Transition to a Professional Nursing

Introduction

Nurses who have prepared to assume advanced nursing roles can contribute to the healthcare system through new ideas and insights in education, administration, research, and practice. During the process of further education nurses are exposed to professional socialization, which addresses values, norms and ways of viewing situations that are unique to the profession. This process will later provide the common ground that shapes the way work is conducted. Such process, forces nurses to go through different models of transition that will help them overcome personal and professional challenges that occur while experiencing change.

Consequently, helping form the individual’s professional identity, his/her view as a member of a profession with the required knowledge and responsibilities. (Blais & Hayes, 2011). Models of Transition (Bridges; Spencer & Adams)

Change can make people apprehensive, which can lead them to resist it or oppose it. Considering the challenges and struggles that people experience with change, Bridges and Spencer and Adams describe models of transition.

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According to Blais and Hayes (2011) Bridges Model describes a model of transition that consists of three phases: the ending, neutral zone, and new beginnings. There are four components within the ending phase: disengagement, disidentification, disenchantment, and disorientation. On the other hand, Spencer and Adams developed a model of transition that includes seven stages: losing focus, minimizing the impact, the pit, letting go of the past, testing the limits, searching for meaning, and integration.

These two models of transition describe the internal struggles, and the external influences that occur when people experience change.

The first four stages of Spencer and Adams’ model of transition is similar to Bridges’ ending phase, where behaviors can be mixed and include inability to think clearly and resistance to change. Stage 2 of Spencer and the components of disenchantment and disorientation in Bridges’ model, described the conflicting emotions that occur during change. The neutral zone of Bridges’ model and stage 5 of Spencer and Adams’ include the establishment of new skills and behaviors associated with the change.

The individual feels optimistic and a sense of comfort with the change. In the last stages of both models, the individual experiencing change internalizes the new role behaviors and feels satisfied. Nursing has dramatically evolved in recent history in response to the changes in society, the healthcare system as well as to the evolution of the profession itself. Changes include: an aging and more diverse population, changing reimbursement practices, new technology and scientific discoveries, new diseases related to social and environmental problems. Changes in nursing roles represent a shift in the view of nursing from simply an occupation or job to a profession with a commitment to the role (Blais & Hayes, 2011).

Changes in the healthcare system affect society’s expectation of nursing care. Due to these high expectations, nurses are returning to school in order to satisfy these prospects and are more effective in their roles. Prospective nursing students and registered nurses that are returning to school are undergoing many of the challenges described in these two models of transition. I recently change my work place and after studying the different models of transition I can identify myself with Bridges’ model.

I went through the ending phase feeling forced to leave something I was comfortable with. I moved to a new house and it was a long distance from my previous work place forcing me to look for a new job closer to home. I felt frustrated and disoriented. Then, I started what Bridges will call the “neutral zone”, where I am adapting to the new job, but still thinking of the old one. I do not feel completely satisfied. But, I do feel some comfort with the change.

Roles in the Nursing Profession

Role theory “involves preparation for particular job expectations or roles” (Blais & Hayes, 2011, p. 4). A role is a set of expectations associated with a position in society. Any role has three elements: the ideal role, the perceived role, and the performed role. The ideal role is what society expects from a person in a particular role. The perceived role is what the person carrying out the role believes he/she should behave in the role. The performed role is what the person actually does. Role stress is the discrepancy between the person’s perception of what a particular role should be and the reality of what it is. Role strain refers to the felt difficulty in fulfilling role obligations. As of today, I am playing several roles in society; wife, mother, nurse and student.

In my roles as wife and mother, I have been stretched through daily challenges and frustration as well as through life’s victories and joys. As a nurse, I feel I have a responsibility with society. It gives me the satisfaction of seeing a critical-ill patient go through intensive medical treatment, rehabilitation, and at the end that same patient “walks out” of the hospital to continue with his/her roles in society. But, being a nurse also makes me feel stressed. This role stress comes in the form of work overload, where there is a high demand with little control in the job and low supportive relationships. As a current student, my satisfaction is to be able to meet my due dates and pass my classes. In the long run my satisfaction would be to finish my master’s degree.

Role stress as a student comes with the feeling of being overwhelmed and thinking I might not be able to manage it. These and many other obstacles I have encounter in the transition in my role as a student; but the support from my family has given me the strength to continue working for my personal and professional goals. Taking care of me by getting adequate sleep and eating healthy are part of my strategies for stress reduction. Also time management, in which I include time to spend with my family. I definitely have to start working on my delegation skills.

Advanced Nursing Education and Practice

In the United States the number of advanced practice nurses (APN) delivering health care is increasing. There are four principal types of APNs: certified nurse-midwives (CNM), clinical nurse specialists (CNS), certified registered nurse-anesthetists (CRNA), and nurse practitioners (NP). There are two specific types of APNs that I was debating on becoming; they are the certified registered nurse-anesthetists and the nurse practitioner. A certified registered nurse-anesthetist (CRNA) is a registered nurse who has advanced educational preparation in the delivery of anesthesia to clients in a variety of practice settings.

Programs preparing nurse-anesthetics are all at the master’s level or higher. The tasks CRNAs assume in performing the role is to take care of patient’s anesthesia needs before, during, and after surgery (Blais & Hayes, 2011). A nurse practitioner (NP) is a master's prepared, advanced practice registered nurse with advanced academic and clinical experience within a specific population. Nurse Practitioner provides primary and some acute care, and is qualified to meet the majority of patients' health-care needs. They promote a comprehensive approach to health care and emphasize the overall health and wellness of their patients.

NPs take health histories and provide complete physical examinations; they also diagnose and treat many common acute and chronic problems. Although the full-text article “Comparative Assessment of Informatics Competencies in Three Undergraduate Programs” is mainly based on three undergraduate tracks, we can apply the main concept to graduate nurses like Nurse Practitioners. Informatics knowledge and skills are essential if clinicians are to manage the great volume of information generated in healthcare today. The initiative is focused on using informatics tools to enable nurses to make healthcare safer, more effective, and patient centered.

Conclusion

In the context of nursing and the healthcare system I can say to what I have seen and experience that nursing is changing, evolving, and is a dynamic profession. Together and individually we should embrace change in order to acquire the knowledge pertinent to the role to be performed. I have learned that changing roles or even just changing expectations might frighten us. Although we go through a transition while experiencing change, once we accept the knowledge and behaviors of the new role we become self-confident and satisfied.

References
Blais, K., & Hayes, J. S. (2011). Professional nursing practice, concepts and perspectives. (Sixth ed.). Upper Saddle River, NJ: Prentice Hall. Choi, J. (June 2012). Comparative Assessment of Informatics Competencies in Three Undergraduate Programs. Online Journal of Nursing Informatics (OJNI), vol. 16 (2). Retrieved from http://ojni.org/issues/?p= 1700