendering of multidisciplinary health care services in the Republic of South Africa since 1994. Political issues which will be addressed include: changed provincial borders; opening up of the Republic of South Africa's international borders; increased emphasis on primary health care services; enhanced international involvement of the Republic of South Africa; changes in the statutory bodies governing the nursing profession; and changed legislation affecting health care workers. Political know-how is essential for professional survival. Unless nurses in the Republic of South Africa collaborate proactively as a united group representing the largest proportion of health care professionals in the country, the nursing profession and nursing education might become irrelevant to the political realities of the country and its people. Unless nurses can succeed in engaging in successful political debates and in negotiating their rights, they might become an increasingly voiceless, faceless and powerless female profession in the Republic of South Africa. However, politically knowledgeable nurses may help to ensure that the people will get the nurses and the nursing care they deserve, whilst the nurses will enjoy the benefits to which they are entitled, including market-related salaries.     

Smoke-free nurses: leading by example.

Occupational health nurses' scope of practice includes health promotion and restoration of health from environmental hazards (American Association of Occupational Health Nurses, n.d.). Because the nursing profession is the largest constituent of health care providers, it is essential that occupational health nurses tackle the smoking epidemic among the nursing profession. By encouraging smoking cessation among nurses, occupational health nurses reduce the environmental hazard of second-hand smoke and improve the health of nurses who smoke. When occupational health nurses take an active role in encouraging smoking cessation among nurses, they become leaders in reducing smoking within their communities. Members of the nursing profession are also role models. Occupational health nurses must help nurses become healthy role models and credible educators in the battle against smoking.     

Political involvement in nursing--education and empowerment

Political apathy in the nursing profession can be attributed to numerous factors, including a lack of knowledge of the political process and public policy formation, feelings of powerlessness, and a perceived ethical conflict between professional values and political involvement. Nursing as a profession has arrived at a prestigious point in development where the word "nurse" now is synonymous with the words "patient advocate," thus giving the specialty an important image to fulfill. The public, however, will not recognize nurses as patient advocates until they begin to champion public health and social issues at the Institutional, community, and national levels. Numerous changes in health care delivery methods, together with politicians' increased involvement in health care development, have left nurses in a precarious position even though nurses are the largest group of health care workers in the United States. In this article, the first of a two-part series, the lack of knowledge of the political process and feelings of powerlessness in the nursing profession will be examined, along with their effects on political involvement among nurses.     

Mastery path for developing nurses for management: a conceptual model

The demand for knowledgeable and skilled nurses in health care management positions highlights the importance of identifying management practices, competencies, and skills of effective managers. Once these attributes are identified, then approaches can be identified for developing nurses for these positions. This article describes a conceptual model, the Mastery Path for Developing Nurses for Management, that serves as a tool for the profession of nursing, health care organizations, and academic institutions to identify and educate nurses in the health care system.     

The moral leadership of the nursing profession.

As the largest group of professional workers in the health care field, nurses possess the numbers to command a key role among health professionals. It is, however, apparent that nurses must assume a more visible and vital leadership role in the delivery of health care if nursing is to remain a viable profession. Nursing's immediate goal must be to unite forces in an effort to bring about greater involvement of nurses in planning, delivering and assuming accountability for the nursing component of health services at all levels. The ease with which the profession is able to accomplish this goal is dependent upon the ability of nursing's leadership to evoke a sense of harmony and balance within the profession, while creating a dynamic image of nursing among other health professionals and the public. Today, there is a need for strong moral leadership in the nursing profession. In ‘moral leadership’ the power of the leader is used to work with the group as a whole, while guiding individual members towards satisfaction and self-fulfilment. A critical evaluation of the profession's leadership capabilities should begin with definitions of the role and responsibility of nurses for leadership in the professional association. By its very nature, the professional association stands as the leadership mechanism of the profession and, by working through the association, nursing leadership can unify nursing forces, implement plans aimed at involving more nurses in health planning activities, and facilitate the involvement of individual nurses in determining the conditions of employment under which they practise.     

