Journal of Nursing Education

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Professionalism Among Nurse Educators

Janet G Schriner, RN, MS; Isabel Harris, RN, PhD

Abstract

ABSTRACT

Three hundred seventy nurse educators who teach in a midwestern state in nursing education programs participated in a mailed survey to investigate the relationship of educational preparation of faculty to their attitude on professionalism. Hall's 25-item Professional Scale was used to measure the dependent variables of autonomy, use of the professional organization as a major referrant, belief in the public service nature of nursing, belief in self-regulation and sense of calling to the field, and the independent variable educational preparation of the nursing faculty member. There were very few significant differences among nurse educators when grouped according to highest level of education. Mean scores on the attitudinal components of professionalism, however, illustrated a consistent pattern of the higher the educational preparation, the higher the attitudes on professionalism. Implications for further study are discussed.

Abstract

ABSTRACT

Three hundred seventy nurse educators who teach in a midwestern state in nursing education programs participated in a mailed survey to investigate the relationship of educational preparation of faculty to their attitude on professionalism. Hall's 25-item Professional Scale was used to measure the dependent variables of autonomy, use of the professional organization as a major referrant, belief in the public service nature of nursing, belief in self-regulation and sense of calling to the field, and the independent variable educational preparation of the nursing faculty member. There were very few significant differences among nurse educators when grouped according to highest level of education. Mean scores on the attitudinal components of professionalism, however, illustrated a consistent pattern of the higher the educational preparation, the higher the attitudes on professionalism. Implications for further study are discussed.

Background of Study

One hallmark of a profession is the periodic reaffirmation of its status. Within the profession of nursing there has been an ongoing debate as to whether or not nursing is a profession. Such discussions from within nursing are healthy, since it is from these that nursing evolves its future. The nurses of the next decade are today being educated by a faculty who could best be labeled as the energizers of the profession of nursing. From academic communities, nursing faculties form a core of professional nursing. It is within these educational centers that nursing, as the largest health profession, must continue to develop well-educated professional nurse leaders.

The nurse faculty member plays a significant role in the development of a graduate who is committed to professional goals. The critical need to prepare these graduates, then, is the challenge faced by the nurse educator. Nursing faculty, more than educators in any other discipline, include nurses with a variety of preparations. Faculty teach in three types of basic nursing programs that prepare nurses for entry into practice. In addition to these faculty groupings, graduate faculty constitute a grouping of educators who foster professional growth beyond the baccalaureate level. Since these nurse educators vary in educational preparation, it is necessary to examine the manner in which faculty members with varying levels of education respond to questions on professionalism.

To belong to a profession is to belong to an occupation that is delegated high status. Historically, the term "profession" has been delegated to such learned occupations as medicine and law. From the same historical prospectus, nursing has had problems with status since the founding of modern nursing by Florence Nightingale. Central to the current debate on professionalism in nursing is educational preparation. When faculty are grouped according to highest educational level, is there a difference in their attitude toward professionalism in nursing?

Review of Literature

The intent of this review is to survey the meaning of the concept of professionalism. Studies on professionalism tend to provide conceptual frameworks that distinguish professionals from non -professionals. There are a large number of such definitions with similar central cores.

Greenwood (1957) proposed five attributes that distinguish a profession. "Succinctly put, all professions seem to possess: (1) systematic theory, (2) authority, (3) community sanction, (4) ethical codes, and (5) a culture" (p. 45). Greenwood views the difference between professionals and non-professionals as a quantitative rather than a qualitative one. This can be conceptualized by imagining all occupations in society distributing themselves along a continuum, with the occupations grouped at the professional pole possessing more of the above attributes, and other occupations possessing these attributes to a lesser degree (p. 54).

Nursing, teaching, and social work have been characterized as semi-professions by Etzioni on the basis of several criteria (1969). One, their training is shorter. Two, their status is less legitimated. Three, their right to privileged communications is less established. Four, there is a less specialized body of knowledge, as is evidenced by the different educational preparation programs. Five, they have less autonomy from supervision or societal control than the full professions. The probability of less autonomy can be established by realizing that 61% of todayk 1.4 million nurses work in a hospital setting, yet under the jurisdiction of hospital administration (Moses, 1979).

