23Jones Leadership(F)-ch 22 368 1/14/07 3:54 PM Page 368 Skills for a Successful Career charge of supervising other nurses in the provision of care to patients Normal human development follows a pattern of transitions that have their own set of unique characteristics and tasks For example, an infant transitions to the toddler period Both the infancy and toddler stages have a distinct set of developmental tasks Yet each individual child experiences the infancy and toddler stages in a unique way The transition from student to professional nurse is not unlike the transition from infancy to toddler There are predictable developmental tasks and skills to be achieved Yet each transition is unique to the experience of each nurse One of the developmental tasks of adulthood involves a recognition of responsibility for our reaction to circumstances and any resulting behavior Self-management skills empower the student to proactively transition from the student role to that of professional nurse chapter star John M is a staff nurse in a critical care unit of a medical center hospital John is working 12-hour shifts and is frequently called upon to work extra shifts to cover unit staffing John’s goal has always been to become a nurse anesthetist He has delayed enrollment because anesthesia programs require students to be full-time, which allows little time for part-time work He is married to Kira, who is a nurse manager in the same institution and is on permanent call to assist with unit decision making; e.g., she frequently works a 10-hour day and receives calls at home about unit problems In addition to working full-time, Kira is pursuing an MSN on a parttime basis When Kira becomes pregnant, John and Kira are excited about becoming parents but realize that their lifestyle will need to adjust with the birth of their first child They discuss their personal goals for school and career and consider their mutual goals for family lifestyle, home life, and their relationship After carefully assessing their economic situation, they decide that they can afford for Kira to resign her position when the baby is born and to continue to attend school and finish her MSN as a full-time student Meanwhile, John will continue to work at his job as a staff nurse When Kira is near finishing her MSN, they agree to reassess their personal and mutual goals as a family and determine when it might be feasible for John to enroll in a program to become a nurse anesthetist ADJUSTING TO THE ROLE OF PROFESSIONAL NURSE The nursing student, new graduate nurse, and staff nurse roles each have role behaviors, norms, sanctions, and status dimensions that are unique to their specific designation When a person changes roles, the process of learning the new role is called socialization Professional socialization is a term used to describe the social processes that occur between the time a student enters a nursing program and graduates The professional socialization that goes on during education in a professional nursing program is designed to shape attitudes, values, self-identity, role skills, role knowledge, and role behavior (Hardy & Conway, 1988) As intense as the socialization is during the nursing program, there is still need for socialization to the nursing role within the employment setting During the orientation to the employment setting, the new graduate nurse must reconcile the values and expectations of the educational program with the values and expectations of the job For example, while a student, the usual assignment may be one or two patients This allows the student time to provide total patient care, including a bath and all treatments The expectation is the student is learning skills and gaining in-depth knowledge of all aspects of the patient’s condition As a nurse, the assignment may increase to six to eight patients, and the bath and treatments may be delegated to a nurse aide It may take new nurses time to adjust to the idea that while they alone are not giving total patient care, they are responsible for all care for the patient whether they physically supply that care or delegate it to another employee The transition from student to professional nurse employed in an organization frequently involves giving up the practice of personally providing total patient care to being sure that patient care is accomplished according to the model of care delivery that is adopted by the hospital or other organization Making a successful transition from student to new graduate to professional nurse is affected by past experience with transitions as well as the socialization to the profession that went on in the educational program The transition to an employment setting is particularly important because this experience can establish precedents and patterns for dealing with the many future transitions that 23Jones Leadership(F)-ch 22 1/14/07 3:54 PM Page 369 Manage Yourself for a More Fulfilling Career can be anticipated in the rapidly changing healthcare delivery system The transition from student to professional nurse involves unplugging from the world of student and plugging into the values and expectations of becoming an employee and staff nurse In general, all role transitions involve: Letting go of old ways and old identities An “in-between time” when the old is gone but the new identity is not fully operational, which involves psychological realignments and repatterning of behavior Emerging from transition when the new identity is established and a new sense of purpose arises (Bridges, 1980; Bridges, 2003) Moreover, role transitions may elicit a sense of loss and/or anxiety as old roles fade and new roles—and accompanying expectations—demand attention For example, as the role of professional nurse demands more time and attention, the days of being able to call the instructor when a new procedure must