Sit in on any nursing class and you’ll probably hear professors reminding students that nursing is a career, or a profession, not just a job with a laundry list of duties. You’ll also hear professors emphasize the importance of professional behaviors of nurses, and instruct students to treat instructors and each other with collegial regard or to maintain collegial behavior at all times. What do those concepts mean and what does this difference between job vs. profession reflect about the mindset of nurses or the mentality nurses are trying to cultivate within the profession? As we carry out care for patients and perform procedures in the clinical setting what does collegial behavior look like or not look like? And how exactly does collegial behavior play apart in distinguishing nursing as a profession?
Conceptual constructs can play a tremendous role in understanding the intent of a policy or the definition of an idea that is desired to be manifested into actions and desired results. So to better understand “collegial behavior” and “Professional” as concepts, let’s just go back to elementary school and define the words. I do this all the time and find that definitions of terms often removes previous misunderstanding or even argument between individuals.
Merriam Webster’s Online dictionary defines collegial as:
a: marked by power or authority vested equally in each of a number of colleagues
b: characterized by equal sharing of authority especially by Roman Catholic bishops
c: marked by camaraderie among colleagues
Merriam Webster’s Online dictionary defines behavior as:
a: the manner of conducting oneself
b: anything that an organism does involving action and response to stimulation
c: the response of an individual, group, or species to its environment
d: the way in which someone behaves; also: an instance of such behavior
e: the way in which something functions or operates
Chitty and Black (2011), defines collegial behavior as, “The promotion of a supportive and healthy work environment, cooperation and recognition of interdependence among members of the nursing profession is the essessce of collegiality.”
The definition of profession according to Merriam Webster is:
“: the act of taking the vows of a religious community
: an act of openly declaring or publicly claiming a belief, faith, or opinion :
: an avowed religious faith
: a calling requiring specialized knowledge and often long and intensive academic preparation
: a principal calling, vocation, or employment c: the whole body of persons engaged in a calling”
According to Chitty and Black (2011), this quality of collegial behavior is also recognized as vital by the ANA’s Nursing Scope and Standards of Practice, though I’ll have to take their word for it as I’ve not been able to locate a version of that document for review (without purchasing it).
Maybe it could be said that collegial behavior is a fancy word for respect or teamwork. But not all teams win games or play well together. Many teams fall apart because no one really understands the parts their team members play in relation to their own field boundries; or they may pick each other apart with belittling criticisims, undermining, ball hogging, and other deconstructive behaviors. For those of us in nursing the old phrase “eating their own” may come to mind. This is quite a grim idea no doubt, and all too often a reality with no quick solutions.
In considering this issue we may begin to ask ourselves too many questions, “Why would we eat our own? What causes a lack of collegial behavior? Who does it affect and what is the value to me? How can its’ implementation be improved or even the concept brought to greater awareness among the body of the profession? How can I practice collegial behavior in my own nursing practice for which I am responsible regardless of the practice standards adopted by other professionals? Why does it matter how we treat each other professionally? How do we become aware of our behavior as professionals specifically related to how it affects patient care, and professional relationships? How do we distinguish between personality traits and negative behaviors that contradict the promotion of collegial behavior? Toward whom am I obligated to extend this collegial behavior?”
Figuring all this out sounds like a whole lot of work to me, and aren’t nurses already feeling over worked? Doesn’t the profession already suffer from a deficit of members and poor member retention rates in the field? Yeah, it looks like a hot mess. However nurses are great problem solvers by training, education and nature. Also, as a group we also value the ideals of concepts like team and respect. So, now, how do we implement this concept? First we have to do some digging and answer some of those questions I threw out earlier. We have to understand our current construct before we can replace it with a new one. Understanding the pitfalls of the old construct will make the maintenance of the new construct easier and we will be quicker to catch slight deviations or lapses back to an old, familiar and convenient construct or way of being and doing as nurses.
If we are trying to cultivate collegial behavior then are we currently operating in a culture of non-collegial behavior? Or we could ask, “What are the barriers, potential conflicts, real conflicts that derail or prevent collegial behavior? Disruptive behavior is one identifiable factor. Danielle Miller, NSNA Director wrote an article for the NSNA magazine Imprint in the April/May 2011 issue addressing disruptive behaviors and cited the AMA’s definition of disruptive behavior, via an ANA publication on the same subject as, “personal conduct, whether verbal or physical, that affects or that potentially may affect patient care negatively (Miller, 2011).” Wow! Personal conduct, that means that the onus is on me; I am the only one ultimately responsible for my conduct and how it does or, could affect patient care. That is a huge defining facet of behaving as a professional, personal responsibility for those we serve. So the mentality nurses are trying to cultivate is the understanding that our personal conduct affects or could affect patient care. Miller also asserts that the nurses best defense against disruptive behaviors is to maintain professionalism and to provide support to fellow collegues who may be experiencing disruptive behaviors regardless of the source.
