Surface - Professional Identity: What it means to think, act and feel like a nurse – Part 2

This episode of the NLN Nursing EDge Unscripted Surface track is part 2 of 2 featuring guests Nelda Godfrey and Beth Phillips.

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Transcript

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[Music][Music] Welcome back. Last episode we talked with Drs. Beth Phillips and Nelda Godfrey about  their novel work with the International Society for Professional Identity in Nursing. Today we  return to continue discussing the importance of professional identity in nursing. Thank you for  joining us. I'm going to turn the measuring idea over to Nelda because I think she has something  to share about that one. Yeah. So hold on to your seats because we've done what we needed to do to  get this moved forward and be this big. So just as a teaser where some of our colleagues are going  are they are going to try and bring all of this information to the public. So we have a group that  I mean and in nursing we don't do this very often but we are planning on bringing this to the public. We had this iterative group in 2018 that met for a day and a half with really good facilitation. We used a participatory action research approach. We vetted and met every three months after  that first year to solidify what the definition of professional identity and nursing, was what the  definition of each of the four domains was I told you about some of the changes that we made then we  determined key elements, competencies, exemplars, we wrote scripts for video performances if you  will, and did that heavy lifting early on. And then, very quickly after that, decided it's time to do an  instrument. So we have done an instrument at with the highest level of integrity that measures all  four of the subscales and has been tested with first 1100 nurse  educators and nurse educator administrators and then another 600 nurses in practice so we have  a reliable and valid instrument that measures not only professional identity but the four subscales. And it's measured twice. It's what you call a truth scale, so if you say one of the elements  for knowledge is "recognizes cues and patterns." Okay, one of the elements for knowledge  is "recognizes cues and patterns" and so you use a Dreifuerst scale, novice to expert, a five component  Dreifuerst scale to assess your own skill in that area. Am I proficient, am I competent, am I a novice, am I a master at it? And then we also at the same time when you're saying recognizing cues  and patterns you say thinking about my work environment. What would I say about my work  environment's expression of where they are on the skill level using the Dreifuerst skill model? Are are they proficient, are they competent are they masters, are they novices? What is my work  environment like? And so we have the data from that and Beth has figured out the scaling and  we can now do aggregate scoring and we have this ready for people to use in research studies and actually with all nurses everywhere. That's quite the claim to be able to make that we have an  instrument that is robust enough to be used with all nurses everywhere. I want to add a caveat that  we don't, we're not sure that it's for students though because students are just in the learning  process so we actually have one of our work groups looking now at instrument development for nursing  students because if we can't expect them to be at the level that we would expect nurses to be  at. So one more thing I would say and I I really hope to have your questions very soon. I want to  know what you're thinking. The four domains that we determined those were domains for nursing in  a contemporary sense. So many of us are fans of Florence Nightingale, but this is a contemporary  assortment of professional identity terms and it's been vetted and and iteratively determined  and worked on and I mean it's this is well studied and so I think that's a really important  point here that this didn't just come out of nowhere. We weren't sitting at a kitchen table  deciding what was going on the survey. This has been very well tested and when we did  the conceptual model, that model was tested with us educated nurses and internationally educated  nurses and the four domains held together it was the historical, political, societal influences  that were different, but the nugget of that professional identity held together.  Nancy Crigger and I did a philosophic inquiry on professionalism in nursing back  in 2011 and we found through that scholarly work that it's like a sieve. Professionalism in  nursing is like a sieve. You don't get words that hang together and so we are suggesting let's  set that back on the shelf, the definition of professionalism was useful  in 1904 with a Flexner Report and let's set that on the shelf and let's use professional identity  moving forward. So what questions and thoughts do you all have? Oh so many. You are just, you're  having my mind spin in a really good way and I for my first and foremost thought I want  to get out there is I think that this is going to have a huge impact and be paradigm shift especially because I agree with Michelle that I think in many nursing programs across the  country we have a lot of opportunity to grow in our excellence in teaching professional identity  and socializing nursing nurses to the nursing profession. I think that this can be a  huge paradigm shift for educators. Oftentimes this is the two credit course that gets put online  and in the in the eyes of the students it's that other thing I have to do on top of my core patho  and pharm and specialties. They put a lot of their effort and time and attention to and it's just  this other thing and it's really shifting to this is the...this is the big thing. This is the  foundation upon which everything else builds and anchors so that was my first response. And my  question, and I think it's Michelle knows I'm the one that comes from this from a different angle , so I think for the for the audience that might be listening and thinking about professional identity  and personal identity and the cohesiveness of this which is wonderful. I love the articulation of that.  