be done are being replaced with locating the procedure manual or co-opting the assistance of an experienced nurse to help with the learning process The realization that you are totally responsible for patient care can produce much anxiety until you can gain confidence through experience and successfully access the resources of the workplace to provide help and support for your professional practice REALITY SHOCK Role transition from student to new graduate to registered professional nurse is a process that has been studied from a variety of perspectives and disciplinary orientations In the 1970s and 1980s, Marlene Kramer studied the new graduate adjustment to the hospital work world She concluded that during the process of adjusting to the professional nurse role in the hospital, the new graduate may recognize that there are differences in the values and expectations between school and workplace Dr Kramer called this phenomenon reality shock Reality shock is a universal phenomenon used primarily to describe newcomers’ reactions when they move into an occupation, after years of arduous preparation, only to find that many of the professional ideals and values learned in school are not operational and go 369 unrewarded in the work setting They end up feeling less than competent and uncomfortable Resolving reality shock occurs when the new nurse learns to live comfortably with the values and expectations of the work world and the profession (Kramer & Schmalenberg, 1977) Reality shock has several phases, including the honeymoon, shock, recovery, and resolution The honeymoon phase occurs early after hire when only the best aspects of the job are apparent During the honeymoon phase, nurses believe that the good things they experience far outweigh any negative experiences Shock occurs when the full extent of the differences in expectations between being a student and being a graduate nurse becomes apparent The recovery stage involves the new graduate regaining a balanced and modified view of the work world For example, the new graduate may continue the commitment to learning but recognize that the kind of learning involved in the work setting will be focused primarily on the task at hand and the procedure as dictated by the agency Resolution takes place when the conflicts become resolved, new expectations are met, and the new graduate becomes assimilated into the culture of the work world and able to position professional values within the work environment (Kramer, 1974) Resolution takes place as new nurses realize that they can handle a patient assignment and complete tasks within the given shift New nurses begins to hear from peers, managers and, most important, the patients that they are doing a good job Resolution comes as new nurses experience a sense of accomplishment and purpose Experience has demonstrated that many new graduates experience this phenomenon to some extent In order to ease the transition from school to work, nursing programs have initiated role transition experiences like partnering with a preceptor and working the preceptor’s schedule This provides experiences that are closer to the reality of the work world while still in school These experiences are aimed at easing the transition from school to work TRANSITIONING TO ROLE OF SKILLED CLINICIAN Embedded within the transition from school to work is the process of becoming a skilled clinician 23Jones Leadership(F)-ch 22 370 1/14/07 3:54 PM Page 370 Skills for a Successful Career Dr Patricia Benner studied the process of new nurse skill acquisition and critical thinking and concluded that new graduates’ perceptions of complex clinical situations were significantly different from those of nurses with more experience and skill (Benner, 1984; Benner, Tanner, & Chesla, 1996) Benner (1984) identified the stages of skill acquisition as novice, advanced beginner, competent, proficient, and expert Knowing about the characteristics of these stages allows an individual to increase his awareness of what he is experiencing This awareness is the first step of learning to manage the transition from new graduate to skilled clinician Dreyfus and Dreyfus (1996), whose work with chess players provided the basis for Benner’s work, offer the following descriptions of this process of skill acquisition The novice stage is a time of using the theory and translating the lessons of the nursing program into the real-life patient care environment This is a time for learning the rules and rule-based reasoning The beginnings of intuition related to patient care start developing during this stage The new graduate begins the professional nursing career as a novice After experiencing a variety of real patient care settings, the novice progresses to the advanced beginner stage, during which professional performance improves to become marginally acceptable During this stage, the nurse is beginning to discern the situational elements to clinical decision making The nurse knows the rules that govern care in a situation but begins to understand how and when the rules can be applied based upon the patient’s condition, desire, and needs Both rules and skills become more complex, and it is not unusual for the advanced beginner to feel overwhelmed “by the effort required to notice all relevant elements and to remember an increasing number of more and more complicated rules” (Dreyfus & Dreyfus, 1996, p 38) During the competence stage, the number of elements that the nurse is able to recognize as relevant in a clinical care situation may still be overwhelming But during this stage the nurse begins to understand and adopt a hierarchical perspective, i.e., to categorize the rules according to relevance and set priorities Nurses at this stage must devise a plan to determine which elements in a situation are deemed to be important enough to require action