examples of promoting professionalism and trust in nursing essay

30 Examples of How to Demonstrate Professionalism in Nursing

Whether you are a nursing student or a nurse with several years of experience, you know that professionalism is a significant trait all nurses should have. While nurses are referred to as healthcare professionals, many do not understand the concept of what true professionalism encompasses. Maybe you have asked yourself, "What is professionalism in nursing?” In this article, you will find information about nursing professionalism, including 30 examples of how to demonstrate professionalism in nursing. As you continue reading, keep in mind that each nurse is responsible for developing professional characteristics and implementing those characteristics into daily practice.

What Is Professionalism In Nursing?

Who determines the standards of professionalism in nursing, 10 reasons why professionalism is so important in nursing, what are the 7 key elements of professionalism in nursing, 1. leadership:, 2. professional values:, 3. professional development:, 4. basic care competency:, 5. altruism:, 6. social justice:, 7. human dignity:, how to demonstrate professionalism in nursing, example #1: learn effective communication, how to demonstrate it in nursing practice:, why is it important in nursing:, example #2: show compassion, example #3: participate in interdisciplinary collaboration, example #4: be accountable, example #5: never stop learning, example #6: have a positive attitude, example #7: provide high-quality patient care, example #8: dress the part, example #9: be ethical, example #10: practice cultural awareness, example #11: have a “patients first” mindset, example #12: mentor other nurses, example #13: practice integrity, example #14: be detail-oriented, example #15: become a critical-thinker, example #16: help resolve conflicts, example #17: be adaptable, example #18: lead by example, example #19: make yourself a priority by practicing self-care, example #20: show respect and appreciation to your co-workers, example #21: be a faithful patient advocate, example #22: show up for work, example #23: promote safe nursing practices, example #24: pursue personal growth and development, example #25: be willing to show empathy, example #26: be sympathetic to others, example #27: practice resilience, example #28: exercise your right to practice autonomously, example #29: be confident in your abilities, example #30: be willing to accept constructive criticism and advice, what are some examples of unprofessionalism in nursing, 1. participating in or causing conflict among team members:, 2. missing work unnecessarily:, 3. not protecting patient privacy and confidentiality:, 4. taking credit for someone else’s work:, 5. avoiding responsibilities:, 6. providing misleading or false information:, 7. abandoning patient care:, 8. accepting an unsafe patient assignment:, 9. failure to maintain professional boundaries with clients or their families:, 10. using unsafe practices:, consequences of unprofessional conduct in nursing, 1. increased absenteeism:, 2. hostility among staff:, 3. disciplinary action:, 4. loss of license:, 5. damaged professional reputation:, 5 most-common challenges to professionalism in nursing practice and how to overcome them, challenge #1: maintaining positive relationships with unprofessional peers, what is it:, how to overcome:, challenge #2: knowing where to draw the line with nurse-patient relationships, challenge #3: dealing with rude patients, challenge #4: unprofessional work environment, challenge #5: emotionally charged situations, 5 tips to enhance professionalism with patients in nursing practice, 1. make patient care a priority., 2. take time to hear what your patient needs to say., 3. speak up on your patient’s behalf., 4. protect your patient’s privacy., 5. demonstrate high standards of care., 5 tips to enhance professionalism with co-workers in nursing practice, 1. be honest with yourself., 2. encourage and participate in team collaboration., 3. recognize the accomplishments and contributions of your co-workers., 4. be accountable to your team members., 5. invite co-workers to join professional nursing associations with you., bonus useful resources to learn more about professionalism in nursing, blogs/websites, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. does nursing require a higher level of professionalism compared to other healthcare careers, 2. what are professional boundaries in nursing, 3. why nurses should set boundaries to maintain professionalism in nursing, 4. what is professional presence in nursing, 5. what is professional misconduct in nursing, 6. what is personal and professional development in nursing, 7. what is professional caring in nursing, 8. what is professional communication in nursing, 9. what is professional competence in nursing, 10. what is professional advocacy in nursing, 11.what is professional accountability in nursing, 12.what is professional socialization in nursing, 13.how does professionalism in nursing influence health policy, 14.how complaining in the nursing profession hurts professionalism, 15.how should professionalism be evaluated in nursing, 16.how do nursing schools teach professionalism, 17.what are the top 3 professional goals every nursing student should aim for.

Professionalism in Nursing Practice Essay

Introduction, professional ethics, contact with the patient.

Each profession imposes certain requirements on a person, but only the work of a nurse imposes such high and specific duties on a specialist, who assumes high responsibility for the care provided to patients. People entrust the most precious things to medical workers – health and life, and therefore expect complete dedication from them. The most critical components of a people’s psychological activity are their qualities. Their development and integration in the process of professional formation lead to the formation of a system of professionally essential qualities.

A nurse should be constantly ready to provide competent assistance to patients regardless of their age or gender, the nature of the disease, race, or nationality, religious or political beliefs, social or financial status, or other differences. When providing care, the nurse must respect the patient’s right to participate in the planning and conduct of treatment (Azemian et al., 2021). Manifestations of arrogance, neglect, or humiliating patient treatment are unacceptable. A nurse does not have the right to impose her moral, religious, or political beliefs on a patient (Kim et al., 2018). When setting the order of medical care for several patients, a nurse should be guided only by medical criteria, excluding discrimination.

Having information about the peculiarities of the patient’s personality, character, and experiences, the nurse can tactfully explain to the patients their rights and duties, prepare them for upcoming examinations and therapeutic procedures, and talk about them in an accessible form. The unwillingness of the patients to undergo certain types of examinations or medical procedures should not cause a negative attitude toward them on the part of the nurse (Azemian et al., 2021). Nurses are required to be honest and truthful in communicating with patients. However, any conversations concerning the diagnosis or features of their disease should not go beyond the limits indicated by health professionals (Kim et al., 2018). The same rule should be observed during conversations with the patient’s relatives.

The views of other staff and nurses regarding some aspects of patient care may sometimes differ somewhat. There should be no fundamental disagreements, but it is necessary to discuss the problem with colleagues since achieving complete agreement tactfully facilitates the work. Discussing such disputable situations with third parties or directly with the authorities is unnecessary since this may provoke an unhealthy situation within the labor collective (Azemian et al., 2021). Undoubtedly, nurses have every right to defend their point of view, but at the same time, they should be ready to admit and correct their own mistakes (Kim et al., 2018). High self-demand is one of the essential qualities of any professional, and a nurse is no exception.

The main qualities that a good nurse should possess are knowledge, skill, tenderness, tenderness, compassion, mercy, boundless patience, responsibility, and politeness. Unfortunately, due attention is currently not paid to the definition and promotion of these essential qualities. Huge loads on the nurses during the performance of their professional duties only sometimes allow them to show the necessary qualities to the proper extent. Ideally, the work organization in a medical institution should be such that knowledge, skills, competence, and professional growth are expected and rewarded accordingly. Any person who has decided to devote his life to medicine should understand that no circumstances would justify any unethical act.

Azemian, A., Ebadi, A., & Afshar, L. (2021). Redefining the concept of professionalism in nursing: an integrative review . Frontiers of Nursing , 8 (4), 327–340. Web.

Kim, Y. H., Jung, Y. S., Min, J., Song, E. Y., Ok, J. H., Lim, C., Kim, K., & Kim, J. S. (2018). Development and validation of a nursing professionalism evaluation model in a career ladder system . PLOS ONE , 12 (10), e0186310. Web.

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Northern Ireland Practice and Education Council. Enabling Professionalism in Nursing and Midwifery (project overview). 2022a. https://tinyurl.com/555b3y3z (accessed 16 May 2022)

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Promoting professionalism

Chief Nurse, Oxford University Hospitals

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Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on professional pride and discussions of what ‘professionalism’ in nursing and midwifery looks like—and how to enable it

Reflecting on International Nurses Day this month was a time to celebrate and be proud of why we entered the profession and why we call ourselves nurses. Among some truly wonderful examples of practice development and research shared at my own organisation's celebrations, two of the most powerful sessions for me included hearing personal stories from our ‘Daisy’ award winners and presenting four long service awards to nurses who had all delivered over 40 years of NHS nursing each. I felt very reconnected with the profession and reflected that we should never underestimate the difference we can make for the people that we work with and those in receipt of our services and their families.

In 2015, the Nursing and Midwifery Council (NMC) published a strategy setting out development plans in order to fulfil its mission to protect patients and the public effectively and efficiently. This would incorporate the revised NMC Code (2018) , containing a series of statements that taken together signify what good nursing and midwifery practice looks like: putting the interests of patients and service users first, providing safe and effective care and promoting trust through professionalism.

The NMC launched professional revalidation in 2016. In discussing what this involves, the regulator makes the point that revalidation is about promoting good practice, as well as strengthening public confidence in the nursing and midwifery professions. It is also stated that revalidation helps to encourage a culture of sharing, reflection and improvement—that it will provide benefits for nurses as well as the people they care for.

Latterly, the four national Chief Nursing Officers, working alongside the NMC, took forward a nationwide initiative to define what ‘professionalism’ means in practice. The work was chaired by Professor Charlotte McArdle. This has led to the development of a revised conceptual framework, Enabling Professionalism ( Northern Ireland Practice and Education Council, 2022a ; 2022b ). The framework defines professionalism as characterised by:

‘The autonomous evidence-based decision making by members of an occupation who share the same values and education.’