There may be folks in the audience thinking, okay, well we can swing the pendulum too far the other  way and because we're in a service profession a giving profession that innately pours ourselves  into our service work, it's giving of our self, has your work in this area taking you into  the realm of the compassion fatigue, the other outcomes that happen when the cohesiveness  between self and professional identity get so blended that the professional identity really  is taking on as a personal identity? That may be a bigger, big juicy question that we can only  sort of scratch the surface of but that's where my head's going right now. So I can tell you I'm  an ethicist and I have a big background with the ethics research and in the early days of bioethics  we looked at nursing a research study about asking nurses what their theoretical framework was for  approaching ethical issues in nursing practice and they didn't have anything that talked like  nursing. They had everything that talked about their person. So I would argue that, number one, I mean shout it from the rooftops that the person we are is so incredibly important in this nursing  endeavor that we don't segregate that to this four domain notion of professional identity. It  is only an additive so we wouldn't want any of the uniqueness of any of nurses to be dampened  by this. It's simply another item to hold onto, another idea to hold onto, which is germaine for  every profession. Every profession has that. So it's really important to me that we talk about diversity, equity and inclusion along with professional identity as is written  in the new AACN Essentials and also developing a professional identity in nursing. These things  are really important but they don't take away that individual at all in the mix, but it does give us  some common ground. It does give us a way to teach it, a way to communicate this. And I hope,  well, and I believe that these four domains are non-emotional domains and I think they will move  us away from this idea of compassion fatigue and exhaustion and burnout. Imagine if you are...I'll  just kind of make this up as I go along but if you are a C-suite person and you say, I don't know  what the nurses want, can't figure out what the nurses want and what you are hearing is the nurses  want more compensation. Well, there's a reason why, but what if the nurses can then say also I  need...I've done ECMO once and I'm terrified. I need some more training on doing ECMO or our unit could  really benefit from nursing ethics rounds because we have so many ethical issues here we need to  have time and space to discuss them or I want to be a leader in place on my unit but I need more  background to be able to do that I really need some education on this or comportment we really  on our unit we need to raise that level of respect to a high enough level that it permeates our unit  and so we've given people words that are more than the limited words our young discipline has and I  would, I would totally agree with you and Rachel. I think your question is really critical. We have  to solve that or we're going to be in big trouble as we move forward because I think that's part of  the missing link and I would make the case that self-care is embedded in all of those domains. The knowledge of it, the values and ethics of it, the as nurse as leader part of the element is  advocacy and that includes self- advocacy, and then comportment as well. I can't have...my behaviors will  show if I'm not taking care of self first and so that has to be part of that. Even for educators, I  think that for too long in our profession we have kind of gone by our traditions and  there's been bullying, there's been mistreatment of each other even we ran into a situation we  believe as an organization, we believe that nurse as leader starts from LPNs to the highest ranking  nurse that exists and LPN's are leaders of their clients, they're leaders of their work, they learn  about conflict resolution, they learn about good communication skills, they learn about teamwork. All of these these are leader characteristics that they can carry with them wherever they go. And so one of our groups wrote a paper and sent it to a journal I will not name and it was denied  because we included LPN and they felt like the word professional should never go hand in hand  with LPNs. And I mean if our profession can't get past those kind of things, I've been hearing that  I've been in this now for 40 years and I've been hearing it that whole time and it's been longer  than that. We've got bigger fish to fry. We have bigger issues and we need to get past it so yeah. I agree with you and there's a connotation of value with that, right? What are we saying about  how we value all the members of our profession when that's the connotation  and the paradigm that we carry with that. So I agree. I appreciate your thoughts on that. Can  I jump right back too? I just want to emphasize that we have a subgroup working on diversity,  equity, inclusion and belonging as a it is a concept that has to be hand in hand with  professional identity formation. It has to be part of our work and we have a conceptual model now. We  want that to be blended into everything that we do because otherwise we're going to leave people  out. With all of the