or intervention These new rules cannot be taught by lecture or come from a textbook Another characteristic of this stage is recognition that by making decisions that affect the outcome, the competent nurse becomes emotionally involved in the outcome The competent nurse begins to assume and feel responsibility This emotional involvement marks the end to the detached rule-following stance of the advanced beginner and the beginning of the rather frightening acceptance of risk and responsibility that sets the stage for further advancement The hallmark of the proficient stage of performance involves approaching a care situation with both concern and involvement and knowing intuitively what the priorities are and being able to perform the required procedures with proficiency, speed, and confidence Action becomes easier and less stressful as the nurse simply sees what needs to be achieved and does it (Dreyfus & Dreyfus, 1996, p 41) The expert nurse can handle complex and unique situations Achieving the expert level requires the ability to discriminate and set priorities among situations all seen as important and to know how to achieve goals once a decision has been made This ability to discriminate and choose one priority over another requires both maturity and practice (Dreyfus & Dreyfus, 1996) Not every nurse achieves the expert stage of practice Furthermore, when a nurse transfers from one specialty area to another, a proficient nurse may return for a time to the competence stage while he learns and gains experience in the new specialty Results from Kramer’s and Benner’s work have been applied by employers to design new graduate orientations, internships, and residencies: these reflect the nursing profession’s concern with actively managing the transition from student to employee and to professional nurse These efforts are also a response to the high turnover rate of new graduates within the first year of employment (Goode & Williams, 2004) Part of self-management is finding an organization where you can meet your professional goals Within the job search and interview process for that first job, you need to assess whether a potential employer offers a special orientation, internship, or residency for new graduates and whether this is something that will be available to you 23Jones Leadership(F)-ch 22 1/14/07 3:54 PM Page 371 Manage Yourself for a More Fulfilling Career Practice to Strive For 22-1 In order to ease the transition from nursing student to graduate nurse and to decrease attrition, many health-care organizations have initiated nurse internship programs These programs extend the period of traditional orientation from several weeks to as long as a year When this period is extended to a year, it is frequently referred to as a nurse residency program Both the duration and content of the program are determined by a variety of factors, including but not limited to financial and human resources of the organization, type of specialty unit, number of new graduates hired, and type of academic program attended by the majority of new graduates Whatever the duration of the program, the goals in general are to: • Help the new graduate develop clinical knowledge and skill to function as an independent professional nurse • Provide support for the new graduate during the transition from student to nurse employee • Help the new graduate gain increased awareness of the patient/family needs and how to access the resources of the system to meet these needs The format for most internship programs includes experiences in the classroom, skills and computer laboratories, and on the clinical units While classroom and laboratory experiences are directed by instructors from the education department, experience on the clinical units is directed by a preceptor who is an experienced RN who works closely with the new nurse to supervise patient care and introduce her to the culture of the clinical unit and the nursing organization Some organizations predetermine how long the new nurse must work with the preceptor; other organizations establish an expected time frame for the relationship Usually, the new nurse works the same schedule as the preceptor until the new nurse has achieved self-confidence and the trust of the preceptor (Blanzola, Linderman, & King, 2004; Bowes & Candela, 2005; Casey, et al., 2004; Ihlenfeld, 2005; Rosenfeld, et al., 2005) BALANCING CAREER/LIFE LINKAGES Adjustment to the role of professional nurse does not occur in a vacuum, away from the expectations of other life roles and transitions “Recognizing ties between one’s personal well-being and work life is what is called ‘career life linkages.’ It is impossible to segregate work and personal life” (Miller, 2003) Being able to balance the interaction of professional and personal life roles results in “life sat- 371 isfaction, which differs from the sum total of the marital, job, leisure and other role indices taken separately High-functioning people have welldeveloped and prioritized values” (Brown & Crace, in Niles & Harris-Bowlsbey, 2002, p 81) People who are happy and satisfied know what they want and have a plan for achieving their goals that are consistent with their personal and professional values Achieving and balancing personal and professional goals require self-management Balancing career/life linkages involves timing and pacing Timing involves deciding when to begin a new project or approach a new goal Pacing is about how quickly one proceeds with implementing the project or achieving the goal An example of timing involves a decision about when to start the next educational program Pacing relates to the decision whether one will attend full- or part-time and, if part-time, whether one will enroll in one or two courses a term Balancing career/life linkages adds the dimension of personal to this professional