My Transition into the Advanced Nursing Practitioner Role - Research Paper Example

 My Transition into the Advanced Nursing Practitioner Role Introduction Transition has generated a great deal of interest from nurses, clinicians, researchers and theorists. Transitioning to a new role or organization represents a real challenge to the prospective incumbent. Often, the individual involved in the process faces an overwhelming level of novelty that implies learning new information, gaining familiarity on new procedures, and being acquainted with new co-workers (Ashforth, 2001). Transition is a process in which an individual can observe and learn suitable behaviors, attitudes, and the mindset necessary in taking on the new position (Schumacher, 2007). I have decided to shift from professional nursing and pursue a career in advanced nursing. To become accustomed to new tasks and duties, I underwent a learning process to define my new role and adapt to the responsibilities that are expected of the position. All these are requisites to demonstrating professionalism in the new post. Schlossberg’s Transition Theory According to Evans et al (1998), the Transition Theory was established to have a framework for facilitating and understanding individuals, adults in particular, and helping them deal with the processes involved in living. Furthermore, using this model, practitioners may understand the reasons behind the reactions and coping abilities of people towards transition and the circumstances that surround it. Schlossberg (1984) has also pointed out that it is necessary to have complete awareness and understanding of what transition means for a person. To do this, the first step that one has to take is to classify the transition, whether it occurs predictably (anticipated transition), unpredictable or unplanned (unanticipated transition); continuous and persistent (chronic “hassles”); or is expected but does not take place (non-event transitions) (Evans et al, 1998; Schlossberg, 1984). The second step is to identify the relationship that exists between the person and the event that results into changes. This step represents one of the most critical facets that permit an understanding of the transition. Finally, the impact of the transition on the individual should be evaluated as to degree of change that it implies on the person’s life. Moreover, whether the transition is positive or negative as recognized by the person, can create stress. Such experience of stress mainly depends on the ratio of assets and liabilities or the balance that weighs out one’s positive and negative emotional affect related to the transition (Farley, 2002). It essentially predicts personal sense of happiness and comfort and clarifies why one person can have different reactions to various situations at different times. The theory included three components in its revised form - approaching change, taking stock, and taking charge. The component of taking charge focuses on three phases of transition, namely, moving in, moving through and moving out. During the “moving in” phase, the individual will have to learn about new rules, procedures and expectations in the new system (Schlossberg, 1997). On the other hand, the “moving through” process, will evaluate his or her endurance. Finally, the “moving out” stage, feelings of unhappiness or dissatisfaction is possible, even if the transition is considered positive, helpful and voluntary (Schlossberg, 1997). Transitions typically lead to growth and development; however, failure is also potential outcome and individuals involved in the transition may be hesitant to go through the process. The taking stock component identifies the 4 S’s- “situation, self, support, and strategies” (Chickering & Schlossberg, 1995).The idea of the 4 S’s was established to look for an organized process for change while taking charge and taking stock. For an individual to effectively manage transition, there is a need for him to consider these four concepts (Goodman, Schlossberg, & Anderson, 2006) and closely examine his own situation by asking questions in relation to the situation, self, support and strategies for coping. The examination of the situation involves asking about the kind of transition, or how it is perceived to be (e.g. positive, unexpected or desired). The self concept examination asks about the strong and weak points of an individual or how he copes with uncertainty. In the support facet, the person asks whether he has acquired support from family and friends, or co-workers and managers and in what way they have provided support (Goodman, et al 2006). Once he has considered these assets and liabilities, the next thing to do is to take charge. In the facet of strategies for coping, the person plans how to address and cope with the transition. Therefore, the individual evaluates how he can cope with the situation by managing his reactions to change and stress. The 4 S System rests on several assumptions. First, there is not one single factor that is necessary to cope with change; second, each individual has a balance of resources and deficits in facing transitions (Chickering and Schlossberg, 1995, p. 51). Furthermore, the resources and shortfalls of an individual are not permanent as these can change over time. Placement in the Transition Process: Where I Am Using the Transition Theory, I believe I am still in between the “moving in” and “moving through” phase in which there is still a great need to learn more about my new role as a practitioner of advanced nursing, along with the duties and professional responsibilities that come with it. Moreover, I am entering into a new context that is related yet somehow different from my role as a nurse. I believe that I am also in the “moving through” stage as I am beginning to manage and deal with everyday tasks and decisions related to my new role in advanced nursing. These include time management; practicing with a wider perspective; choosing appropriate means for communicating and interacting; as well as finding my place within the new community. I perceive that shifting to advanced nursing will be a positive transition for me. It shall allow me to competently evaluate the status of a patient’s health. I shall also be able to adapt more easily to this change in role, as it is a personal