Transition Class #4

11/30/05

Role Transition
Transition – passages or changes from one situation, condition, or state to another over
a period of time.

Reality Shock
 This term describes what a person often experiences when moving into the
workplace after years of educational training. The new graduate may become
stressed about meeting the patient's needs as taught in nursing school rather than
also thinking about their own needs. The basis of it is the discrepancy between the
expectations of the employer and the education prep of the graduate nurse.

Phases of Reality Shock

1. Honeymoon Phase
 Sees the world through “rose colored lenses”
 Fascinated with the thrill of entering the profession
 This phase is very short lived because of reality setting in
 In this phase, you will want to be helpful to coworkers.
2. Shock Phase
 Excessive mistrust
 Physical concerns such as sleep and stress
 Decreased energy
 Feelings of failure because trying to be perfect
 Sticks with peers with like values
 Hypercritical attitude
 Moral outrage
 Graduate nurse should stick with like values
3. Recovery Phase
 Sense of humor returns
 Decrease tension
 Increased objectivity
 Conflict resolution appears
 You learn and grow and develop

Resolution (Possible Methods of Resolving Conflict)

 wave makers - get involved in workplace and nursing organizations, most
successful at adaptation. This group was able to take worthwhile values
learned during school and integrate them into the work setting.
 burned out - stuck in a rut resulting in griping and complaining , work for
the check, don't belong to any nursing organizations
  organizational nurses - content with the workplace but switch units or
shifts constantly to avoid increase demands for professional performance
 job hoppers - go to grad school, seek safer and more idealistic workplace.
These graduates achieve a high profile in nursing organizations.

Role Transformation
 Novice to expert
 Transition to graduate nurse
 Survival tips for role transition
 “Rules of the Road”

Novice to Expert
 First time having that experience
 Advanced beginner – where we are now until 2 or 3 years into your
career. To be able to recognize characteristics that can be identified only
through experience is the signifying trait of the advanced beginner.
 Competent –
 Proficient
 Expert

Transition to Graduate Nurse

Activities which reinforce your progress and movement along the continuum from
advanced beginner to competent nurse:
1. no more mama management- teacher should have cut cord allowing you more
independence
2. more realistic pt care assignments - taking on more than 1 patient at a time to
help with time management and work organization.
3. increased opportunities for follow up care in the home or community setting to
obtain experience in different settings
4. clinical hours that represent realistic shift hours – being there for reports,
closing charts, completing patient care and communicating with the oncoming
staff. As a graduate you are in for a rude awakening if you have never had the
opportunity to work a full shift.
5. perform nursing procedures instead of observing to gain experience in
unperformed or uncomfortable skills
6. more truth about the real work setting experience - talk to people who've been
there
7. look for opportunities to problem solve and practice critical thinking so you can
stand on your own 2 feet
8. request constructive feedback from staff and instructors so you can improve
your nursing care
9. Discuss your feelings/perceptions

Survival tips for role transition (preparing for role transition):

 Think positive – surround yourself with positive people
  Be flexible – there are many correct ways of doing things, be prepared to
do things differently than you learned when you were a student
 Get organized both personally and professionally
o To do lists
o Start a file folder system
o Post a calendar to keep tract of schedule
o Learn to say “no”. remember no is a complete sentence.
 Stay healthy – take care of yourself, eat healthy, take your vacation time,
take breaks, exercise
 Find a mentor – a mentor is an established professional (selected by you)
who takes a long term personal interest in your nursing career. Serves not only
as a role model or a counselor, actively advises, guides and promotes you in
your career. Trust and Caring are the hallmarks of the bonding that occurs
between mentor and graduate.
 Have some fun
 Know what to expect – plan ahead, know the “rules of the road”

Rules of the Road for Transition:

