24Jones Leadership(F)-ch 24 398 1/14/07 3:56 PM Page 398 Skills for a Successful Career recruitment continues from various foreign countries such as the Philippines, Canada, Mexico, and others But while there has been an increasing trend to recruit foreign-born nurses to increase the U.S labor market, the shift in supply to the United States does little for the global shortage of nurses and the demand it creates within the countries they left (Booth, 2002; Zurn, Dolea, & Stilwell, 2005) More recently, South Korean nurses have been proposed as an answer to the current shortage of nursing educators Living in a highly competitive Korean job market, many Korean faculties are already doctorally prepared nurses and English-proficient and have taken the NCLEX International (2005) examination administered by the National Council of State Boards of Nursing (NCSBN) In the Western Pacific, Korea is among three nations that have reported a surplus of nurses at present (SocioEconomic News, 2003) With the potential influx of nurses into the United States from diverse countries, the most poignant question that U.S nursing professionals ask is, “Do foreign nurses hold similar professional nursing values and practice models as nurses in the United States?” Flynn and Aiken (2002), in their secondary analysis of nearly 800 nurses surveyed (with nearly a third from 34 other countries), challenged the prevailing sentiment that foreign nurses would have different nursing values and professional practice models compared with U.S nurses The findings also revealed that in the absence of a professional practice environment, foreign-born nurses would experience similar high levels of burnout as U.S nurses Although one answer to the nursing shortage might be to recruit from foreign countries, health-care administrators will still need to ensure that organizational and leadership attributes are congruent with a professional nursing practice environment With blurred boundaries, the world has become increasingly vulnerable to both (re)emerging infectious diseases, once thought controlled or never experienced before, and to natural disasters, such as earthquakes and hurricanes Given the current size and mobility of the global community, the world is at risk for pandemic outbreaks and increasing climatic disasters For example, increasing contact between humans and animal disease reservoirs contributed to the emergence of severe acute respiratory syndrome Ecological changes, such as habitat fragmentation by deforestation, may increase the contact between people and reservoir species, all contributing to zoonoses (e.g., hemorrhagic fever virus) Early recognition of cases and application of appropriate infection control measures will be critical in controlling future outbreaks Moreover, global warming has been identified as contributing to the spread of dengue beyond tropical regions and possibly contributing to the global climatic and typological turbulence Technological Forces and Unintended Consequences Scientific and technological advances promise revolutionary changes in the health-care system Yet such promises of technology and its ability to fix human ills may need to be balanced with cautious optimism Beyond the impact on global communication capabilities, technology promises to offer resources to improve the quality and length of people’s lives It promises to transform the way diseases are diagnosed and treated The technology presents new possibilities to design innovative methods for (1) preparing future generations of nurses, (2) addressing the issues of medical errors and the nursing shortage, and (3) satisfying and extending the requirements for entry-level RN practice in terms of knowledge, skills, and abilities One exciting example for nursing education and practice is the ability “to practice” low-frequency high-risk patient events through the use of simulation technology Such technology has multiple applications in helping to reduce nursing and medical errors, advancing nursing skills, and improving teamwork without putting real patients in harm’s way Not unlike the military field training for combat, the simulation laboratories can be created as virtual hospital rooms and clinical settings with physiologically/verbally responsive mannequins for nurses, students, and other medical teams to act out realistic scenarios that simulate actual events The impact of this technological training tool is enormous as it addresses multiple educational, nursing, and organizational issues It provides a safe environment in which novice nurses and students can train; allows for errors to take place without putting an actual patient in harm’s way; permits organizations to gather data and develop system changes to protect patients and adjust policies to improve patient safety; provides new possibilities for preparing novice nurses to expert level in a shorter time; 24Jones Leadership(F)-ch 24 1/14/07 3:56 PM Page 399 Career Development promotes teamwork by helping the health-care team to communicate with each other (where the majority of medical errors occur); and trains nurses and other medical members to improve their communication with patients/families (Institute of Medicine, 2000) The flip side of technology is its unintended consequences With any new technological advances, we need to scrutinize and critically think through what the unintended effects might be on the greater whole: the world Without getting into the philosophical debate about the benefits/risks of reliance on technology, William Barrett (1979), in his classic The Illusion of Technique, warned about placing such high reliance on technology to solve human problems Similarly, Ehrenfeld (1981) critiqued society’s reliance on humanistic power to solve the world’s problems Some questions that need to be asked are: ■ ■ ■ ■ ■ How is the technology to be applied? Who will be applying it? To whom is it being applied? What are alternate uses of such