In every profession it is essential for an individual to develop and grow professionally. Leaning is a ritual aspect in professional development. Each day presents new demands that call for specified techniques in solving them. This paper studies career development for registered nurses working in the ICU.
The first step an individual needs in personal growth is to personally understand themselves that is creating and having self-awareness. This involves an understanding of ones self what an individual is and where they are their own environment as well as their perceptions. When a person understands what and where they are the benefits he or she is likely to get one various like, it would enable the individual to establish the essential steps they need to take so as to be more competent in certain particular situation.
In essence by establishing myself as an individual; I am able to establish the aspects within me that require development in order to be competent (Johnson 2003). This would also help me professionally, and as well to become the person I desire to be. Self-awareness offers a launch pad and foundation from where I can charter and enhance my development and thus the probability of becoming the nurse I want to be. The other benefit of self-awareness is that it enhances my individual sense of sensitivity and aids me to present myself in the way that I wish to as well as create the kind of impression I desire.
The other significant benefit about self-awareness is that an individual like me is able to communicate effectively (Johnson 2003). In view of the rational nature of the nursing profession as relates to practice; patients, families as well as the interdisciplinary health care organizations self- awareness is crucial as it provides me with a foundational knowledge of my self- understanding as well as self- knowledge. My individual familiarity with myself as a nurse that is born out of the realization of my self- awareness is a basis for self-acceptant as well as self-appreciation
However for me as an individual to attain a high level of self awareness I have to overcome certain personal factor that, become a barrier bas a tutor (nurse tutor/speaker) the fear is an emotional response that the nurse has to learn to deal with to achieve the full potential of self awareness. As a nurse I have to understand my personal fears as this would enable me get the support I need to progress and how to change to be the person I want to be. Additionally as a nurse I must be ready to change so as to be the person I want to be. I must abandon the “old” ways which have or were hindering me from being the teacher /speaker I want to be.
The individual nurse has to build within him/her as high level of self-esteem so as help develop the process of self-awareness. High self esteem makes an individual feel great about him/her self which makes it easy for self-exploration.
In order to expand the level of my self-awareness as a nurse I should be able to involve myself with others through conversations so as to learn more about my personality. For instance a nurse I can engage myself with colleagues to understand who I am, and what the teaching professional is all about. She can also engage with students too. This I can achieve by; asking questions then sharing the response I receive with my colleagues. I can also adopt the approach of self-interrupted, where I periodically challenge the participants to offer examples as well as concepts learned up to that point (Jeff Menguin 1968).
The effect of dialogue is that it can help me to develop my self –awareness in two broad categories, when the nurse is expressing her/himself, she or he begins to develop the speech skills as well as self-understanding is raised to a new lever. The process of dialogue enhance the aspect of clarity that is needed both in speech and teaching skills similarly suggestions as well as observations the colleagues as well as students together with others would promote the level of awareness as relates to aspects of themselves that were initially unknown to them.
The second aspects for the nurse to consider while trying to develop his/her speech/teaching skills is the theory of critical thinking critical thinking can generally be defined as the intellectually disciplined process that an individual employs actively and skillfully to analyze, synthesize with the aid of concepts to evaluate information generated by observation or experience.
Thus critical knowledge presents the individual with an integral competent in the development of self-awareness and its addition to reflection as a nurse enables them to understand their encounters. For instance as an nurse educator who has a problem of too much “teacher talk” and I make proposals to her colleagues as well as others is likely to find better solution to my discussion skills. The critical thinking process would enable me nurse to understand the other aspects that coalesce to form situation during my speech or teacher talk sessions.
According to Brookfield (1987) critical thinking involves first identifying as well as challenging the assumptions the nurse educator is likely to make. The nurses should then consider the significance of the context under which she operates and then explore as well as be very imaginative to find other alternatives. I can then engage in what is known as reflective skeptism. However it does not have to be in this sequence
One of the best ways an individual may best achieve the best approach toward great critical thinking would be through reflections. As an individual nurse educator, I should try to flashback on my past experiences that helped my speech or teaching skills growth and those that as well as changed the speech /teaching skills, however these aspects could either be personal or professional. I should then analyze as well as evaluate my response to these situations like the kind of approach I took. Further I should look at what I normally do when attempting growth or change as relates to my profession as well as personal life. I should then consider the various results of my approach and whether the approach elicits the desired change or growth and finally consider the various steps I took to make the approach work.