In that same issue of Imprint, Marion Broome (2011), cites that nursing is associated with a culture of incivility including participants as nurses, faculty, and students related to their interactions among each other (Broome, 2011). She also asserts that based on her 38 years in the profession roughly 10-20% of nurses do not embrace collegial behavior, and credits them with the ability to destabilize work environments where the culture of caring should prevail. From this assessment it would seem that we are our own barrier. I seem to remember a grandparent warning me and my cousins of that life trap.
So if in being collegial we are to avoid disruptive behaviors and we understand that disruptive behaviors are not congruent with professionalism then what constitutes professionalism? How do we define professional behavior for nurses? Broome provided a list of “Behaviors Reflecting Professionalism in Practice”:
- “Base your choices and actions on contemporary evidence and best practices
- Own your ideas/complaints/concerns
- Take the high road when dealing those who are uncivil. Calmly refuse to be treated in an unprofessional manner.
- Trust colleagues to do the best they can.
- Be prepared- think through alternative scenarios before they happen, especially when dealing with challenging situations.
- Be timely and straight forward with advice, complaints or praise
- Give others the benefit of the doubt when things do not appear as you are told. Ask questions.
- Always display integrity (your actions should be congruent with your beliegs).
- Couch harsh truths with caring words.
- Private behavior that offends others is just that. It should be kept private.”(Broome, 2011)
These are great guidelines for implementing professional behaviors. Read the full article at the following link: http://www.nsna.org/Publications/Imprint/AprilMay2011.aspx
Chitty and Black (2011) assert, “A code of ethics is a hallmark of mature professions…a social contract through which the profession informs society of the principles and rules by which it functions.” Do we as “professional nurses” know what the ANA adopted Code of Ethics for our profession is comprised of, how to interpret it, apply it, and thereby represent it accurately? The ANA has a read only version available here http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
These 9 provisions are guides for professional behavior and cultivate collegial behavior. Each provision has itemized and related sub-provisions, ie: Provision 1 and 1.1, 1.2, 1.3, 1.4 and 1.5. In addition there are interpretive statements furnished by the ANA as well to add to the understanding of the basic provision and the concept it is intended to address. When we become licensed we agree to these ethics as the tenants of our professional identity. If we are aware of these guides, and utilize them for professional improvement in our practice we cannot help but develop collegial behavior.
Another potential barrier to embracing collegial behavior may be that many nurses and nursing students may not like the idea of this idealized accountability, and I think that bears further discussion. Though some may be hard pressed to admit it, nurses are only human. The beauty is that collegial behavior leaves room for self assessment, improvement and greater understanding for each other as we develop professionally. So long as our licenses are active and in good standing we are never, not nurses. On vacation, at home, recreational activities, in line at the grocery store, driving down the road, anywhere we come into contact with others, they will size us up and make a discernment of our capabilities as a nurse, and they will have certain expectations. We don’t have to like it. It is simply the nature of the human mind to draw conclusions from evidence and experience. So the collegial behavior we do or do not present is evidencial experience for our image as professionals.
Here’s a personal example, and I’ll change the name for the protection of the person related to the account. I remember when I first began nursing school and had been newly introduced to the Code of Ethics. What a grand purpose to uphold as a nurse right? Well, this introduction, just so happened to coincide with an encounter I had with a nurse I knew as a recently aquainted friend. We were at a gathering of friends in the home of a mutual friend. Everyone brought their children. They were all playing outside. The ages ranged from 3yo-14yo. Many of the other parents teased me of being over protective because I wouldn’t go inside and leave the kids to their own devices. Well part of the reason for my behavior was that my child was the youngest in addition to the fact that he had no siblings or friends in that group to look out for him. I was his only advocate. I expressed this lightheartedly to my peers and then commented to the effect, that at least if one of the kids did get hurt, we had “Kara”, a wonderful nurse among us to patch them up or know if we needed more than bandaids. To which this RN&CNA with over 17 years experience responded in a tone of absolute serious inflection, “Oh no, I’m off duty. If they get hurt that’s on you and you take ‘em where you think they need to go.”
Now whether I liked it or not, I did make a judgement about that nurse. I went from high levels of trust to no trust in a nano-second. Thankfully I was able to temper that reaction with the understanding that, she is human, maybe she was teasing (though no one laughed), or maybe she had a hard day because she had been at work for 12 hours before this gathering. But those rationales did not dissuade my reaction to that statement, and in the back of my head there was a lingering doubt saying, “Maybe she did mean it, just the way it sounded.” And to me it sounded like someone I wouldn’t even want to put a bandaid on my finger, let alone that of someone I love. Provisions 1 and 9 from the Code of Ethics, took a hard hit with that one comment. I now doubted her compassion, and wondered about her integrity as a professional. I didn’t want to think these things, partly because I knew I would be under the microscope soon enough and because of how long she had been in practice. But the doubts remained.