decision For example, the decision to enroll part-time may be affected by the need to work full-time and use employer-provided tuition benefits or the need for quality time with school-age children There are no hard and fast rules about achieving a career/life balance for everyone The best strategy is to approach goal setting and planning with a realistic understanding about what is possible for you and those who are important in your life Any potential decisions about plans, including timing and pacing, need to take into account your personal and professional values and the values and preferences of the important others in your life All Good Things People who are happy and satisfied know what they want and have a plan for achieving their goals that are consistent with their personal and professional values They proactively take charge and make conscious decisions to act in ways that lead to goal achievement, i.e., they are skilled in self-management Self-management is built upon a clear differentiation between what is within our power to control and what we can only influence With this understanding, goal setting can be specific, measur- 23Jones Leadership(F)-ch 22 372 1/14/07 3:54 PM Page 372 Skills for a Successful Career able, attainable, realistic, and time-oriented Strategies that help with goal achievement include positive self-talk and developing emotional intelligence Managing life to achieve goals involves dealing with the barriers along the way One of the biggest barriers is stress Stress is a natural part of life and cannot be avoided, but the stress response can be managed and controlled The first step in managing stress is identifying sources of stress Some examples of stressors that frequently affect the lives of nurses are sleep deprivation, surreptitious energy drains, and lack of time to manage all the competing demands of our fast-paced lives with their multiple roles There are many strategies for dealing with each of these stressors A stressor that has received attention from the nursing profession is the process of transitioning from student role to the role of professional nurse to expert clinician Two nurse researchers have studied this process Evidence-based programs can help you with these transitions in many employment settings Dr Marlene Kramer has identified this process as reality shock Many employers have programs in the form of orientations, internships, and residencies aimed at helping you to cope with this transition and the resulting reality shock Dr Patricia Benner studied the process of acquiring nursing skill and outlined a series of stages that nurses pass through on the journey from novice to expert Many hospitals have adopted a novice-toexpert model for progression within a clinical career ladder Decisions that you make in your career will affect your personal life, and what goes on in your personal life affects your professional development These career/life linkages must also be managed to achieve personal happiness and professional fulfillment Having a clear understanding of personal and professional values helps to provide the compass for decisions about timing and pacing related to both personal and professional issues and these linkages Let’s Talk Write a personal mission statement to meet the following criteria: What you want to be (character); what you want to (contributions and achievements); what values and principles you will use to accomplish “being” and “doing.” Based on the mission statement, develop a longterm goal (something that will take more than a year to achieve), and then develop some shortterm goals to operationalize the long-term goal Evaluate the goals using the SMART criteria Develop a list of things that are within your control, that are outside of your control, and the things that you may be able to influence How does this realization of the ability to control, have no control, and possibly influence affect the kinds of goals that we set for ourselves? Review the characteristics of emotional intelligence Identify someone you think is emotionally intelligent Describe the behaviors that this person exhibits that demonstrate emotional intelligence How does your behavior compare with the behavior of the person? How would you go about developing your own emotional intelligence? Identify a time when you experienced a great amount of stress, but others around you did not perceive the situation as stressful What factors made the situation stressful for you? Why did other people respond in different ways to the same experience? As this chapter is about self-management, what stressors you anticipate, and how you plan to manage your stress response? NCLEX Questions Self-management is all of the following EXCEPT: A Knowing who you are B Knowing what you want and where you want to go C Taking charge of the process of gathering the resources and positioning yourself to achieve your goals D Developing a time line for activities of daily living Self-concept is an overall term that is used to describe all of the following EXCEPT: A Thoughts and evaluations regarding specific aspects of self, such as gender, racial identity, and social class membership B The ideal self, which includes hopes and dreams about personal attributes ... a sense of loss and/ or anxiety as old roles fade and new roles? ?and accompanying expectations—demand attention For example, as the role of professional nurse demands more time and attention, the... situation but begins to understand how and when the rules can be applied based upon the patient’s condition, desire, and needs Both rules and skills become more complex, and it is not unusual for... with their personal and professional values Achieving and balancing personal and professional goals require self -management Balancing career/life linkages involves timing and pacing Timing involves