It goes on to discuss that professionalism in nursing and midwifery is ‘realised through purposeful relationships and underpinned by environments that facilitate professional practice’ reflecting that ‘professional nurses and midwives demonstrate and embrace accountability for their actions’.

The framework concentrates on maintaining professionalism as being underpinned by the NMC Code, and demonstrated through a number of attributes:

• Being accountable
• Being a leader
• Being an advocate
• Being competent.

There are further elements to the framework involving leaders enabling professionalism through:

• Recognition and encouragement of nursing and midwifery leadership
• Encouragement for autonomous innovative nursing and midwifery practice.
• Enabling practice learning and development
• Provision of appropriate resources.

And finally, there are key areas we must all consider our own individual responsibility to uphold professionalism:

• Learning and developing
• Being a role model
• Supporting appropriate service and care environments
• Enabling person-centred and evidence-informed practice
• Leading professionally.

The framework was officially launched on International Nurses Day 2022 alongside the ‘Here for Life’ campaign (https://herefor.life), which aims to empower nurses and midwives to tell their own stories, so that the general public will develop a fuller understanding of the breadth and diversity of nursing and midwifery roles and expertise, and the impact that these professions have on the people they care for and on our society as a whole.

The Here for Life campaign is asking registered midwives and nurses to share their own story on social media using the hashtag #HereforLife. This can be a single image or video clip that gives an example of something you do in your role that makes you ‘Here for Life’ or that sums up who you are and what you do as a nurse or midwife.

The campaign will also be asking the public to get involved by sharing a photo or story of a moment when the skills of a nurse or midwife made a significant difference to them or a loved one. After the last couple of years that the profession has been through, I think that this is a really positive way to celebrate our wonderful profession and I hope it will reignite individuals' pride and help to recruit and retain colleagues.

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Professionalism experiences of undergraduate learner nurses during their 4-year training programme at a Higher Education Institution in the Western Cape, South Africa

Portia bimray.

1 School of Nursing, University of the Western Cape, Cape Town, South Africa

Karien Jooste

2 Department of Nursing, Cape Peninsula University of Technology, Cape Town, South Africa

Hester Julie

3 Faculty of Community Health Science, University of the Western Cape, Cape Town, South Africa

Associated Data

Data sharing is not applicable to this article as no new data were created or analysed in this study.

Professional socialisation of student nurses needs to be integrated into the formal teaching and learning during the nursing programme. Embedded in the training programme are professional values that are used synonymously with nursing professionalism. Professionalism is the conduct, qualities, values, vision, mission and/or goals that characterise a profession, and describes behaviours that are expected within the profession’s members. However, one’s values are shaped by one’s experiences, influence one’s behaviour and interactions with others, and are manifested in many aspects of professional behaviour. New nurses to the profession are expected to display behaviours of professionalism, thus requiring nurse training schools to help students internalise these behaviours. Nurse educators therefore carry a responsibility to shape future nurses’ growth towards professionalism.

This article reports on the experiences of undergraduate student nurses regarding nursing professionalism during their 4-year training programme at a Higher Education Institution in the Western Cape, South Africa.

A qualitative, exploratory and descriptive design was applied. Eight focus group discussions were conducted with first- to fourth-year student nurses registered for the undergraduate nursing programme. Data were transcribed verbatim and analysed using open coding. Ethical principles and trustworthiness were maintained throughout the study.

Six main themes indicated that undergraduate student nurses experienced issues with role modelling, language barriers, their own understanding of professional behaviour, reasons for students and practitioners’ unprofessional behaviour, prejudice towards degree students and students’ professional or unprofessional behaviour experienced as contributing to the image of the profession.

Student nurses received mixed messages leading to emotional turbulence. They needed clear guidance from role models to demonstrate how to behave professionally.

Introduction

Nursing professionalism is an integral part of the formal curriculum of the undergraduate nursing programme leading to a professional qualification. Embedded in the training programme are professional values, a term which is used synonymously with nursing professionalism (Jooste 2017 :21). Professional nursing values refer to the attitudes, beliefs and priorities of nurses that ultimately function as a guide and motivation in interactions with patients, colleagues and other professionals (Leners, Roehrs & Piccone 2006 in Caldwell & Miller 2016 ). In the context of the nursing profession, values are essential to maintain high standards of nursing care (Kaya et al. 2017 :716). It is generally assumed that student nurses who have completed an accredited training programme and have been socialised into the professional culture would have internalised the requisite professional values (Jooste 2017 :22). These values are important to healthcare facilities because they are an important way of living out ethical commitment and affect patient safety and outcomes (Caldwell & Miller 2016 :3). Caldwell and Miller ( 2016 :3) mention that because prospective employers and practising nurses are looking for professional values in new nurses, nursing schools and nursing students should be concerned with student development of professional nursing values.

A review of literature at international and national levels demonstrates the challenges of nursing students in basing their clinical practices on professional values. Research has focused on seeking patterns to explain deficiencies in values that lead to a diminished quality of patient care (Caldwell & Miller 2016 ). The increase in ethical conflicts in healthcare necessitates further addressing of professional values (Shafakhah et al. 2018 :5).

Developing professional values in nursing students strengthens their capacity for reasoning and ethical decision-making in challenging situations and enables the provision of safe, legal and ethical care. It is also an important aspect of nursing education, which is taught through training nursing students and clinical experiences (Shafakhah et al. 2018 :5). According to Shafakhah, these values develop through education and contact with nurse educators. The challenges to the development of professional values are a key concern for nursing educators.

Nursing educators are mindful of the challenges students are faced with in practice. Cognisance is taken of factors such as the burden of disease, shortages of nurses, cultural diversity and a stressed socio-economic environment, which could impact professional nursing practice and health service delivery (Erasmus 2008 :62) (Muller 2009 :75). The current healthcare environment requires competent professional nurses capable of managing complex professional issues. It thus becomes essential for professional nurses to take responsibility for their actions, as well as initiative to understand and master the changing work situations, yet to keep up with the increasing demands and changes in healthcare practice (De Braganca & Nirmala 2017 :60).

Coupled with the above factors is the overall professional culture of a student’s training environment, which is a powerful determinant in shaping professional values and attitudes, and which is believed to contradict or work against what is learned in the classroom. Training programmes must aim to provide professionals with professional values that will enable them to make a meaningful contribution to health services and the practice environment to improve patient care outcomes (South African Government Gazette 2011 ). Geyer, Mogotlane and Young ( 2010 :33) are of the opinion that the student nurse entering the profession should positively commit to adjusting his or her behaviour in the interests of ensuring quality and safe patient care. This may require adaptation of the personal values of student nurses to ensure that their conduct adheres to the professional values of nursing. Caldwell and Miller ( 2016 :37) indicate that it is possible for student nurses to transition from a lay to a professional nurse over the course of their 4 years. It is, hence, undoubtedly that awareness of the need for strong professional values on the part of nurse educators, clinical facilitators and professional nurses is needed in preparing nurses to manage patient care in a capable and professional manner. By developing these professional values, a student nurse develops her or his professional identity (Fagermoen 1997 :434).

The development of professional values and behaviours forms a significant part of the professional socialisation process (Hammer 2000 :455). Professional socialisation is a process through which people selectively acquire the current values and attitudes, interests, skills and knowledge (culture) in the groups in which they are, or groups of the profession of which they seek to become a member (Hammer 2000 :455).

Kubsch, Hansen and Huyser-Eatwell ( 2008 :375) state that despite the gains that have been achieved regarding the professionalisation of nursing, the profession continues to struggle with its professional status. Kubsch et al. ( 2008 ) agree that nursing education programmes at institutions of higher education play a significant role in how professional values are learned and demonstrated in nursing practice. It is argued that the educational preparation of the registered nurse (RN) may make a difference in professional values, as nursing education programmes instil in their student nurses the notion that they are professionals and members of the nursing profession (Kubsch et al. 2008 :375). The authors suggest that these values acquired in nursing education programmes may be discarded after the nurse has graduated. Some of the reasons for this may be that values were imposed on the student rather than freely chosen, or because of work pressures. Iacobucci et al. ( 2012 :418) confirm that the internalisation of professional nursing values among undergraduate nurses continuously increases from junior to senior levels during their training. Despite findings which indicate that professional value internalisation evolves during undergraduate nursing programmes, student nurses continue to report difficulty in enacting behaviours that support values because of various professional and organisational factors (Iacobucci et al. 2012 ).

Theoretical framework

This study was guided by the theoretical framework of Brown and Ferrill’s ( 2009 :4) taxonomy of professionalism. Brown and Ferrill ( 2009 ) created a professionalism model to organise the abstract concept of professionalism and reflect how professional values link with professional behaviours. Generally, value development is a long-term process of consolidating and embedding one’s own beliefs, attitudes and values into one’s moral behaviour. Any kind of human development is associated with learning, for example, learning ideas and skills, and then making use of them. These factors were considered in the data analysis and interpretation of the findings. The model of Brown and Ferrill ( 2009 :4) assumes a focus shift from learning to practical performance or behaviour. Assumptions about professionalism in nursing that emanate from the model were adapted for this study. The elements of professionalism include the core professional values (also referred to as characteristics) of nursing. Professional values of nurses are, thus, linked to their expected professional behaviour in practice. A student’s professional values determine his or her professional behaviour in nursing practice. The development of professional values is a long-term process of learning that leads to professional behaviour in a professional practice setting.