Several authors have identified similar and other criteria for a profession. Two major criteria, according to Sussman (1966), are a long period of specialized education and a service orientation. A third characteristic which is derived from the knowledge and service orientation is autonomy. Autonomy is defined as existing with a group of professionals when its members are self- regulating and have control of their functions in the work situation. This is of prime interest to nursing - nursing must try to honestly answer the question of the existence of autonomy in nursing practice. Katz (1969) describes the major problem in the professionalization of nurses as the existence of little consensus about the sort of knowledge nurses need.

The vision and leadership of those directing the nursing education of students is a vital element in the promotion of nursing as a profession. The future impressions of nursing can only be expected to reach as high a level as the role models for the profession. Christman contends that the move to full professional status in nursing will accelerate when the majority of nurse faculty members are prepared at the doctoral level (1978).

Hall (1968), in a synthesis from several works, formulated the attitudinal attributes of professionalism that were used for this study. An assumption is made that there is a correspondence between attitudes and behavior. Hall's attitudinal attributes are (p. 93):

1. The use of the professional organization as a major reference. This involves both the formal organization and informai colleague groupings as the major source of ideas and judgments for the professional in his work.

2. A belief in service to the public. This component includes the ideas of indiepensability of the profession and the view that the work performed benefits both the public and the practitioner.

3. Belief in self-regulation. This involved the belief that the person best qualified to judge the work of a professional is a fellow professional, and the view that such a practice is desirable and practical. It is a belief in colleague control.

4. A sense of calling to the field. This reflects the dedication of the professional to his work and the feeling that he would probably want to do the work even if fewer extrinsic rewards were available.

5. Autonomy. This involves the feeling that the practitioner ought to be able to make his own decisions without external pressures from clients, those who are not members of his profession, or from his employing organization.

Hypothesis

The general hypothesis tested that nurse educators will differ in degree of professionalism when grouped according to educational level. These relationships were specifically categorized in the sub-hypotheses that nurse educators will differ in their use of the professional organization as a major referent, in their belief in the public service nature of nursing, in their belief in selfregulation, in their belief in autonomy and in their belief in a sense of calling to the field.

Subjects

Data were collected in January 1980 by mailing a questionnaire to nurse educators in a midwestern state. The original mailing went to 440 educators with an overall 88% return after two follow-up letters. The response was as follows: 83% of the faculty who teach in associate degree programs, 86% of the faculty who teach in diploma programs, 84% of the faculty who teach in baccalaureate programs, 100% of the faculty in the graduate program.

A comparison of these nurse educators with nurse educators nationally demonstrated the representativeness of the sample faculty. The sample faculty have a slightly higher educational preparation level at the PhD and MS levels than the national data (NLN data book, 1978), although the national data are from a 1978 survey and the present data are 1980. In this same time span, it could be assumed that the preparation of faculty nationally would also increase. This comparison is illustrated in Table 1.

Table

TABLE 1COMPARISON OF SAMPLE NURSING FACULTY AND NATIONAL NURSING FACULTY BY HIGHEST DEGREE OF EDUCATION

TABLE 1

COMPARISON OF SAMPLE NURSING FACULTY AND NATIONAL NURSING FACULTY BY HIGHEST DEGREE OF EDUCATION

Table

TABLE 2MEAN SCORES AND STANDARD DEVIATIONS OF COMPONENTS OF PROFESSIONALISM BY EDUCATIONAL LEVEL OF NURSE EDUCATORS

TABLE 2

MEAN SCORES AND STANDARD DEVIATIONS OF COMPONENTS OF PROFESSIONALISM BY EDUCATIONAL LEVEL OF NURSE EDUCATORS

Instrument

Using the attitudinal attributes of professionalism, Hall designed a scale to measure these attitudes of professionals. His research included data from "acknowledged professions" (physician, lawyer) in addition to those groups which are aspiring to become professions (social worker, nurses). Hall's Professional Scale contains 25 statements for the purpose of measuring attitudinal components of professionalism, with five statements per component. Statements were worded so that the respondent designated agreement on a Likert scale. Agreement with the scale items was assumed to be a measure of professionalism, except in the instances of statements where an expression of disagreement measured professionalism. Monnig (1978) used this form of Hall's Professional Inventory Scale to measure attitudinal components of professionalism among a random sample of nurses and physicians. Hall's instrument has both construct validity and reliability (Snizek, 1972).

