Stand up! Claiming our profession.
Subject: Professional workers (Evaluation)
Nurses (Practice)
Medical societies (Beliefs, opinions and attitudes)
Medical societies (Social aspects)
Author: Myers, Carole R.
Pub Date: 03/22/2012
Publication: Name: Tennessee Nurse Publisher: Tennessee Nurses Association Audience: Academic Format: Magazine/Journal Subject: Health care industry Copyright: COPYRIGHT 2012 Tennessee Nurses Association ISSN: 1055-3134
Issue: Date: Spring, 2012 Source Volume: 75 Source Issue: 1
Topic: Event Code: 200 Management dynamics; 290 Public affairs
Product: Product Code: 8043100 Nurses; 8622000 Medical Associations NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners; 81392 Professional Organizations SIC Code: 8621 Professional organizations
Geographic: Geographic Scope: Tennessee Geographic Code: 1U6TN Tennessee
Accession Number: 283984743
Full Text: What does it mean to be professional? A professional is distinguished by their mastery of a complex body of knowledge and skills. Professional knowledge is not easily understood by the general public and consequently can be under-appreciated. We have an obligation to our nursing colleagues who practice in a variety of settings to convey the value of our profession to the general public (who benefits from our specialized knowledge and skills), to legislators (who often make decisions about our profession), and to other health care providers (with whom we frequently interact).

What rights and responsibilities are conferred on a professional? Professional knowledge is validated by professional licensure and certification in some instances. In general, professionals have substantial control over the use of their knowledge. With the control comes an obligation, in the case of nursing, to use the knowledge to promote health and health care and do this according to current, applicable, and credible evidence.

A professional is committed to high-quality work and is guided in their work by an ethical code. Professional ethical codes govern behavior and are the anchors of social contracts. As nurses, our contract is with individuals, groups, and communities to practice ethically and with integrity. The ANA Code of Ethics is a living document that can only be fully appreciated when used on an ongoing basis to reflect on the many complex and challenging situations we face as nurses. In exchange for control over the development, use, and dissemination of professional knowledge and the privileges of autonomy and self-regulation, professionals must assure competency and integrity, as well as adherence to a moral obligation to clients. The social contract between professionals and clients, which delineates professional rights and responsibilities, entails a promise to put clients' interests and protection above self-interests.

How are professionals governed? Professionals are governed by various entities. In Tennessee, the practice of professional nursing is governed by the Board of Nursing which solely defines the scope of practice for all nurses in the state. This is the case for all but three states (in these three states, the scope of practice for Advanced Practice Registered Nurses, APRNs, is authorized by the Board of Nursing and the Board of Medicine). The regulation of professional nursing by state boards and other entities exists in conjunction with the self-regulation that is characteristic of a profession. The role of a licensing board is not to govern or protect the profession. Instead, the role is to protect the public by assuring that minimum quality standards for practice are met. While regulating boards protect the interests of the public, professional organizations, such as the Tennessee Nurses Association, protect the interests of their individual members through legislative action, continuing education, and national credentialing. Although the distinction is important, the two are not mutually exclusive.

Although the autonomous practice of nursing as a profession has been emphasized thus far, this is not meant to negate the long-standing and growing need for the "collaborative care of all individuals of all ages, families, groups and communities, sick or well and in all settings" described by the International Council of Nurses. As the diversity of the patients we care for, the complexity of care and client needs, and pressures to create value by enhancing quality and managing costs increase, the support for transforming the delivery of health care services via highly-integrated, team-based, patient-centered care is gaining momentum. All of this requires interdisciplinary collaboration and a new commitment to focusing on what is best for the patient. This shift in orientation to being patient-centered is a departure from practices that have too often been provider-centric.

In Tennessee, we are at one of those critical junctures that prompt us to consider and advocate for our profession. The motivation, consistent with the definition of a professional, is not self-interests. My personal concern emanates from the threats to the relatively restrictive scope of practice for APRNs in Tennessee. In 25 states and the District of Columbia there are no statutory or regulatory requirements for physician collaboration, delegation, direction, or supervision for APRNs. Another 19 states require physician collaboration for APRN practice. Tennessee is one of three states that requires physician supervision, a more restrictive configuration than collaboration. My concern is three-fold. First, according to the Institute of Medicine (IOM) report on the Future of Nursing, "No studies suggest that APRNs are less able than physicians to deliver care that is safe, effective, and efficient or that care is better in states with more restrictive scope of practice regulations for APRNs," such as we see in Tennessee. Secondly, in a state with relatively poor access to primary care and health outcomes and strong competition for scarce resources, it makes no sense to limit care provided by APRNs, given their safety and efficacy. Lastly, APRNs are faced with challenges to our relatively restricted practice. The attempts to further restrict APRN scope of practice in Tennessee defy trends seen across the country (with no documented untoward effects) and creates a barrier to meaningful cooperation between nurses and physicians at the organizational level.

What are threats we are facing? Many bills have been introduced this year and in years past that attempt to restrict the scope of practice of APRNs (specific bills are described in the article by Wilhelmina Davis in this issue; you can look-up bills' numbers or keyword at These bills include attempts to grant the Board of Medical Examiners direct jurisdiction over the regulation of key aspects of professional nursing practice in the state by prohibiting APRNs from providing legitimate services or only authorizing the performance of these services under restrictive provisions controlled by physicians. Bills have been introduced in an attempt to thwart the practice of professional nursing, despite nurses having the knowledge and skills and a sound evidentiary base for the provisions of these services. It is inappropriate for one profession to control another. As nurses, we must resist these efforts as they will disadvantage our clients and our profession. One way to chart our way through the turbulent times is to always consider are we placing patients at the center of our thinking and are we relying on empirical evidence.

Why is it important that all nurses stand-up to protect our profession? If you are not an APRN, the threats may seem distant and insignificant. This is dangerous thinking. If organized medicine is allowed to chip away at the legitimate practice of nursing in one area, it weakens efforts to resist future attempts. All nurses "should be able to practice to the full extent of their education and training" (according to the IOM recommendations). If one group of nurses is unable to do this, all nurses are vulnerable. Equally important is the reality that we cannot afford to minimize the contributions of nurses at a time when the need for transformation of the delivery of health care is so acute. We cannot meet the challenge of improving health and health care in Tennessee and across the country without a prominent role for nurses commensurate with their professional knowledge and skills. This is the essence of the premise of the Future of Nursing report. It is incumbent upon all of us to maximize the contributions of nurses to effect needed change. It is essential that we fully embrace our professional responsibilities and rights. They are inseparable and inextricably intertwined, just as all groups of nurses in the profession should be. How do you define a professional? You define a professional by what they know and what they do. It is clear to me what we must do as nurses in Tennessee. We must advocate as a profession to do all we can to improve health and health care. This includes protecting our rightful practice for the benefit of the individuals, groups, and communities we serve.

The dissemination of professional knowledge takes many forms. The most obvious is pre-licensure professional education and other forms of formal learning. Another way that professional knowledge is transmitted is through mentoring. I want to thank one of my long-term and valued mentors, Dava Shoffner, PhD, RN, for her willingness to help me in clarifying the ideas presented in this article. She is a true professional. Thank you Dava!

by Carole R. Myers, PhD, RN, Chair Government Affairs & Health Policy Committee
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.