Nursing image—how is it perceived?
After completing this chapter, you should be able to:
• Discuss the effect of image on the public perception of nursing.
• Describe different sociological models that characterize “professionalism.”
• Apply Pavalko’s characteristics as a framework to describe modern nursing practice.
• Identify the impact that nursing organizations have on professional practice.
• Describe the role of credentialing and certification in professional practice.
Nursing image—how is it perceived? What does it mean to be a professional nurse? How does the public view nursing? How does nursing define and view itself? What role does the public image of the nursing profession play in our current nursing climate? What do you do to further the image of a professional nurse?
Historically, nurses have struggled to define the image of nursing and the professional role of the nurse. There are many different views and opinions, but nurses are definitely gaining ground when it comes to defining the profession of nursing. The annual Gallup survey for professions noted that for honesty and ethical standards, nursing has been rated at the top of the list for the past 13 years. In 2014, 80% of the American public rate the standards held by nurses as either high or very high; this rates the nursing profession 15 percentage points above any other profession (ANA, 2014). The image of nursing is evolving and changing, with nursing being promoted and viewed as an intellectual, autonomous profession that demands a high level of commitment, focus, and a dedication to advancing education and scholarly activity.
Modern-day nursing has many dimensions, one of which includes the debate surrounding its identification as a profession. One ongoing challenge in nursing is to diligently foster and enhance the public image and the self-image of the nurse. In this chapter, the development of nursing into a profession is discussed, and the present and future dimensions of nursing’s “image” are explored. The lasting impact of the 2010 Institute of Medicine report on The Future of Nursing and other significant position statements and reports on the profession will be discussed. Historical knowledge about our “rites of passage” provides an appreciation of the path nursing has taken as a profession and what the future of nursing may hold for the recent graduate in this complex and evolving health care world.
Professional Image of Nursing
What Do We Mean by the “Image” of Nursing?
Santa Filomena
Lo! in that hour of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.
Longfellow, 1857
Nursing has been identified as an “emerging profession” for at least 150 years. The historical context of nursing’s image is often traced back to Florence Nightingale, the “founder of nursing.” Florence Nightingale is recognized as a nurse, statistician, and writer who became known for her groundbreaking work during the Crimean War. Nurse Nightingale was also called the “Lady with the Lamp,” as she was reported to have made rounds on her patients at night by the light of a lantern. International Nurse’s Day is celebrated each year on her birthday, May 12, and the Nightingale Pledge is still recited by new nursing graduates around the world, often with the accompaniment of flickering candles in symbolic lamps. Even though much has been written about Florence Nightingale’s many contributions, she is undeniably remembered as the pioneer of nursing education (Bostridge, 2008).
The image of professional nursing continues to evolve and is significantly affected by the media, women’s issues and roles, and an ever-evolving high-technology health care environment. How nursing views itself in the evolution of the profession and how actively nurses are involved in the definition process will continue to determine the image and role of nursing in the future.
In a 2008 study on public perceptions of nursing and factors that influence these insights, the study determined a personal experience with nurses either as a patient or with a family member was the leading influence on perceptions of nurses and the profession of nursing (Donelan et al., 2008).
There is a new, innovative approach to recruiting and retaining more men into nursing, seeking a more gender-neutral attitude. The American Assembly of Men in Nursing (AAMN) has initiated the marketing campaign “Advancing Men in Nursing” with materials highlighting the camaraderie and opportunities available to men entering the profession. The professional, skilled, compassionate male image portrayed in posters and advertising is designed to break down the stereotypes typically associated with men in nursing (Stokowski, 2012). As more men enter the profession and there is a push to increase minorities in nursing, will the image of nursing change (Critical Thinking Box 9.1)?
Picture in your mind your image of a nurse—did you just think of a female, tidy hair, professional looking uniform, serviceable white shoes, stethoscope around the neck, determined look in the eyes, energetic walk, clipboard in hand? Or did you just envision a male nurse with many of those same attributes? The image of nursing is changing, and many media depictions now include men as nurses. There have always been men in nursing, but with the increasing respect for the profession, and the high touch, high technicality in the field of nursing, more men than ever are looking to become nurses. Indeed, many men who enter nursing are interested in fighting the same stereotypes that woman have battled through the years. The term “male nurse” is considered an unnecessary distinction, much like saying a “female physician”—the gender bias is simply not a critical element (Wilson, 2009). The first step in turning the tide of thought about gender in nursing is for members of the profession to alter their own perceptions.
Nurses should be thought of as autonomous and competent decision makers within their nursing practice areas. Throughout the 1990s, a nationwide advertising campaign supported by the National Commission on Nursing Implementation Project produced radio and television ads that said, “If caring were enough, anyone could be a nurse.” Nurses of America, an advocate organization sponsored by the National League for Nursing (NLN), implemented a very successful program directed toward improving the image of nursing as depicted on television, on radio, in print, and on lecture circuits. Consultants were contracted to work with executives, politicians, and celebrities to present nursing in a positive manner. This approach reinforced the image of the modern professional nurse as having critical thinking, evidence-based decision-making, and problem-solving skills.
