Guest Editorial: Professional Behavior

   The events of September 11, 2001 have had a sad and sobering effect on all of us and will impact our lives forever. Within the context of this awareness of the world beyond our private microcosms, I want to address an issue that I have been pondering for several years. The focus on professional behavior is not meant to negate the significance of our national tragedy but rather to remind us of the importance of courtesy and consideration in the work setting.

   Professionalism in healthcare is a much-used term. Clinicians, especially, use it to frame their concerns about a variety of issues, including staffing shortages, unsafe working conditions, lack of respect among disciplines, and financial issues. In reality, professionalism includes a variety of behaviors that differentiate attitudes and behaviors among members of an occupational group - personal philosophy of practice, critical thinking skills, collaboration and communication with other healthcare professionals, accountability, and altruism are but a few of the considerations. Within this context, one must examine the way in which clinical situations are defined, analyzed, and resolved.

   A dichotomy has developed between professionals caring about their patients and their caring about the organization of which they are a part. Clinicians devote much time and energy to patient care but seem to lack this same sense of dedication and advocacy with regard to their employers, whether the healthcare system or the people to whom they report. One example of the healthcare professional's lack of respect for and support of his or her employer is the lack of "notice" that healthcare providers give to their employers. As a nurse teacher of long standing, I remember being told that an educator should notify superiors of changes in work status in a timeframe commensurate with rank and/or seniority; ideally, the educational program should be notified 1 year ahead of time that a teacher plans to resign. Recently, I had one educator give 2-weeks' notice via a colleague (no letter was ever sent to me). Another newly hired instructor came for orientation one day and called the next to say she had changed her mind and did not want the job. In retrospect, these decisions proved to be positive for the institution, but neither of the individuals considered the impact of their short notice on recruitment of students and faculty, teaching assignments, academic advisees, or committee activities. One colleague questioned my frustration; she pointed out that industry routinely escorts employees out of the building. My response was that as professionals we should be more considerate of our employers and colleagues.

   This is also true of healthcare providers who depart from other practice settings with little nor no notice, often leaving colleagues to work "doubles" and to change plans for time away, including vacation time. Although the policies of many systems seem to tempt retribution (abuse of leave time and short notice given when overtime and vacation policies make time-invasive and workload demands), the professional caregiver should maintain self-respect and exercise common courtesies rather than respond out of retribution.

   Another example of a dearth of professionalism in the work situation is a lack of accountability in meeting standards of practice. Occasions may arise when caregivers fail to provide adequate care and then use the excuses of being too busy, not having enough help, and/or not having patient/family cooperation. This makes it appear as though the facility and its clients should provide a safe and caring environment for the clinicians, rather than the other way around. Healthcare professionals sometimes seem to forget that the patient and family are under great stress, often entering the healthcare system for the first time - they are afraid, unsure, and suffering. How can one expect that person to "act like a good patient"? Why should one think that is the patient's role? The clinician's responsibility is to orient the patient to the environment, to provide a sense of caring and concern, and to be patient with inappropriate and unappreciative behavior. Caregivers seem to lose sight of their mission of caring for others when they focus on their personal needs; one of the attributes of professionalism is altruism - unselfish concern for the welfare of others. This is not to say that the clinician's own safety and well being should not be considered; however, such issues should be addressed by the organization and not by its clients. Nothing is more gratifying to the clinician than having a patient express thanks for the care given, but clinicians should not make that an expectation of practice.

   These are only two of numerous examples of issues of professionalism that need to be addressed in today's healthcare systems. The "me" culture may be prevalent in American society, but it has no place in the healthcare professions. We have a duty to the profession, to the persons for whom we care, and to our employers to address these issues in a manner that reflects our understanding of and appreciation for the complex nature of the delivery of healthcare in today's world.