24Jones Leadership(F)-ch 24 1/14/07 3:56 PM Page 393 Career Development your self-assessment and reality, creating your career vision, developing your strategic career plan, and marketing yourself”(p 9) These discrete and yet fluid processes can be expanded relative to the process of becoming an entrepreneur or intrapreneur For example, it is important to build personal characteristics that promote the entrepreneurial mindset, take control of self-knowledge gained, become aware of the dynamic forces that may ultimately shape your career, integrate the knowledge of self with the existing environmental opportunities, and then to take the risk and take action Finally, the nurse is ready to use critical thinking and decision making to build a strategic plan that includes self-marketing CAREER ASSESSMENT Career assessment as a part of career development is key to finding career satisfaction while maintaining ethical integrity Nurses need to take a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis of their job situations and their individual characteristics and values to ascertain if they are congruent or divergent Why they like their chosen areas of work? What are the strengths and weaknesses of their professional areas? When and where are there opportunities? What are the threats to success? Assessing your current status is the first step of planning a career Remember the adage, “If one fails to plan, one plans to fail.” Perhaps there is still a chance to maintain ties within the organization yet meet career goals McGillis-Hall, et al (2004) noted, “Nurses who are committed to the organization in which they work and have the skills and flexibility to link personal effectiveness and satisfaction with achievement of the organization’s strategic objectives” (p 232) may continue to prosper Currently, viewing supply and demand economics of nurses willing to work within an institution, nurses can see that this can work in their favor Contino (2001) noted, “Accepting that hospital revenues are somewhat fixed, nurses need to find ways to help hospitals control costs, increase profitable service lines, and meet staff’s scheduling and income needs.” (p 21) To assess the career development process, you need to ask the following questions: ■ ■ What are the basic values in nursing? How nurses merge these core values to address the environmental needs? ■ 393 What forms of nursing bring greatest satisfaction in meeting the needs of their patients and society? Answering such questions can help the nurse determine whether it is possible to continue to work within the status quo or go in the direction of change Two areas that many nurses identify as basic career needs are the ability to feel in control of their practice and to have flexibility in their work Autonomy in decision making, as long as it is within the scope of the organization’s policies and procedures, allows nurses the flexibility to individualize care, think critically, and set patient priorities according to established standards of practice Comparing one’s own practice standards with those observed in the work environment will supply vital data that the nurse can use to decide whether to continue to practice in that setting PERSISTENCE: PUSHING THE ENVELOPE Bellack and O’Neil (2000) described nursing as being at its “crossroads” with a chance to grow and develop its own vision of its professional practice As entrepreneurial “free agents,” notable nursing leaders such as Florence Nightingale, Lillian Wald, and Mary Breckinridge all carved out their own missions beyond their immediate callings to help patients or address community needs They took chapter star Mary Seacole, referred to as the “Black Nightingale,” was a daughter of a well-respected “doctress” who practiced Creole medicine in Jamaica Guided by her mother, Mary was repeatedly rejected (due to the social constraints of the times and the color of her skin) in her quest to join Florence Nightingale in aiding the soldiers during the Crimean war After many rejections, she funded her own trip and established an innovative entrepreneurial way of responding to battle-fatigued and injured soldiers by opening a comfort and recovering center in a British hotel Returning to England destitute and ill, the press came to her aid by publishing her plight; this resulted in a grand military festival to raise money for her efforts and led to her being decorated with some of the highest medals of honor: the Crimean Medal, the Legion of Honour, and a Turkish medal (Florence Nightingale Museum, 1997) 24Jones Leadership(F)-ch 24 394 1/14/07 3:56 PM Page 394 Skills for a Successful Career action to reach beyond their usual practice, to create nontraditional nursing roles, to publish, to use epidemiological methods to address populations at risk, to lobby for health-care reform, to raise philanthropic funds, and to bring awareness of the plight of the poor and their lack of access to health care These quests all stemmed from personal values about which they felt passionate, and they all channeled their voices through their professional practice (Carper, 1978) These entrepreneurial spirits pushed their goals and stirred up the social, political, and policy status quo to bring new standards to health care and nursing practice (Bellack & O’Neil, 2000) Not unlike our predecessors, today’s cyberworld requires nurses to challenge their old beliefs and assumptions of the way the nursing profession is envisioned It will require nurses to break loose from worn-out thinking and to dream of new ways of practicing the profession Porter-O’Grady (2000) noted the difficulties of change; however, humans naturally prefer the familiar and resist change The greatest challenge for nurses will be to leave the familiar industrial era model of task-oriented nursing care, which served organizations well but left nurse/patient interactions to suffer Roy (2000) illustrated the power of entrenched minds and the strength of resistance: A major hospital chain in the 1980s hired a futurist firm to envision what changes the hospital should make by the 1990s, given the changing trends in society The