health and equities that we're seeing today nursing has an opportunity to really  make a major change in this country and in the world if we can embrace that because we have  our hands everywhere in schools and in businesses and in industry and in politics and everywhere and  so we feel really about that and we have a very active group that's moving and the chair of  our group is actually a someone you may value very much, Dr. Janice Brewington, and she has just  led our group and we're doing some amazing things but that is our next big endeavor is to make sure  that people see that connection. That's great and I think to also circle back I think what I keep  hearing you saying is this integration piece, you know that professional identity has to be  integrated with DEI, diversity, equity, inclusion and belonging it also needs to be integrated with  understanding how to take care of yourself and then I heard you from kind of a bigger perspective  talk about how professional identity needs to be integrated with accreditation standards so it  kind of comes sort of from our guiding principles that help us to create our programs. I am curious  I know and and nursing education is making this move towards competency-based education,  AACN being one of the organizations that have taken a a really big step in that direction with  the AACN Essentials. I'm curious really because I don't know, I'm not that versed in the  Essentials line by line, is professional identity showing up in the Essentials? And I'm thinking that  might also help with some of the integration for the academic piece of our learners development. I'll go ahead and take that Beth. Is that okay? Yeah. Okay, so one of the great things about nursing is  that we have three different accrediting organizations for our nursing programs.  There's nothing wrong with that. There are five in business. I mean, it's okay that we've got  three different accrediting groups. This is not a problem, but what is good is that we don't have  all three that have gone off and written the structure that should be around professional nursing education. That has been to date handled by AACN and then accredited through  CCNE. So "they say," whoever they are ,say that any innovation takes 16 years to get turned through an  accreditation process. Okay, I mean you think about new innovations that have happened in many or  whatever 16 years. It took two because as the new Essentials were being developed we brought this  forward to the leaders and they said, oh my gosh, we need this. We really need this. So domain nine  is listed as professionalism, but I think it was too new for people to accept professional identity. If you look, the definition of professionalism is exactly the definition of professional identity. And all of the domains under that and sub all of competencies under that and the subcompetencies  relate to professional identity as we're defining it today. The best news is that there is one  9.5 is demonstrate a professional identity of nursing. 9.6 is integrate diversity equity  and inclusion in one's professional identity of nursing. And what's fabulous is AACN talks and  talks and talks about DEI, but the only competency that it is listed in specifically is this one so  this is ours to lose! so integrating diversity, equity and inclusion in one's professional  identity is just on a platter waiting for us to take. And what we're seeing from this, this is new  for us, we didn't realize that we need to take our faculty through the same process we would  take our students through. So now we're starting to work workshops that treat the faculty totally  as learners and say so let's evaluate where you are on values and ethics and where you are on  knowledge and nurse as leader in professional compartment and let's start to use this as a  frame. You don't have to use it as your life frame, but start using it as a frame and then last week  we found out that one of our colleges in Canada has adopted the professional identity and nursing  domains as the framework for their curriculum. This is incredible work. So great. Both Nelda and Beth and I  think you closed the loop beautifully by talking about how this integration is showing up in some  of the competencies that are really guiding our curricula and on the academic side hoping  that that will then transition our learners into practice with some good opportunities to  demonstrate professional identity. So thank you, thank you, thank you. Well you're both welcome  to join us. Yeah no question, no question. You know, we really are trying to change the whole  darn place so come along with us and let's see whether we can get it done. We didn't think we'd  be anywhere near we are now. Yeah, so I guess anything is possible. So for people  in the audience who are just, yes, I want to get on this train, I am passionate about this mission too,  I want to learn more, I want to help out, what would you say to them in a way to get involved or learn  more information? So the easiest way is to Google "professional identity and nursing" and put "KU  School of Nursing" with it. That'll get you there fastest or you can email me: ngodfrey@kumc.edu and  we will get you on the distribution list. There is no cost to be part of the International Society  for Professional Identity in Nursing. Well thank you both. It's been an absolute pleasure and honor  to really be in this space with you both to be able to talk about something so important. Thank  you for all your important work in this area. Thank you for joining us on this episode of  NLN Nursing EDge Unscripted Surface. We hope you join us next time. Until then, remember: whether  your water is calm or choppy, stay connected, get vulnerable, and dare to go beneath the surface.[Music]