Research methods and design

This study aims to report on the experiences of undergraduate student nurses regarding professionalism during their 4-year training programme at a Higher Education Institution (HEI) in the Western Cape. The study was part of a bigger research project that developed a conceptual framework for nurse educationalists and professional nurses to facilitate professionalism among undergraduate student nurses at a HEI in the Western Cape.

Study design

This was an exploratory, descriptive and contextual qualitative study design. Eight focus group discussions (FGDs) were used to explore data from student nurses regarding nursing professionalism in an undergraduate programme in the Western Cape.

The study was conducted at a HEI that offers a 4-year degree programme for nurses in the Western Cape. The programme consists of an integrated theory–practice component. Theoretical learning takes place in a classroom environment, while student nurses are placed for clinical learning at accredited public healthcare facilities across the Western Cape Metropole.

Study population and sampling strategy

The target population was all undergraduate student nurses (1058) registered for the B.NUR programme in 2013 in a school of nursing at a HEI in the Western Cape. Purposive sampling was followed with first- to fourth-year student nurses. Any participants who did not give consent to partake in the study, or who did not meet the inclusion criteria, were excluded from the study.

Data collection

Student FGDs were used as a means of data collection. The FGDs were held during the students’ lunch hour, or after classes. The FGD sessions lasted for not longer than 60 min. During this time, participants were encouraged to ask questions about the study. An interview guide was used to pose the questions. The initial question asked to student nurses was: ‘What are your experiences about professionalism in the undergraduate nursing programme at this institution?’.

Data analysis

Recorded data were transcribed verbatim. All the transcripts were carefully read and reviewed to contribute to a meaningful whole. The data were subsequently analysed using a process of identifying themes in the data for underlying meanings. Categories were assigned to the themes, and the researcher also reviewed documented observations made during the interviews. A total of eight focus group interviews were conducted until data saturation occurred and no new data emerged. No new information was observed at the eighth focus group of student nurses.

Ethical considerations

Ethical approval to conduct this study was obtained from Research Ethics Committee of a university in the Western Cape and permission was granted by the Western Cape Department of Health to conduct the study with participants at the accredited healthcare facilities where the learner nurses were placed for clinical learning. Ethical clearance registration number 12/10/18. Ethical principles and trustworthiness were maintained throughout the study. The following ethical principles were adhered to

• the principles of no harm and beneficence
• the principle of respect and justice
• the principle of privacy and confidentiality.

Despite being exposed to and trained to develop professionalism and receiving support from educationalists and professional nurses (both in theory and practice), the student nurses experienced mixed messages and emotional turbulence about what it really means to be a professional. The dominant themes that emerged from the data were role modelling of unprofessional behaviour; language barriers in the development of professional behaviour; participants’ own understanding of professional behaviour; reasons for students and practitioners’ unprofessional behaviour and suggestions for improvement; prejudice towards degree students; and students’ professional or unprofessional behaviour experienced as contributing to the image of the profession.

Role modelling of unprofessional behaviour

The findings reflected strong feelings about the ‘unprofessional behaviour’ of professional nurses in some settings and wards towards the university’s first- and second-year students. Examples of poor role modelling or misconduct were mentioned, while some participants advocated for students to take control of negative role modelling and pay attention to their own unprofessional behaviour. The experiences of unprofessional behaviour by nurse practitioners included humiliating and demoralising communication towards student nurses.

The dominant experience related to professional nurses’ communication with students. These experiences were regarded as not upholding the values of respect and dignity of co-workers or peers: ‘she’s shouting in front of the patients, your dignity is going to like decrease’ (1st year, P11, FG1).

A participant described being humiliated in front of peer student nurses by the way the nurse educationalist communicated loudly with her:

‘I also had a misunderstanding with a supervisor and the way she conducted herself with me. She was not; … I can say and stand for this, that she was not professional. She insulted me in front of my peers and she spoke loud enough so that her colleagues could also hear.’ (1st year, P7, FG2)

Participants expressed the need for professional nurses to demonstrate to them how to behave professionally in the clinical placements:

‘I believe that the sisters in the wards have a huge role to play to portray how professionalism should be and … practically showing us how to behave professional. We do have lots of information – theoretically … you can teach me how to remove sutures, but it is a different story to remove them. You must show me how to remove them also if you’re going to teach me. I need someone to show me how to behave professionally and that is not happening.’ (4th year, P3, FG3)

Language barriers in the development of professional behaviour

Student nurses throughout all year levels in the undergraduate nursing programme experienced that language barriers negatively affected their professional development. They had difficulty in understanding the language in the placement facilities because of the way people spoke with each other:

‘I think there is a language barrier. … It must come with the way you talk to people. … There is a language barrier there. We don’t understand.’ (4th year, P6, FG3)

On the contrary, occurrences were described where participants were treated with kindness, and where professional staff were considerate in showing that they cared about the cultural differences of student nurses, by explaining tasks to them in a language that they understood:

‘… The environment that I’m working in, the nurses there are very professional, even though they are Afrikaans speaking. But they’ve got a way of making you feel comfortable, even though their files/folders are written in Afrikaans. But they are willing to explain and try to make you understand what does this mean.’ (1st year, female P, FG1)

Participants also described that not being able to express themselves in a specific language lowered their self-image:

‘And English. Because when you’re not able to communicate, you become shy when you need to address anyone – whether it’s a superior or someone else, a co-student, you become inferior to address them because you feel that, okay; I’m not fluent in this kind of speech.’ (1st year, female P, FG2)

Participants’ understanding of professional behaviour

Participants thought that professional behaviour should be centred around admiration for educators and mutual respect between educators and students:

‘Mutual respect. One needs to make sure mutual respect. I think that’s the first … I think that’s the most important thing. Just as long as there’s respect for the teacher and respect for the students as well.’ (3rd year, P1, FG2)

Participants mentioned that background played a role by indicating that nurses enter the nursing profession with basic values of respect, kindness, politeness or good manners, and punctuality, and that they should maintain these values throughout the undergraduate nursing programme:

‘… In your schooling and in your life experience you just learn the basic values, punctuality – when you have to be somewhere, you must be there, you must be on duty. You know if you have an appointment, you must be there. Basic respect, basic politeness, all of these things are just basic human conduct that most people have. And it just seems that for some reason when you become a student you just lose all of these values.’ (4th year, P3, FG3)

Reasons for students and practitioners’ unprofessional behaviour and suggestions for improvement

It seems that a lack of comprehension of professionalism resulted in undesirable behaviour on the part of the participants. Student nurses revealed that they memorised the professional values to pass an assessment:

‘I didn’t even understand it. I just memorised it and then I wrote it in a test and then I let it go.’ (4th year, P6, FG3)

Participants were unclear about what professionalism meant and how they should apply it in the clinical settings:

‘Not everyone knows what the word “professionalism” means. They don’t know. So they act, like in their eyes, they’re professional. But actually they’re not. Because there’s not enough emphasis placed on professionalism. Also, in the clinical settings you get to work in, 20 percent of the time the staff is professional, but the other 80 percent of the time they’re not. They do what they want to do and that is the time that you also fall into that trap when you do things that isn’t right. And that is unprofessional.’ (4th year, P4, FG3)

There was a need for clear guidance and direction on how to act professionally in nursing practice, and the value of having standards of professionalism:

‘And I would really appreciate it if there should be someone who can explain to me what must I do. If you want professionalism, you must put everything down. What must I do if you want me to be a professional – 100 percent professional.’ (4th year, P6, FG3)

They were unaware whether professional standards exist:

‘ … If there should be standards of professionalism for us to be taught. What are the standards? What are the things if I’m doing this I’m being unprofessional? Or if I’m doing this I’m not being professional. I think that will help us a lot to understand what professionalism is all about. Honestly, we are told to be professional, but we don’t know how to be professional.’ (4th year, P2, FG3)

Other participants thought that a mentor should be available to whom they could air their personal issues:

‘I think if we can just have someone like a mentor to go to just to in regard to any questions that you would have, just to make sure that you are still fine and on track, not just your studies, but your personal life as well. It would be much easier … at least once a month.’ (3rd year, P4, FG2)

Practitioners’ prejudice towards degree students

There was a perception among the hospital staff that university degree student nurses thought that they were better at performing skills:

‘So they always have that mind-set that the university students think that they’re smarter than them because we do things in a certain way.’ (3rd year, P1, FG1)

However, other participants felt judged and discriminated against because of the HEI from which they came. They expressed feelings of inferiority and humiliation in clinical settings:

‘You’re from HEI A. You don’t know what you do … and … they would be like why are you so stupid? They are very condescending and judgmental towards you.’ (3rd year, P1, FG2)

Participants also mentioned having issues with the professional nurse in charge, who passed judgement and compared the practical skills of the university students to those of the college students in the clinical practice setting:

‘The sister in charge … they have like that attitude, HEI A (offering degree) students are full of theory and not practical. So they’re like … they are separating us. No, the HEI B (offering non-degree) students are like good in practical and you are the ones that are good in theory. So we don’t want theory here at work.’ (1st year, P3, FG1)

Students’ professional or unprofessional behaviour was experienced as contributing to the image of the profession

According to participants, some student nurses did not know how to conduct themselves professionally and were disrespectful towards senior professional staff in the clinical placement settings:

‘They (some students) don’t know how to speak to the other person, how to speak to a senior when they’re working as well. So they don’t know how to be professional or what to do to act professional towards any other person.’ (4th year, P1, FG3)

It was reported that student nurses were not serious and did not have the appropriate attitude or mind-set when they went to the nursing workplace environment:

‘… We are taking this student mentality to a hospital or to a work place and we’re still thinking we’re students in that sense – have fun and enjoy ourselves throughout the whole day, which is not true. Immediately there is a professional standard in the hospital self.’ (3rd year, P1, FG2)

This qualitative study reports on the experiences of undergraduate student nurses regarding nursing professionalism during their training at a HEI. The experiences of student nurses in an undergraduate programme highlight important issues for both nursing education and nursing practice. Undergraduate student nurses, throughout their 4-year training programme, have expressed some of the main aspects that could be factors in preventing them from reaching the expected nursing professionalism at the end of their training.

