Professional Development, Reflection and Decision-Making in Nursing and Healthcare

Melanie Jasper, Megan Rosser, Gail Mooney

• Publisher: Wiley-Blackwell
• Year: 2013
• ISBN:
  9781118303276
• Edition: 2
• Topic: Medizin
• Subtopic: Pflegefähigkeiten

This essential text brings together in one place the inextricably linked concepts of professional development, reflective practice and decision-making. Fully updated and revised throughout, the new edition of this easy-to-follow, jargon-free title is targeted at nursing and healthcare practitioners and nursing students, providing clear guidance to help the reader think critically about their practice, work within professional boundaries, be accountable for their actions, and plan for their future.

Chapter 1

The Context of Professional Development

Melanie Jasper and Gail Mooney

---

Learning objectives

This chapter explores the basis of professional development as an ongoing component of professional practice. It lays the foundations for the rest of the concepts in this book by exploring the context in which registered nurses, midwives and specialist community public health nurses work as accountable practitioners. It explores the responsibilities of nurses in terms of their own professional development, as lifelong learners and as practitioners belonging to a specific professional group. Finally, it presents a simple strategy for guiding professional development activities.

By the end of this chapter you will have

• an understanding of the context within which professional development is framed
• considered your own professional development in relation to the Nursing and Midwifery Council's standards for continuing professional development
• an understanding of the nature of professional development from pre-registration to expert practice
• considered a range of professional development activities
• considered key mechanisms for professional development
• considered professional development within the context of lifelong learning
• used a strategy for identifying your professional development needs.

---

---

Activity

Before going any further, explore your own understanding of professional development.

Why is professional development important?

Why do professionals need development?

What drives professional development?

What would you consider professional development in nursing to mean?

---

The context of professional development in Britain today

Nursing and midwifery function in a constantly changing environment that needs to respond to sociopolitical and economic drivers within which health care is delivered. In the United Kingdom, the National Health Service (NHS), within which the majority of the 370,000 practicing nurses and midwives are employed, is funded from general taxation and under direct control from an elected government. As a result, registered practitioners need to develop robustness and resilience in their professional lives in order to respond to the competing demands of the service environment, quality and standard improvements to their care, service redesign and demographic changes. Nurses and midwives have always undergone professional development to maintain and develop their competence to practice within the caring working environment. However, the past decade has seen further changes to the healthcare infrastructure that demands nurses and midwives to expand and develop their roles at a pace far swifter than seen previously.

Media publicity and the publication of reports from the Francis Inquiry (2013), The Patients Association (2012) and the Willis Commission (2012), all draw attention to the impact of systems' failure on the standard of care delivered to patients. This has been compounded by financial austerity measures imposed since the late 2000s. The Prime Minister's Commission on the Future of Nursing and Midwifery in England (2010) resulted from societal concern in many sectors of the direction of nursing and a need to emphasise the significance of nursing care to the NHS's mission. Nurses and midwives, as the largest group of employees within the NHS, have had to bear the brunt of downward pressures on costs and upward demand from increased acuity in patient need amongst criticisms of a crisis in professionalism.

On the other hand strategies to manage the NHS in times of increased demand and financial stringency, have provided nurses and midwives with greater opportunities for career development and diversity unimagined 20 or 30 years ago. Society has witnessed the growth of nurse-led services, the development of the nurse practitioner and advanced nurse practitioner roles, and the introduction of consultant nurses in many specialties. Nurses have returned to board-level appointment, with wide scopes of practice and remits for accountability for overarching service provision within health providers. Education for nurses and midwives has continued to develop in universities, with degree-level preparation for initial registration introduced as a standard in 2012–2013 (NMC 2010) in all UK countries. In terms of career progression, increasingly higher educational qualifications need to accompany promotions to both managerial and specialist nursing and midwifery posts, with routes for Master's awards and doctoral programmes located in practice arenas, such as clinical and professional doctorates, that aim to explore and remediate challenges in the practice environment. Finally, service redesign in the United Kingdom means that many nurses and midwives, even if they do not desire career progression, will need to develop further knowledge and skills to deliver their services in different contexts and environments as much provision is transformed into primary and community care settings, increased short-stay and day-case working, and delivered by unregulated practitioners under the supervision of registered nurses and midwives.