A matter of extinction or distinction

In view of fiscal constraints and the increasingly technical environments of health care, the essential and unique contributions of all health care providers, including nurses, are being challenged. This article examines current challenges to the role of nurses and the future of nursing as a unique discipline. As the work of nurses becomes increasingly defined by the technologies of care, what will distinguish nursing from other disciplines and nurses from other care providers? Can nurses lay claim to uniqueness in their knowledge base, technical competencies, and caring behaviors? Other types of workers are increasingly rendering elements of clinical care traditionally provided by nurses. As we move into the next millennium, will nursing become extinct or distinct as a health care profession?     

Patient safety and the need for professional and educational change

Questionable quality of health care delivered in the United States has become a front-line issue, taking a strong place alongside more traditional concerns such as increasing costs and access to care. Given that nurses comprise the largest component of the health care workforce, safety and error reduction in health care are central concerns for the profession.     

Clinician mental health,nursing shortages and the COVID‐19 pandemic: Crises within crises

Around the world, nurses are working under enormous pressure providing care to sick and dying patients during the pandemic. Many are faced with increased stress, and other negative effects on their mental health. They are also faced with the possibility of infection and death from COVID‐19. Before the pandemic there was a global shortage of nurses, but this is likely to be exacerbated by the increased demands of caring during COVID‐19 as well as the usual care of non‐COVID patients. One serious concern is that the pandemic and multitudinous effects on the nursing profession will exacerbate nursing attrition and their poor mental health into the future. Another serious concern is whether the profession will be able to attract sufficient numbers of nurses to care for populations into the future. Governments and health policymakers everywhere need to invest in nursing and health care and pay attention to the needs of health systems to ensure a healthy population. It is argued that without this, economies will not recover and prosper, and health systems will not be able to provide quality care.     

The impact of perceived medical dominance on the workplace satisfaction of Australian and British nurses

Current literature on the sociology of health views medical dominance as a structural feature of the health division of labour, and a body of literature has developed exploring the structural components contributing to the subordination of the allied health professions In this paper, nursing literature describing the nature and source of nurses' perceptions, complaints and dissatisfactions with their profession, and sociological analyses of the position of nurses within the structure of the health care delivery system, were employed to provide a framework for assessing the degree to which structural medical dominance of the nursing profession impinges on nurses' perceptions of dominance and how these perceptions affect nurses' workplace satisfaction A 69-item questionnaire covering aspects of doctor-nurse, doctor-patient, nurse-patient and nurse-hospital administration relationships was developed One-hundred and thirty-three Australian nurses and 108 British nurses completed the questionnaire, in which they ranked their own level of professional satisfaction and the level of satisfaction they perceived doctors to experience Results indicated that Australian and British nurses were not only dissatisfied with many aspects of then- work environment, such as their pay and working conditions, but also experienced dissatisfaction with their professional status while perceiving the medical profession to be highly satisfied British nurses were significantly more dissatisfied with their own profession and perceived the medical profession to be more authoritarian than did Australian nurses No difference between Australian and British nurses' perceptions of degree of medical autonomy was found The implications of nurses' perceived discrepancy in workplace satisfaction between nurses and doctors in the delivery of health care are discussed in terms of the structural barriers created by medical dominance Recommendations for the trainmg of nurses and the implications of the findings for nurse practitioners are made, together with suggestions for further research     

Leadership: a means of empowering the nursing profession.

For too long now, nurses have assumed an obsequious role in their working relationship with other health professionals. The nursing profession holds the majority membership in the field of health care professions yet nurses continue to be cast into subordinate roles within professional relationships, failing to be recognised as peers. This is despite many nurses possessing unique but analogous knowledge, credentials and professionalism. It is time nurses were agitated to reflect upon their position and be reminded nursing is also a profession. Some suggestions and motivation are offered.     

Theory Z as a framework for the application of a professional practice model in increasing nursing staff retention on oncology units

Recruitment and retention of nurses is the most significant issue facing nursing administrators, educators, researchers and clinicians in the ongoing nursing shortage in the United States today. It has been cited in the literature that American nurses feel that job satisfaction is a major issue in retaining qualified nurses in hospitals. Satisfaction occurs when nurse expectations are matched with the hospital's vision and values. It is for this purpose that the authors have chosen theory Z as a hospital management model to coincide with the institution of the Marker Professional Practice Model to increase job satisfaction (autonomy) in hospital-based nurses. There are four 'hidden' challenges in health care today. They are: (a) fundamental changes occurring within the profession and practice of nursing; (b) the expanded role of women in management; (c) ethical dilemmas related to advances in medical technologies; and (d) the difficulty for health care managers in the United States to make changes related to the above three challenges. The authors feel that it is inherent to the nursing profession to combine existing theories and models to enhance the retention of nurses to the profession.     

