nancy crigger phd ma fnp bc associate professor graceland university lamoni iowa n.
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Nancy Crigger, PhD, MA, FNP-BC Associate Professor Graceland University Lamoni, Iowa. From the inside out: Forming Professional Identity An Inclusive Transformation . Objectives.

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nancy crigger phd ma fnp bc associate professor graceland university lamoni iowa
Nancy Crigger, PhD, MA, FNP-BC

Associate Professor

Graceland University

Lamoni, Iowa

From the inside out:Forming Professional Identity An Inclusive Transformation

  • Describe the current trend to move from an exclusively social paradigm to an inclusive paradigm of professional education.
  • Contrast the limitations of traditional ethics with that of virtue ethics to frame professional identity formation.
  • Discuss the usefulness of the Framework for Nurse Professionals for educating professionals and for life long professional growth.
  • Describe waysto implement a transformational approach in undergraduate and graduate nursing education.
the crisis my doctor my enemy
The Crisis: my doctor, my enemy
  • Professions misconduct and wrong doing have corrupted public trust.
  • Sullivan, 2005
response to the crisis of professionalism
Response to theCrisis of Professionalism
  • Prompted a serious evaluation of professions and professional development
  • Carnegie Foundation funding five disciplines to address professionalism and professional education.
crisis of professionalism in nursing powell and young
Crisis of Professionalism in Nursing? Powell and Young
  • Powell and Young were charged with …a felony... Prosecutors say they failed to report that Sachdeva ordered nurses to make retroactive entries in patients’ files.
  • , Thomas Fortner, said the nurses are charged with failing to report a crime related to patient files, not the more serious allegations faced by the clinic, like reusing syringes on multiple patients. Young did not receive extra pay for not reporting the changes in patient files.
  • In sentencing …U.S District Judge Daniel Jordan said the “most horrifying” evidence was that unqualified technicians performed bone marrow biopsies. He also said syringes were re-used and multiple patients’ chemotherapy drugs were drawn from the same bag.
  • Authorities say the clinic billed Medicaid and Medicare for about $15.1 million during the scheme.
  • Mississippi Business Journal
is this a problem for nursing
Is this a problem for nursing?
  • Gallup Poll:
  • Please tell me how you would rank honesty and ethical standards in these fields.
  • Winners
  • Nurses……82%
  • Pharmacists…70%
  • Graduate faculty…70%
  • Medical doctors…69%
gallup poll losers
Gallup Poll Losers


  • State office holders…14%
  • Care salesmen….9%
  • Members of congress…8%
  • Lobbyists…4%
winds of change
Winds of change
  • Educators believe:
    • professional education deficiency.
    • dramatic changes in educating professionals.
    • educating for character development through virtue ethics
how important is ethics to professionalism in nursing
How important is ethics to professionalism in nursing?
  • Who do you want taking care of you?
  • Smart nurse
  • or
  • Ethically excellent nurse
two paradigms of professional education
Two paradigms of professional Education


empty uniform


Raging individualist

Being a person of good character

Practice is a manifestation of good character

Transformational process

How should I live?

  • Doing good work
  • Practice is following rules, standards
  • Transactional process
  • Am I doing what others expect?
social paradigm limitations
Social paradigm limitations

Following rules is not situated.

Compartmentalized into roles: Jekyll and Hyde

No path to reconciliation

Not inclusive of one’s professional development

psychological paradigm limitations
Psychological paradigm limitations

Perception is not impeded by social norms or expectations

Fairness and capricious

one ethical as foundational
ONE:Ethical as foundational
  • Almost all of our thinking, decision-making and doing as professionals requires ethical choices
third change in conceptual foundation dual paradigm
Third: Change in conceptual foundation: Dual Paradigm
  • Current dominant view: sociological or consensus