The increasing pace of change requires a workforce comprised of practitioners able to take responsibility for their practice, and develop their understanding of their accountability as they move into more challenging spheres of practice. Individual professional and personal development, alongside the recognition that reflective practice is essential to practitioners working under their own registration, is essential to effective decision-making in professional practice. More than ever, nurses and midwives need to accept their own responsibility for their professional development, and view this as an essential component of the privilege to be able to work in the exciting environments that contribute to the health and well-being of our society.

All professionals practise within certain boundaries imposed by the society and culture that licenses them and the professional ethos of the profession to which they belong. For nurses, the authority to practise once qualified comes from four sources:

• government legislation
• the Nursing and Midwifery Council (NMC)
• their employers
• their service users.

All of these have certain expectations of a person qualified to call themselves a nurse, and indeed lay down certain standards of behaviour and practice that all professionals are required to adhere to. Within these expectations is the requirement that professional practitioners will continue with their professional development throughout their working life (NMC 2008).

Governmental influences on continuing professional development

In 2001, the government introduced a framework for lifelong learning in the British NHS, with the aim of equipping staff with the skills they need to

• support changes and improvements in patient care
• take advantage of wider career opportunities
• realise their potential. (Department of Health 2001)

In Working Together, Learning Together: A Framework for Lifelong Learning in the NHS (Department of Health 2001) the idea of the NHS as a ‘learning organisation’ with a commitment to professional development for all grades of staff was floated, with the aim of creating ‘an organisation which puts lifelong learning at the heart of improving patient care’. In presenting the framework, the government outlined their beliefs:

• a set of core values central to lifelong learning in the NHS and health care generally
• an entitlement to work in an environment which equips them with the skills to perform their current jobs to the best of their ability, developing their roles and career potential, working individually and in teams in more creative and fulfilling ways
• access to education, training and development should be as open and flexible as possible – with no discrimination in terms of age, gender, ethnicity
• learning should be valued, recognised, recorded and accredited wherever possible
• wherever practical, learning should be shared by different staff groups and professions
• planning and evaluation of lifelong learning should be central to organisational development and improvement, backed up by robust information about skills gaps and needs
• the infrastructure to support learning should be as close to the individual's workplace as possible, drawing on new educational and communications technology and designed to be accessible in terms of time and location. (Department of Health 2001, p. 6)

This provides a framework for continuing professional development (CPD) for all staff, from the beginning student to the experienced practitioner. Student practitioner preparation is perceived as a partnership between the NHS and universities, with a 50:50 ratio between the time spent in practice placements and in the educational environment for nurses and midwives. Much CPD activity is commissioned by the NHS from universities, where strict quality assurance processes are imposed, both internally and externally, to ensure that educational activity is of high quality, appropriate for the NHS's needs and relevant for the individual practitioner. The government further suggest that there are core knowledge and skills that should be common to all NHS employees. These are presented in Box 1.1.

---

Box 1.1 Knowledge and skills framework: Core knowledge and skills (Department of Health, 2001, p. 7). Crown copyright.

All staff should:

• fully understand and respect the rights and feelings of patients and their families, seeking out and addressing their needs
• communicate effectively with patients, their families and carers, and with colleagues
• value information about, and for, patients, as a privileged resource, sharing and using this appropriately, according to the discretion and consent allowed by the patient and by means of the most effective technology
• understand and demonstrate how the NHS, and their local organisation works
• work effectively in teams, appreciating the roles of other staff and agencies in the care of patients
• demonstrate a commitment to keeping their skills and competence up to date, including the use of new approaches to learning
• using information and supporting the learning and development of others, recognise and demonstrate their responsibilities for maintaining the health and safety of patients and colleagues in all care settings.

---

With relevance for CPD there is a requirement for practitioners to:

Demonstrate a commitment to keeping their skills and competence up to date – including the use of new approaches to learning and using information – and supporting the learning and development of others.

(Department of Health 2001, p. 8)

This is reinforced by various other strategies and by the professional body. Within the current legi...