At a nursing symposium in May 2012, it was noted that while the depiction of nurses in the media can affect how the public views nurses, it is truly up to each individual nurse to be proactive in presenting nursing as a respected profession (Muehlbauer, 2012). The American Academy of Nursing (http://www.aannet.org/raisethevoice, 2014) through the Raise the Voice campaign has brought nursing policy innovators to the forefront of health care policy debates. A concentrated effort by individuals and organizations is raising awareness of what nurses do and heightening the image and voice of nursing as a profession. As noted by Groves (2007), accurate portrayals of nurses as professional members of the health care team are rare, but it takes time to change perceptions. The continued trend of building a positive, intelligent, competent, and professional image of nursing must continue. Nurses who are new to the profession need to be aware of the extraordinary challenges and opportunities that they will face. It is equally important for nurses to improve the self-image of the professional nurse. The behaviors and ethics displayed by nurses on a day-to-day basis can do much to elevate the present and shape the future image of nursing (Cohen & Bartholomew, 2008).
Nursing associations are working together to promote a positive image and to handle nursing shortage issues. Nurses for a Healthier Tomorrow, an alliance of 43 nursing and health care organizations, has launched a national media campaign that demonstrates, through print and broadcast media, the many opportunities for the career of nursing. One tangible example of this effort is the website www.nursesource.org. Sigma Theta Tau International, the international honor society for nursing, is the coordinator of Nurses for a Healthier Tomorrow. Review their website at www.nursingsociety.org. The American Nurses Association published a flyer titled Every Patient Deserves a Nurse, along with other promotional materials for the lay public. The promotional message of these materials reinforces the positive image of nurses as patient advocates and critical resources both to patients and families, while also emphasizing the right of people to a safe health care environment.
In 2002, the Johnson & Johnson Company developed a nationwide campaign to support the nursing profession. This program, titled “The Campaign for Nursing’s Future,” was developed along with health care leaders and nursing organizations such as the National Student Nurse’s Association (NSNA), the American Nurse’s Association (ANA), the American Organization for Nurse Executives (AONE), the National League for Nursing, and Sigma Theta Tau. The goal of this program is to increase the number of young adults entering nursing through raising the visibility of nurses of varied races, gender, and roles. The website for the campaign can be found at www.discovernursing.com.
The negative images of nursing, those of the “naughty nurse” or the “Nurse Ratchet” that are depicted in the media, are still prevalent, but these erroneous portrayals do offer professional nurses the opportunity to educate the public about what nurses truly do. Nursing is not the only profession that struggles with a skewed media image. Some of these erroneous depictions may be related to the largely female population who seeks these professions; consider the sexual media images that are often illustrated by flight attendants, massage therapists, or secretaries. Other occupations that suffer from poor media portrayals include the “mad scientist” role (chemist or researcher), construction worker (often a sexual male image), or consider the negative images that both female and male lawyers are often faced with! Devaluation of the nursing profession by demeaning or comical images only extends the nursing shortage and further discourages talented people from entering the nursing profession. It is up to each individual to continue to display professional role modeling and provide public education on what nurses really do to empower the professional image of nursing (Cohen & Bartholomew, 2008).
How can nurses change the image of nursing? How can the image of nursing become more congruent with the actual role the nurse plays in today’s rapidly evolving health care environment? Nurses outnumber all other professions in health care. Mee (2006) suggests that nurses can promote the professional image of nursing by doing the following.
Patient Interactions
One by One. During the first 60 seconds that a patient sees the nurse, a lasting impression may be formed. Take a moment before meeting a new patient to portray confidence in your role and a respect for the patient from the beginning. Many health care institutions require nurses to wear nursing uniforms of a distinct color that separates them from nurse assistants and respiratory therapists.
Personal Interaction With the Public
Have a professional response ready in case someone asks about nursing. Present nursing’s image positively, and relate what an important role nurses have in society as health care providers. Nursing advocacy starts with you! Every professional nurse has the responsibility to educate the public about what nurses do and the amount of education and dedication it takes to be a nurse. Believe in yourself, and project the image you want the public to see (Jacobs-Summers & Jacobs-Summers, 2011).
Public Speaking and Community Activities
Consider speaking at or visiting schools on Career Day. You don’t have to be an expert at public speaking to discuss the role of the nurse with local community groups. A brief, interactive presentation at an elementary or high school can stimulate interest in nursing early—for both male and female students.
