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

Foreword by the Chief Nursing Officer

Although the landscape of health care has changed beyond recognition over the last 30 years, the importance of professionalism has remained constant in the minds of patients, the public and healthcare professionals.

I see professionalism as the "value-added" factor that enhances the quality of care and the contribution of practitioners. It implies a commitment to vocation and to public interest and presumes adherence to a set of values that are owned and understood by all. Professionalism provides nurses, midwives and allied health professionals (NMAHPs), and patients, service users and carers, with much needed continuity in the face of an ever-changing system and an "internal compass" to guide them in challenging circumstances.

One might assume from objective health data that professionalism is thriving in Scotland. However, with numerous formal and informal reports highlighting examples of "unprofessional" behaviour and workforce surveys referring to low morale among NMAHPs, this cannot be assumed.

Despite this, I do not subscribe to the view currently expressed through the media that we are witnessing a fundamental crisis of professionalism, particularly in nursing, and that a return to the ethos and structures that dominated in the past is necessary. The reality is that while evidence of unprofessional behaviour in healthcare undoubtedly exists, there are far greater examples of excellence in service delivery. From a personal perspective, I see evidence of professionalism everywhere I go.

I do believe, however, that it is now time to look at professionalism afresh and ensure that it reflects today's realities rather than those of the past. Professionalism must speak to a multigenerational audience and act as a driving force for quality. We must ask whether professionalism goes beyond regulation, competence and compliance and question whether it is the vital spark that can motivate staff to work with pride and passion and do the right thing every time. We also have to ensure that NHS boards and their leaders and managers play their part in creating a culture in which professionalism can thrive.

The publication in 2010 of the Healthcare Quality Strategy for NHSScotland, with its vision of a world class healthcare system, offered a timely opportunity to undertake a review of professionalism and to consider how we could re-energise the concept.

It is important to say at the outset that it is neither my intention nor that of the NMAHP community to lay claim to the notion of professionalism. The Chief Medical Officer for Scotland is leading a workstream promoting professionalism and excellence in Scottish medicine, and related work is also being taken forward to progress the quality strategy. Professional and regulatory organisations continue to promote professionalism through their work and to embed its values in everyday practice.

Professionalism is seen by the NMAHP community as an inclusive and potentially unifying force, particularly as we progress to an integrated health and social care system. Although this report is targeted primarily at NMAHPs, it is clear from discussions with a wide range of stakeholders that the interdependencies highlighted within mean that it will have much wider applicability.

I wish to offer my sincere thanks, and express my great admiration, to all members of the working group for the effort and expertise they have brought to their task of producing the report. My particular thanks go to Dr Frances Dow, who has chaired the group with skill, tact, humour and the great insight that her experience in academia and public service brings. They have delivered, I believe, a landmark report that sets the direction of travel for recognising, promoting and, most importantly, practising the principles of professionalism within healthcare services.

Ros Moore
Chief Nursing Officer and Director for Patients, Public and the Health Professions, Scottish Government