technology? How and whom might it harm? The Human Genome Program (2005) is an example that illustrates the cost of technology It affects myriad social and clinical applications, but there are a number of ethical dilemmas attending its use, ranging from ensuring privacy to informed consent CREATIVITY AND INNOVATION: THINKING AND PRODUCING Rollo May (cited in Driver, 1971b) wrote, “out of the creative act is born symbols and myths It brings to our awareness what was previously hidden and points to new life The experience is one of heightened consciousness—ecstasy.” Creative expression is vital to quality life, and everyone has the creative potential if they follow their interests Although “creativity” continues to elude empirical measurement, we can see creativity in a person’s affective “act of doing,” seeing their spark through their being in the world/nature-at-large, and discovering their interactions with us and exploring their effect on us Because creativity is an intrinsically motivating trait, its action may be associated with nonconformity, independence, persistent questioning, and persistent in-depth inquiry This internal drive is what pushes entrepreneurs and intrapreneurs toward excellence The adage, “time flies when 399 you’re having fun” can be applied to the process and outcomes of creativity Csikszentmihalyi (1997) identified the spark as the heightened consciousness, or the creative flow, an energy that is not necessarily an isolated experience but can result as a synergy working with others To learn how creativity worked, Csikszentmihalyi (1995) interviewed 90 leaders in various disciplines and discovered that they regularly experienced this state of flow, a heightened state of pleasure experienced when one is engaged in physical or mental challenges that absorb us and give us joy Based on these interviews with some of the most creative people in the world, Csikszentmihalyi (1995) listed the steps that individuals could take to cultivate one’s creativity Furthermore, he recommended (1995) that one needs “to acquire many interests, abilities, and goals and to use them in such a way they harmonize with one another” (p 30) Creativity and innovation reflect “thinking and producing” respectively; both share in creating something new Merriam-Webster (2005) describes creativity as a reflection of these two parts: creativity as “the ability or power to create something new” and innovation as “the power that puts the creative inspiration into action.” The three key personality elements required to build a new vision of oneself as creative include having a high tolerance for ambiguity, being comfortable with the unknown, and having faith in yourself to handle any outcome CREATING VISIONARY CHANGE: SELFREFLECTING AND REALITY CHECKS Sister Callista Roy (2000), renowned theorist on adaptive nursing theory, wrote that nursing faces a great challenge: to create a visionary change within its own profession However, Carper, Chinn, and Kramer (cited in Roy, 2000) revealed that nurses all too often struggle to find effective strategies for developing integrated knowledge, defined as a way of knowing that comes with synthesizing “the personal, ethical, aesthetic, and sociopolitical knowledge” (p 118) Self-reflective thinking brings the “invisible” knowledge of self into clearer view This process requires a nurse to assess what in his current position gives him joy and what he believes and values about life and the people around him (White, 1995) Guided by the Professional Standards of Nursing Practice, nurses’ core values and practice of nursing 24Jones Leadership(F)-ch 24 400 1/14/07 3:56 PM Page 400 Skills for a Successful Career are centered on people and serving the good of society, which is unchanging and timeless (Strader & Decker, 1999; White, 1995) Conversely, nursing skills evolve to reflect the context of the time and environment (Williams-Evans & Carnegie, 2002) Specialized skills evolve over time, as one can see with many nurse practitioner skills Their skills of assessment, diagnosing, and prescribing medications evolved from both the greater push for nursing practice and to fill the need of the primary care physician shortage Yet the core of nursing values remains immutable, to advocate for the needy populace and to promote the good of society; thus, these values are embedded in each nurse’s personal values and beliefs Creating the vision for career necessitates selfreflective thinking, a process that requires nurses to assess what in their position gives them joy and what they believe and value about life and the people around them Nurses can then bring this selfreflection and compare it with how others perceive them (Donner & Wheeler, 2001) This process helps to identify the “invisible” personal and professional values (Roy, 2000) This vision of self is then linked to how you fit into the environment, how your values fit with the organization and whether the organization fits with your values, a reality check This begins the “self-reflective” process of wondering and thinking: ■ ■ ■ ■ ■ ■ ■ Where am I? Where I want to be? Where have I been? How can I use my experience, and what else I need to know? Who I go to for more information and direction? How I get there? How can I salvage what I already know? INTEGRATING THE SELF WITH THE ENVIRONMENTAL OPPORTUNITIES Nurses too often struggle to find strategies for integrating the self into the environmental opportunities (Carper, et al., 1978; cited in Roy, 2000) After completing a career self-assessment, you need to repeat the environmental assessment discussed earlier in the chapter Through this repetitive process of self-assessing and seeking feedback from colleagues, the level of self-awareness deepens With an accurate picture of your values, strengths, and desires, you can immerse yourself in the offerings within and outside the health-care field It is vital to scope the environment and keep abreast of the surrounding