Results

Table 2 illustrates that the mean scores on a scale of 1 to 5 of professionalism were higher with increased educational preparation. On Component 1, the use of the professional organization, the PhD in a related field group mean was 3.98. Each educational grouping mean was less than 3.98 until the low mean of 2.80 at the diploma level. Concerning the belief in public service, the group mean of PhDs in a related field was 2.68 with subsequent groups ranking with lower mean scores until the low mean of 2.90 at the diploma level. In a belief in self-regulation, the PhD in nursing group mean was 3.75, the high mean, followed by PhD in related field with a 3.72 mean. In this component the MS and BS groups were very close in mean scores. The low score was the AD grouping with a mean of 3.4. Concerning a sense of calling to the field of nursing, the PhD in a related field mean was the highest at 3.23. Subsequent groupings were scored with similar means, but again the low means were the AD and diploma groupings. Component 5 dealt with autonomy. The PhD in nursing mean was highest at 3.90, followed by PhD in related field. Group means dropped then to the AD group mean low of 2.4. The total professionalism group means reflected a consistent trend of a drop in mean scores by educational level. PhD in related field scored a 3.67 mean, followed by PhD in nursing at 3.59. The low mean was 2.84 in the AD group. This data demonstrated that faculty, when grouped by educational level, did differ in opinions on professionalism in nursing.

The varying mean differences on components of professionalism and total professionalism score indicate a variance does exist. A one-way analysis of variance of the educational level of nursing faculty and components of professionalism was computed to determine the probability of such differences occurring by chance. Table 3 illustrates these data. The first component concerning the use of professional organization as a major referent elicited the greatest F-ratio of 5.257 and is statistically significant beyond the .05 level (Table 3). In this component, then, a difference did exist between faculty of different educational levels. The total professionalism score demonstrated an F-ratio of 2.949 and is statistically significant at the .0005 level. Of the remaining components, a sense of calling to the field demonstrated a lower F-ratio of 1.725 which was not significant statistically. The component autonomy likewise had a low F-ratio of 1.503 and was not statistically significant. For these two components, very little between group difference existed. The two remaining components - belief in public service and belief in self-regulation - had negative F-ratios indicating that the difference on the mean scores was greater within groups of educational level than between groups.

Table

TABLE 3A ONE-WAY ANALYSIS OF VARIANCE OF EDUCATIONAL LEVEL OF NURSING FACULTY AND COMPONENTS OF PROFESSIONALISM

TABLE 3

A ONE-WAY ANALYSIS OF VARIANCE OF EDUCATIONAL LEVEL OF NURSING FACULTY AND COMPONENTS OF PROFESSIONALISM

With the preceding data analyzed, it was felt that a related variable, program type, may be contributing to the group differences. The components of professionalism were then analyzed according to the type of educational program in which the respondents were employed. Table 4 illustrates mean scores and standard deviations of faculty from the four program types. Those faculty employed as graduate faculty consistently scored the highest mean on each component of professionalism, except belief in public service where diploma faculty scored higher. The total professionalism score indicates that as a group, graduate faculty mean was highest with a mean score of 3.67, followed by diploma faculty with 3.44, baccalaureate faculty with 3.39 and associate degree with 3.37. Table 4 illustrates these data.

Table 5 illustrates the mean professionalism scores of faculty when grouped by educational level within the program types. The highest mean score (4.27) was recorded for those faculty with an MS in a related field who teach in the graduate program, followed by the one faculty with a PhD in nursing who teaches in a baccalaureate program. In the graduate program, the group of MS in a related field had the highest mean, in the baccalaureate program the PhD groupings were highest, the MS in nursing group were highest in diploma programs, and the MS in related field group demonstrated the highest mean professionalism score in associate degree programs. The lowest mean score of 2.99 was recorded by the group of faculty with a BSN who teach in a baccalaureate program. There are no faculty with a PhD in nursing or a related field who teach in diploma programs.