Role modelling has been highlighted as essential in undergraduate training programmes for student nurses. Role models who portray a positive attitude and are approachable play a vital role in supporting these student nurses in the classroom and clinical learning environment. Important learning, including the teaching of concepts, theory, critical thinking skills and research, happens in the classroom, but is best integrated with the skills learned in the clinical setting where integration of theory and practice takes place (Cunze & Van Rensburg 2016 ). Role models as leaders are needed to guide followers appropriately, so that they feel inspired and motivated to carry out the right tasks (Zhu et al. 2012 ). It is regarded as essential that professional leaders set a positive example as role models whose attitudes and values are assimilated by students. The most appropriate way for students to learn what it means to be professional is to see it in action (Felstead 2013 ).

Language barriers can cause limitations and challenges to healthcare professionals (Omolola & Gray 2014 :18). Within the context of South Africa as a diverse country with different languages, findings in this study revealed that language was a barrier to communication in the clinical placement facilities, and that especially English could be an obstacle in the professional development of student nurses during their undergraduate training programme. English as a second language complicates communication in the clinical practice environment (Ho & Coady 2018 ). Student nurses from diverse cultural backgrounds often misunderstand or misinterpret messages in practice, when English is not their first or preferred language of communication. This is consistent with a finding by Houle ( 2010 ) that the majority of nurses reported that language barriers are a significant impediment to quality care and a source of stress in the workplace. Incomplete nursing assessments, misunderstood medical information and the lack of therapeutic relationships between providers and patients are problems encountered when there is limited English proficiency among role players (Butts 2013 :93; Houle 2010 ). In this study, participants reported on the use of Afrikaans as the language of choice in healthcare facilities in the Western Cape Metropole. The patient’s treatment plan should be communicated in a language universal to all healthcare professionals involved with the patient. Furthermore, professional nurses should convey body language that is congruent with their verbal communication because they are sending out a professional message that has great impact on the emotions experienced by student nurses (Diogo et al. 2016 ). Student nurses become more receptive to the messages of the professional nurse if they can sense true caring in the body language of the professional nurse.

Professional behaviours influence nursing professionalisation and these behaviours strongly impact professional development (Tanaka et al. 2016 ). Professional behaviour was understood by student nurses as having important values such as respect and dignity to interact with others in a caring way. Being treated with respect has a positive impact on trust and the self-image of a person. Poor interpersonal relationships with clinical staff are seen as barriers to learning, and may have a huge impact on students’ attitudes and confidence (Lawal et al. 2015 ). Communication that humiliates students is regarded as negative and creates effects such as anxiety in the learning environment (Richmond, Wrench & Gorham 2009 ). Diogo et al. ( 2016 ) allude to the importance of monitoring the emotional needs of students in clinical practice.

The need for emotional support of student nurses therefore becomes essential, as it has been indicated that student nurses often experience emotional trauma in different forms during their placement in the clinical facilities (Diogo et al. 2016 ). A supportive learning environment is expected by these student nurses where they feel comfortable enough to make mistakes and learn from them. They learn from mentors who appreciate their individuality and different learning needs. Nurse educators must therefore ensure that the clinical environment is ideal for learning (Lawal et al. 2015 ). The provision of emotional support to student nurses should, thus, be by nurse educationalists in the academic environment, who connect with them on a different level in the classroom setting and who understand their unique needs, as opposed to the professional nurses in the clinical learning environment. Although the university or enrolling institution does provide support structures for students with academic and psychosocial needs, these resources are available to the broader campus community. However, student nurses have expressed that their need for support is different from the general student population on campus.

The reasons for unprofessional behaviour that were reported in the findings of this study were, among others, the lack of understanding of what professionalism means, that the specifics of professionalism are not clear and that there is a need for standards and practical guidelines. It would be invaluable if student nurses could be empowered by nurse educationalists and professional nurses to resist poor practice examples, by having clear professional policies and guidelines in place that would guide the student nurse in the clinical placement facilities on how to behave in the practice environment. Consistent with the previous work by Laschinger, Zhu and Read ( 2016 ), the student nurses need support and guidance as they transition into their professional role. This is essential for new nurses learning their professional role, and especially for those student nurses who may be unsure of their scope of practice. Professional nurses should guide student nurses to adhere and conform to the rules of the profession, to achieve in the student nurse the desired standard of what is acceptable and unacceptable behaviour in clinical practice. Adherence to guidelines (e.g. procedural performances) promotes patient safety and is associated with positive clinical outcomes (Nilsson et al. 2014 :1). It is, however, not an unusual phenomenon that deviation from guideline practices does occur during a student nurse’s training. The issue of students deviating from practice guidelines while attending a university programme should be taken seriously (Nilsson et al. 2014 :6). As such, it has been confirmed in this study that professional values are taught but not internalised by undergraduate student nurses. Disparities between idealism and professionalism taught in nursing education programmes in a classroom environment may be part of the challenges experienced by the new student nurses when exposed to the realities of the clinical practice environment. Often a perfect situation is sketched in a classroom setting, which is not reflective of the real-life situation in practice. Therefore, providing ongoing support in the form of mentorship for student nurses is important to ensure that they are receiving the necessary guidance in learning how to be professional (Laschinger et al. 2016 ).

The findings also indicated differences in perceptions of student nurses who enter the clinical learning environment from different training institutions. Participants who undergo the undergraduate training at the university, for degree purposes, are occasionally labelled as ‘being full of theory and not practical’ and compared with their counterparts who study at nursing colleges for non-degree qualifications when they are in clinical placement facilities, sharing the accredited facilities with nursing students from other institutions. Furthermore, undergraduate student nurses from the university felt judged and discriminated against by the attitudes of hospital staff. They have expressed feelings of inferiority when they are in the facilities supported by the following responses: ‘You’re from university A. You don’t know what you do’ (1st year, P1, FG2) and ‘Why are you so stupid? They are very condescending and judgmental towards you’ (3rd year, P1, FG2).

They struggle to fit in with perceived skilled student nurses, who study at the college and who are placed for a longer period of time in the practice environment during their training. The time spent in the wards or facilities by college students leads to formation of relationships or comfort in the practical setting that the undergraduate student nurses from the university do not have the luxury of developing. However, increased nursing experience is not associated with increased professional values (Caldwell & Miller 2016 :5). While the perception is that college nurses perform better because they are more exposed to practical work in their training, degree nurses undergo an integrated theory–clinical curriculum that encourages critical thinking. There is, thus, an assumption among permanent hospital staff that degree nurses ‘know more’, and therefore the expectations are higher for student nurses who are in the undergraduate training programme. The findings suggest that undergraduate student nurses experience challenges in the clinical learning environment. Similar challenges have been reported in previous studies, in that clinical learning is always influenced by relationships in context, that is, student–staff relationships are shaped by the curricular and programme context (Jamshidi et al. 2016 ). Not being exposed to clinical learning in the same way as college-trained nursing students, for example, created a specific situation for student nurses in degree programmes. These dynamics created conditions that constrained learning. Equality and non-judgemental treatment of training nurses from different nurse training institutions at healthcare facilities are essential for achieving learning outcomes and gaining competence in theory and practice.

The study revealed that some student nurses did not act with respect and did not take professional responsibility in practice seriously. Student nurses are expected to apply a different mind-set or attitude in clinical practice by conducting themselves appropriately in the different learning environments to when they are in the classroom setting on campus. When they go as ordinary students to the workplace environment, student nurses should be aware of the professional standards that exist in the hospitals. These standards should be adhered to when they transition from the academic learning environment. However, participants reported that they wanted to be regarded as normal university students who want to have fun or feel free to be like the bigger student community who seems to be carefree students on campus. Their peers were of the opinion that this mind-set should change when they enter the clinical practice environment, as student nurses should know how to conduct themselves professionally in practice. Their communication with senior professional nurses in the clinical placement settings should be respectful. Participants also strongly motivated for student nurses to take responsibility for their own learning. Peer student nurses verbalised the importance for student nurses to have the professional capability to create a learning environment in which they take ownership of being competent in initiating their own learning, and that they are self-motivated while conveying a positive image of the nursing profession.