marketplace, to view the trends in business and organizations, both related and unrelated to the health-care system Scanning the environment means following the technological development and immersing yourself in the global news and local and national current events: identifying the sociopolitical and economic issues that directly or indirectly affect our nation and our profession For example, topics of importance to hospital industry, business, and global news can easily be identified and collected by simply typing in the subject of interest through a search engine, such as Google For example, a search of hospital CEOs concerning the financial outlook for health care resulted in a survey of hospital CEOs done by Deloitte and Touche, USA (2005) It reported that the industry was taking a more optimistic outlook of its financial future (Deloitte and Touche, USA, 2005) With a consumer-empowered market, it reported that the United States offers a more interconnected economy, which offers consumers greater advances in new drugs and medicine, promises of genetic research and its potential curative application to chronic diseases, greater investment in telemedicine, and new cyber- and biomedicine technology (Deloitte & Touche, USA, 2005) Sources of information need to be widespread and diverse Both online and library sources can bring a wealth of literature information Also important is networking with a variety of people both inside and outside the field of nursing Attending national conferences to learn about the national and global trends and ongoing issues and to meet others within and outside the field can be energizing and valuable Information can be gathered easily online by signing up on a listserv, such as KaiserFoundation.org, which provides continuous legislative and policy information and updates relevant to one’s interest area Other access to information may be through a live or archival recorded Webcast of national and international conferences Searching professional journals within and outside nursing, and even searching popular magazines, would give insight into current events and what the public is reading Once the environmental search is completed, sift through the materials identifying similar, related, 24Jones Leadership(F)-ch 24 1/14/07 3:56 PM Page 401 Career Development and dissimilar issues within diverse disciplines Analyzing the dissonance and the interconnectedness between various disciplines allows one to bring the pieces together, the parts brought together to bring a new whole, a synthesis of new ideas Pulling this together, one can begin to identify the gaps, view the needs within the environment, and bring one’s strength of expertise to develop a strategic plan, a blueprint of actions OPPORTUNITY SEEKING AND RISK TAKING: TAKING THE ENTREPRENEURIAL LEAP Taking the “entrepreneurial leap” is the same for the intrapreneur as it is for the entrepreneur Taking the leap requires the entrepreneur and intrapreneur to view themselves as opportunity seeking (Gordon, 1985; cited in Hisrich, 1990) and as having the ability to recognize opportunity (Paterson, 1985; cited in Hisrich, 1990) For the entrepreneur, that means seeking the opportunity outside the current employment; whereas, for the intrapreneur it means seeking an opportunity within the current workplace In fact, many budding entrepreneurs arise from having evolved as intrapreneurs (Manion, 2001) Brugleman (cited in Hisrich, 1990) integrated these two traits of seeking opportunity and recognizing opportunity to describe entrepreneurship as “seeking to find and recognizing when opportunity knocks.” These traits give entrepreneurs and intrapreneurs the leading edge in developing and diversifying their businesses For the nurse entrepreneur and intrapreneur, this can mean developing new skills to create a new role outside and inside of nursing It is the discovery of something new, the creativity that ignites the entrepreneur’s (and intrepreneur’s) innovative ideas and propels her forward to the opportunity (Gordon, 1985; Paterson, 1985; cited in Hisrich, 1990) Beyond the risk-bearing attributes, entrepreneurs and intrapreneurs themselves are known to have other unique personality attributes They quest for quality, a willingness to move beyond the standard solution in preference for creating a new “original idea.” McClelland (1965) noted that entrepreneurs had a need for high achievement, and Roscoe (cited in Bird, 1989) found they had a strong drive for independence and an exceptional belief in themselves Smilor (cited in Baum & Locke, 2004) 401 suggested that passion is “perhaps the most observed phenomenon of the entrepreneurial process” (p 342) Locke (cited in Baum & Locke, 2004) identified, in a qualitative analysis, core characteristics of famous wealth creators, such as Bill Gates and Michael Bloomberg: their zeal and their love for their work Moreover, Lackman (cited in Bird, 1989) found that entrepreneurs held the personal values of honesty, integrity, duty, responsibility, and ethical behavior constant and applied them toward their life and work Consistent with these values, Cunningham and Lischeron (cited in Bird, 1989) deemed high self-esteem as a notable characteristic of entrepreneurs As leaders, they were found to be more flexible and adapted their leadership style to the needs of the people (Katz and Brockhaus, 1995) BUILDING A STRATEGIC PLAN: CRITICAL THINKING AND DECISION MAKING As discussed earlier, one of the first steps for a nurse considering the role of an entrepreneur or intrapreneur is to look within herself to see whether she has the ambition, fortitude, and inner strength needed to venture outside the role definitions that have been used in the past As nurses begin to imagine what their professional lives could be, they need to some critical thinking about their present environment Can their goals and professional achievements be fostered from within their current organization, or must