futurist predicted accurately, but with the hospital operating at its peak of financial growth the hospital administration failed to respond and so missed opportunities that would have benefited the organization The lesson to be learned here is two-fold: what may be working today will not necessarily work in the future, and the time to change is when things are going well Pushing the envelope necessitates getting out of your comfort zone and being proactive rather than reactive to change TAKING CONTROL: QUEST FOR A VISIONARY CHANGE Donner and Wheeler (2001) urged “nurses to be proactive, to assert more control over their careers” (p 80) Yet traditionally nurses have not articulated their expertise well, especially in health-care settings where high levels of accountability and evidenced- based practice were concerned (Hardy, et al., 2002) Whereas nurses are people-skilled and interface with a large network of disciplines, such as medicine, business, policy, and government, their core competencies in communication and group interactive skills have gone unrecognized Furthermore, beyond their expert clinical skills in delivering patient care, their role in successes in patient outcomes has also not been acknowledged As a result, nursing has allowed others to direct its own job redesign whenever hospital chief executive officers (CEOs) have sought operation efficiency or costcutting tactics; nurses have been treated as no more than dispensable production task-oriented workers Such lack of recognition has suppressed nurses’ ability to contribute actively to the goals of improving patient care Short-term downsizing business tactics have phased out lifelong employment tenure and ignored the benefits of nurses’ contributions and loyalty to institutions These trends have damaged nurses’ morale, led to shortages of nursing supply through professional attrition, and threatened patient safety In response to skyrocketing costs of health care in the United States over the last three decades, various forms of structural funding and payment mechanisms evolved, fundamentally changing treatment of patients With decreasing length of costly hospital stays and a shift toward treating more acute care in the ambulatory and home settings, the need for experienced, highly skilled nurses dramatically increased outside hospital settings Many nurses who remained committed to in-hospital settings found themselves unemployed and having to shift toward community-based care Even for those who deemed themselves lucky to remain employed within their chosen setting, the heavy demands began to take a toll For nurses to take control of their careers, they will need to steer away from the old assembly-line shift-work mentality and to take active responsibility in managing their careers and actively marketing themselves This will require nurses to identify their core competencies and to gain confidence in articulating to others (and to themselves) what they can market beyond their tenured process-oriented care Regularly, nurses are faced with complex decision making, both in managing acutely ill patients and working collaboratively with multidisciplinary professionals and business organizations Yet for nurses to take credit for their innovative care, they 24Jones Leadership(F)-ch 24 1/14/07 3:56 PM Page 395 Career Development will need to show evidence that such interventions are proven to bring successes, especially when it comes to patient outcomes This will be a challenge, as nursing care has traditionally been viewed as an extension of medicine, a tool in which medical care is provided, and not as a distinct profession in which the art of caring is founded on empirically based scientific principles Asoh, et al (2005) noted, “Nursing presents an excellent opportunity for entrepreneurial activities since they (nurses) are trained in a holistic manner to care for patients rather than treat specific diseases” (p 218) Beyond nurses’ expertise in caring for patients, Roggenkamp and White (1995) found that nurses exhibited entrepreneurial characteristics of “commitment to service, desire to stay close to their customer, and had risk-taking, assertive and strong leadership skills” (p 8) Above all other factors, the most dominant motivating factor was their “love for nursing” (p 8) The biggest challenge in this visionary transformation may be the process of change in the image of self and instilling the image of nursing as innovative intrapreneurs The first step toward gaining control of your career is becoming aware of one’s valued contribution in bringing successful patient outcomes Once the transformation has begun, nurses need to identify the value of their product (their expert ability), to take control of their careers, to shape them, and actively market so that other professionals and consumers will recognize nursing’s unique knowledge base and innovative care Only then can nurses expect to become valued players and be invited into the circle of caregiver experts Gaining control of your career entails defining the value of your product in the marketplace To build a valued product line (or career specialty), nurses will need to recognize what knowledge and specialty skills they can offer to either fulfill or create a market demand so as to create career opportunities that will grow Finally, for nurses to develop their careers and identify marketable expertise, they will need work environments and leaders who will be supportive of the nurse’s intrapreneurial ventures In selecting where the nurse will market her wares, it will be important to select organizations that promote a culture that rewards shared and creative ideas, translates creative ideas into action, acknowledges successes, and puts failures into perspective Failures are lessons that improve ideas and help build an even better product Therefore, gain- 395 ing control requires an environment that is supportive of your professional practice and career goals and personal goals Broscio, Paulick, and Scherer (2005) warn that careers will need to be more responsive to the freemarket ideology; there will be a need to employ free agents with