Strengths and limitations

This study formed part of a larger doctoral study that describes the experiences regarding nursing professionalism from the perspectives of three cases, that is, student nurses, nurse educationalists and professional nurses. They remain the main stakeholders in nursing practice and nursing education. The views of student nurses are therefore the same under contextual conditions and beliefs about professionalism within nursing education and practice. The original contribution of the study is its relevance to nursing education and nursing practice in preparing nursing graduates for their future careers and service in a dynamic, yet unpredictable environment, in which the professional values of the nursing profession could be compromised. Furthermore, the study provides input into the implementation of the Provincial Nursing Strategy to address challenges faced by the nursing profession in the Western Cape in facilitating professionalism in professional nursing practice. New knowledge was generated by a framework that included all stakeholders involved with the education of the new generation nurse, to internalise professional values in an ever-changing environment. This article reports on the integration of the findings from the case of student nurses into the professionalism framework. The qualitative study emphasises depth and insight from the information produced by undergraduate students and cannot be generalised to the larger population of student nurses across the Western Cape.

The study is also limited to HEIs and healthcare facilities in the Western Cape Metropole, focusing on a setting in an urban area in which nursing education and clinical practice take place. Future research should focus on rural areas, other urban areas and other provinces as this would provide an understanding of the extent of the phenomena around nursing professionalism across the entire country, taking into consideration a wider contextual field to explore.

Implications and recommendations

The issue of nursing professionalism remains a topic of wide discussion. It continues to lack a clear definition to guide new comers to the profession on how to behave when they do not have role models to demonstrate what it means to be professional.

The following recommendations are suggested as a result of the findings. Professional nurses in clinical nursing practice should inter alia role model the total image, the code of conduct and the expected professional behaviours required for nursing practice, and demonstrate the desired attitudes, values and behaviours of professionalism expected from all members of the profession. They should provide a proper orientation for undergraduate student nurses to ensure that they know what is expected of them from the start and that they get a sense of belonging or feeling welcome as part of the team of professional nurses in practice. The orientation programme for new nurses should include concepts in the nurses’ pledge and code of conduct or ethics. It is strongly recommended that professional nurses provide privacy when student nurses are disciplined for their mistakes in the patient care wards and foster a culture in which student nurses feel comfortable to ask questions or look for help when they are in the clinical placement environment.

It is furthermore recommended that educational opportunities be provided to accommodate the different and specific learning needs of both undergraduate student nurses and those student nurses from non-degree programmes. Student nurses from the respective programmes, however, should be treated equally at similar levels of learning and should be treated respectfully for the strengths they bring to the clinical learning environment in practice.

Healthcare institutions need to ensure that the communication policy in all hospitals includes the use of a universal language that will prevent misunderstandings that might potentially be an obstacle in achieving excellence in patient care outcomes.

Lastly, healthcare institutions should make the expectations that will facilitate professionalism among student nurses known. There is, thus, a need for wards within the healthcare institution to make the vision, mission and goals that lead to excellence in patient care visible to all nursing staff.

Conclusions

This study reported on the experiences of undergraduate student nurses regarding professionalism during their training at a HEI in the Western Cape Metropole. Undergraduate student nurses are expected to internalise professional values and assume nursing professionalism during their training programme at a university or HEI. Challenges that they experience regarding nursing professionalism have significance for both nursing education and nursing practice.

Acknowledgements

The authors would like to thank Prof. Mario Smith for the research support and Dr Prof. Anna Strebel for mentoring and editorial assistance.

Competing interests

The authors have declared that no competing interests exist.

Authors’ contributions

P.B. was responsible for conceptualisation of the article, literature review and acquisition of data, analysis and interpretation of data and discussion. K.J. was the thesis supervisor and critically revised for intellectual content. H.J. was the thesis co-supervisor and critically revised for intellectual content.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Data availability statement

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.

How to cite this article: Bimray, P., Jooste, K. & Julie, H., 2019, ‘Professionalism experiences of undergraduate learner nurses during their 4-year training programme at a Higher Education Institution in the Western Cape, South Africa’, Curationis 42(1), a2030. https://doi.org/10.4102/curationis.v42i1.2030

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• Open access
• Published: 07 February 2023

What is nursing professionalism? a concept analysis

• Huili Cao 1 , 2 ,
• Yejun Song 3 ,
• Yanming Wu 1 ,
• Yifei Du 1 ,
• Xingyue He 1 ,
• Yangjie Chen 4 ,
• Qiaohong Wang 1 , 4 &
• Hui Yang 1 , 4  

BMC Nursing volume  22 , Article number:  34 ( 2023 ) Cite this article

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Nursing professionalism plays an important role in clinical nursing. However, a clear conceptual understanding of nursing professionalism is lacking.

Walker and Avant’s strategy was used to analyse the concept of nursing professionalism. We searched electronic databases, including PubMed, Scopus, and CINAHL, for studies published from 1965 to 2021. Quantitative or qualitative studies published in English that focused on nursing professionalism were included in the study.

The three attributes of nursing professionalism are multidimensional, dynamic, and culture oriented. Based on the analysis, nursing professionalism is defined as providing individuals care based on the principles of professionalism, caring, and altruism.

Conclusions

This study offers a theoretical definition and conceptual model of nursing professionalism that may be applied to develop standardized assessment tools or nursing professionalism training programs.

Peer Review reports

Introduction

The COVID-19 outbreak has exposed deficiencies in the underinvestment of the global health system, including the shortage in nursing resources and nursing staff, and a similar situation is noted in China ( https://www.icn.ch/news/investing-nursing-and-respecting-nurses-rights-key-themes-international-nurses-day-2022 ). An unbalanced number of nurses and patients, high work pressure, lack of social occupational identity and other reasons have led to job burnout, low job satisfaction, and even the resignation of many nurses. Research has also shown that the lack of nursing professionalism adversely affects patient care and patient outcomes [ 1 ]. Ohman [ 2 ] pointed out that lower levels of professionalism may cause negative outcomes, such as turnover and attrition and lower productivity.

In recent years, researchers have tried to solve the above problems through professionalism.

However, nursing professionalism plays a more important role in clinical nursing. Some studies have shown that professionalism can improve the professional knowledge and skills of nurses and ameliorate reductions in institutional productivity and quality [ 3 ]. Higher levels of professionalism can improve nurses’ autonomy and empowerment, increase their recognition and facilitate organizational citizenship behaviours, establish nursing care standards and even improve quality services [ 4 , 5 ].

Nursing professionalism has been discussed for several decades. Hall (1968) developed the Professionalism Inventory Scale [ 6 ]. Miller et al [ 7 ] (1993) first specified the 9 standards criteria of nursing professionalism (educational background; adherence to the code of ethics; participation in the professional organization; continuing education and competency; communication and publication; autonomy and self-regulation; community service; theory use, development, and evaluation; and research involvement.). Yeun et al. (2005) summarized five themes regarding nurses’ perceptions of nursing professionalism: self-concept of the profession, social awareness, professionalism of nursing, the roles of nursing services, and originality of nursing [ 8 ]. Yoder defined nursing professionalism based on six components: acting in the patients’ interests; showing humanism; practising social responsibility; demonstrating sensitivity to people’s cultures and beliefs; having high standards of competence and knowledge; and demonstrating high ethical standards [ 9 ]. Although some researchers have explored the concept of professionalism. How can professionalism be evaluated in nursing clinical practice? Few studies have shown a clear conceptualization of nurses’ professionalism [ 10 , 11 ]. To nurture nursing professionalism, the concept of professionalism must be clarified.

Given that the meaning of professionalism varies across time, contexts, or cultures, it is difficult to define, quantify or measure professionalism [ 12 , 13 ]. The operational definition of nursing professionalism in studies has shortcomings. Sullivan et al. [ 14 ] found professionalism to be a multidimensional concept, but some papers have addressed only one dimension, such as values [ 15 ] or behaviours [ 16 ]. Moreover, professionalism is considered a complex concept. The links and dynamic processes between these different inner characteristics have not been included in the concept. Thus, a comprehensive definition of nursing professionalism, including its characteristics and the relations between them, is necessary.

Recognizing and understanding the concept of nursing professionalism may be an essential step towards providing quality care for people. It may also provide more information for further developing nursing professionalism for nurses.

Method of concept analysis

Walker and Avant’s method used linguistic philosophy techniques to contribute to the philosophical understanding of a concept [ 17 ]. The W & A method is considered a mark of the positivist paradigm, which views the concept as a stable factor that can be reduced or extracted from its context of application [ 18 ]. This study used Walker and Avant’s method, which assumes that nursing professionalism is a relatively mature and stable concept (numerous studies on nursing professionalism have been published to date). This approach to conceptual analysis, although not perfect, is helpful in clarifying the concept of nursing professionalism.

Using the structured method of Walker and Avant enables conceptual clarity to be obtained based on an inductive identification of the concept’s attributes, antecedents and consequences. The concept analysis helps to clarify meanings and develop operational definitions, considering evidence from a wide range of information resources for further research or clinical practice [ 17 , 19 ]. These features make this method particularly useful for the analysis of the concept of ‘nursing professionalism’. The conceptual attributes as well as antecedents and consequences are based on the research team's analysis of the literature using Walker and Avant’s strategy and are not the product of a priori theoretical categories.

Walker and Avant’s [ 17 ] eight-step method includes the following: 1) selecting a concept; 2) determining the aims or purposes of analysis; 3) identifying all uses of the concept; 4) determining the defining attributes of the concept; 5) constructing a model case; 6) constructing borderline, contrary, invented, and illegitimate cases; 7) identifying antecedents and consequences; and 8) defining empirical references.

