Since the 1800s when nursing first began to be thought of as a legitimate profession, as opposed to a calling, the issue of what constitutes and how to define ‘professionalism’ in the nursing industry has been vigorously debated. Achieving consensus on the definition of professionalism and what constitutes professional action by nurses enables the industry to provide a standard of care that is consistent and of high quality. Today, there are several key industry, professional and quality assurance bodies which exist to set standards, guidelines and codes of practice to ensure the best possible standard to care. These organisations guide professionals in nursing by defining what constitutes professionalism and monitoring the quality of care and services provided by nursing professionals and their organisations.
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It is widely agreed that there is a strong link between professional competence and behaviours and the quality of care and service provided to patient and clients. As stated by Dhai “… at the heart of being a good health care practitioner, lies professionalism, setting the standard of what a patient should expect” (Dhai p 174). In order to understand the true meaning of professionalism, however, we need to begin by defining the meanings and relationship between the two concepts ‘profession’ and ‘professional’. Whilst there is no singular uniform definition of a profession, the Australian Competition and Consumer Commission (ACCC) define it as “A disciplined group of individuals who adhere to high ethical standards and uphold themselves to, and are accepted by, the public as possessing special knowledge and skills in a widely recognised, organised body of learning derived from education and training at a high level, and who are prepared to exercise this knowledge and these skills in the interest of others” (Southwick, 1997). According to Pinkerton, author of ‘The future of professionalism in nursing’ there are six characteristics that are frequently used to evaluate whether an occupation is a profession. They are: “Education of the practitioner, having a code of ethics, receiving compensation commensurate with the work, being organized to promote a needed service, having autonomy in practice, and being recognized by the government with licensure” Pinkerton, S. (2001). Nursing is therefore a recognized profession as it can be described using all of the characteristics listed above.
In much the same way, a ‘professional’ can be defined as an individual who is expected to demonstration competent and skilful behaviours in agreement with their profession. In regards to the health industry, a ‘professional’ is defined as, “any person who has completed a course of study in a field of health. This person is usually licensed by a government agency or certified by a professional agency.” (Mosby’s Medical Dictionary, 2009). Being professional therefore, can be interpreted as behaving in a manner which supports the effective operation of the profession.
Taking into account the meanings of ‘profession’ and ‘professional’, ‘professionalism’ can thus be described as the behaviour, goals or qualities that characterise a profession or professional person. Calls for an outline for professionalism in nursing began back in the 19th century with Florence Nightingale who once said that “Nursing is an art, and, if it is to be made an art, requires as exclusive a devotion, as hard a preparation, as any painter’s or sculptor’s work…”(Nightingale, 1868). Nightingale wanted nursing to be seen as professional and as a profession that required discipline, ongoing learning and values and at the same time selfless commitment for effective patient care and a commitment to passion and love. She set a high standard for herself and therefore set a high standard for the future of nursing. She held similar desires for the nursing profession as did Dhai.
Erith-Toth & Spencer stated that “The provision of quality patient care is a priority in all health care institutions” (1991). “Formal definitions of what constitutes quality are numerous” (Ambler Peters, 1991), “as are the approaches used to assess the quality of patient care” (Harvey, 1991; MacGuire, 1991). Quality care has had a lot of collected works written about it over the years. Although, significant variations exist in its interpretation and use of the word. According to Attree, 1993, “quality care continues to be assured, controlled, evaluated and managed in the Health Service today” (p.355). Additionally, characterizations and valuation of quality of care infrequently consider the reality encountered by nurses on a day-to-day basis, in the practice and delivery of quality care. Harteloh studied numerous conceptualizations of quality and concluded with a very abstract definition: “Quality is an optimal balance between possibilities realised and a framework of norms and values.” (Mitchell, P. H., Robins, L. S., & Schaad, D, 2005).
In 2010 a study was conducted in the USA by Burhans, L. M., & Alligood, M. R. with the aim to uncover an understanding of the meaning of quality in relation to nursing practice. The question asked was ‘What is the lived meaning of quality nursing care for practicing nurses in the USA?’ The study concluded that there were six main themes or livid meanings of what quality of care meant in the words of nursing participants. These were ”Advocacy, Caring, Empathy, Intentionality, Respect, and Responsibility” (Burhans, L. M., & Alligood, M. R, 2010). These themes listed coincide with how Nightingale saw nursing many years ago and how she stated that “Nursing is an art” (Nightingale, 1868) and highly valued by practicing nurses.