Participation in Political Activities
Increase the positive visibility of nurses through politics by becoming actively involved as a nurse lobbyist. Be aware of the current health care issues on the community, state, and national levels. Get to know the elected officials, and talk to them about the role of the nurse. This may be a valuable opportunity to present nursing in a very positive manner. Remember that most elected officials do not understand the role nurses play in health care (Mee, 2006).
The image of nursing continues to evolve as the many roles of nurses are portrayed through the media in the restructuring of health care environments and in a variety of settings, from emergency rooms to war zones. Studies continue to verify that competent nursing care affects mortality rates in critical care patients, and the future for many nursing jobs lies in the expanding role of nursing into emergency and disaster preparedness and integration of technology and informatics into practice settings (Health Resources and Services Administration [HRSA], 2010). The role and image of the nurse will continue to change as the many facets of health care delivery evolve during this century. The current nursing shortage will play a significant future part in the creation of the image and role of the nurse. How will nurses respond to these changes? How will you present yourself as a professional?
What Constitutes a Profession?
There are many ways to describe a “professional.” What meaning does the word have for you as a graduate professional nurse? Controversy about the definition of the term professional as it relates to nursing is not a new issue. Strauss (1966), a noted sociologist, found the word professional used in reference to nursing in a magazine article published in 1892 titled “Nursing, a New Profession for Women.” The nurses of the 20th and 21st centuries owe a great deal to Isabel Adams Hampton (later Isabel Hampton Robb) for her visionary focus in the late 1800s. She was an outstanding advocate for the professionalization of nursing. In the textbook Nursing Ethics (1900), she wrote:
The trained nurse, then, is no longer to be regarded as a better trained, more useful, higher class servant, but as one who has knowledge and is worthy of respect, consideration, and due recompense…. She is also essentially an instructor; part of her duties have to do with the prevention of disease and sickness, as well as the relief of suffering humanity…. These are some of the essentials in nursing by which it has become to be regarded as a profession, but there still remains much to be desired, much to work for, in order to add to its dignity and usefulness.
In Caplow’s classic work from the early 1950s, The Sociology of Work (Caplow, 1954), several steps in the process of “becoming professional” were defined further, and the value of forming an association that defined a special membership was addressed. Caplow suggested that making a name change to clarify an area of work or practice would subsequently produce a new role. With the creation of this new role, the group would then establish a code of ethics and legal components for licensure to practice and educational control of the profession (Caplow, 1954). This process of becoming professional was taking place in nursing in 1897 with the establishment of the ANA. Other aspects of professionalization were also beginning to develop. For example, the Code for Nurses was suggested as early as 1926, although it was not written or published by the ANA until the early 1950s. Revisions were made in 1956, 1960, and 1976, with changes made in 1985 that included interpretative statements. In the summer of 2001 at the ANA convention, delegates again updated the code and changed the name to the Code of Ethics for Nurses with Interpretive Statements. The American Nurses Association deemed 2015 the Year of Ethics and issued an updated Code of Ethics with Interpretive Statements found at http://nursingworld.org/MainMenuCategories/EthicsStandards.
Almost 20 years after Caplow’s work, Pavalko (1971) described eight dimensions of a profession. Pavalko’s dimensions of a profession and their specific application to nursing are examined in more detail later in this chapter. Nursing continues to apply these dimensions to support nursing’s move away from the occupational focus to a professional focus. Is nursing a profession or semiprofession?
By responding to the questions in Critical Thinking Box 9.2 (which presents Levenstein’s model, a fourth model of professionalism), you will identify common themes in describing a profession. What are your thoughts about the nursing profession in light of these criteria?
What do you think about …
• The element of altruism
How do you define caring in your clinical practice?
• Code of ethics
Are you familiar with the ANA Code of Ethics?
• Collaboration with groups and individuals for the benefit of the patient
What other groups do you work with in your clinical setting that affect the health needs of the patient and family?
• Colleagueship demonstrated by
An organization for licensing
• What is the role of the State Board of Nursing in your state?
A group that helps ensure quality
• Are you aware of the role of national nursing organizations that accredit nursing programs?
• There are two national nursing organizations that accredit nursing programs; do you know what they are?
Peer evaluations of practitioners
• What is the role of job evaluations in terms of professional growth?
• Accountability for conduct and responsibility for practice decisions
Who monitors professional conduct issues from a legal and ethical point of view?
Does shared governance reflect more control of one’s nursing practice?
• Strong research program
Are you aware that a national center for nursing research is now operating in Washington, DC?
Others have written about professions and their development, but these sociological models present some logical characteristics for you to use to examine professionalism. According to Henshaw, a noted nursing leader and researcher, a profession includes “self-regulation and autonomy with ultimate loyalty and accountability to the professional group” (cited in Talotta, 1990). Nursing is a dynamic profession and continues to strive to enhance a professional image—which leads us to the next question.
Is Nursing a Profession?