 Stop – take care of yourself. Take time to plan your transition. Get involved with
other recent graduates; they can help you. Don’t be afraid to ask questions
 Detour – You will make mistakes. Recognize them, learn from them, and put
them in the past as you move forward. Regardless of how well you plan for
change, there are always detours ahead. Detours take you on an alternate
route. They can be scenic, swampy, or desolate, or they can bog you down in
heavy traffic. Don’t forget to look for the positive aspects - the detour may open
your eyes to new horizons and new career directions.
 Curve ahead – Get your personal life in order. Anticipate changes in your
schedule. Be adaptable, because the transition process is not predictable
 Yield or compromise – You don’t always have to be right. Consider alternatives
and make compromises within your value system.
 Resume speed – maintain a positive attitude. As you gain experience, you will
become better organized and begin to really enjoy nursing. Be aware;
sometimes as you resume speed, you may be experiencing another role
transition as your career moves in a different direction.
 Exit – pay attention to your road signs; don’t take an exit you don’t really want.
Before you exit your job, critically evaluate the job situation. “look before you
leap”: Make sure the change will improve your work situation
 Slower traffic, keep right – you may be more comfortable in the slower-traffic lane
with respect to your career direction. Take all the time you need – it is o.k. for
each person to travel at a different speed. Don’t get run over in the fast lane.
 School zone – plan for continuing education, whether it be an advanced degree
or one to maintain your clinical skills or license. Allow yourself sufficient time in
your new job before you jump back into the role of full-time student.
  Slow speed zone – take time to get organized before you resume full speed!
Have a daily organization sheet that fits your needs and works for you in both
your job and your personal life.
 Caution – don’t commit to anything with which you are not professionally or
personally comfortable. Think before you act. Don’t react. Don’t panic. If in
doubt, check with another nurse.
 Roadside park ahead – take a break, whether its is 15 minutes or 30 minutes a
day to indulge yourself or a week to do something you really want to do.

Pulling – as a new nurse, you do not need to be pulled to another unit.

Make-up weekends – if you call in on a weekend shift, you have to make it up

Charge nurse – when should you take on this responsibility?

Power and Politics

Power -

Five Laws of Power (352)

1. Power invariably fills any vacuum – if there is an issue someone is going
to come and make the peace.
2. Power is invariably personal – provides leadership or spark to develop a
strategy to carry out such and initiative, thus inspiring people to contribute to the
effort.
3. Power is based on a system of ideas and philosophy – ethics type of
people, the patient’s bill of rights into policies and procedures
4. Power is exercised through and depends on institutions – be members of
organizations
5. Power is invariably confronted with and acts in the presence of a field of
responsibility. – individual in the power position is acting on behalf of the group,
power is communicated to observers and is reinforced by positive responses, if a
group thinks that its ideals are not being honored, the vacuum will be filled with the
next candidate capable of the role and supported by the organization

Politics – simply a process of human interaction within an organization. It is described

as “influencing the allocation of scarce resources”. It is a vital tool that enables the
nurse to nurse smarter.

Skills for Political Savvy:

1. Analyze an issue – must do the homework necessary to be well informed.
Must know all the facts relevant to the issue, how it looks form al angles and how it
fits into the larger picture
2. Being able to present a possible solution – must be prepared to coherently
frame and present arguments in support of his recommendation
 3. Participate in a constructive way – if an individual’s concern is not directed
toward solving the problem, they will not be seen as a team player, but as a trouble
maker. Positive action can produce the kind of creative brainstorming that results
in a solution.
4. Voice one’s opinion – sit back and listen to figure out who best to
communicate your opinion or solution.
5. Analyze and use power bases – be alert to the various power brokers

Political Involvement:
 Know the candidate
 Campaign involvement
 Contribute to health care knowledge
 PAC (Political Action Committee) – way to pool resources in order to endorse a
candidate
 Lobbying – attempt to sway or influence a public official to take a desired action
o It is important to educate officials on the issues

Controversial Issues Affecting Nursing (364)

 Uniform core licensure requirements
o Mutual recognition, it is important that health care consumers have
access to nursing services that are provided by a nurse that meets
consistent standards regardless where the consumer lives.
o Three primary areas of framework
1. Competence Development - the method by which a nurse
gains nursing knowledge, skills and abilities.
2. Competence Assessment – the means by which a nurse’s
knowledge, skills, and abilities are validated.
3. Competence Conduct – refers to health and conduct
expectations, including assurance that licenses possess the functional
abilities to perform the essential functions of the nursing role.
o Interstate compacts
 Collective bargaining
o Unions – The National Labor Relations Act grants employees the
right to form, to join or to participate in a labor organization
o Supporters argue that unions are a tool to force positive changes in
the practice setting, a method of controlling the practice setting.
o The major advantage of coverage under a collective bargaining
agreement is that it is a contract negotiated and signed by duly authorized
representatives of management and nurses and it, therefore binding and
enforceable.
o Opponents feel the contract will restrict freedom, flexibility and as a
result the professional judgment of the RN
o Opponents also feel that striking should not be used.
 Equal pay
 o Jobs that are equal in value to an organization ought to be equally
compensated whether or not the work content of those jobs is similar
o Salary compression