Enrichment and expand to include: psychological view: character/virtues

virtue ethics proper use of desirable traits
Virtue ethics proper use of desirable traits
  • Qualities or dispositions of character
  • Are used contextually and applied to situations
  • If inappropriate can be too little or too much
virtue ethics addresses the being
Virtue ethics addresses the “being”
  • Professional ideal: what you are striving to be?
  • Flourish through a transformational process that aspires toward professional ideals and that seeks the highest good for care recipients, community and themselves.
  • Applies virtues well: virtues are situated.
virtue adds contextualization
Virtue adds contextualization
  • Each situation requires us to act in the appropriate way
  • Ones decisions are situated.
cardinal virtues for nursing
Cardinal Virtues for Nursing
  • Compassion
  • Humility
  • Integrity
  • Courage
your career groups of four
Your Career: Groups of Four
  • Describe characteristics of your ideal nurse .
  • Have these ideals changed over time?
  • Identify “mild stones”, critical events that shaped you. What significant processes have occurred over your career life?
your career groups of four1
Your Career: Groups of Four
  • What significant processes have occurred over your career life?
  • Have you made mistakes and taken steps down? How did you overcome?
  • What future changes do you see for yourself?
kohlberg moral development good fit
KohlbergMoral Development: good fit?
  • 3 Stages:
  • Pre-conventional: motivated by fear
  • Conventional: motivated to follow the rules
  • Post-conventional : situated and does things from critical thinking
implementation of and stair step model
Implementation of and Stair Step Model
  • Nothing piecemeal: this is a paradigm shift in two ways:
  • Educating for transformation: Being and Doing paradigms
  • Educating to view ethical traditions
  • Educating for moral resiliency and a life-long process
step i educate the faculty and administrators
Step I: Educate the Faculty and Administrators
  • US: little knowledge of virtue ethics
  • Resistance to educating in a secular environment
  • Awareness of the Framework for Nurse Professionals and shift in conceptualization
step 2 thread or block into curriculum
Step 2: Thread or block into Curriculum
  • Lens through which the professional is viewing the world and the lens through which the faculty member views the student.
  • Frequent and multiple integration
  • Applicable, out of the classroom and into the clinical wastelands.
step 3 content
Step 3: Content

Broader view of self development; more inclusive

Work with development of situated use of virtues, moral resiliency, and reconciliation.

Teach virtues, and how to show a virtue to others

How to manage mistakes

step 4 methods
Step 4: Methods
  • Use of exemplars
  • Reflection
  • Weaknesses as opportunity
  • Portfolios
  • Shift from evaluative role to education
  • Faculty become more transparent
the making of nurse professionals

Nancy Crigger


Nelda Godfrey

Foreword by Patricia Benner

The Making of Nurse Professionals

  • .
  • Coulehan, J., & Williams, P.C.(2003 a). Conflicting professional values in medical education, Cambridge Quarterly of Healthcare Ethics, 12, 7-18..
  • Coulehan, J., Williams, P.C., McCreary, V. & Belling, C. (2003b). The best lack all conviction: biomedical ethics, professionalism, and social responsibility. Cambridge Quarterly of Healthcare Ethics, 12, 21-38.
  • Crigger, N.J., & Godfrey, N. (2011). The making of nurse professionals: a transformational ethics approach. Sudbury, MA: Jones and Bartlett.
  • Crigger, N. & Godfrey, N. (2011). Of courage and ‘leaving safe harbors’. Advances in Nursing Science. 34 (4), E13-E22.
  • Crigger, N., Godfrey, N, (2010). The importance of being humble Advances in Nursing Science, 23(4): 310-319.
  • Dierckx de Casterle, B., Izumi, S., Godfrey, N.& Denhaerynck, K.(2008), Nurses response to ethical dilemmas in nursin practice: meta-analysis, Journal of Advanced Nursing, 63(6); 540-549.
  • Erde, , E.L.(2008). Professionalism’s facets: ambiguity, ambivalence, and nostalgia, Journal
  • of Medicine and Philosophy, 33; 6-26.

Godfrey, N. & Crigger, N. (2012). Ethics and professional conduct: Striving for a professional ideal.

Journal of Professional Regulation, 3 (1) 10, 32-7.

  • Godfrey, N.S. & Crigger, N. (2011). Ethics and professional conduct. An online offering for the Learning Extension, National Council of State Boards of Nursing .Chicago: NCSBN
  • Handelsman, M.M., Knapp, S. & Gottlieb(2009). Positive ethics: themes and variations, Chap. 11, in Oxford Handbook of Positive Psychology, ED C.R. Snyder & S.J. Lopez, Oxford: Oxford University Press.
  • McCammon, S.D. & Brody, H.(2012). How virtue ethics informs medical professionalism, HEC, 24; 257-272.
  • Sullivan, W.M.(2005). Work and integrity. (2nd ed.). San Francisco: Jossey-Bass.
  • .com/poll/1654-honesty-ethics-professions.aspx