ANA Code of Ethics, NP role development, NP role threats, professional loyalty



  1. Berg, Judith A. PhD, RN, WHNP-BC, FAANP, FNAP, FAAN (Clinical Professor)


ABSTRACT: The professional obligations to protect and promote nursing professional roles stem from the American Nurses Association Code of Ethics. Nurturing new generations of NPs to assume leadership role is foundational to succession planning and is critical to assuring NPs' continued contributions to health care. Making professional role development a priority at various points in educational programs, modeling ways to contribute to the profession, and encouraging professional organization membership are a few of the suggestions presented for the academic environment. In clinical settings, NP meetings are opportunities to engage NPs in legislative and policy issues important to practice. Attaining employee benefits, such as conference attendance, can promote commitment; and precepting NP students forges professional bonds. Present and future generations of NPs must assume responsibility for protecting and promoting the role. Many threats to NPs' scope of practice and other professional conundrums are ongoing. Instilling the values of protecting and promoting the NP role in students and colleagues and then identifying leaders to direct these efforts are essential to succession planning.


Article Content

Protecting and promoting the nurse practitioner (NP) role are professional obligations that stem from the American Nurses Association Code of Ethics (ANA, 2015). Protection and promotion the NP role as foundational to succession planning and critical to assuring NPs' continued contributions to health care. There are various ways to instill the need to protect and promote the NP role so that all NPs engage in such endeavors.


A profession is defined as a calling or vocation, especially one that involves some branch of advanced learning or science that requires having special knowledge and the self-imposed obligation to serve the community (Bryan-Brown & Dracup, 2003). The definition of community is not completely clear but implies the community served; we extend the meaning to include serving our own community of NPs. Although professions vary in their discipline-specific expectations (Gavett, 2014; Green, Zick, & Makoul, 2009; Porcupile, 2015; van Mook et al., 2009), society holds professionals to a higher standard of ethics, honesty, and morality (Bryan-Brown & Dracup, 2003). Loyalty to a profession and working to improve the profession are not always discussed, but in the case of the NP role, we believe both are integral to serving our community of health care consumers and our own professional community.


The expectation that NPs protect and promote their professional role originates in ethics underlying the nursing profession. Provision 9 of the American Nurses Association Code of Ethics calls for maintaining the integrity of the profession, whereas Provision 7 states that nurses must participate in the advancement of the profession (ANA, 2015). We maintain these are the bases for a mandate to all NPs to demonstrate the commitment to the professional role. Missing has been the clarity about how to achieve this end. Fouche (2011) suggested a need to succession plan by nurturing a new generation of NPs, which is essential for securing our collective future. Early leaders in the NP movement are aging and many have retired from practice. To ensure the future of NPs' contributions to health care, we must foster an NP workforce dedicated to protecting and advancing the role. Who will take up the mantle and how do we instill the desire to do so? How do we identify new leaders? Where and when do these vital aspects of the NP professional role germinate? Following are our ideas about "how to" instill the professional values and skills to advance and protect the NP role.


Instilling values and skills to advance and protect the NP role during education

One of the obvious places to foster role protection and advancement is during NP education programs. Ideal would be for nurses entering their NP programs to have previously been introduced to the promotion and protection of the nursing profession. However, loyalty to nursing and the advancement of nursing roles are not necessarily always covered in basic nursing education. A wiser approach would be to discuss role protection and promotion as crucial to the NP role during all NP programs (BSN to MSN; BSN to DNP; post-master's NP certificate programs; post-master's DNP programs). We have compiled the following list of suggestions that could and should occur in the educational setting.


* Make professional role development a priority at various points in educational programs. For example, add an objective about professionalism and the ethical obligation to protect and promote the NP role in entry-level courses and during clinical courses and place emphasis on protecting and promoting the NP role in capstone courses.


* Teach aspects of role development, such as professional engagement, knowledge dissemination, and faculty development across curricula (Berg, Hicks, & Roberts, 2017).


* Cite the benefits of maintaining professional organization membership, such as personal and professional development, collaborative research, policy activism, evidence-based practice, and intra- and interprofessional connections (Goolsby & DuBois, 2017).


