Professionalism in nursing, midwifery and the allied health professions: report

5. Recommendations

Professional values and behaviours are expected of all those with whom patients and service-users come into contact, as is adherence to existing standards and, where relevant, codes of conduct, performance and ethics within regulatory frameworks. While the recommendations in the report are intended primarily for the NMAHP community, it is anticipated that the related principles will have relevance to, and will resonate with, all healthcare staff and will serve to unite the wider workforce.

The following recommendations are presented for consideration and action by the Coordinating Council.

There may be value in disseminating a vision for professionalism, with further exploration of its application in a changing healthcare world.

Recommendation 1. Develop and publish a vision for the delivery of professionalism in the changing healthcare context and test with a range of stakeholders.

The imminent review of the Staff Governance Standard is likely to focus not only on the rights of staff (as is the current focus), but also on their responsibilities. There is an opportunity here to ensure that the requirement of professionalism is explicitly stated within the standard.

Recommendation 2. Incorporate professionalism within all staff governance and employment activity.

There is a personal cost to professionalism, and it is important that organisations seek to assuage any potential negative effects through appropriate support and promotion of professionalism among the workforce. Supportive mechanisms should be investigated, assessed and introduced to enable staff to deal with the emotional and psychological impacts of healthcare practice. Failure to do so may have significant impacts on the ability of individual practitioners to continue to function in a professional way.

Recommendation 3. Introduce supportive mechanisms to enable staff to deal with the emotional and psychological impacts of health care.

A key element in facilitating professionalism within services is to identify where team cultures are hindering professional behaviour and taking action to nurture more positive approaches. The aim must be to create consistency in approach to professionalism across teams by raising the bar for those who are not functioning in accordance with the principles of professionalism, rather than lowering it for those who are.

Recommendation 4. Implement measures to enable a professional culture to flourish across NHSScotland.

The NMAHP workforce has a strong culture of mutual support that includes the provision of mentorship, preceptorship, coaching, personal development planning and review, opportunities for reflective practice and clinical supervision, although there is significant variation across the country in terms of opportunities for staff to access support schemes such as these. They are nevertheless important in relation to promoting professionalism and could usefully be organised around the underpinning principles of professionalism; these would serve as benchmarks for personal development planning and performance review with a view to identifying ongoing development needs.

Recommendation 5. Develop existing support measures to facilitate and embed professionalism across NHSScotland.

The addition of a professionalism strand into the personal development planning and review process would appear attractive. There is a need to consider how this could be achieved and integrated into current processes without creating an unnecessary and overly bureaucratic burden.

Recommendation 6. Incorporate the requirements of professionalism within personal development planning and review processes.

Healthcare organisations' mechanisms for recruitment and selection at all levels should be sensitive to the key underpinning characteristics of professionalism and should be capable of identifying these in potential recruits, both within written and online submissions and in interview and assessment processes. Similar considerations should govern processes for recruitment and selection to education and training programmes.

Recommendation 7. Explore and implement mechanisms for selection and recruitment that incorporate the requirements of professionalism.

Professional leadership and role modelling is a key influence on the adoption of professional behaviours. Positive leadership and instilling a sense of responsibility and accountability in all staff will assist in building a sense of team contribution and will promote the principles of professionalism.

Recommendation 8. Promote positive role modelling and leadership across NHSScotland as a means of enhancing professionalism.

There is broad agreement across the healthcare sector that personal responsibility for learning and a commitment to lifelong learning are core aspects of professionalism. Organisations should aim to reinforce individuals' commitment to lifelong learning and ensure the provision of ongoing CPD opportunities to support their professional development.

Recommendation 9. Reinforce personal responsibility for lifelong learning as part of professionalism, facilitated by organisational support.

Recommendation 10. Focus NHSScotland learning and development activity on issues of conduct as well as knowledge, competence and skill.

Pre- and post-registration education and training programmes provide opportunities for students to explore the concept of professionalism for their practice. The concept of professionalism needs to be embedded in education programmes, including undergraduate and postgraduate curricula, with support provided to mentors to promote awareness of its principles among students and other learners.

Recommendation 11. Incorporate professionalism as a central concept within all training and education programmes, including undergraduate and postgraduate curricula.

Promoting professionalism requires a multi-faceted approach that will address different communication needs and different levels of motivation to ensure that the key messages reach their intended audiences (managers, educators, practitioners and the public). Various forms of research, including that related to psychology and educational experience, can show the complexity of behavioural change and the influence of attitude and motivational factors. Such research should be used to support any promotional work that may be taken forward.

Recommendation 12. Secure all relevant research input into any promotional and communications work.

A subgroup of the working group identified an array of potentially suitable measurement tools (proxy measures) that might be appropriate to measure professionalism and to identify development needs. Essentially focused on behaviours, relationships, practice, context and culture, the tools cover diverse approaches to facilitating quality improvement through professionalism. When making choices on tools, it will be important to consider if they adequately cover necessary professional attributes, include a measure(s) of patient/servicer user feedback, and are endorsed through personal development planning/appraisal mechanisms. Consideration also needs to be given to the infrastructure required to train and support a range of people to use the tools and give the necessary feedback as part of the improvement cycle.

Recommendation 13. Ensure that information-gathering and measurement tools are appropriate to needs and are endorsed and facilitated through systems such as personal development planning and review processes.