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Career Choices and Directions: an Issue Analysis Nicole Cory Ferris State University
CAREER CHOICES Abstract The field of nursing has many career options for men and for women. Nurses are employed in many positions at many different types of organizations with several different levels of education. This subject affects students and nurses as well as other members of the healthcare
field including physicians, educators, and administrators. This paper will discuss the importance of planning a career in nursing and having a long-term goal. The nursing shortage has caused problems in healthcare nationwide. Career development plans have been shown to increase job satisfaction and increase productivity among registered nurses at all levels. Career development is a long-term project that is ideally started early in a career, and continues throughout that career. This paper discusses assumptions on the topic, provides a general synopsis of information and research available, and a plan for implementation and evaluation of that process.
CAREER CHOICES Career Choices and Directions: an Issue Analysis One purpose of researching this topic is to understand the many options available to nurses throughout their careers. Nursing can begin at different levels of education: Licensed Practical nurses (LPN), Associate¶s degree nurses (ADN), Bachelor¶s degree nurses (BSN), or Advanced Practice Nurses (APN). The options from the LPN level to the APN level are many. There are choices from clinical nursing jobs, to research nursing careers, to nursing education positions, to leadership or management positions. Nurses can work in politics, administration, patient care, public health, and long-term care. Finding the right path for each individual nurse can be difficult. Choosing the wrong path can be detrimental. The real issue at hand is, How does career planning impact the field of nursing? Many nurses choose to leave the field after obtaining their degree and working for only one year (Murphy & Sherman, 2010). There are several issues in the healthcare field right now. One issue is the nursing shortage. It has been shown that those who plan out their careers and have a goal and plan to obtain that goal are more satisfied with their jobs (Donner et al., 2004). This issue can affect nurses at all levels. It is also a topic of interest for nursing students, or any student considering nursing. If having a career plan and goal can help a nurse to be more
satisfied and more productive then this concept could impact healthcare as a whole. ³According to the International Council of Nurses (ICN) career development is a major contributing factor in the advancement of health systems and the nursing profession worldwide, and is directly linked to the maintenance of high quality care delivery´ (Bloomberg & McGillis, 2008, p. 208).
With the nursing shortage causing nationwide concern among the public it is a critical time to discuss career development in nursing. According to Raines and Taglaireni of the article
Career Pathways in Nursing: Entry Points and Academic Progression , ³the current shortfall in
the number of nurses needed to provide care in the United States (US) is expected to increase to more than 500,000 by the year 2025 according to the latest projections by workforce analysts´ (2008). The article goes on to state that, today's nursing shortage cannot be attributed to lack of interest in nursing careers, and the American Association of Colleges of Nursing (AACN) and the National League for Nursing (NLN) have reported steady increases in enrollment in entrylevel nursing programs over the past few years (Raines & Teglaireni, 2008). Applications to nursing programs are up across the board and competition is intensifying. Of great importance to the field of nursing is the retention of already trained and educated nurses. According to a Hospital and Healthcare Compensation Service survey conducted in 2003, the turnover rate for RNs is 14.6 percent (2005). Recent studies of the costs of nurse turnover report results ranging from about $22,000 to over $64,000 (U.S.) (Gates and Jones, 2007). Several benefits of improved nursing retention listed in this article are: patient satisfaction, nursing satisfaction, patient safety, and quality of care(Gates and Jones, 2007). Having a well-defined career plan can also improve nurse satisfaction and thus improve nursing retention. Individuals who exert more control over their work are likely to be more satisfied with their jobs and more committed to the organization (Donner et al., 2004). Career planning is a continuous process of self-assessment and goal setting and is an integral part of ongoing professional development (Donner et al., 2004). Nursing careers can begin at several different levels, although most of these careers begin at the associate degree level in a position at a hospital providing patient care (Raines & Talgaireni, 2008). One article discusses the advanced age of many advanced practice nurses or doctorate prepared nurses and relates it to the requirement of experience for admission into some
CAREER CHOICES bachelor¶s and master¶s degree programs (Donley and Flaherty, 2008). Many programs require