The third option involves the theory of envisioning, that is trying to imagine what may be. This theory presents the nurse teacher with a look and understanding at what they wish to be and therefore a chance to grow. For instance an individual who wants to change but engages in the same process to obtain the desired change will always have the same results and thus be in the same familiar position he or she does not want to be in. thus it is essential for one to reflect on their past experiences of growth as well as change in their lives to determine the degree of changes as well as growth envisioned and at the same time achieved was aided or influenced by their sense of recognizing the possibilities of the outcome.
In most cases the nurses’ educator may view the chances of growth as a result of her or his life experience. However it is prudent for the individual nurse educator to find ways to expand this vision of growth to become something achievable and desired.
In essence an individual’s thought process offers an essential component to expanding their vision as the thinking patterns greatly affects the process of vision. Creative thinking thus presents a very effective as well as efficient means to development growth and change if well incorporated to the critical thinking concept as well as that of reflection. The integration of these three processes is vital as they help to broader the individual’s vision and equal aids him or her in understanding as well as referring their options and or possibilities.
The focus of creative thinking is usually based on “exploring ideas generating possibilities” as well as finding various correct answers instead of first a single answer (Harris, 1998). According to Harris (1998) creativity is the ability to appreciate new ideas and change and be ready to play with ideals as well as Charles, possibilities. In view of this definition a nurse educator may be able to develop my speech/teaching skills through the exploration of newfound ideas. Like in instances when I engage in discussions with my friends or colleagues both at personal and professional level I am able to find new ways to which I can make my presentations. This new developments may serve to enhance the educators speech /teaching skills
There are about five principle ways in which the creative thinking process is able to manifest itself; firstly there is the evolution process where the already existing ideas are broadly expanded as well improved on. This can be summarized as “a work in progress” in essence the nurse should by has learned or as well mastered. She can thus begin the process of synthesis that involves choosing an idea from two or more ideals.
The chosen is an integration of the other thoughts resulting in a better way which she can present during her speech and at the same may be a best way to approach and make presentations to her audience. The third step of revolution process where a new idea that is considered best but is totally different from the previous one may be developed. For this case I can as a nurse during my presentations should look for new innovation ways even if they involve radically changing the already learned ideas. This may involve a new approach to new audience that she has not handled before to enable her meet their expectations.
The fourth aspect of creative thinking involves reapplication of “old” ways to new situations for instance if in a previous speech certain phrases or processes worked and she or he is faced with a similar audience, she can reapply the same processes used. The final aspect would involve change of direction. This entails the speaker/teacher shifting attention for one perspective to another to fix the demanding situation.
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Supervising and Curriculum Development, Washington DC
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Mark came up to me last week and broached the subject of mercy killing of terminally ill patients by medical staff. He explained how painful he is finding it attending to such patients feeling their pain, hearing them groan in pain and breaking the bad news to the kin. As an intern, this had taken toll on him and with time he would become disillusioned. We talked over the issue and discussed what the consequences would be. We have developed a tight professional bond since he was assigned to me as his mentor. We reinforce each other when the pressure is too much. Mostly, he draws from my large experience to find solutions to his problems while I rely on his youthful vigor that makes me feel rejuvenated at times when am hopeless. Our relationship is therefore complementary.
Mentoring involves two individuals where a person acts as the guide who is more knowledgeable in a certain filed to a new entrant in that field. As the mentor I provide my protégé with source of information and advice. The protégé presents me with questions, observations and ideas for scrutiny and recommendations. This relationship is beneficial to us both in terms of profession growth. The protégé can always walk up to me whenever encountered with a problem. He or she is guaranteed of my accessibility and availability to discuss professional issues. In my interactions with my protégés, I recount to them the various instances my protégés have saved the day for me. I once overlooked a skin rash when diagnosing a patient only for my protégé to point it out to me. It later proved to be the key to our treatment.
