Desperately Seeking Professionalism

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I’ve been writing an online advice column as ‘Dear Donna’ at for over 10 years.  Nurses (and others) write in their career related questions and I answer them. Here’s one such Q&A. Tell me what you think about the questioner’s observations and my response to her.

Dear Donna,

I work for an insurance carrier. Many of my peers (nonnurses) comment on the lack of professionalism among nurses. Even though I’d like to defend our profession, it’s becoming increasingly hard to do so. I’ve had applicants wear Capri pants to interviews and short shorts to job fairs. I’ve seen staff refuse to follow direction by nonmedical supervisors simply because a nurse didn’t give them the direction and staff insist on wearing scrubs to work because they’re nurses and shouldn’t have to follow the business casual dress code. The problem is further magnified when nursing applicants demand higher salaries in spite of that. Nurses have a wealth of knowledge that is beneficial in many different work settings; however, it’s difficult to persuade management of this fact when nurses are doing very little to promote themselves or display a team-player attitude. I’m not at all trying to bash the nursing profession, but I’d appreciate your thoughts on this subject.

Desperately Seeking Professionalism

Dear D.S.P.,

One simple explanation for lack of “professional” job finding skills with many nurses is the fact that historically we never needed these skills. There was a time when nurses could walk into any hospital and get hired on the spot. We didn’t need a résumé, we weren’t interviewed, and a license to practice was more important than what we were wearing. We became very casual about job finding.

Of course, times have changed, but that message hasn’t gotten out to all nurses yet. On my first interview outside the hospital years ago, I dressed rather casually and didn’t have a clue as to how to conduct myself. I learned from experience, trial and error, observation, and self-study. But some other nurses have not yet had that opportunity or that experience.

Besides all of that, many nurses don’t even own “business” clothes. Their wardrobe consists of uniforms/scrubs and casual clothes. It’s not an excuse. It’s just a fact. When I had my first job out of uniform, I was panic-stricken because I didn’t know how to dress if it wasn’t white and sold in a uniform store.

Regarding some of the other issues you raise, the whole nursing culture has taught nurses to be somewhat paranoid about what they do, whom they take orders from, where they work, and even whom they speak to. (When I went to school, we weren’t even allowed to reveal a BP reading to a patient. We had to defer to the physician.) Historically, nursing was kept separate from other hospital departments, and we began to believe we truly were separate in every way. We isolated and insulated ourselves to our detriment. When hospitals began converting to a “business” model rather than a “charitable” model and incorporated the nursing department into that model — as it should be — nurses rebelled against it, thinking “health care” was good and “business” was bad. However, neither is mutually exclusive.

Like it or not, health care is a business today. And if nurses want a good salary, benefits, and work environment, we need to have a more businesslike orientation in the delivery of care in any setting with our appearance, our communication skills, our workplace and social savvy, our ability to promote ourselves, our profession, and our programs. Why? Because, becoming more integrated in any work situation and developing a professional image to match the professional people we are will promote understanding and appreciation of what we do, as well as the value we bring to any healthcare situation. You’re right when you say nurses have a wealth of knowledge that is valuable in many settings. That is a well-kept secret, even among nurses.

Nurses have been fighting for so long to get paid a decent wage in the hospital that some believe they have to be paid the same salary everywhere or they’re giving up something. Some who move into nontraditional areas don’t consider the fact that they will no longer have to work weekends, holidays, or overtime, take call, or do shift work. One nurse recently told me that a family member who was not a nurse was goading her to ask for top salary at an insurance company because of the “nursing shortage.” I explained to her that the shortage applies primarily to patient care areas, but she wasn’t aware of that. The “business world” outside the hospital is like a foreign land for many nurses. But even in the hospital, nurses need to understand the importance of workplace savvy, image, and integration. More important, they need to understand how this can help them individually and how it will help the profession as a whole.

So how can we change all this? Nursing educational institutions, professional associations, and even places of employment need to provide education and training to nurses (and many other employees) about the concepts of “professionalism” and “image.” There are many educators and consultants who do this work, including me. In nursing, we often define professionalism as strictly related to patient care issues. We have to expand that definition and learn the related skills.

Even you, D.S.P., have an opportunity and a responsibility to be a role model, a mentor, and an educator. It isn’t that nurses don’t care. It’s simply that many of us come from a longstanding culture with deeply embedded beliefs and practices and have never heard about other ways of doing things or the reasons behind them. Nurses need to learn these things from other nurses.

Best wishes,

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