Eunice Cole, a past president of the ANA, described nursing as a dynamic profession that has established a code of ethics and standards of practice, education, service, and research components. The standards for both the professional and practical dimensions of nursing are continually reviewed and updated. Nurses, strong in numbers but splintered professionally in many ways, represent the largest group of health care providers in the United States.
There are approximately 2.9 million registered nurses in the workforce with an average age of all licensed RNs increasing by about 2 years for RNs, and about one-third of the current nursing workforce is older than 50. The RN supply is anticipated to grow by 952,000 full-time equivalents (FTEs)—from 2,897,000 FTEs in 2012 to 3,849,000 FTEs in 2025—a 33% national increase (U.S. Department of Health and Human Services, 2014).
The majority of nurses (59.7%) complete their initial education preparation at the associate degree level. Currently, approximately 55% of the RN workforce holds a bachelor’s or higher degree. Additionally, there has been a substantial increase (86.3%) in the number of RN-BSN graduates over the past few years, noting a trend of increasing postlicensure education. There was significant growth (a 67% increase from 2007 to 2011) in the numbers of RNs with a master’s or doctoral degree in nursing or a related field (HRSA, 2013).
In October 2010 the IOM released its report, The Future of Nursing, initiated by the Robert Wood Johnson Foundation, which called for increasing the number of baccalaureate-prepared nurses to 80% and doubling the population of nurses with doctoral degrees. The current nursing workforce falls short of these recommendations, with approximately 50% of registered nurses prepared at the baccalaureate level. Nursing leaders, educators, and practice partners are working to increase the number of baccalaureate-prepared nurses using innovative educational strategies for advancement.
The key to addressing the need to increase the educational preparation of the nursing workforce is progression. In 2012, the Organization for Associate Degree Nursing (OADN), joined with nursing educators, community leaders, college presidents, and other national organizations to endorse a Joint Statement on Academic Progression for Nursing Students and Graduates (http://www.aacn.nche.edu/news/articles/2012/academic-progression).
Examine the issues that challenge nursing as a profession by using Pavalko’s eight dimensions to describe a profession.
1. A Profession Has Relevance to Social Values
Does nursing exist to serve self or others? Nursing historically had its roots in true altruism with lifelong service to others. As nurses, we focus not only on the treatment component of patient care as a part of our nursing practice but also on wellness and health promotion issues. The goal is to shift the focus of health care so that primary prevention becomes more valued. As this shift occurs, nurses will become increasingly important because of their ability to be teachers of health promotion activities and managers of wellness, which are activities that have an impact on social values.
2. A Profession Has a Training or Educational Period
According to Florence Nightingale, a nurse’s education should involve not only a theory component but also a practice component. An educational process for any professional is critical, because it transmits the knowledge base of the profession and, through research and other scholarly endeavors, advances the practice of the profession. The diversity of educational pathways for nurses has stimulated debate regarding the entry practice level for registered nurses. The Institute of Medicine report (2010), the OADN progression statement (2012), the National League for Nursing (2011), and the Carnegie Foundation Report on the Advancement of Teaching (2010) all speak to the issue of advancing nursing education and entry into practice (see the end of this chapter for a list of relevant websites and online resources). Some questions surrounding the issues include the following:
▪ What changes will shape the future of associate degree nursing programs?
▪ Will diploma or hospital-based nursing programs remain?
▪ How critical is it to complete a bachelor of science in nursing (BSN) program to handle the challenges of the health care environment, complex patient–family needs, and the expanding community-based settings for clinical work?
▪ Is a “ladder” approach or a concurrent enrollment program (CEP) to advanced education the best pathway for you?
▪ Will the practice doctorate in nursing (DNP) degree clarify or confuse advanced-practice roles in nursing?
These questions have been debated since the publication in 1965 of an ANA position paper that charged the profession with the goal of establishing nursing education at the baccalaureate level within 25 years. Almost 40 years have passed since then, and the issue continues to challenge the profession. The inability of nursing organizations and educational systems at all levels to come to agreement on this issue continues to affect the solidarity of the profession.
In the mid-1990s, some states (e.g., Maine and Idaho) engaged in debate about regulatory issues concerning the BSN as the entry credential. Beyond this generic-degree controversy are the issues associated with specialization: With the momentum from the AACN, the DNP has been established as the clinical practice degree for advanced practice. What should be the focus of the MSN degree or PhD degree? How will those degrees integrate into nursing education?
3. Elements of Self-Motivation Address the Way in Which the Profession Serves the Patient or Family and Larger Social System
In 1990, the Tri-Council of Nursing, along with the American Association of Colleges of Nursing, designed a “Nursing Agenda for Health Care Reform” to express collectively the views of nurses concerning health care. Endorsed by 39 major specialty nursing organizations, along with the ANA and the NLN, the Tri-Council emphasized a restructured health care system that would provide universal access to health care, direct health care expenditures toward primary care, and reduce costs.
