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Professionalism is under increasing scrutiny across the health and social care

professions, with many of the issues that emerge later in peoples careers being linked to a broad
range of behaviors distinct from their technical ability. Fitness to practice cases heard by
regulators such as the Health Professions Council (HPC) and the General Medical Council
(GMC) often include components of inappropriate or unprofessional behavior which would not
be captured by competency testing. These behaviors are not trivial, including issues relating to
substance abuse, theft or sexual assault against patients or service users. Identifying and
addressing these issues is also a problem to be faced by possible revalidation processes.
However, there is evidence from medical professionalism research that issues presenting in later
careers may be associated with similar concerns in training. For example action against doctors
by state medical boards in the United States was found to be predicted by factors such as
disciplinary action in medical school 1 and a low supervisor rating of their professionalism
during their residency year.2
Nurses are expected to recognize and respond to a plethora of new demands arising from
an ever-changing and increasingly complex healthcare system. Multiple new regulations and
accreditations processes, professional standards, increased accountabilities, and financial
priorities require more of direct care nurses and nurse leaders already struggling to gain and
sustain competencies in evolving arenas of practice, quality, and safe patient care. Todays
politico-societal healthcare environments include growing shifts and disconnects in patient care
needs and the availability of human, material, and fiscal resources required to meet those needs.
Nursing professional development specialists are the keys to successful succession
planning, managing competing priorities, and effecting cost avoidance. These practitioners are
more than educators. They emphasize safety, quality, efficiency, and effectiveness of practice
while rapidly transitioning diverse generations of nurses into practice. They understand adult
learning principles, career development in healthcare and communities of practice, continuing
education program development and management, transformational/servant leadership (Keith
2008), systems redesign, complex implementation, and strategic planning. The American Nurses
Association (2009b) distinguishes Nursing Professional Development (NPD) as a professional
specialty based on the sciences of nursing, technology, research and evidence-based practice,
practice-based evidence, change, communication, leadership, and education.

NPD specialists work in a variety of practice settings and environments of care. Some are
in colleges and universities and facilitate the learning experiences of student nurses. Others work
in clinical settings to orient, precept, and manage competencies of staff nurses, new graduates,
and student nurses working at the point of care, providing support and facilitation to nurses with
an immediate need for knowledge and/or skills to guide their practice, sometimes called bedside
learning or just-in-time learning (American Nurses Association 2009a, 2009b). These NPD
specialists are often called Clinical Nurse Educators and wear many hats, i.e., educator, servant
leaders (Keith 2008), facilitator, consultant, change agent, coach, and researcher. They support
nursing research, evidence-based practice, and quality improvement through professional
development of direct care nurses and nurse leaders at the point of care (American Nurses
Association 2009a, 2009b).
Some of the many ways NPD specialists contribute to professional development in
practice and learning environments and services are woven into their roles and accountabilities
(American Nurses Association 2009a, 2009b; Bruce 2009; Keith 2008; Cohen 2007). NPD
specialists provide orientation, in services, and competency and continuing education programs
for interdisciplinary and interprofessional employees. Orientations include organizational and
service-specific mission, vision, philosophies, goals, policies and procedures, role expectations,
and an introduction to the organization. In services and competencies management generally
address knowledge and skills acquisitions related to environments of care, job functions, and
decision-making responsibilities, thereby increasing professional abilities and confidence.
Continuing education helps nurses meet regulatory requirements, i.e., certification criteria,
licensure/relicensure mandates, and The Joint Commission, among others.
Some organizations seek credentialing as education providers with their state boards of
nursing and/or the American Nurses Credentialing Center to enable them to provide programs
that enhance professional learning experiences, contribute to career development and
advancement, and respond proactively to issues and trends that contribute to quality, safe,
ethical, innovative, and efficient health care practices.
As change agents, NPD specialists trend healthcare issues to influence practice environments
(hospitals, long-term care facilities, community/public health care centers, schools and colleges,
outpatient clinics, healthcare systems) and learning environments (provider-directed, learner-