specialized skills Paradoxically, working in a virtual world, what one presumes as a greater emphasis for autonomous and independent work will actually require greater emphasis on interconnected relationships and communication (Neuhauser, Bender, & Stromberg, 2000) Moreover, effective communication is strongly influenced by previous experiences, culture, and relationships For example, as in a global interface, without face-to-face contact, without language fluency, more emphasis is placed on communication in both the transmission and feedback loop There will need to be a check and balance between parties in communication and a greater reliance on the nonverbal communication that requires being sensitive to diverse human beliefs, values, and modes of communication Nurses are people-skilled and interface with a variety of multidisciplinary teams, regularly implementing and utilizing collaboration, negotiating, and building partnerships in their collaborative interactions with a highly educated network of professionals Complex environments require complex decision making; therefore, a bureaucratic hierarchy model of top-down communication does not fit the needs of today’s dynamic, unstable environment Where environmental boundaries have become blurred, our response to such complex dynamic forces requires decentralized decision making that is flexible and rapid-response Popularized by the profit center concept developed during World War II, decentralized decision making allows for those who are closest to the operations to exert greater freedom to take control Decisions need to be made closer to the operational level or at the point of patient care Whereas physicians and other health professionals have expertise in the disease management or various elements of the human body, it is the nurse who has the greatest patient contact in hospitals and in the home Knowledgeable about human responses to illnesses during the most vulnerable times in people’s lives, nurses have unique caring ways to bring patients back to health through their expert clinical skills and human interactions Again, nurses’ expertise in “knowing the patient” 24Jones Leadership(F)-ch 24 396 1/14/07 3:56 PM Page 396 Skills for a Successful Career brings unique skills that help motivate clients with their self-care; thus, nurses have a unique ability to carve out patient education niches within the marketplace DYNAMIC FORCES: SHAPING NURSES’ FUTURE CAREERS Amidst the optimism of scientific and technological advances, health care is under the shadows of a growing socioeconomic crisis: issues of the growing uninsured and entitlement costs of the soon to retire Baby Boomers (Robert Wood Johnson Foundation, 1999) Such opposing forces create a complex landscape, vastly different from that of the past In terms of the health-care system, how the care will be delivered, what will be required of its providers and consumers, and what provider roles will be expected to address in terms of institutional capacity needs will also differ (Kressley, 1998; Porter-O’Grady, 2000; Porter-O’Grady & Wilson, 1999) For nurses, the work of providing care will be greatly altered as well (Porter-O’Grady, 2000) Clearly, nurses’ skills and career paths will need to mirror the changing health-care environment (Porter-O’Grady, 2000) Taking stock of the world in which we live is the first step to shaping our careers Porter-O’Grady (2000) outlined three major converging forces that are changing our healthcare landscape, which directly and indirectly affect nursing: economic, sociopolitical, and technological forces National Forces: Economic and Sociopolitical Today’s U.S health-care system is faced with some daunting challenges Economic forces drive the health-care delivery system to monitor its service use and patient health outcomes Closely related to economics are sociopolitical forces as the healthcare industry shifted its focus of care from costly curative hospital-based care to a less costly preventive consumer-accountable community-based care The change from cost-based to prospective pay has brought managed care to its third decade of maturity; yet the great hope of curbing escalating healthcare costs has still not been fully realized To improve U.S health-care shortfalls, U.S health-care leaders are now rethinking forms of funding and mechanisms for health-care alternatives, even learning from other countries Accompanying such sociopolitical forces is the change in America’s demographic topography in terms of age and ethnicity: fewer young productive citizens to support aging Baby Boomers, increased ethnic diversity, with growing economic gaps leading to even greater disparities The “wide-angle image” shows inadequate insurance coverage that is inching up toward middle class Americans, along with an insecure entitlement reimbursement for the retired In the next decade, our nation is projected to have one of the highest dependency ratios of younger ethnically diverse underemployed to older retired citizens The close-up brings to view images of the plight of the nursing and labor shortages, which create a patient dependency ratio that exceeds that of hospital capacity The current nursing shortage is said to be unlike that in the past; it is deemed more dire and enduring (Nevidjon & Erickson, 2001) Fueled by the aging demographics, its primary shortfall is the result of attrition, both in nurses and nursing educators According to Nevidjon and Erickson, “from an economic perspective, this shortage is being driven more by the supply side of the supply/demand equation” (p 1) Adding to the nursing shortfall are the shortages in allied health professionals and ancillary staff, such as secretaries and support staff Thus, this is a more complex shortage, which promises to worsen during the next decade as more health-care professionals and educators retire Such shortages all adversely affect the health-care delivery system Early in the 1990s, for cost-cutting reasons, hospital executives increased the use of unlicensed assistive personnel; however, these models failed due to increasing patient acuities, higher patient nurse ratios, concerns