Political activity is a way of translating social values into action. Nursing faces special challenges when, for example, nurses must go on strike for better pay and benefits or demonstrate a united front to gain federal funding rather than continuing a passive role in such issues. It is time for the nursing profession to define a new narrative that reflects how much the profession has changed, how critical nursing skills are to today’s patient care, how the profession has stayed abreast of medical and technological innovation, and what nursing is going to look like in the future (Kaplan, 2005).
4. A Profession Has a Code of Ethics
Nursing, like other professions, has ethical dimensions. As noted earlier in the chapter, the nursing Code of Ethics published by the ANA dates to the 1950s. Key points of the code are provided in Box 9.1. The Code of Ethics is discussed in more detail in Chapter 19.
5. A Professional Has a Commitment to Lifelong Work
By this statement, Pavalko means that a professional sees his or her career as more than just a stepping stone to another area of work or as an intermittent job. Government data show that 83% of the nearly 2.9 million registered nurses work in health care (HRSA, 2010). Nursing constitutes the largest health care occupation, and more jobs are expected for registered nurses than for any other occupation. This faster-than-average growth is being driven by technological advances. Thus, nursing as a career has great potential for financial rewards, involvement in a variety of professional endeavors, several different areas of practice, and a commitment to lifelong work.
6. Members Control Their Profession
Nurses are not entirely autonomous. Although nurses have the challenge to ensure that members of the profession honor the trust given them by the public, they also work under professional and legislative control. Among these controls are the 50 state boards of nursing, which regulate the scope of nursing practice within each state, and the professional practice standards that are supported both at local and national levels. In 1973, the ANA wrote the first Standards of Nursing Practice and since then has had a leadership role in the development of general and many specialty nursing practice standards. Moreover, specialty organizations maintain standards for certification.
Another publication by the ANA, the Standards of Clinical Nursing Practice (2003), discusses the use of nursing process and professional practice standards. The development of professional practice standards indicates to the larger social system that nursing can define and control its quality of practice. These national standards are incorporated into institutional standards to help guide nursing practice. Most recent publications by the ANA can be found on their website (www.nursingworld.org). The issue at hand, however, is that these professional practice standards authorize nurses to practice nursing. Nurses are expected to take responsibility for their own actions and not just follow orders without thinking critically.
Nurses practice in varied settings, and the advanced practice nurse functions in a more autonomous professional role, such as the nurse-midwife, psychiatric clinical specialist, nurse practitioner, or certified nurse educator. In 1992, there were 100,000 advanced practice nurses in the United States. Among practicing RNs, 55% achieved a baccalaureate or higher degree in nursing or a nursing-related field in 2010, compared to 27.5% in 1980 (HRSA, 2013). These changes represent the largest growing segment of specialty nursing practice. Advancing education and knowledge levels often allows for increased autonomy.
Most nurses in the United States work within a structured setting; three out of five jobs are in hospital, inpatient, or outpatient settings. Trends in those settings are slowly changing to give nurses a stronger voice. For example, nursing care delivery systems that have case management and shared governance reflect more progressive and autonomous environments (see Chapter 15). Nursing can control its scope of practice through professional organizations and published documents, along with an active voice in regulatory bodies, such as state boards of nursing.
7. A Profession Has a Theoretical Framework on Which Professional Practice Is Based
Nursing continues to be based in the sciences and humanities, but nursing theory is evolving. It was not until the 1950s that nursing theory was “born.” In 1952, Dr. Hildegard Peplau published a nursing model that described the importance of the “therapeutic relationship” in health and wellness. Since then, other nursing theorists such as Martha Rogers, Sister Callista Roy, Dorothea Orem, and Betty Neuman have contributed to our evolving theory-based nursing science.
8. Members of a Profession Have a Common Identity and a Distinctive Subculture
The outward image of nursing has changed remarkably within the past 50 years. Nurses were once identified by how they looked rather than by what they did. The nursing cap and pin reflected the nurse’s school and educational background. The modern-day trend emphasizes that it is not what is worn but what is done that reflects one’s role in the nursing profession. The struggle to shift out of rigid dress codes was a major issue in the 1960s. Clothing and other symbols identify a subculture, and changes in that identification process occur slowly. What kind of image do you want to project as a professional nurse (Critical Thinking Box 9.3)?
Nursing colleagues reflect attitudes and values about the profession. Many schools of nursing have alumni associations, student nurse associations, and nursing honor societies or clubs on campus. These groups provide social interaction during the nursing education years and are great ways to network later in one’s career. Belonging to a professional organization (such as the ANA) or a specialty organization helps professional nurses maintain certifications and network with peers, and it enhances collegiality and scholarship.
What Kind of Image Do You Want to Project As a “Professional”?
• Should nurses wear visible body jewelry, piercings, or have tattoos?
• Are the doctors on your unit called by their first or last names? How are you addressed in a professional setting?