Selection criteria

The inclusion criteria were as follows: related to the concept of nursing professionalism; included nurse professionalism, nursing spirit, or nurse spirit; written in the English language; qualitative, quantitative, mixed methods or systematic reviews; published between 1965 and 2021 (when professionalism was first introduced by nursing in 1965); and published in books or dictionaries. We excluded articles published in nonpeer reviewed journals, editorials and letters to the editor.

Data sources

We searched several online databases, including PubMed, Scopus, and CINAHL, for articles published from 1965 to 2021. We searched the words that appear in the title, abstract, and keyword section of the studies.

(((((((((Nursing professionalism[Title]) OR (Nursing professionalism[Title/Abstract])) OR (Nurse professionalism[Title])) OR (Nurse professionalism[Title/Abstract])) OR (Nursing spirit[Title])) OR (Nursing spirit[Title/Abstract])) OR (Nurse spirit[Title])) OR (Nurse spirit[Title/Abstract])).

TI Nursing professionalism OR AB Nursing professionalism OR TI Nurse professionalism OR AB Nurse professionalism OR TI Nursing spirit OR AB Nursing spirit OR TI Nurse spirit OR AB Nurse spirit.

TITLE-ABS-KEY (Nursing professionalism) OR TITLE-ABS-KEY (Nurse professionalism) OR TITLE-ABS-KEY (Nursing spirit) OR TITLE-ABS-KEY (Nurse spirit).

Any quantitative or qualitative studies published in English focusing on nursing professionalism were included in the study. Two researchers independently screened titles and abstracts to determine the selection criteria for electronic retrieval and application. The study was included only when both researchers agreed that the study met the inclusion and exclusion criteria. If the two researchers’ judgements were different, a third person was consulted to resolve the issue. Researchers identified the different usages of the concept and systematically recorded the characteristics of the concept that appeared repeatedly [ 17 ].

We used definitions and examples in the systematic record (Table 2 ) to define a cluster of antecedents, attributes and consequences (Figs. 1 and  2 ) frequently associated with the concept [ 20 ].

Flowchart of the study selection process of the concept analysis

We identified 6013 studies on nursing professionalism. After excluding duplicates, irrelevant studies, studies that were not original scientific studies or articles, and studies published in languages other than English, 138 studies were selected for analysis. Tables 1 and 2 show some typical literatures used in this study.

Uses of the concept

Dictionary definitions of the concept.

The Merriam-Webster Dictionary defines professionalism as ‘the conduct, aims, or qualities that characterize or mark a profession or a professional person’ [ 48 ], whereas the Cambridge Dictionary [ 49 ] defines professionalism as ‘the combination of all the qualities that are connected with trained and skilled people’. These definitions are generic and difficult to use to clarify the factors involved in nursing professionalism.

Definitions of the concept reported in the literature

Hwang et al. [ 50 ] defined professionalism as commitment to a profession and professional identity level. Health-care workers demonstrate professionalism through attitudes, knowledge, and behaviours, which reflect approaches to the regulations, principles, and standards underlying successful clinical practices [ 33 ]. Nursing professionalism reflects the value orientation, concepts of nursing, work attitude and standards of clinical nurses [ 51 ].

Subconcepts

The Nightingale Spirit, named in honour of the founder of professional nursing, refers to the spirit of altruism, caring, and honesty [ 52 ]. In the past, the Nightingale Spirit advocated that nurses are willing to dedicate themselves, but the term currently encompasses more innovation [ 53 ]. E-professionalism is defined as evidence provided by digital means, attitudes and behaviours reflects the traditional models of professionalism [ 54 ]. Nurses use the internet to communicate about work or daily life, blurring the boundaries between individuals and professions; thus, e-professionalism applies to nurses [ 55 ].

The defining attributes of nursing professionalism

The defining attributes of the concept aim to understand its meaning and differentiate it from other related concepts [ 17 ]. The key defining attributes are as follows.

Nursing professionalism is multidimensional

Nursing professionalism is a three-dimensional concept based on the knowledge, attitudes, and behaviours that underlie successful clinical practice [ 33 ].

Professionalism can be conceptualized as a ‘systematic body of knowledge’ with complex configurations of work expertise [ 21 ].

Professionalism refers to the attitude that represents levels of recognition and commitment to a particular profession [ 22 ]. Hall [ 6 ] noted that nurses’ attitudes have a high correspondence with the behaviours of the respondent. Measuring professionalism at the cognitive level can be thought of as measuring potential professionalism at the behavioural level. Researchers noted that given the reduced restrictions of environmental constraints, measuring professionalism at the cognitive level may be more precise than measuring it at the behavioural level [ 23 ].

Nursing professionalism is often described as a set of professional behaviours [ 11 ]. Some researchers judge whether nurses exhibit professionalism through their behaviours. Miller [ 24 ] (1988) developed the Wheel of Professionalism in Nursing Model. The model is considered a framework for understanding professional behaviours among nurses. Kramer [ 56 ] (1975) quantified professionalism by assessing the number of professional books purchased, subscriptions to journals, and the number of articles published.

In addition, the perspective of professional identity formation complements the behaviour-based and attitude-based perspectives on professionalism [ 57 ].

The formation and development of professionalism are dynamic processes

Nursing professionalism is an inevitable, complex, varied, and dynamic process [ 58 ].The professionalism concept is considered ever-changing, replacing static or definitive views [ 59 ].

Socialization process

Nursing professionalism is instilled through a process of socialization in formal nursing education [ 25 ]. Nurses’ socialization process begins with formal, entry-level education to acquire knowledge and skills.

Yeun et al. [ 8 ] (2005) discussed the developmental process of nursing professionalism in which the individual’s thoughts and beliefs are formed by socialization factors through perception. These thoughts and beliefs may in turn influence the individual’s professional image or self-concept, thereby influencing nurses’ actions and performance.

Process of interaction

The dynamic of professionalism is also reflected in the process of interaction. Dehghani et al. [ 26 ]noted that nursing professionalism means the appropriate interaction of the individual and the workplace and the maintenance of interpersonal communication.

Culture oriented

One study showed that altruism is an essential element of medical professionalism in Asia or North America but not Europe [ 27 ]. In China, medical professionalism was influenced by its longstanding Confucian traditions [ 28 ]. Therefore, any definitions of professionalism should match its rooted culture and be validated with respect to the culture and context in which it is applied [ 60 ].

The connotation of nursing professionalism

Professional, having a systematic nursing knowledge system.

The nursing process is considered a method for solving problems or dilemmas in a logical and scientific manner [ 11 ]. Freidson [ 29 ] (2001) noted that professionals perform their specialized work only with the required training and experience. Professionals have specific, tacit, almost esoteric knowledge to do their work [ 61 ]. Miller et al. [ 7 ] considered that a formal university education with a scientific background is critical for professionalism in nursing.

Professional certification

Nurses actively seek specialty certification given their personal commitment to the nursing profession [ 30 ]. Specialty certification promotes nursing professionalism. When attaining the highest levels of clinical knowledge, nursing professionalism also indicates personal responsibility and dedication to best practices [ 31 ].

Lifelong learning and participation in continuing education

Due to professional and ethical obligations, nurses should sustain continuous professional growth and development to maintain individual competence. Professional growth in nursing requires lifelong learning. Lifelong learning includes continuing education and self‐study, seeking advanced degrees, etc. [ 62 ].

Continuing education is one of the indicators of professionalism. Professionals keep up with the latest developments in the field and partake in continuing education. Additionally, continuing education is as important as other criteria for increasing professionalism in nursing [ 7 , 32 ]. Ongoing education brings fresh knowledge to health care, consequently leading to more efficient and quality service for people.

Evidence-based practice

Evidence-based practice (EBP) is a hallmark of professionalism [ 33 ]. Dollaghan [ 63 ] (2004) reported that we identify and use the highest quality scientific evidence as an integral part of our efforts to provide the best patient care; EBP is a knowledge base that responds to specific clinical issues in a clear, intelligent, and serious manner while considering clinical practice in the context of the highest-quality scientific evidence available.

Innovation in nursing helps to improve patient care quality and improve nurses’ job performance [ 64 ]. Shen et al. [ 34 ] noted that innovative education plays an important role in the professional quality of undergraduate nursing students.

Striving for excellence

Striving for excellence is a requirement and attribute of nursing professionalism. There is a growing need in nursing practice to possess knowledge and skills in quality improvement science, translational research, and implementation science [ 35 ]. Clinical nurses have the same responsibilities as nursing scientists.

Caring is considered the core attribute of nursing professionalism

The practice of caring is central to nursing [ 65 ]. Caring is defined as the moral ideal of nursing [ 36 ]. Therefore, caring is an important core attribute of nursing professionalism.

Creating a caring-healing environment

Nurses devoted to creating a caring-healing environment embody professionalism. Caring means nurses should create a healing environment at all levels by providing a supportive, protective environment as well as a corrective mental, physical, societal, and spiritual environment for patients. People’s basic needs include a clean environment, comfort measures, safety concerns, and feeling safe or protected [ 65 ].

Displaying kindness/concern/empathy for others

A nurse is defined as someone caring for the ill within the hospital setting [ 66 ]. Caring means showing or having compassion, concern and empathy for others [ 37 ]. Caring behaviours are an interactive and mental process between patients and nurses [ 38 ]. Displaying kindness and concern for others is shown by love, compassion, support and involvement [ 39 ].

Using all methods of knowing support and involvement

‘Human problems reside in ambiguity, paradox, and impermanence’. Therefore, suffering, healing, miraculous cures, and synchronicity are all part of knowing support and involvement.