NCLEX - National Council Licensure Examination for Registered Nurses (543)

Test Plan:
 The Nursing Process
o
 Patient’s Needs
o Safe effective care environment (23%)
o Health Promotion and maintenance (10%)
o Psychosocial integrity (15%)
o Physiological integrity (52%)

NCLEX Facts:
 Computerized Testing (CAT)
 Amount of time for testing – 5 hour time slot scheduled, the average time for
testing is around 2 hours

NCLEX Reviews:
 Review books
 Review courses
 Test taking strategies

Career Planning
Self Assessment (501)
 Clinical interests
o Make lists of clinical areas that interest you and why and prioritize
them
 What are your likes and dislikes?
1. Do you enjoy an environment that provides a great deal of patient
interaction, or do you thrive in a technically oriented routine?
2. Do you enjoy working closely with other staff or prefer a more autonomous
role in patient care?
3. Do you learn best in a highly structured environment of in a more informal
on the job training?
4. Do you really like making autonomous decisions, or do you want and need
more direction and supervision at this point in your professional
development?
5. How much physical energy are you able and willing to expend at work?
6. Are you a day, evening or night person?
7. Do you like rotating shifts, or perhaps more realistically, can you work
rotating shifts?
 8. Can you work long hours (e.g., 12-hour shifts) without too much tension and
fatigue?
9. Do you like making decisions quickly or generally favor a more relaxed
approach to clinical problems?
10. What do you need in a job to be happy?
 Personal needs
 Career goals

Planning for Employment

 Determine which position/job you want

Employment Considerations (492)

 Job responsibilities
 Salary
 Locations

Maintaining Competency
 Continued learning
 Educational advancement
 Certification

Self Management (523)

Potential Occupational Threats to Health and Well Being
 Biologic/Infectious – back injuries, shift violence
 Chemical – radiation exposure
 Environmental
 Physical
 Psychological

Impaired Nurses:
 Alcohol
 Drugs
 Psychosocial

Burnout:
 Loss of energy
 Weariness, gloominess
 Dissatisfaction
 Increased illnesses
 Absenteeism
 Decreased efficiency
 Self doubt

Five Stages of Burnout:

1. Initially a feeling of enthusiasm for the
 2. Loss of enthusiasm
3. Continuous deterioration
4. Crisis
5. Devastation and inability to work

Causes of Burnout:
 Restructuring
 Increased use of unlicensed personnel
 Staffing shortages
 Working environment not congruent to personal philosophies

Holistic S (531)

Emotional Wholeness (532)

 Ability to feel and know what we are feeling
 Expressing one’s emotions is a sign of good mental health

Mental Wholeness
 Ability to dream and fantasize
 Remove negative and self defeating thoughts
 Give self daily affirmations
 Tell self you are special and worthy of self-love of others

Social Wholeness
 Tend to over-commit personally and professionally
 Need to engage in recreational activities
 Money in the budget for fun
 Form relationships outside of nursing
 Friends in other major areas of study
 Maintain your humor

Physical Wellness
 Tend to neglect our physical health
 Non compliance
 Need
o Proper nutrition
o Exercise

Spiritual Wholeness
 Doesn’t necessarily deal with religion
 Feeling of being alive, purposeful and fulfilled
 Daily pray, meditation
 Read spiritual and/or philosophical materials
Choice Potential (540)
 Realize that we have choices on how to respond and react
 Be proactive rather than reactive
 Make things happen rather than waiting for things to happen
 We can choose to respond to people rather than react
 Must act responsibly toward ourselves and others
 Involves self acceptance and self love