* Model (by faculty) aspects of professional development, such as professional presentations, manuscript development and publication, and organization leadership and activities. Broadcast faculty professional accomplishments.


* Encourage students to attend conferences and demonstrate engagement and organization contributions.


* Provide opportunities to develop professional writing and presentation skills within the NP program. Mentor students to convert educational assignments and products into professional publications, posters, and/or presentations.


* Identify opportunities for students to contribute to the profession, such as submitting abstracts for presentations at conferences.


* Discuss with students the local, regional, national, and international issues that challenge NP practice.


* Create course assignments for students which require them to posit solutions to practice and policy issues confronting NPs.


* Provide opportunities for students to engage in constructive dialogue that includes potential solutions to issues raised. Keeping such a positive approach to problems and solutions avoids negativism.


* Arrange opportunities for students to meet with state legislators to discuss critical practice or policy issues facing NPs.


* Provide opportunities for students to meet and network with NP alumni and other positive professional role models.


Instilling professional values and skills to advance and protect the NP role in clinical arenas

In our experience, NPs in clinical roles are sometimes not offered the same number and types of opportunities as are NP academicians. It may be that NPs in clinical settings are less connected or may have less encouragement to disseminate their knowledge and expertise to colleagues and other health professionals. It may also be that there are fewer inherent rewards for them to engage in these activities. We have observed that NPs in clinical settings who have published and presented at professional meetings are more visible as are those who take on service to regional, national, or international professional organizations. These NPs can bring decidedly different, but essential, perspectives about the needs of the profession than do NP academicians. Therefore, it is important that NPs not solely associated with academic institutions are purposefully encouraged and supported to make contributions to their professional groups. Following is a list of suggestions to encourage NPs in clinical settings to use activities that protect and promote the NP role.


* Review legislative and policy issues of interest to NPs at team meetings.


* Hold brown bag lunches that feature a professional presentation by an NP colleague.


* Encourage clinical research and scholarship and assist colleagues to submit abstracts for presentations and to write publishable manuscripts.


* Publicize NPs' activities and accomplishments in professional organizations.


* Work toward getting employee benefits and/or paid time for professional activities such as conference attendance, conference presentations, and organizational involvement.


* Ask NPs in staff meetings about practice, policy, and legislative issues that might be of interest to their colleagues. Highlight the need for this knowledge and professional engagement.


The activities listed above are feasible for those NPs who work in larger clinical settings, such as hospitals, clinics, or group practices. However, reaching NPs who are the sole clinician in their practices may be more difficult. Following is a short list of potential ways to encourage all NPs, including those in solo practice settings, to engage in role protection and promotion.


* Work with local NP groups to invite all NPs to meetings that offer continuing education credits, and include professional development activities and networking.


* Precept NP students to mutually benefit the professional learning and development of both parties.


* Involve NPs in the development of orientation or development programs for new NPs to foster integration into the work setting and profession.


* Offer preceptors opportunities for continuing education credit at local meetings and devote some portion of those meetings to discussions about protecting and promoting the NP role.


* Send e-mails and regular mail to all NPs inviting attendance at local NP organization meetings and include discussions about issues that affect practice parameters.


* Engage practicing NPs by sending newsletters to local and regional NPs about upcoming meetings, regulatory and practice conundrums, and accomplishments of NPs.


* Ask local NP organization(s) to offer a scholarship for professional conference attendance by a practicing NP to disseminate practice knowledge.


* Ask local NP organization(s) to offer a grant for a practice-focused research or quality improvement project. Highlight findings/results at a meeting or conference.


The present and future generations of NPs must assume responsibility for protecting and promoting the role. The NP role has existed for more than 50 years, and those early NPs who created and protected the role across decades are retiring. It is critical that new NP leaders be identified and groomed for the leadership previously provided. Although different issues have been raised, many of the same threats continue, such as the scope of practice problems, payment issues, full practice authority obstacles, and neutral provider language disputes. All these issues require concerted and collective efforts of the entire profession to overcome. To achieve positive outcomes, it is incumbent on all of us to instill the values of protecting and promoting the NP role in students and colleagues and then tap potential leaders to direct the way.




American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD:, the Publishing Program of ANA.


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