Some of my mentorship relationships are long-term others short term. They usually end once the protégé has gained enough knowledge. I usually wean off my protégé in terms of assistance or help with time as he or she gains more experience. Our relationship will continue till the point where the protégé is fully assimilated in that field. My mentoring relationships therefore are temporary processes with the aim imparting knowledge on new nurses in our hospital. Through this mentorship program we are able to enhances the ability of new employees to exercise their full career potential. (Developing mentoring)
Theoretical approach taught in schools cannot be fully relied on in the real world especially in the nursing world. A new nurse will need hands-on experience to learn how to carry out various delicate tasks. Instead of leaving a new nurse to grope in the dark, I provide him or her with tested and proven solutions or workable plans. As the protégé internalizes these skills, I gradually fade further into the background. I let him or her more freedom to work on his or her own without close supervision. The protégé is developing new knowledge and applies his or her original ideas to it. Over time, he or she acquires knowledge that would be useful in advancing his or her career.
Mentorship does not necessarily come at the onset of one’s work life. It can also apply where an experienced individual in one field decides to practice in a different field. He or she will look for guidance from those who preceded him or her in that field. (Developing mentoring). When I decided to switch to being nurse educator ten after becoming a Registered Nurse, I armed myself with an MBA. But even with this theoretical base, I would not have matured into all rounded educator if the senior educators did not mentor me. They guided me on how to handle and motivate student nurses. Usually, the mentor will have undergone the protégé stage at a point in his or her life.
Our mentorship program helps individuals achieve potential growth in their nurse careers. Inexperienced entrants gain confidence through our mentorship. When they start out, they fear that they will fail to live up to the professional expectations. They want to deliver but are not given full chance to prove their abilities. This is especially so in fields that requires maximum care in handling work.
That is, when work involves delicate procedures such as nursing. Through our mentorship programs however, a person who has been through it all guides the new nurses through the operations of the hospital. We also give the protégés support in delicate organizational operations. We push for the protégés case to the hospital’s administration to ensure that the protégé is allocated more satisfying roles in the hospital. Our mentorship program also provides the protégés a forum to present their ideas.
New entrants after observing operations and by applying knowledge learnt elsewhere may develop ideas to improve our operations. He or she will present these ideas to his or her mentor putting forward all major points of the idea, its merits and demerits and other issues such as cost. Together we brainstorm the issue to see how workable it is. We as the mentors straighten out any assumptions that the protégés may have wrongly made drawing from our advanced knowledge and our wealth of experience in that field or organization. This would give the idea a more realistic and workable face. We as mentors are also able to easily gain audience with the administrators to push for the adoption of the idea.
As a mentor, I also provide psychological support to new entrants who find the hospital environment to be too hostile. The first few days at work are usually frustrating to the point that some may consider quitting. Most of the workforce will not care how well a new nurse has adapted to the job. They expect speedy service and will grumble at the slow service offered by a new nurse. Some of the seniors are even very hostile to the new nurses. We step in to reassure the protégé and make him or her (protégé) to feel appreciated and welcome. I also provide an opportunity for the new nurses to make friends especially with my colleagues. This makes the new employee feel welcome. (Developing mentoring)
My mentorship services can either be formal or informal. Formal is the sense that its start can be traced to a particular time. Both my protégé and I know that we are getting into a mentorship program and both approve of it. Our roles are set out clearly for both of us. This mentorship program is mostly assigned in that the faculty allocates the protégé to me. It can also be self-appointed. Here, the protégé approaches and arranges with me for a mentorship services. This relationship is usually long and its results measurable.
Mentorship relations that are informal do not have a specific beginning time. It just happens that I find myself in a mentor-protégé relationship with another person. Rather it is not what we had set out to do. It’s the situation that makes one of us to rely on the other for guidance and counseling. This relationship develops due to another relationship in place between us. When it’s evident to both of us that we are in a mentorship relationship and approve of our roles we continue to play them.
A new nurse may be inducted in to a hospital through an organized mentorship program usually by assignment. He or she learns the hospital’s style of doing things. Such a program ensures a new nurse fits in and is able to deliver quality service. It boosts his or her confidence and job security. Whenever I offer mentorship services, I achieve self-gratification and also strengthen my leadership skills.