• Are your credentials visible to indicate additional degrees or certifications? If not, why not? Is it the policy of the agency or facility where you work to display these?
• Are the nurses on your unit certified in their specialty areas? Is this recognized by your facility?
• What do your peers wear?
• Do you think scrubs look professional?
• Can a nurse wearing cartoon-character scrubs be taken seriously? Why? Why not?
• Should nurses leave the hospital in their scrubs and go run errands?
• What other professions are associated with a “uniform”?
When will the conflicts in educational preparation be resolved? How will we use further refinement and application of nursing theories in our clinical practice? What can nurses do to have more control of nursing practice regardless of the clinical setting? Will there be an increase in the percentage of people who are choosing nursing as a career? What are the forces that will help nursing “come together” and become not only a true profession but the largest and most powerful of all the health care professional groups? (Remember, there is always strength in numbers.)
Nursing Organizations
What Should I Know About Professional Organizations?
Nursing organizations have significant roles in empowering nurses in their emerging professionalism (Fig. 9.1). Yet many nurses do not belong to a national organization such as the ANA, or to their state affiliate organization, or even to specialty-focused groups such as the American Association of Critical-Care Nurses (AACN) or the National Black Nurses Association (NBNA). Of the 3.4 million registered nurses, membership in the constituent associations in ANA represents less than half of the nurses (ANCC, 2015; HRSA, 2010). During the past few years, researchers have examined the issue of belonging to a professional organization. Although there are no conclusive findings regarding why or how nurses choose nursing organizations, some have suggested that organizations representing nursing as a whole, such as the ANA and the NLN, do not meet the needs of the individual nurse practicing in today’s changing health care environment.
Affiliation with a nursing organization to facilitate networking with colleagues is a valuable resource. As a recent graduate, you will need to examine your options for joining a professional group and then demonstrate your professional commitment by active participation. The question should be “Which ones should I join?” rather than “Should I join an organization?” (Box 9.2). In the next section, various organizations are reviewed, with historical notes to assist you in making the best choice as you begin your nursing career. A more complete directory of nursing organizations can be found on the Evolve website.
What Organizations Are Available to the Recent Graduate?
A few of these key professional organizations for individual and organizational membership are described in this section in alphabetical order. Many of these organizations publish a newsletter or professional journal, and most have websites. Individual memberships in your professional nursing organization and a specialty organization are great ways to maintain current knowledge about changes in your career field and create networking opportunities for both new graduate nurses and experienced nurses seeking to find a new position or to increase their knowledge (see Box 9.2).
American Nurses Association
The ANA is identified as the professional association for registered nurses. It was through the early efforts of Isabel Hampton Robb and others that the Nurses Associated Alumnae of the United States and Canada was formed. At the World’s Fair in 1890, a group of 15 nursing leaders began discussions about forming a professional association. Six years later, alumnae from the training schools organized the professional association now known as the ANA. Canadian members split from the original group in 1911 and formed their own professional association. The organizational structure of the ANA has undergone many changes through the years.
Currently, when an individual joins the ANA, he or she joins the national organization along with the constituent associations at the state and local levels. This method geographically groups smaller clusters of members together according to their practice interests. According to the ANA website, the current membership is almost 180,000 individual registered nurses (ANA, FAQ—Membership, 2010).
In 1974, the Employee Retirement Income Security Act (ERISA), an amendment to the Taft-Hartley Act, allowed professional nursing organizations to be considered labor unions. United American Nurses is the collective bargaining organization representing the ANA. After this significant event, some nursing administrators and managers withdrew their memberships from ANA because of the potential conflict of interest between professional affiliation and the workplace. However, this change generated the development of other major nursing organizations: the Center for the American Nurse (CAN) and the American Association of Nurse Executives (AONE).
The ANA has been at the forefront of policy issues and represents nursing in legislative activities. The cabinets and councils of the ANA have provided standards of practice for both the generalist and the specialist. The 1988 Social Policy Statement document defined nursing practice at both the generalist and specialist levels; this is echoed in the current 2010 Social Policy Statement. The certifying organization of the ANA is the American Nurses Credentialing Center (ANCC), which has certified more than 250,000 RNs in different practice areas at both the generalist and specialist levels, along with more than 75,000 advanced-practice nurses (ANCC, 2015). The ANCC, a subsidiary of the ANA since 1991, identifies its mission as improving nursing practice and promoting quality health care service through several types of credentialing programs. The ANCC has created a modular approach to certification that enables the nurse to be recognized for multiple areas of expertise, not simply for competency in a core clinical specialty. There are 27 generalist care clinical specialties, 12 nurse practitioner certifications, 10 clinical nurse specialist certifications, and an interprofessional certification (ANCC, 2015). As a result of their “open door 2000” program, all qualified registered nurses, regardless of their educational preparation, can become certified as generalists in any of the following specialty areas: ambulatory care, home health, informatics, gerontology, medical-surgical, pediatrics, perinatal, and psychiatric-mental health nursing to name a few (ANCC, 2015). Check out the available nursing specialty certifications at http://www.nursecredentialing.org/Certification.aspx.