over medical errors, and the declining numbers of ancillary personnel The impact was felt by the patients as well, as nurses are deemed to have the most continuous contact and develop the closest relationships with the patients and their families Global Forces: Sociopolitical Economy, Nursing Shortage, Unintended Consequences With globalization, today’s world has become interdependent, yet highly competitive International boundaries have become more fluid, especially in terms of U.S interdependency in global trading The blurring of domestic and international bound- 24Jones Leadership(F)-ch 24 1/14/07 3:56 PM Page 397 Career Development aries has shaped the environment in which we work and live Its impact has filtered down to everyday American lives and work (Hall, 2002; RiverinSimard, 2000) Our social sphere is growing smaller, with tightly interwoven diversity, both racially and ethnically Partly the result of the American’s insatiable consumerism, our link with foreign labor markets is much more visible The 2000 U.S Census indicated that, between 1990 and 2000, 33 million people were added to the total U.S population, with the fastest and second fastest racial/ethnic groups being Hispanics and Asians, respectively Such dramatic demographic change can be viewed positively as an enriched cultural mix for our society, or it can be viewed by others as a menacing mix of clashing values that threaten our society In our country’s efforts to assimilate our newcomers into society quickly, there is a demand not only for bilingual nurses but also a greater demand for employees who are sensitive to the nuances of working within a racially/ethnically mixed culture Culture has a significant impact on how people interpret health and illness (Spector, 2000) This provides nurses greater career opportunities Nurses are inherently peoplesensitive, which fits the required portrait of the type of leader that is needed for tomorrow’s culturally diverse employees (Vicere, 2004) Indeed, nurses are not only advocates and care experts to individuals, families, populations, and communities, but their leadership skills often include mentoring employees of diverse cultures So in terms of expertise, nurses have a wealth of possible career development options that could be carved into a specialty niche to fit the needs of a growing international community With the increasing size and mobility of the human population, there are direct and unintended consequences of emerging diseases that pose a continuing threat to global health Historically, the United States had come to see open trading as “a means not only of advancing its own economic interests but also as a key to building peaceful relations among nations” (Garrett, 1998, p 787) Yet even with economic incentives and peaceful motivations, there are subtle political ideologies promoted This can create ideological clashes between diverse nations, which can surface as trade disputes and power struggles Ideological clashes have caused America (and other nations) to be targeted for terrorist attacks as protests against American policy 397 Global unrest and international instability can have overreaching effects on countries and their people The global outreach in nursing is extensive, and it encompasses a full spectrum of expertise and services, from policy-making, capacity-building efforts to point-of-service primary health-care delivery International organizations, such as the World Health Organization (WHO) and the International Council of Nurses (ICN), provide opportunities for nurses to work abroad and to mix their expertise with their love of travel and learning about diverse populations With growing global disputes, traveling outside the United States has become increasingly risky for Americans, especially to the most severely economically depressed, war-torn countries Such global unrest has curbed the activities of many nurses and medical volunteers who otherwise would reach out with humanitarian efforts to serve where the nursing (and medical) shortages are the greatest International trade agreements have transformed the capacity of governments to monitor and to protect public health by regulating occupational and environmental health conditions, exporting and importing food products, and ensuring affordable access to medications (Shaffer, et al., 2005) Proposals are under way for the World Trade Organization’s General Agreement on Trade in Services (GATS) and the regional Free Trade Area of the Americas (FTAA) agreement to seek coverage of a wide range of health services, health facilities, sanitation services, and clinician licensing Linkages among global trade, international trade agreements, and public health will no doubt open new opportunities for global exchange, especially for nurses to participate overseas in a wide spectrum of entrepreneurial-type services Linkages among global trade, international trade agreements, and public health deserve greater attention The effects of interdependency in trade of products can be seen in human resources as well Shortages in the health workforce, especially nurses, present a major challenge for health-care policy makers nationally and internationally The nursing shortage is worldwide, even in developed countries such as the United Kingdom, Canada, and Sweden International exchanges, especially in nursing resources, could become an area of dispute Working under North American Free Trade Agreement (NAFTA) status, current trade of foreign market is keenly felt in the area of nursing shortages; ... These entrepreneurial spirits pushed their goals and stirred up the social, political, and policy status quo to bring new standards to health care and nursing practice (Bellack & O’Neil, 2000) Not... them, and actively market so that other professionals and consumers will recognize nursing? ??s unique knowledge base and innovative care Only then can nurses expect to become valued players and be... are changing our healthcare landscape, which directly and indirectly affect nursing: economic, sociopolitical, and technological forces National Forces: Economic and Sociopolitical Today’s U.S