What my protégé and I settle for depends on the issues at hand. Different people will have different needs. As mentor I sometimes determine future job my protégé. I usually encourage the protégé to raise his or her level of education to achieve faster rise through the ranks. I also provide guidance to my protégé on what line specialize in depending on his or her strengths. I also advise the protégé on how to avoid certain mistakes in their careers that would hinder their rise. (Developing mentoring)
My mentorship relationships are built on key individual characteristics found in both of us. We must have adequate understanding of each other. Only then can we help each other out. Only with good understanding of each other can we combine to set up goals. Both of us are more comfortable with each other and can open up more easily if we are familiar with each other. Another key characteristic is respect. I should not look down at a new nurse as incapable rather should see him or her as an individual with a potential to be exploited. I must believe in my protégé’s abilities and treat him with dignity. Communication between us is key. Without a functioning communication, neither the protégé nor I would be in a position to put across ideas, questions or recommendation.
We start by identifying the needs and determining our end goal. Then we put in place a clear plan indicating the specific roles of each party, and the formula for achieving our end goals. Then we develop the framework by which to adopt the plan. The program is then set up with regular appraisals done to determine its effectiveness. (Canadian Nurses Association, 2004)
The cost of a mentorship program is forbidding. It requires a lot of resources to set up. It is also prone to sabotage by either parties. The mentor may also take advantage of the protégé either financially or sexually. To prevent such problems I usually insist on meeting normal our meetings and in my office.
In my career so far, the worst experience I have had was to work under a menacing senior nurse as a greenhorn. She had a bad tempered and I took the worst of it. She would constantly shout and gesture at me. I could no right thing in her eyes no matter how hard I tried. She heaped blame on me on things that were even beyond me as an intern. What hurt me most was when I did a good job and expected praise only to get a reprimand for a certain commission. I started feeling that I was in the wrong career and almost quit in frustration. Only after I talked to another senior nurse who was my mentor did I regain my interest in my vocation. She told me to stand my ground and engage my senior in a reasonable controlled argument. She also told how to report the issue to the administration if the harassment did not stop immediately. When I did not back off when the bully came at me, it took her by surprise and she ended up breaking down. She explained her fears and hardships to me, which she was passing on to me. The behavior stopped immediately and my job became more fulfilling to me. When Rose, one of my protégés, approached me with the same problem, I related my experience to her. I told her that she should neither give up on her vocation nor accept bad treatment.
Workplace violence is violence meted against employees of an organization. It could be across employees of the same rank who unite and make life hard for others or it would cut across different ranks. Here, the seniors mistreat the junior rank employees. Work place violence could be verbal or physical. It includes sexual harassment, racial slurs or mere rudeness. It can also occur from the customer being served. Some customers are very rude to the new employees when being served. Some jobs have higher risk of workplace violence than others. Social work services and cab drivers are examples of work groups, which face a lot of hostility from customers. Workplace violence meted to a junior officer by a higher rank officer is very prevalent. It even passes off as effective management. This is especially in high-tension work environment such as a theater in a hospital.
I always address the problem of work place violence when mentoring my protégés. I spell to them what is work violence, how to recognize it and the options open to the protégé Nurses are usually the recipients of verbal onslaught and physical attacks b physicians. Nurses are also victims of attacks by their colleagues who gang up to victimize a targeted member or their workforce. The victims of these bullies have to deal with many accusations and insinuation that are untrue. The bullies usually blackmail their victims or just use threat of violence to stop them from reporting. When they zero in on a target, they are sure that they will not get punished making them bolder in their attacks. The victims recoil further unable to take any action.
Bullying of nurses by fellow nurses is most unfortunate as this is supposed to be a team that functions together in provision of health care. Most of these attacks are prompted by jealousy especially where senior nurses see new recruits as having had an easier time when joining the profession. They brand them demeaning names and withhold information from them. They sabotage their work and heap blame on the young entrants. The poor attitudes of the senior nurses are passed on to the physicians who also ridicule and harass the new recruits. The new nurses are criticized at the slightest of mistakes. The bullies may make crude remarks or use non-verbal language to hit out at the recruits. They make work environment for the new nurses very hostile. (O’Reilly, Pauline, 2005)
I usually present to my protégés the effects of this violence on new nurses in the long run. When faced by continued bullying, most nurses want to quit. They were previously enthusiastic about the vocation and had great ideas in mind on how to care for their patients. Not being given a chance to develop into fully skilled careers frustrates them. They become disillusioned and want to leave. Constant intimidation and humiliation leaves them greatly dissatisfied. This leads to high turnover of nurses as more nurses quit causing acute nursing shortages. Most of them will quit at the first opportunity o getting on their job. Others will even opt for a lower paying job than nursing.