at least one year of experience in clinical nursing for admittance. According to the authors, there is little evidence that experience is necessary, and this requirement of working before each step on their way to a doctorate degree can explain the ³under-education of the nursing field´ (Donley & Flaherty, 2008). Careers in nursing informatics begin generally after one obtains a master¶s degree in nursing. The days of nurses in this field are spent more with computers than with patients. According to the article, How about a career in nursing informatics?, ³If you choose informatics as a career, you will be introducing changes to the ways people work, think, learn, and live. Informatics nurses and specialists need a high tolerance for uncertainty, strong organizational and management skills, and knowledge of and abilities in interpersonal and organizational dynamics´ (Ozbolt et al., 2007). Interestingly, nurse educators do not all have master¶s degrees. To become a nurse educator at a major university or a community college, nurses must possess, ³graduate-level academic preparation and advanced expertise in the areas of content they teach´ (AACN, 2008). More than 86 percent of current vacancies in baccalaureate and higher degree granting nursing programs either require or strongly prefer faculty with a doctorate (AACN, 2007). Faculty with primary responsibility for the oversight of courses in baccalaureate, master's, and doctoral nursing programs will have doctoral preparation. Clinical Nurse Specialists hold a master¶s or doctoral degree in a specialized area of nursing practice such as: 1. A population (e.g. pediatrics, geriatrics) 2. A setting (e.g. critical care, emergency room)
CAREER CHOICES 3. A disease or medical subspecialty (e.g. diabetes, oncology) 4. A type of care (e.g. psychiatric, rehabilitation) 5. A type of health problem (e.g. pain, wounds) (Ozbolt et al., 2007). To obtain employment in entry-level positions in nursing or health care management a basic BSN degree may suffice. According to the Ferris State University website, ³nurses who desire to hold executive positions in those same settings must possess the knowledge and skills that are critical to the administrative role in these tumultuous times in the health care industry.´
Points of View
Many high school students may need direction and information regarding the career paths that can be chosen in the field of nursing. If students develop a career plan at this stage the journey will be much easier. With a long-term goal in sight it is easier to plan courses and schedules. Saving money by taking only courses that are required for a goal is another perk of having a career plan. Equipped with the best information and a well-developed career plan, students can spend more time developing their careers, and less time deciding on a career. Nurses currently working in the field could also benefit from career planning. If nurses become more aware of their options and continually strive for their long-term goals they can become more productive and satisfied with their current positions. Nurses who are not satisfied in their current jobs often consider leaving the profession altogether (. If a career development plan was available to the nurses who are in this position, it could be possible to retain them, with the idea of striving toward a long-term goal in a different area of nursing that may suit them better. Nursing really should be thought of as a field with something for everyone .
There are many assumptions about careers in the field of nursing. Many nurses assume that if they choose nursing, they will always provide direct patient care. According to Kim (2009) in the article Clinical academic research careers in nursing: towards global nursing , ³Nursing, which began as a practice discipline, since its inception has evolved to be a scientific discipline with practice´ (p. 126). Nurses are not required to provide care to patients and there are many options outside of this realm of nursing. Another assumption is that bedside nurses should only plan on obtaining an associate¶s degree. Research has shown that when an organization hires more nurses prepared at the baccalaureate level, there is a significant decrease in patient mortality in the acute care setting (DeBasio, Roberts, and Siler, 2008). In the future, it could become mandatory to hold a bachelor¶s degree in nursing to provide patient care in the acute care setting. This situation has arisen in England, where there will be required to hold a BSN to practice by the year 2013 (England hikes, 2010). As a nurse, it is critical to continually educate and to maintain an up-todate practice and to strive to provide the best care possible, even if that means continuing one¶s education. It is also important to know that not all nurses have associate¶s degrees or bachelor¶s degrees. Many nurses hold advanced degrees and provide care in a much different manner. The number of career options available by obtaining different types of degrees is vast, and the type of work performed after attaining such degrees is much different than the general public may assume. If everyone who entered the field nursing had full understanding of job responsibilities and the opportunities open to them, it could mean better nursing retention overall as well as a more diverse interest in nursing.
Career planning and development can impact nursing in several ways. Several organizations have implemented career ladders or mentoring programs. Both of these programs have been shown to have an effect on the culture of nursing at each organization (Donley & Flaherty, 2004). Although there has been significant research on the importance of variables such as control over practice, competency, and self-efficacy in relation to nursing work role effectiveness, there is little evidence in the literature of the existence of career planning programs and their subsequent evaluation (Donley & Flaherty, 2004). In the article Outcomes of a career planning and development program for registered
nurses , a career development program provided a workshop and individual career coaching to
registered nurses at a hospital (Donley & Flaherty, 2004). The goal of the program was to ³offered to staff to promote ownership for career development and visualize pathways for adaptation´ (Donley & Flaherty, 2004). The results of this study, ³demonstrated that the CPDP was effective as participants were able to create a career vision and develop an individualized career plan´ (Donley & Flaherty, 2004).
In the article, Career planning and development for nurses: the time has come, the authors describe a career in several steps (Donner & Wheeler, 2001). The steps are as follows: 1. Learning 2. Entry, 3. Commitment, 4. Consolidation, 5. Withdrawal.