Researchers suggest that nursing comprises Caritas Nursing, Energy Nursing, Transpersonal Nursing, Holistic Nursing, or Contemplative Nursing…… It goes beyond ordinary nursing. Nursing should have higher standards with excellence for caring, healing, and peace in the world. Therefore, caring means using all methods of knowing support and involvement [ 65 ].

Embracing the unknowns and miracles in life and practising loving

Nursing is a special profession. Nurses confront special circumstances daily and witness people’s struggles with life and death. Everyone has his or her own specific story about his or her experiences and predicaments. Each person seeks his or her own meanings to find inner peace and balance in the midst of fear, doubts, despair, and unknowns. Therefore, the care of nurses is not to blindly sacrifice their own needs but to be a real nurse, embracing the unknowns and miracles in life and caring for patients [ 65 ].

The central tenet of professionalism is to put the needs and best interest of others over self-interests. Altruism is an engagement in caring acts towards others without expecting something in return [ 67 ].

Patients first

To be altruistic means to put others’ needs before your own. Altruism is the selfless concern for others and doing things with the other person’s well-being in mind [ 40 ].

During pandemics, nurses were considered to have a high sense of duty and dedication to patient care [ 41 ]. Front-line nurses perceive high work engagement, especially in self-dedication [ 42 ]. Grøthe et al. [ 43 ] showed that cancer patients in a palliative unit appreciate nurses who have the most dedication and expertise characteristics.

Public service

Due to a strong sense of civic and social responsibility, nurses participate in public service. Nurses volunteer as participants in summer camps, schools, or health-care teams. Nurses are also committed to responding to large-scale crises, such as the terrorist attacks on the World Trade Center in New York, as well as national and international relief efforts, such as tsunamis and Hurricane Katrina [ 44 ].

Disaster and infectious disease rescue

Individuals involved in providing disaster relief face many challenges, experience fatigue and personal suffering, and encounter numerous personal stories of life and death [ 45 ]. Nurses have played a significant role in the fight against infectious diseases such as severe acute respiratory syndrome (SARS) and the coronavirus disease 2019 (COVID-19) pandemic [ 68 ]. Nurses are closest with patients. Nurses provide intensive care, regularly assessing and monitoring airways, tubes, medications, and physical therapy. Nurses are also devoted to reducing complications. Nurses assist with daily living activities when patients are unable to care for themselves [ 46 ].

Community service

In addition, emphasizing professionalism means respecting values and commitment to community service delivery [ 69 ].

According to Walker and Avant [ 17 ], cases help further clarify concepts.

Model cases (a real case example)

Model cases help demonstrate all the defining attributes of a concept and helps to better articulate its meaning [ 17 ].

MS A is a 63-year-old nursing director. She worked in clinical nursing and management for 42 years. As she progressed from a new nurse to a nursing expert, she gradually poured her enthusiasm (Multidimensional: Attitudes) into nursing work (Dynamic). She believes that the core of nursing professionalism in China is dedication and responsibility (Culture oriented). In 2020, COVID-19 broke out in Wuhan, China. She led a team to Wuhan to provide support (Multidimensional: Behaviours), reflecting the spirit of altruism (Altruism). She actively promoted exchanges and cooperation among disciplines and the development of academic conferences. She guided students to pay attention to practical innovation and develop evidence-based innovations (Professional). Although she is retired, she still imparts knowledge and experience to students everywhere (Multidimensional: Behaviours). She stated that the development of nursing professionalism is very difficult and requires nursing education and role models. (Multidimensional: Knowledge). The role of a nurse is like that of a mother, bringing care to the people (Caring).

Borderline cases (a real case example)

Borderline cases provide the examples that contain the most defining attributes of the concept [ 17 ].

B is a novice nurse. When working in the infection ward, she was so worried about being infected. She was reluctant to care for patients and wanted to escape from the ward environment. Fortunately, her nurse manager fully understood her situation and helped her adapt to work and reduce her anxiety. B observed that her nurse manager had been helping patients solve problems and giving them comfort and hope. This prompted her to think about what nursing truly means. In 2020, she volunteered to help COVID-19 patients (Altruism).

Related cases (a real case example)

Related cases are related to the concept but do not contain all its defining attributes [ 17 ].

C is a novice nurse. After graduating from nursing school, he became a nurse in the emergency department. He saw many patients who died or recovered, which made him realize the importance of caring (Caring). He said that emergency nurses need strong professionalism (Multidimensional: Attitudes). He participated in social service activities (Multidimensional: Behaviours), for example, promoting knowledge of cardiopulmonary resuscitation (Altruism) in the community. After working for five years, he returned to school for a master’s degree to help the head nurse conduct nursing research or evidence-based practice (Professional). In his Asian cultural milieu, his is embarrassed about his identity as a male nurse (Culture oriented), but he believes he can do well.

Contrary cases (a fictional case example)

A contrary case does not include any defined attributes of the concept [ 17 ].

D is a nurse in paediatrics. She disliked nursing when she was a nursing student and even did enjoy communicating with patients (poor dynamics). She was exhausted after work and felt her life was out of balance. One of the values of the hospital where she worked was dedication, which confused her (Poor culture orientation). She considers it unrealistic to require professionalism (Poor nursing professionalism knowledge) and thinks that taking care of new-borns is particularly troublesome (Poor nursing professionalism attitudes), so she is always careless in her work (Multidimensional: poor attitude). D’s child felt ill last week, so she secretly reduced a patient’s medicine (Poor nursing professionalism behaviours) and took the remaining medicine home for her child (lack of altruism). She stopped doing so after her colleagues sensed something strange. One day, a baby kept crying; D reported it to the doctor and did not make further observations (Poor professional). When the shift nurse took over, she observed abnormal limb activity on one side of the child. The child’s family asked the nurse to bear legal responsibility. D said it was no big deal; she no longer wanted to be a nurse (Poor dynamic, professionalism not established).

• Antecedents

Antecedents are events that occur before the intended concept [ 17 ].

Macro antecedents

Jin [ 28 ] suggested that the conceptualization of professionalism is influenced by culture. Employees defined organizational culture underlies an organization’s values and beliefs [ 70 ]. Nursing professionalism may be supported by a variety of cultures, so a firm understanding of and personal congruence with each particular culture is essential [ 71 ].

Religious beliefs

Religiosity is another contributing factor in the cultivation of altruism [ 72 ]. Taylor noted that nurses’ job motivation and views of the patient and nursing services are affected by their religious beliefs [ 73 ].

Micro antecedents

Snizek [ 74 ] (1972) reported that devotion to work is a professional value originating from a sense of calling to the field. Liaw et al. [ 75 ] (2016) found that nursing students who had caring and compassionate qualities as the most common personal characteristics strongly believed that they were called to nursing.

Individuals who pursue excellence in the workplace may be described as motivated and devoted to their work. Attree [ 76 ] (2005) noted that nurses’ perceived lack of autonomy over their practice could impact quality of care.

Personal characteristics

Nursing professionalism is influenced by various factors, such as educational background, personal interests, professional satisfaction, and professional values [ 77 , 78 , 79 ]. In each country, nurses with higher educational levels may have a higher level of professionalism [ 22 ]. Professionalism is thus a trait related to personal character and upbringing [ 80 ]. Researchers [ 81 ] have demonstrated that professionalism is positively associated with female gender, striving for professional goals, and acceptability. One study found that people’s values tend to shift to emphasize altruism over personal gain as they age [ 79 ]. Nursing professionalism is closely associated with personality traits (extraversion, conscientiousness, and agreeableness) [ 82 ].

Consequences of nursing professionalism

Consequences are events or incidents that are the result of the occurrence of a concept [ 17 ].

Consequences for patients 

Professionalism is one of the decisive factors that critically influences patient satisfaction [ 50 ]. Professionalism can also improve practising nurse career development and the quality of service [ 81 ].

Consequences for nurses

Studies have shown that professionalism and a sense of belonging with colleagues and managers affect the satisfaction [ 83 ] and retention rate of nursing students in academic institutions [ 84 ]. Izumi et al. [ 85 ] (2006) found that good nurses felt pride and happiness in caring for patients closely related to their professionalism.

Empirical references

As the last step to concept analysis, empirical references can further clarify the concept and facilitate its measurement [ 17 ].

Hall’s professionalism inventory scale

Hall’s Professionalism Inventory Scale [ 6 ] identified five attitudinal attributes of professionalism: (a) use of professional organizations as major referents, (b) belief in public service, (c) self-regulation, (d) a sense of calling to the field, and (e) autonomy. Nursing researchers used Hall’s Professionalism Inventory Scale to measure professionalism in nursing [ 22 , 47 ]. Snizek [ 74 ] (1972) modified the professionalism scale to more closely match the clinical context of nursing and better reflect the professionalism of nursing staff.

Kramer’s index of professionalism

Kramer (1974) [ 86 ] constructed an index of professionalism that includes indicators of behaviours, such as the number of professional books published, subscriptions to professional journals, hours spent on professional reading, continuing education, participation in professional organizations, number of professional publications, speeches given, committee activity, and participation in research.

The behavioural inventory for professionalism in nursing (BIPN)

The Behavioural Inventory for Professionalism in Nursing [ 7 ] (BIPN) identifies professional behaviours and values among nurses. The nine categories in the BIPN are (1) educational background; (2) adherence to the code of ethics; (3) participation in the professional organization; (4) continuing education and competency; (5) communication and publication; (6) autonomy and self-regulation; (7) community service; (8) theory use, development, and evaluation; and (9) research involvement.