In addition to certifying individual nurses, the organization also accredits educational providers (i.e., organizations that issue continuing education credits for professional programs), recognizes excellence in magnet nursing services through the ANCC Magnet Recognition Program®, and educates the public about credentialing and professional nursing. This organization is electronically linked on the home page of the ANA (www.nursingworld.org).
American Nurses Foundation and the American Academy of Nursing
Two other organizations associated with the ANA are the American Nurses Foundation, founded in 1955, and the American Academy of Nursing (AAN), founded in 1973. Briefly described, these organizations serve special purposes in support of research and recognition of nursing colleagues. The American Nurses Foundation was established as a tax-exempt corporation to receive money for nursing research. With the establishment of the National Nursing Research Institute, the focus has changed to one of support in the areas of policy making and research or educational activities. The AAN has a membership of more than 1500 nursing leaders and was established as an honorary association for nurses who have made significant contributions to the nursing profession. When a nurse is elected to the AAN, she or he is called a Fellow, and the credential following the nurse’s name is FAAN. You may have had instructors who were faculty in the American Academy of Nursing, or you may be working with a nurse who is a FAAN. These nurses can provide valuable mentorship for the new graduate. The official publication of this organization is Nursing Outlook.
International Council of Nurses
The International Council of Nurses (ICN), established in 1899, is the international organization representing professional nurses. The focus of this nursing organization is on worldwide health care and nursing issues; it meets every 4 years and is headquartered in Geneva, Switzerland. The ICN has been involved in the development of ethical guidelines for the recruitment of nurses from low-income nations. Many European nations have adopted an ethical code and restrict their recruiting from 150 low-income nations (Anderson & Isaacs, 2007).
National League for Nursing
The NLN was established in 1952; however, the beginning of NLN can be traced back to the 1893 organization of the American Society of Superintendents of Training Schools for Nurses of the United States and Canada. Between the late 1800s and the early 1900s, seven nursing organizations formed and joined under the collective name and function of the NLN. One of the unique features of the NLN is that both individuals and agencies are members. The NLN adopted a strategic plan in 1995 to place community-based health care education and health care delivery at the center of its focus and activities (NLN, 1995). The NLN continues to foster improvement in nursing services and nursing education and offers annual educational summits so that nursing faculty and leaders in all types of nursing education programs can come together. Non-nurses can also join the NLN, fulfilling its purpose of promoting the consumer’s voice in some nursing policies. The NLN has a biennial convention and publishes N&HC: Perspectives on Community (called Nursing & Health Care before 1995), NLN Update, and numerous other publications that can be obtained by calling 800-669-1656 or by visiting their website at www.nln.org.
Before 1997, the NLN functioned as an accrediting body in all levels of nursing education. In 1997, the NLN created an independent organization called the National League for Nursing Accrediting Commission (NLNAC) to accredit educational and professional nursing programs. This organizational change was in response to new standards established by the U.S. Department of Education (USDOE). This step was taken to separate accrediting activities from membership activities and to respond to the Higher Education Act Amendment of 1992. In 2013, NLNAC changed its name to the Accreditation Commission for Education in Nursing (ACEN) to maintain continued recognition by the USDOE as a Title IV Gatekeeper. This recognition by the USDOE ensures that nursing students enrolled in an accredited nursing education program continue to receive Federal Student Aid. Also during 2013, the National League for Nursing Commission for Nursing Education Accreditation (NLNCNEA) was established as another accreditation service of the NLN, which is not for Title IV purposes. Is your school an ACEN or CNEA-accredited institution? To find out, visit their websites at http://acenursing.org/or http://www.nln.org/accreditation-services/.
National Student Nurses’ Association
The National Student Nurses’ Association is a fully independent organization with a membership of approximately 60,000 nursing students throughout the United States. NSNA mentors the professional development of future nurses and facilitates their entrance into the profession by providing educational resources, leadership opportunities, and career guidance.
The organization was formed in 1952. Becoming a member of the NSNA may be viewed as a way to begin the “professional” socialization process. There are local school chapters as well as state and national level memberships. Often, members of the NSNA serve on selected committees of the ANA and speak to the ANA House of Delegates regarding student-related issues. The quarterly journal, Imprint, is published by the NSNA. Visit their website at www.nsna.org.