With the differences evident in Table 5, a two-way analysis of variance was computed to observe the interaction of educational level and type of program the nurse educators were employed in. The diploma and associate degree levels of education were dropped due to the small cell size. This, then, allowed the analysis to be completed with the levels of nursing educators who have a PhD in related field, a PhD in nursing, an MS in related field, an MS in nursing, a BS in related field and a BS in nursing. In this two-way analysis the interaction between educational level and use of the professional organization as a major réfèrent was significant at the .004 level with an Fvalue of 3.45. The only other component that demonstrated a significant F-ratio was a sense of calling to the field which has an F of 1.87 at the .04 level. Further analysis of this variable, sense of calling, was done to determine at what level of education and program type this difference in groups was evident. From this analysis of "sense of calling," it was found that the variance within educational levels rests with two levels of nurse educators - those with a master's degree in nursing and those with a master's degree in a related field. Within those groupings, faculty with an MSN who teach in a diploma program have higher means and differ significantly on this component than those teaching in an associate degree program. Faculty with an MS in a related field who teach in the graduate program have higher means that differ significantly from those who have the same degree and teach in an associate degree program. These two educational levels, then, accounted for the variance. All other educational levels, i.e., BSN, BS in related field, PhD in nursing and PhD in related field did not vary significantly when the interaction of program type and educational level were analyzed.

Table

TABLE 4MEAN SCORES AND STANDARD DEVIATIONS OF FACULTY BY TYPE OF PROGRAM AND COMPONENTS OF PROFESSIONALISM

TABLE 4

MEAN SCORES AND STANDARD DEVIATIONS OF FACULTY BY TYPE OF PROGRAM AND COMPONENTS OF PROFESSIONALISM

Table

TABLE 5MEAN PROFESSIONALISM SCORES OF NURSE EDUCATORS BY PROGRAM TYPE

TABLE 5

MEAN PROFESSIONALISM SCORES OF NURSE EDUCATORS BY PROGRAM TYPE

Conclusions from the Findings

There were very few significant differences among nurse educators when grouped according to highest level of education. Regardless of this, Table 2 - Mean Scores and Standard Deviations of Components of Professionalism by Educational Level of Nurse Educators - reported data that illustrated a consistent pattern of high to low mean scores in keeping with educational levels. This pattern was particularly evident in the data as reported in Table 3, illustrating an F-ratio of 5.257 at the .000 probability level.

The findings related to the use of the professional organization are in keeping with Monnig (1978), who reported in a study of nurses and physicians using Hall's Inventory that nurses with an MS scored higher means on this component than did AD, Diploma or BSN nurses. Like Monnig, the current study likewise found significance in the statistical analysis regarding professional organization. The use of the professional organization may imply different meanings and have different levels of importance to nurses. Some nurse educators would view the organization as a barrier and obstacle to goals, while others a facilitator. This is an era where the issues are known and cause great discussion. The entry into practice issue directly affects job security of some groups of nurse educators. At the time this questionnaire was mailed, some of the nurses were awaiting the outcome of collective bargaining efforts - another issue directly tied in with the professional organization. Therefore the interests of the members of the organization may or may not have been best represented in recent professional organizational activities.

The F-ratio for the public service nature of nursing was negative illustrating that the variance within the groups of different educational levels was greater than that between groups. This relatively high within-group variance suggests either the totally personal or idiosyncratic nature of this issue or the fact that there is some social or cultural characteristic or attribute within the sample that outweighs the importance of education and cross cuts educational groups in a relatively uniform manner. Analysis of other variables might prove enlightening.

Nurse educators grouped according to educational level did not differ significantly on the issue of self-regulation in nursing. Negative F-ratios again demonstrated a greater within-group variance. Mean scores as reported in Table 5 showed little differences, and it was the only component that the mode remained constant on each measure within the component. The notion of collégial control within nursing varies within educational grouping.

The component "sense of calling to the field," although not significant on the one-way analysis, was significant with the interaction of program type. This attribute had the lowest overall mean of any component. In Monnig's study (1978), nurses who had a diploma education scored highest on this attribute. The type of program and level of education interacted on this component with two groups of nurse educators, those with an MSN who teach in a diploma program and those who teach with the same degree in an associate degree program. The organizational climate could contribute to this attribute within the diploma program setting which has a heavy reliance on the hospital. Sense of calling statements referred to commitment irrespective of monetary or extrinsic rewards as an indicator of the attributes of professionalism. This issue is topical - and may cause nurses to react negatively to the notion of fewer extrinsic rewards when other health occupations continue to gain.