There are multiple industries, professionals and quality agencies that set standards, guidelines and codes of practice in nursing. These agencies can be divided into three broad groups. The Australian College of Nurses (ACN), the Australian College of Midwives (ACM) and the Royal College of Nurses (RCN) as recognised training providers, equip individuals with the necessary skills and competency to practice nursing. While the Australian Health Practitioner Regulatory Agency (APRAH) ensures and supports the “National Boards in their primary role of protecting the public manage the registration processes for health practitioners and students around Australia” (APRAH, 2012). For the purpose of this essay I am going to give an in depth overview of ways APRAH contributes to the nursing profession in a positive way.
AHPRA is the national organisation responsible for implementing the National Registration and Accreditation Scheme across Australia, in partnership with National Boards. “This conceptual definition reflects the fact that quality is an abstraction and does not exist as a discrete entity. Rather it is constructed based on an interaction among relevant actors who agree about standards (the norms and values) and components (the possibilities)” (Mitchell, Robins, & Schaad, 2005, p.1).
AHPRA’s is governed by the Health Practitioner Regulation National Law, and each state and territory follows Legislation relevant to their region (the National Law), which came into effect on 1 July 2010 (APRAH 2010). It is the first time that 14 health professions stand regulated by the same national legislation under the National Registration and Accreditation Scheme in the history of Australia.
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The 14 national boards that APRAH represents are the “Aboriginal and Torres Strait Islander Health Practice Board of Australia, Chinese Medicine Board of Australia, Chiropractic Board of Australia, Dental Board of Australia, Medical Board of Australia, Medical Radiation Practice Board of Australia, Nursing and Midwifery Board of Australia, Occupational Therapy Board of Australia, Optometry Board of Australia, Osteopathy Board of Australia, Pharmacy Board of Australia, Physiotherapy Board of Australia, Podiatry Board of Australia, Psychology Board of Australia”. (APRAH, 2012)
The legislation that the AHPRA follows is the Health Practitioner Regulation National Law (Victoria) Act 2009. The purpose of this Act is to provide for the adoption of a national law to establish a national registration and accreditation scheme for health practitioners. (APRAH, 2009). This Act helps nurses and midwives working within Australia to work alongside a code of conduct and ethical guidelines that help guide the practice of nurses. It also helps to legally protect and guide nursing practice. The focus is to provide a national registration and accreditation scheme for the regulation of health practitioners and the registration of students undertaking study or clinical training in the health profession.
According to APRAH, the purposes of the Act are to “provide safety for the public by guaranteeing that only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered. Their job is to also facilitate workforce mobility across Australia by reducing the administrative burden for health practitioners wishing to move between participating jurisdictions or to practise in more than one participating jurisdiction, whilst facilitating the provision of high quality education and training of health practitioners” (2010).
The AHPRA is the chief registration body for health practitioners and nurses in Australia. Through setting initial registration standards, as well as on going professional development standards, AHPRA can help ensure that all nurses that get registered are accountable and competent. National registration of nurses and midwives helps them if they wish to travel and work across the country by eliminating the need for multiple registrations.
They publish national registers of all practitioners so information regarding health professionals is available to the public. This allows the public to make informed decisions about who they entrust to play a role in their personal health queries and status. In addition, AHPRA provides advice to the ministerial council about the administration of the national registration and accreditation scheme for both health professionals and students undertaking study. An on-line register also allows employers to check that employees and forthcoming employees are adequately registered. They have developed a national registration where there is a consistent and common set of standards, across all the different states. AHPRA have worked hard to develop registration standards, such as continued professional development, professional indemnity insurance and recent practice. They carry out audits to ensure these requirements are being met and that a high quality of care is being maintained across the country.
To ensure that nurses are maintaining that high standard of care the APRAH enforce a policy where it is imperative nurses continue professional development in order to maintain their registration as a nurse. In doing so they ensure that services provided by registered nurses are up to date and of a high quality standard, which in turn helps ensure safety of the patients. Codes of professional conduct also help maintain safety within the workplace. In this way we can see that Dhai’s statement, “… at the heart of being a good health care practitioner, lies professionalism, setting the standard of what a patient should expect” (Dhai p 174), is central to the way the Australian nursing industry is structured, moderated and governed. To ensure that the nursing profession is seen as being professional and high in professionalism means that it is an upmost importance that employee’s demonstration competent and skilful behaviour at all times. Being professional also means that the employee must behave in a manner defined and expected by the chosen profession. In addition it is imperative that they must adhere to the set of standards, guidelines and codes of practice out by their governing body to make sure that the highest quality of care is achieved for not only themselves, but just as vital their team and their patients.
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