Organization for Associate Degree Nursing
This group was organized in 1986 as an outgrowth of several state organizations. Texas was the first state to have a chapter, which was started in 1984. Membership in the Organization for Associate Degree Nursing (OADN) is open to associate degree nursing graduates, educators, and students. Individuals, states, agencies, and other organizations may also join. There are state and national chapters. The mission of this organization is to be the advocate for associate degree nursing education and practice while supporting advanced nursing education through academic progression. OADN strives to maintain eligibility for RN licensure for graduates of associate degree (AD) programs, to promote AD nursing programs in the community, to provide a forum for discussion of issues affecting AD nursing, to develop partnerships and increase communication with other health care professionals, to increase public understanding of the AD nurse, to participate at state and national levels in the formation of health care policies, and to facilitate legislative action supporting the activities of OADN. Visit their website at http://oadn.org/.
American Association of Colleges of Nursing
This organization is the national voice for university and 4-year college educational programs in nursing and has a membership of more than 500 colleges. The mission of the organization is to serve the public interest by assisting deans and directors in improving and advancing nursing education, research, and practice. This organization publishes a newsletter and a bimonthly nursing journal called the Journal of Professional Nursing. In the past few years, it has formed a subsidiary for credentialing purposes. That organization is the Commission on Collegiate Nursing Education (CCNE). This autonomous accreditation agency serves only baccalaureate and higher degree programs in the accreditation process. Additional information on either organization can be found at www.aacn.nche.edu.
American Board of Nursing Specialties
Significant growth in specialty practice in nursing has been evident since the late 1990s. Throughout the 1980s and 1990s, specialty organizations met annually as the National Federation of Specialty Nursing Certifying Organization to discuss issues in certification and nursing practice. This organization dissolved, and many of the specialty organizations joined the American Board of Nursing Specialties (ABNS) in 1991. The ABNS was established to create uniformity in nursing certification; it now represents more than 25 specialty nursing organizations that promote specialty practice and address certification issues associated with specialty practice. The ABNS functions as a consumer advocate in promoting nursing certification.
As a recent graduate, are you interested in a particular specialty nursing practice area? How and when do you anticipate obtaining specialty certification? How will you include membership in a professional organization in your 5-year career-educational plan? Do you know the benefits of being a certified nurse? Do you work with nurses who are certified in their specialties?
American Assembly for Men in Nursing (Formerly Known As the National Male Nurses Association)
The purpose of AAMN is to recruit men into the profession of nursing, support men who are nurses in professional growth endeavors, and provide a framework for nurses to influence factors that affect men as nurses. At the time of this publication, the AAMN has chapters in 30 states (AAMN, 2015).
The American Red Cross
The American Red Cross is an international organization of approximately 120 Red Cross organizations around the world. Nurses of the American Red Cross pioneered public health nursing in the early 1900s. The American Red Cross is a voluntary agency that is supported by contributions and plays an important role in providing disaster relief and education in first aid and home health and in organizing volunteers to assist in hospitals and nursing homes. Nurse volunteers with the Red Cross play a significant role in assisting those who have been affected by natural disasters.
In summary, professional organizations play a significant role in enhancing the image of nursing. Their impact is seen in both educational and practice issues for generalist and specialist nurse roles. Organizations provide a voice for nursing in policy issues and serve to unite nurses as a group of professionals. Ultimately, it may be nursing organizations that will serve as the catalyst for change in the health care system, and their impact will be felt in the next century.
Conclusion
Throughout the past century, the image of nursing has undergone many changes. The portrayal of nurses in the media has impacted the public perception of both male and female professional nurses. How will nurses continue to refine, intensify, and manage the image of nursing for the future? Will the self-image of nursing change public perception? Nursing is defined as a profession. Participation in the political side of health care, active involvement in professional organizations, a dedication to furthering academic advancement through progression of all nurses, and a commitment to the improvement of nursing’s self-image are all ways to meet the upcoming challenges both in the nursing profession and in this dynamic health care environment.
The questions will go on and on, and the answers will come from nurses in clinical practice, education, and research. These issues, which have a significant impact on nursing’s professional image, must be resolved so nursing continues to move forward as a profession. As a recent graduate, you are the future of this exciting transition. The question to ask yourself is, what can I do to improve and maintain the image of nursing and the integrity of the profession? Change can and does begin with one person who is willing to step forward and make a difference. Is that you?
Relevant Websites and Online ResourcesCarnegie Foundation for the Advancement of Teaching (2010)
Book highlights from educating nurses: A call for radical transformation.http://archive.carnegiefoundation.org/elibrary/educating-nurses-highlights.
Institute of Medicine (2010)
The future of nursing: Leading change, advancing health. http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx.
Future of Nursing; Campaign for Action (Update 2015)
Academic progression in nursing education. http://campaignforaction.org/apin.
American Association of Colleges of Nursing
Joint statement on academic progression for nursing students and graduates. http://www.aacn.nche.edu/aacn-publications/position/joint-statement-academic-progression.
Bureau of Labor Statistics. Occupational Outlook for Registered Nurses
Discover Nursing (Johnson & Johnson). Information for nursing students and all nurses