CAREER CHOICES Stage one takes place while the person is still in school seeking a nursing degree. The second stage is the stage in which the individual enters the nursing workforce. Stage three
happens between years two and five of a nursing career and is the stage in which one may seek a mentor, evaluate career goals, and seek higher education. Stage four is the stage, ³notable for the dedication of the nurse to their career, commitment to ongoing learning and focus on making a contribution to health care and to society´ (Donner & Wheeler, 2001). The career plan described in this article follows a basic process consisting of scanning your environment, completing a self-assessment and reality check, creating your career vision, developing your strategic career plan, and marketing yourself (Donner and Wheeler, 2001). Scanning the environment consists of examining realities on a local as well as global level, both within and outside the nursing field. The article describes scanning the environment as, ³a continuous activity which, together with self-assessment, forms the foundation of the career-planning process´ (Donner and Wheeler, 2001). The self-assessment and reality check are much like the assessment you would perform on a patient before developing a care plan (Donner and Wheeler, 2001). This step enables you to identify your experience, values, knowledge, strengths, and weaknesses, and then add those together with your scan of the environment to create your career plan (Donner and Wheeler, 2001). Creating your career vision consists of examining the prior two steps and applying them to your career possibilities. In this stage you would ask yourself questions like: ³Where do I see myself going?´ and ³Do I like what I am currently doing?´ (Donner and Wheeler, 2001). Developing your strategic career plan is the stage in which one would specify the activities, resources, and time-span required to help you achieve your career goals. This step is
the part of the process where you start to put on paper the specific strategies you will use to take charge of your future (Donner and Wheeler, 2001). The fourth step, marketing yourself, ³involves the ability to package your professional and personal qualities, attributes, and expertise and to inform others about what you have to offer and why you are the best person for the work that needs to be ³ (Donner & Wheeler, 2001). ANA Standards
Comment [MSOffice1]: This is a nice overview of the article Nicole, but implications should be your interpretation of what you have gleaned from all the other elements of reasoning. If you incorporated these as ³interventions´ as part of the implication section, this is an appropriate piece of the section but should be identified as such with a sub-heading or intro sentence stating same. Also I don¶t see any of the ANA standards addressed?? There are many that would have been applicable to this topic«.
To assess the outcomes of a career development program several things must be considered. The quantitative data that could be monitored are: rates of nursing turnover, absenteeism among nursing staff, patient outcomes before and after implementation, and the number of nursing seeking higher degrees of education before and then after implementing the program. An ongoing evaluation of mentor and mentee relationships is essential. Overall nursing job satisfaction rates can be monitored using a basic survey tool. Another factor that would be monitored is the change in income for participants. If after several years of participating in a career development program nurses are making more money than those who did not participate, it could be said that the program is related to increased wages.
Career development is an important issue for all nurses. Developing a long-term satisfying nursing career is something that with thought and planning can be a smooth and gratifying process. Nursing is a complex career with many issues and seemingly unlimited options. The bottom line is that if one is unhappy with their current nursing position a little thought and planning can take them to an entirely different place, while remaining within the
Comment [MSOffice2]: These are good general evaluation ideas«but more specifics about how these things could be evaluated in a practical sense would greatly strengthen. You should be pulling from your research class to identify strategies«there would be so many variables in measuring the things you identify that it would be important to share how/who you would be studying in what situations.
CAREER CHOICES same career. If nurses are equipped with a plan and emp owered to mark their destinies, the entire healthcare field can only benefit.
CAREER CHOICES References AACN (2004). AACN Position statement on the practice doctorate in nursing. American
Association of Colleges of Nursing, Available at
http://www.aacn.nche.edu/DNP/DNPPositionStatement.htm. Bloomberg & McGillis. (2008). Career planning and development needs of rural and remote nurses. Journal of Research in Nursing, 13(3) , Available at http://jrn.sagepub.com England hikes educational requirements for nurses. (2010). Canadian Medical Association
Journal , 182(2), 129-130.
DeBasio, N., Roberts, K, & Siler, B.,. (2008). Profile of non-nurse college graduates enrolled in accelerated baccalaureate curricula: Results of a national study. Nursing Education
Perspectives , 29(6), 336-341.
Donner, G. J., & Wheeler, M. M. (2001). Career planning and development for nurses: the time has come. International Nursing Review, 48(2), 79-85. Available at http://0www3.interscience.wiley.com.libcat.ferris.edu/cgi bin/fulltext/118972903 /PDFSTART Donner, G., McGillis-Hall, L., Waddell, J., & Wheeler, M. (2004). The outcomes of a career planning and development program for registered nurses. Nursing Economics, 45(12) Donley, R., & Flaherty, M.J., (2008) Promoting professional development: three phases of articulation in nursing education and practice. OJIN: The Online Journal of Issues in
Nursing; 13(3) Available:
Gates, M. & Jones, C. ( 2007) The Costs and Benefits of Nurse Turnover: A Business Case for Nurse Retention. OJIN: The Online Journal of Issues in Nursing, 12(3) , Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/T ableofContents/Volume122007/No3Sept07/NurseRetention.aspx Kim, M. J. (2009) Clinical academic research careers in nursing: towards global nursing.
Journal of Research in Nursing , 14(2), 125-132.
Ozbolt, J., Eun-Shim, N., Roberts, D., & Wilson, M. (2007). How about a career in nursing informatics? American Nurse Today, 3(9), 34-36. Raines. C.F., Taglaireni, M.E., (2008) Career Pathways in Nursing: Entry Points and Academic Progression OJIN: The Online Journal of Issues in Nursing , 13(3), Manuscript 1. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/T ableofContents/vol132008/No3Sept08/CareerEntryPoints.aspx
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