a break be made? A nursing process model, combined with critical thinking, is an excellent framework to use as a problem-solving method of career analysis Nurses are expert at assessing, planning, synthesizing data to form diagnoses, setting goals, creating interventions, and evaluating Nurses can immediately evaluate a plan of action according to its riskbenefit probability and can use critical thinking to develop a short-term evaluation of the consequences, both positive and negative The assessment includes looking at the organization in which nurses are employed; the organizational structure and leadership style should support decentralized decision making As they survey their present organization, nurses should make judgments regarding its culture of human respect, its value of autonomy, and its ability to accept new ideas and discard old ones Another important point to consider is whether the organization will 24Jones Leadership(F)-ch 24 402 1/14/07 3:56 PM Page 402 Skills for a Successful Career thrive and grow or stagnate The question that needs to be answered is whether to stay in the present organization, move to another one, or move outside of any organization Or even whether to remain in the role of a nurse McLees (1988) stated, “Former nurses developed careers in other professions that offered them greater outlets to express their individuality, creativity and freedom.” The intrapreneur can work effectively within an enlightened organization, whereas an entrepreneur is destined to work from the outside, often with many different organizations After the decision for a role change has been reached, the nurse needs to look at what needs to be done and what advantages can be gained from a strategic plan for marketing the idea or product The environment needs to be assessed relative to the networking possibilities and the availability of potential mentors Marketing, Networking, and Mentoring A nurse considering a move to intrapreneur or entrepreneur must become familiar with the concepts of marketing, networking, and mentoring; these are vital to a successful intraprise or enterprise MARKETING Marketing lets potential users know about a product’s existence and advantages The dictionary defines marketing as “the process or technique of promoting, selling, and distributing a product or service” (Merriam-Webster, 2005) For nurses, marketing often becomes indistinguishable from selfmarketing, which involves promoting who they are and what they Having a business plan will allow the nurse to answer objective questions about the product or service as to what it is, the advantages of it relative to its competitors, the innovation of it in relation to the status quo, the worth or value in monetary terms, the break-even point, the potential buyers, what might motivate them to purchase, and what the contractual obligations should entail In order to sell the product or service, the nurse needs to become an expert on the needs of the organization This involves research and tapping into people who may be able to help within the pertinent network as well as soliciting the advice of a mentor Nurses are experts in picking up on behavioral cues and applying them to outcome criteria for their patients Many of the same skills are useful in negotiating with potential clients Reading books on selling and practicing with others who might agree to pose as “buyers” will help to bolster confidence and allow the nurse to anticipate questions and formulate confident answers beforehand Competition and the task of constantly proving one’s worth to organizations can be emotionally draining The independent contractor must be politically savvy within his current organization and able to apply these skills to new situations and people Even though the nurse entrepreneur can, in theory, choose his own clients, when one is just beginning to get established this is usually not a reality The nurse needs to please as many new clients as possible and follow up on other potential clients while they are still interested The role of nurse entrepreneur brings the potential for increasing income, but at first there is often meager remuneration Many unpaid work hours will be necessary to get the business started Sometimes the fledgling entrepreneur must provide services and consultation almost for free just to get started Once the nurse has an established a reputation, fees can be increased and cancellation clauses introduced into written contracts The business plan will include some of the start-up costs; typical needs are a computer with fax and color printer, file cabinets, and copier Also important are business cards describing the nurse and the services available as well as a mailer or cover letter that can be given to prospective clients Mailings and Web-site design may become eventual investments Keeping the overhead down can a lot to keep a fledgling business afloat The nurse entrepreneur may need to borrow money to compensate for business setbacks or to fulfill orders that are not affordable within the current budget Much depends on the type of service or product that the nurse entrepreneur intends to provide NETWORKING Another important concept to consider in order to become a successful intrapreneur or entrepreneur is networking The word “network” literally means a framework of nets It has recently been used as a ... him joy and what he believes and values about life and the people around him (White, 1995) Guided by the Professional Standards of Nursing Practice, nurses’ core values and practice of nursing. .. development and immersing yourself in the global news and local and national current events: identifying the sociopolitical and economic issues that directly or indirectly affect our nation and our... national conferences to learn about the national and global trends and ongoing issues and to meet others within and outside the field can be energizing and valuable Information can be gathered easily