directed, provider-directed learner-paced) through research, education, networking and


consultation, inter-professional collaboration and partnerships, and servant leadership. They
influence healthcare change locally, nationally, and internationally through their global
contributions to nursing professional development and information-sharing around structures,
processes, and outcomes.
NPD specialists facilitate evidence-based practice; practice-based evidence; quality
improvement with data collection, analysis, and synthesis; and, project management by bringing
nursing research to the point of care. Evidence-based practice is a science-to-service model of
engagement of critical thinking to apply research-based evidence (scientific knowledge) and
practice-based evidence (art of nursing) within the context of patient values to deliver quality,
cost-sensitive care. Practice-based evidence is a practice-to-science model in which data are
derived from interventions thought to be effective but for which empirical evidence is lacking.
Providers are engaged in data collection, analysis, and synthesis to inform practice (American
Nurses Association 2008, p 61). They need to understand how nursing research fits into the roles,
responsibilities, and opportunities available for nurses in all practice settings to facilitate their
participation and contributions to their profession. NPD specialists advise, collaborate, translate,
integrate, and evaluate nursing and clinical research that is in the literature and/or in progress
within the organization through practice, education, and reflective discussion with staff and
interprofessional partners.
In the role of the servant leader, NPD specialists provide encouragement, respect,
support, boundaries, protection, advocacy, guidance, and mentorships that influence nurses
transition into autonomous, professional nurses. They integrate ethical principles, service, and
leadership into all of their activities, role modeling transformational leadership and
professionalism that entice nurses to take risks, share in decision-making, and explore their own
potential.
The roles and accountabilities of NPD reflect the unique knowledge, skills, insights, and
experiences of nurses who have advanced their practice into staff development, continuing
education, and academia on a global scale. Todays evolving technology and the shifting
education platforms used to prepare nurses for professional practice are reflected in the expanded
learning needs of new graduates and seasoned nurses alike. NPD specialists work with a wide

range of competencies, learning needs, and tiered academically prepared nurses across all
practice settings and environments of care. They partner with healthcare providers and nurse
leaders to ensure a safe, effective, and efficient environment of care. They are involved in project
management, academic and clinical education, program and portfolio development,
competencies management, continuing education and return on investment, leadership and
relationship-building, research and evidence-based practice implementation, cybergogy (learning
through technology), and nursing practice excellence. They do all of this and more for the
present and future of professional nursing.
Don Berwick, writing for an audience of general practitioners, observed that todays
healthcare workforce must embrace the authority and autonomy of patients and become much
more focused on cooperation, teamwork, inquiry and dialogue than previous generations were
required to do.60 This call for an adjustment to the central components of professionalism
reflects the context and cultural sensitivity of the concept itself, and the need to evolve and
reflect external expectations as well as internal drivers. Professionalism is widely accepted as a
central element of health care, but it is a complex and multifaceted concept that is often difficult
to define. Consequently, it is frequently described in terms of its absence and the negative values,
behaviors and relationships that are demonstrated when things have gone wrong. The emphasis
should therefore shift to reinforcing the positive and professional behaviors that are expected of
staff and to articulating how they can be motivated and supported to enact the quality agenda.
Professionalism is learned in many ways and in many contexts the internal and external drivers
interact with and reinforce one another and may exert differing degrees of influence at different
stages in a practitioners or support workers career. As has been observed elsewhere in this
report, the particular influence of a culture, system, framework, standard or patient/service user
encounter will vary depending upon circumstances. A collective desire to reinvigorate
professionalism in Malaysias and wider healthcare workforce is likely to come from a combined
will to effect change and to see it sustained over time for the benefit of patients and service users.
National standards and codes and quality education and training are important to achieving this,
but it is individual self-regulation along with organizational support, and shared and consistent
leadership and role modeling, that may carry the greatest potential for revitalizing
professionalism in Malaysia in the 21st Century.

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