So based off that one personal experience we can see that the stakeholders of collegial nursing behavior reach beyond the nurse, extending beyond the hospital walls. That nurse had the potential to affect: a new student, all the peers in the conversation as well as any impressionable children within earshot, peer perceptions of the institutions the nurse practiced at, and potentially to affect other people not even in attendance. If you’ve ever played the kindergarden game “Telephone” you know exactly what I mean. The overall potential impact of non-collegial behavior is larger than that one statement. What if we all just said whatever we felt whenever we feel like it? Yeah, something tells me that wouldn’t work very well for society.
Another factor that may contribute to non-collegial behaviors could be stress both personal and professional. Where does the stress come from? Some is certainly personal but there are also other manifestations of stress in the workplace where members may act out in various ways such as acts of lateral or horizontal violence(Smith, 2011). Burnout related to stress is cited as the greatest contributing factor toward nurses leaving the hospital environment or the field all together(Hertel, 2009) and contributes to a high turnover rate in hospitals (Smith, 2011). If collegial behavior could offset the loss of members that would be a beneficial intervention both for nurses as private individuals and professionals effecting patient care.
Also consider that Provision 5 of the Code states that the nurse owes the same duties to self as others. So if we are to extend compassion and professionalism to others, then we are to give that to ourselves as well. Exploration of the code and supplemental readings on professional behavior such as those elaborated by Broome, are one method of increasing awareness and application of collegial behavior. However, some nurses may appreciate a different approach such as cultivating self compassion. Thornton (2011), cites research showing that self compassion is highly linked to greater personal resilience and wellbeing. Surely that would offset stress of individuals and bleed over into professional interactions.
To explore this method of application further you may access additional self compassion tools at: http://www.self-compassion.org/
The stakeholders, or those with vested interest in collegial/professional behavior are almost unlimited. Understanding the purpose of collegial or professional behavior most readily affects the nurse and the profession of nursing. If by the development and use of collegial behavior patient care, outcome and experience is improved, the public esteem of the profession would also be maintained or improved. Professional comportment should also improve inter-professional relationships and protects the nurse and their practice. This also creates the pathway by which the nurse is able to advocate, protect and care for patients safely. Provision 1 mandates compassionate practice and respect within all professional relationships (ANA, 2012). This includes patients, other nurses, students, doctors, other specialty departments, UAP’s, staff, administration, maintenance, security. It does not seem that even one area the nurse interacts within is unaffected by the nurses’ behavior.
Nurses themselves are given charge of their practice in the Code of Ethics. The Code applies descriptive examples of nurse responsibilities that all consistently relate back to collegial behavior and reassessment of self and professional performance, much like the nurse process itself constantly relates back to reassessment of the patient. As pointed out by several of the authors referenced here, nurses may employ collegial behaviors without the mandate of management. If more readily embraced, collegial behavior will empower nurses to support themselves personally and professionally, augment their collegues, while serving clients and the healthcare profession with higher levels of visible professionalism.
Participation in our professional associations on state, national and specialty levels will provide professional socialization opportunities and continued growth. I feel confident that if needed (unless it is already currently required) that I would be able to provide support and help influence the adoption of required CE around understanding and applying collegial behavior as well as continued educational exposure to the Code of Ethics and the Scope and Standards of practice. However, knowing nurses are proactive, I do not believe that mandated education around this issue will become a requirement.
I think that the Code of Ethics should have more emphasis through the nurse educational process. The Standards and Scope of Practice, I believe should be available to students as well. I will continue to look for a free point of access to this document.
ANA (2012). Code of Ethics for Nurses with Interpretive Statements. Nursing World. Retrieved on February 15, 2012 from http://www.nursingworld.org/codeofethics
Broome, M. (2011). Imprint Retrieved on February 20, 2012 from http://www.nsna.org/Publications/Imprint/AprilMay2011.aspx
Chitty, K. & Black, B. (2011). Professional Nursing; Concepts and Challenges. Maryland Heights, MO: Saunders Elsevier.
Hertel, R. (2009). Burnout and the med-surg nurse. Med-Surg Matters, 18(3), 1.
Miller, D. (2011). Imprint. Retrieved on February 20, 2012 from http://www.nsna.org/Publications/Imprint/AprilMay2011.aspx
Smith, S. (2011). Breaking the Cycle of Horizontal Violence in Nursing. Imprint. Retrieved on February 20, 2012 from http://www.nsna.org/Publications/Imprint/FebruaryMarch2011.aspx
Thornton, L. (2011). Self-Compassion: a Prescription for Well-Being. Imprint. Retrieved on February 20, 2012 from http://www.nsna.org/Publications/Imprint/FebruaryMarch2011.aspx
Merriam Webster(2012a). Retrieved on March 1, 2012 from, http://www.merriam-webster.com/dictionary/collegial?show=0&t=1331414380
Merriam Webster(2012b). Retrieved on March 1, 2012 from http://www.merriam-webster.com/dictionary/behavior
Merriam Webster(2012c). Retrieved on March 1, 2012 from http://www.merriam-webster.com/dictionary/profession?show=0&t=1331589150
Neff, K. (2009). Self Compassion: a Healthier way of Relating to Yourself. Retrieved on February, 20, 2012 from http://www.self-compassion.org/