Concerning autonomy in nursing, the between-group difference again was small. There was no significant interaction on autonomy between educational level and program type. Thus autonomy does not appear to be related to either educational level or program type, but may be in keeping with one's position within the more immediate work situation. This may be most evident in the immediate supervisor relationship of the nurse educator.

Thus the conclusion is drawn that despite individual differences with groups of nurse educators, when these educators are grouped according to educational level, increased professionalism with increased educational level is shown.

The implications for graduate education in nursing are demonstrated by the findings. Efforts must be made by nurse educators to foster the need and importance of increased education for nurses. This is best accomplished by teaching about professionalism in the nursing curriculum, i.e., by the educational setting providing the educators best prepared to do this. This research demonstrates that those with the highest level of education expressed the most professional attitudes.

Implications for Further Study

For this study there was a relationship between the levels of education and some components of professionalism in nursing. The nature of that relationship, i.e., causal linkage, was not determined. It remains unclear whether the higher level of education produced higher professionalism scores or whether those with a higher professional orientation are those who seek advanced education. To observe the process of this changing attitude, a longitudinal study would help identify the effect of education on the professional score.

During an examination of previous work, it was noted that a profession constitutes a subculture, and it was suggested that nursing lacks this professional subculture. It would then be of interest to explore the notion of a subculture, especially with nurse educators with different educational levels. Furthermore, if a subculture does exist, is it with faculty within certain types of nursing education programs?

In the beginning of this article, it was noted that professions periodically reaffirm their professional status. This occurs by declarations from professional organizations, proclamations from interest groups, and inquiries into the state of the profession, such as this. This study, and further endeavors, will presumably play a role in clarifying the nature of professionalism in nursing.

References

  • Chistman, L. (1978). Alternatives in the role expression of nurses that may affect the future of the nursing profession. In N.L. Chaska (Ed.), The nursing profession: Views through the mist. (pp. 359-365). New York: McGraw Hill.
  • Etizioni, A. (1969). The semi-professions and their organizations. New York: The Free Press.
  • Greenwood, E. (1957, July). Attributes of a profession. Social Vfork, 3(U), 45-55.
  • Hall, R.H. (1968, February). Professionalization and bureaucratisation. American Sociological Review, 33, 92-104.
  • Katz, F.E. (1969). Nurses in the semi-professions and their organizations. In, A, Etizioni (Ed.), The semi-professions and their organizations. New York: The Free Press.
  • Monnig, Sister Gretta. (1975). Professional Territoriality: A Study of the expanded role of the nurse. Unpublished doctoral dissertation, University of Minnesota.
  • Monnig, Sister Gretta. (1978). Professionalism of nurses and physicians. In N.L. Chaska, The nursing profession: views through the mist. (pp. 35-49). New York: McGraw HiU.
  • Moses, E. & Roth, A. (1979, October). Nursepower. American Journal of Nursing, 79 (10), 1745-1756.
  • The nursing data book. (1978). Publication no. 19-1751. New York: National League for Nursing.
  • Snizek, W.E. (1972, February), Hallfe professionalism scale: An empirical reassessment. American Sociological Review, 37, 109-114.
  • Sussman, M.B. (1966). Occupational sociology and rehabilitation. In M.S. Sussman (Ed.), Sociology and rehabilitation, (pp. 179-237). New York: American Sociological Association.

TABLE 1

COMPARISON OF SAMPLE NURSING FACULTY AND NATIONAL NURSING FACULTY BY HIGHEST DEGREE OF EDUCATION

TABLE 2

MEAN SCORES AND STANDARD DEVIATIONS OF COMPONENTS OF PROFESSIONALISM BY EDUCATIONAL LEVEL OF NURSE EDUCATORS

TABLE 3

A ONE-WAY ANALYSIS OF VARIANCE OF EDUCATIONAL LEVEL OF NURSING FACULTY AND COMPONENTS OF PROFESSIONALISM

TABLE 4

MEAN SCORES AND STANDARD DEVIATIONS OF FACULTY BY TYPE OF PROGRAM AND COMPONENTS OF PROFESSIONALISM

TABLE 5

MEAN PROFESSIONALISM SCORES OF NURSE EDUCATORS BY PROGRAM TYPE

10.3928/0148-4834-19840601-07

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