Across every health system, health workers determine the provision of the nature and quality of services. Surprisingly, most health systems on a global stage face nursing shortage, which further differs across states and rural-urban settings.1 India is still a developing country.2 Nurses structure the major segment of country’s health human resource and nursing services amount to an integral fraction of preventive and curative phases which is evident through the provision of care from tertiary level to every doorstep even beyond the availability of doctors. However, despite the central role, nurses remain unrecognized in the health care delivery system.3
The national estimates indicate shortage of nurses which is further compounded by the international migration of this valuable resource due to varied professional, social and economic reasons. This adds to the non-availability of skilled, standard and quality health services particularly to the under privileged sections in the country.1 Inadequate workforce and deficient quality care further escalates the morbidity and mortality rates in the country further resulting in overburdened workforce. Thus the vicious cycle continues and hampers the progress of nursing profession in the country.
Nurses are perceived as a compliment ‘package’ or ‘quick’ trained caregivers filling up the health provider shortage. However, they are seldom considered while contributing to ideas and views related to client needs or interventions or any form of health care modalities. Also, scenario does not synchronize with the fact that nurses are ‘round the clock’, well-educated health care providers and constitute the largest group of professionals in the health care delivery system. Hence, amidst tremendous development, professionalism among nurses is essential to promote a transition in the profession.4
Adams et al.,5 stated that nursing professionalism necessitates nurses to demonstrate definite behavior illustrating beliefs of the profession in terms of knowledge, attitudes and skills signifying professional identity and commitment to the profession. These features are consistent with the characteristics sketched in the “Registered Nurses Association of Ontario-Best Practice Guideline” (RNAO-BPG), ‘Professionalism in Nursing’6 and “Miller’s model” the ‘Wheel of Professionalism in Nursing’.7
Several researchers have developed instruments to explore and or evaluate professionalism among nurses. Miller’s Model or the ‘Wheel of Professionalism in Nursing’ was an extension of Hall and Friedson’s works. Miller also used “The Social Policy Statement, Code for Nurses with Interpretative Statements and recommendations and policies from the American Nurses Association” as a basis for the behaviors represented in the Wheel which served as a guide for every nurse in monitoring professional behavior. Subsequently, Miller et al.,7 developed an evaluative “Behavioral Inventory Form for Professionalism in Nursing” based on the Model which is widely used to evaluate professionalism among nurses.8–11
Several other researchers explored professionalism among nurses using RNAO-BPG6 questionnaire, an adaptation of Registered Nurses Association, Ontario-Best Practice Guidelines,12,13 and “Hall's Professionalism Inventory” scale.14 “The Professionalism and Environmental Factors in the Workplace Questionnaire, was developed based on literature, code of ethics and jurisdictional practice standards.15
Relevant literature review on the construct professionalism across various professions revealed that most researchers have described, adopted, adapted or developed instruments based on the professional code of conduct and ethics. Physician Charter on Medical Professionalism is a product of the collaboration between American Board of Internal Medicine Foundation, American College of Physicians Foundation, and European Federation of Internal Medicine. This document highlights the principles and responsibilities fundamental to professionalism in medicine.16–18 Some others have used standards from the “Accreditation Council on Graduate Medical Education”.19,20 The “Code of Ethics for Pharmacists and the American Association of Colleges of Pharmacy” and “The American Council on Pharmaceutical Education Accreditation Standards” describing the attitudinal and behavioural components have been considered in pharmaceutical care.21 “The College of Medical Laboratory Technologists of Ontario’s Code of Ethics and Standards of practice” serve as the foundation of their professionalism.22 Pollard23 explored ethical performance contributing to authority, control and social responsibility as the hallmark of professionalism among news workers. American Bar association and the judicial statements on professionalism serve as the basis for evaluating professionalism among lawyers.24
This study aims to develop and evaluate the psychometric properties of Nurse Professionalism Scale (NPS) which is based on the Code of Professional Conduct for Nurses in India, framed by the national regulatory body, Indian Nursing Council. The Code serves the interests and needs of the profession and illustrates individual nurse’s professional responsibility and accountability, nursing practice, communication and interpersonal relationships, valuing human being, management, professional advancement. It reminds the nurses about the attempts mandatory towards upholding the profession while providing direct care, teaching students, conducting research, supervision and management. Stakeholders and administrators also contribute to the sustenance and improvement of professionalism among nurses.4 Multi-source feedback is a method of data collection through supervisors, peers and other staff that helps develop a broad gauge of practice patterns. It aims to raise self-awareness regarding performance, seek encouragement and improvement through feedback.25 It can highlight concerns and fuel awareness regarding professionalism among nurses amidst the shortage and the overburdened schedule in developing countries.