Definition of the concept

Based on the present analysis, we define nursing professionalism as follows: ‘Nursing professionalism is a multidimensional concept manifested by the knowledge, attitudes, and behaviours that underlie successful clinical practice. Nursing professionalism is dynamicized through a process of socialization in formal nursing education. This feature is also reflected in the process of interaction. Therefore, nursing professionalism should match its rooted culture.

The connotations of nursing professionalism include professional, caring, and altruism. These connotations are detailed as follows:

Possesses a systematic nursing knowledge system; professional certification

Exhibits lifelong learning and participation

Participates in evidence-based practice

Demonstrates innovation

Strives for excellence

Creates a caring-healing environment

Displays kindness/concern/empathy for others

Uses various methods of knowing support and involvement

Embraces the unknowns and miracles in life and practices loving

Patient-first

A conceptual model of nursing professionalism is shown in Fig.  2 .

Antecedents, attributes, and consequences of nursing professionalism

Defining the connotation of nursing professionalism

Nursing professionalism has been defined as professional, caring, and altruistic.

Professional values are characteristic of nursing professionalism. Nursing work requires rich knowledge and scientific evidence-based work to improve the quality of nursing services for patients. Nurses need lifelong learning, qualification certification, and participation in academic and practical activities.

Caring is regarded as the core of professionalism. This study suggests creating a caring-healing environment, displaying kindness/concern/empathy for others, employing all methods of knowing support and involvement, embracing the unknowns and miracles in life and practising loving to care for people to obtain high professionalism. This study notes that nursing professionalism emphasizes care for the individual patient and that the nurse does everything possible to create a caring and healing environment for patients. In different health systems worldwide, nurses have incorporated caring about nursing professionalism into everything they do. This characteristic is consistent with Nightingale's view that “Nurses need to be sensitive. A nurse must use her brain, heart and hands to create healing environments to care for the patient’s body, mind and spirit” [ 87 , 88 ].

Nursing has an altruistic nature, and people interested in helping patients are attracted to this profession [ 89 ]. However, some studies have shown that altruistic care is equated with self-sacrifice, self-denial, and unidirectional and unconditional care [ 90 ]. Care for a nurse’s own needs is equally important, but nurses should be able to put aside their own needs when required to focus on the needs of others [ 91 ]. Nurses should view self-care and altruism as dialectical. Self-realization and providing care for others are not conflicting concepts [ 92 ].

Defining the attributes of nursing professionalism

In this study, we defined nursing professionalism as multidimensional, dynamic, and culture oriented.

Nursing professionalism is a multidimensional concept that includes knowledge, attitudes, and behaviour. Previous studies have defined professionalism as the degree of commitment by individuals to the values and behavioural characteristics of a specific career identity [ 6 , 7 ]. However, current research on nursing professionalism is mostly single dimensional. The Behavioural Inventory for Professionalism in Nursing (BIPN) is based on Miller’s model and is used to measure professional behaviours among nurses [ 7 ]. Hall’s Professionalism Inventory Scale [ 6 ] identified five attitudinal attributes of professionalism. This study highlights that it is also necessary to focus on the knowledge dimension of professionalism. Nursing students and nurses should first understand the nursing professionalism that is necessary to become a nurse, which may be the first step in developing professionalism. Nursing students and nurses need to know the values that are necessary to practice the nursing and not have vague impressions. Some studies have shown that nursing students or nurses learn values and norms in informal trainings [ 93 ]. Therefore, this study suggests that the development of assessment tools for the knowledge dimension of professionalism is also necessary. Multidimensional evaluation tools are not available for nursing professionalism. Thus, clarifying the multidimensional nature of nursing professionalism will contribute to the development of multidimensional evaluation tools.

Moreover, understanding the dynamics of professionalism is helpful for cultivating nursing professionalism in stages and steps. Inquiries into medical professionalism should be integrated into the culture of social media interaction [ 94 ]. Nursing educators and managers should dynamically cultivate nursing professionalism in their interactions.

Differences in the connotation of nursing professionalism are noted in different cultures. This study suggests that the cultivation and evaluation of nursing professionalism need to consider the cultural attributes of different regions and countries.

Future research directions

Exploring the antecedents of nursing professionalism can help schools or hospitals cultivate nursing professionalism and develop courses and specific measures.

The macro antecedents of nursing professionalism include culture and religion, and the micro antecedents include calling, autonomy, and personal characteristics. Some researchers have explored methods to cultivate nursing professionalism; for example, role modelling, feedback, group discussions, case-based discussions, reflection, holding ethical rounds, and reports potentially represent more effective methods [ 95 ]. Some researchers have tried to enhance professionalism through social media [ 96 ]. One of the findings this study is that nursing professionalism is complex and its cultivation difficult. Studies have shown that didactic lectures are ineffective for teaching professionalism [ 97 ]. The development of true nursing professionalism requires national advocacy and the immersion of a good professional environment that incorporates professionalism into daily nursing practice. Role modelling is considered an effective method for developing professionalism in nursing [ 98 ]. Therefore, this study suggest that studies should be actively conducted to deeply discuss the causes and processes affecting professionalism and to cultivate and intervene at macro and micro levels as well as the key time periods and populations that form professionalism to truly shape the formation of professionalism. Moreover, an environment for building professionalism [ 99 ] is very important. Williams [ 100 ] (2015) considered that the development of professionalism should begin as early as the first semester of an undergraduate nursing course. One of the themes of nursing students’ professional identity development is ‘doing-learning-knowing-speaking’. Students should develop professionalism in all these areas of nursing practice.

The relationship between nursing professionalism and health outcomes or nurses’ human resources needs to be further studied.

Our research suggests that the ultimate goal of nursing professionalism is to serve patients with professional knowledge and special professional quality. The public has become increasingly aware of certain possibilities, limitations, and consequences of professionalism. COVID-19 significantly increased the discussion of professionalism and patient outcomes.

Improving professionalism has a positive impact on job satisfaction, professional quality of life, and the willingness to continue in the profession [ 101 , 102 , 103 ]. Therefore, it is important to improve support for nurses, create a good environment for professionalism, and establish a training system for professionalism, thus paving the way to enhance training in professionalism and create opportunities for nurses.

Implications for nursing management

In April 2020, the World Health Organization (2020) issued the First State of the World’s Nursing 2020 [ 104 ]. The report highlighted that nursing professionals are the largest occupational group in the health sector, numbering 27.9 million worldwide. Nurses spend more time with patients than any other health care professionals [ 105 ].

Worldwide, nursing professionalism is considered important and associated with expectations. This study clarifies the concept of nursing professionalism and contributes to a framework for developing a theoretical model as well as instruments to measure the concept. A conceptual model of nursing professionalism may increase nurse managers’ insight into nurses’ behaviours and values, creating a good working environment.

Nurse managers should integrate nursing professionalism into their philosophy, mission, and objectives and provide necessary resources, tools, and projects to develop professionalism among nurses. Nurses should cultivate professionalism to provide good nursing services to patients. Further research should explore the relationship between nursing professionalism and patient health outcomes and formulate effective training programs for professionalism.

Limitations

This conceptual analysis has some limitations. First, research on nursing professionalism published in English may be conducted in different countries and cultures. However, it is also necessary to obtain a more comprehensive and mature concept of the study of different national languages. Second, the lack of research on the combination of all elements of professionalism may lead to overestimation of the impact of these subelements on professionalism. Third, the concept analysis focused on the research process and the researchers’ perspectives, possibly reflecting a lack of other professional understandings of nursing professionalism in medical groups. In addition, the concept analysis included a risk of selection bias, extraction bias, and analysis bias because the study selection process, data extraction, and analysis were all conducted by two researchers. Despite these risk, the studies were all described accurately and systematically.

Nursing professionalism is one of the important foundations of clinical nursing. It is multidimensional, dynamic, and culture oriented. Based on the analysis, nursing professionalism has been defined as providing people care based on principles of professionalism, caring, and altruism. The definition, attributes, antecedents, consequences, and reference analysis of the experience of nursing professionalism determined in this study provide a theoretical basis for future research. This information can be used to evaluate nursing professionalism, develop assessment tools, or generate theory-based training courses and interventions.

Availability of data and materials

Data used to support the findings of this study are available from the corresponding author upon request.

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Acknowledgements

The authors would like to thank Hui Yang for the great efforts made in designing the research. We would like to thank linbo Li for providing valuable suggestions for this study.

Postgraduate Education Innovation Program of Shanxi Province in China (No. 2020BY067).

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Contributions

Hl C and HY made substantial contributions to conception and design. HL C, YJ S, YM W, YF D Collectioned and analysis the data. Hl C was a major contributor in writing the manuscript. XY H, YJ C, QH W revised it critically for important intellectual content. All authors read and approved the final manuscript.

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Correspondence to Hui Yang .

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Cao, H., Song, Y., Wu, Y. et al. What is nursing professionalism? a concept analysis. BMC Nurs 22 , 34 (2023). https://doi.org/10.1186/s12912-022-01161-0

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Received : 07 May 2022

Accepted : 23 December 2022

Published : 07 February 2023

DOI : https://doi.org/10.1186/s12912-022-01161-0

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