Beyond profession: nursing leadership in contemporary healthcare

Aim(s)  To examine nursing leadership in contemporary health care and its potential contribution to health service organization and management.
Background  As the nursing profession repositions itself as an equal partner in health care beside medicine and management, its enhanced nursing standards and clinical knowledge are not leading to a commensurate extension of nursing's power and authority in the organization.
Method(s)  An ethnographic study of an ICU in Sydney, Australia, comprising: interviews with unit nursing managers (4); focus groups (3) with less experienced, intermediate and experienced nurses (29 in total); and interviews with senior nurse manager (1).
Results  Inter- and intra-professional barriers in the workplace, fragmentation of multidisciplinary clinical systems that collectively deliver care, and clinical and administrative disconnection in resolving organizational problems, prevented nurses articulating a model of intensive and end-of-life care.
Conclusion(s)  Professional advocacy skills are needed to overcome barriers and to articulate and operationalize new nursing knowledge and standards if nurses are to enact and embed a leadership role.
Implications for nursing management  The profession will need to move beyond a reliance on professional clinical models to become skilled multidisciplinary team members and professional advocates for nurses to take their place as equal partners in health care.     

Specialisation in nursing: are we ready for the year 2000?

The development of specialty nursing practice and nurse specialists in today's health care arena is a controversial yet growing force, fuelled by a complexity of factors from both within and external to the profession. By narrowing the focus on parts of the whole field of nursing, nurses have met the challenge of increasing technology, complexity of the health care system, and nursing care needs. Although the debate regarding nurse specialists continues to rage, the production of such nurses will push beyond the boundaries of the profession into the new millennium, in the interests of patient care.     

Advocacy: From the Patient to the Profession

It is well known that nursing comprises the largest segment of the health care industry at local, state, national, and even international levels. The United States has over 4 million registered nurses, and nursing has been voted the most trusted profession for the past 19 years. With such a vast representation within the health care industry, the nursing profession is well positioned to advocate for legislation that promotes safe and healthy work environments, as well as quality care delivery. Although we have many nurses that have provided insight and thoughtful leadership, we have a long way to go to ensure our voice is heard to create and support policy that is recognized at the same level as our national representation. Successful advocacy and the passage of legislation that promotes professional nursing and safe patient care is a multipronged approach. Establishing and fostering relationships in the political arena require a strong political action committee (PACs), coalitions, and active participation in advocacy efforts.     

Career planning and development for nurses: the time has come

Developments in how the nursing profession is perceived by nurses and by society, along with unparalleled changes in health care systems, have created an environment in which individual nurses must take control of their careers and futures. Educators, employers and professional organizations also have a key role to play in fostering the career planning and development of nurses, usually the largest employee group in most health care organizations. This article provides an overview of what career planning and development is and why it is important for nurses. A career planning and development model is described that provides nurses with a focused strategy to take greater responsibility for engaging in the ongoing planning process that is crucial throughout the major stages of their career. Finally, educators, employers and professional organizations are challenged to collaborate with individual nurses on career-development activities that will enable nurses to continue to provide high-quality care in ever-changing health care systems.     

The devaluation of nursing: a position statement

How nursing as a profession is valued may be changing and needs to be explored and understood in a global context. We draw on data from two empirical studies to illustrate our argument. The first study explored the value of nursing globally, the second investigated the experiences of overseas trained nurses recruited to work in a migrant capacity in the UK health care workforce. The indications are that nurses perceive themselves as devalued socially, and that other health care professionals do not give nursing the same status as other, socially more prestigious professions, such as medicine. Organizational and management structures within the NHS and the independent care home sector devalue overseas nurses and the contribution they make to health care. Our conclusions lead us to question the accepted sociocultural value of the global nursing workforce and its perceived contribution to global health care, and to consider two ethical frameworks from which these issues could be discussed further.