Bullying also harms the victims both bodily and mentally. New nurses feel unappreciated and disliked for their hard work. The constant reminders about their failures get to them. They cannot get an outlet from constant pressures and threats. The workload is made much more difficult by withholding of some necessary information. Hospital administrations do not provide an avenue for them to air their grievances.
In fact they are supposed to forward their complaints through the same nurses who oppress them. Pushed to a corner, they develop escapist tendencies such as drug abuse, alcoholism and depression. They also exhibit other characteristics such as insomnia, general unkemptness, irritability and sheer timidity. They experience burnout and may suffer from nervous breakdown. Some may even turn suicidal due to the frustration.
Some victims of bullying internalize the inferiority complex. They see the whole process as a rite of passage that everybody must undergo. They take the abuse in their stride and will act timidly lest they provoke the bullies. They feel that at one time it will be over. Instead of actively fighting the oppression, they expect that through their passiveness they will gain acceptance and be spared from further attacks by the bullies. (O’Reilly, Pauline, 2005)
To the hospitals, they get reduced productivity from their nurses. There is huge nurse turnover as more nurse’s walk away. High turn over leads to high cost of training and recruitment affecting the hospitals bottom line. Nurses who remain have a big workload and this hurts the quality of service delivered. This is serious having in mind the sensitivity of healthcare provision. The hospital also misses out on creative ideas and innovation that the new nurses would have implemented.
They are not only denied a chance to air them but it is also constantly drummed into them how useless they are. If some of these ideas had been considered, hospitals would make huge steps towards achieving better service delivery and cost cutting and increase efficiency. When the hospital administrations allow the vice to go on unabated, they are killing growth opportunities that would have otherwise been available to them at very low cost. Nurses cannot attempt anything new for fear that it does not take off, it would lead to further attacks and humiliation or even loss of jobs.
Most bully nurses are arrogant, inhumane and selfish. They fall back onto threats and intimidation when running their workplaces. They fear new nurses who might have better qualifications and who might replace them at some point. To wad off this threat, they attack the perceived rival. They are not open to any different point of view and will enforce their view on everybody. They usually hold a key supervisory role earned through domination of those under him or her. They expect everybody to rise through the ranks slowly just as they did no matter the qualifications. In their roles they use coercive force. Victims of bully attacks are usually new nurses who are very enthusiastic about putting skills they learn in to use. They are ambitious which the senior nurses interpret as a threat. (O’Reilly, Pauline, 2005)
In general, the patient stands to loose when bullying is allowed to escalate. Bullying kills team effort among the nurses of different ranks. These nurses and physicians are supposed to operate as a team in order to save lives. Disharmony among nurses would have negative impact on quality of health care. It may even lead to loss of lives. This would spark off another blame game, which would most probably point at he new nurses.
To overcome bullying in hospitals, the administration should put a stop to the vice. They should put in measure that allow for reporting and prompt penalizing of bully attacks. They should put it clearly that all workers of the hospitals should be treated with dignity and respect.
The administration should also organize for effective communication avenues for the hospital staff. Junior nurses should access the hospital management at all times. The hospital administration should enhance communication between the various work groups. Bonding sessions and team building activities should be organized. The hospital should make the nurses to feel appreciated and wanted not as free riders that should be admonished. Higher ranks of hospital staff especially senior nurses should be made to be supportive of the junior nurses in their early period of the careers.
Another strategy to overcome bullying in hospitals would be to encourage the victims to take up Non-Violent Communication. This means that while they do not absorb the vilifications and abuses, they do not react in the same manner used by the bullies. They counter them by calm firmness and engaging them in controlled argument. The victims should maintain a record of the attacks and keep on reporting to the authorities. In this endeavor victims should come together in a one non-violent but firm voice. (O’Reilly, Pauline, 2005)
O’Reilly, Pauline, RN, MN, 2005. Professional Growth: Fostering Psychologically Health Professional Relationships. BCIT, School of Health.
Canadian Nurses Association, 2004. Achieving Excellence in Professional Practice: A Guide to Preceptorship and Mentoring. Developing Programs for preceptorship and Mentoring. Retrieved on 10/24/07 from http://www.cna-nurses.ca/CNA/documents/pdf/publications/Achieving_Excellence_2004_e.pdf