choice, and has been done with a certain, deliberate purpose. Because advanced nursing is more extensive and all-encompassing, I think that there a number of personal changes necessary so I can cope better with the transition process and meet the expectations of those I will work with. First, because advanced nursing involves a larger setting and more individuals, I should further improve my observation, research, and data gathering skills. My new duties feature a substantial degree of collection of information from patients to thoroughly assess their health conditions and overall wellbeing. I am also tasked to identify any future threat or concerns. Moreover, I should also work more on my skills for communicating and interacting with people since successful collaborating and working across boundaries is critical in advanced nursing practice. It can help me in identifying health problems and needs; establishing priorities with patients; and involving them in choosing the best actions to be implemented towards restoring or preserving their well-being. It will also help if my skills for solving problems be enhanced as it is very important for carefully analyzing the health issue and subsequently determine the most optimal nursing care plan. Furthermore, because my job will cover a wider setting, I believe that it is important to know stress management to cope with the increased demands of the new role. Barriers to Advanced Nursing Practice Though I am determined to undergo the necessary changes to cope effectively with the new role, there are some facets of the role that are not within my direct control. There are many barriers to practicing advanced nursing that exist in both the community and international setting. In recent years, Simons and Roberson (2001) report the most common barriers in advanced nursing practice are poor communication and knowledge deficits. When nurses are not able to communicate effectively with patients and lack knowledge and skills to manage the conditions of patients, these may imply risks to patients’ well-being in the process of according care to them. Moreover, Plager and Konger (2007) identified two main barriers to advanced nursing practice, namely, internal disputes between nurse practitioners and clinical nurse specialists, as well as the external barriers related to public policies. It is important to identify these constraints for dovetailing interventions for preparing practitioners for advanced nursing practice and fully preparing them for the role. As pointed out by Bryant-Lukosius, DiCenso, Browne, Pinelli (2004), there have been difficulties in maintaining nursing values in the advanced nursing practice role, including being patient-centered, holism, and being focused on health. Furthermore, consistent with what have been reported in many care organizations, advanced practitioners are expected to replace or substitute for a physician rather than allowing them to focus on their nursing role. These confusing demands have also become barriers to the advanced nursing practice (Jones, 2005). There have also been reports that a number of advanced nursing practitioners work in practice settings that do not allow or encourage them to consider and analyze all factors necessary in treating health conditions. This becomes a disadvantage as teaching and counseling are considered main responsibilities of nurses and APNs, and sets them apart from other health care providers. Graduates of APN have also encountered conflicts between the actual nursing model and the medical model of practice. Practitioners are increasingly being steered into the direction of a medical model and therefore significantly reduce their time in being able to provide holistic care. What becomes a particular challenge to such practitioners is the fact that decisions have to be made between further enhancing and adding to the care that should be provided or becoming substitutes for physicians. The desired objectives of majority of APNs are to become involved in nursing that involves holistic practice that is not medical; rather than becoming physician substitutes, they intend to offer patients with more specialized health care services. In terms of public policy, barriers that exist in the practice of advanced nursing lie in prescriptive privileges, with which those practicing in this field are not allowed to prescribe medications without the supervision of the physician. In addition, being accredited by organizations is essential to the practice of advanced nursing and allows practitioners to be listed as providers and have their set of patients. However, this process of credentialing may be particularly difficult in certain health care organizations (Phillips, 2007). The direction that managed care organizations (MCOs) are taking towards health care has had an impact on the practice of advanced nursing. Three issues were also identified in dealing with the healthcare system along with practicing advanced nursing. First, time issues have had an impact on the constraints that practitioners and nurses experience on a daily basis, particularly between their personal and professional life. Their opportunities for teaching and counseling are also being reduced as well as their time to interact with their peers and colleagues. In short, many APNs struggle when they are placed in work settings and their roles and responsibilities take most of their time (Plager & Konger, 2007). Some practitioners also believe that being placed in rural settings in which there are fewer opportunities, a lack of services and fewer resources for providing optimal care can be a barrier for the nursing practice. In such cases, it has been reported that the practitioners and health care providers have to change their plan and steer towards the direction of the real environmental situation. Strategies for Addressing Barriers To address such barriers, specialized training may be carried out during my transition process as training and supervision has become one of the most rapidly expanding subsystems of advanced nursing. The growth in advanced nursing training has been born out of the effective methods that are utilized in these learning interventions (Schober and Affara, 2006). When practitioners from different agencies are involved, this helps create policies that can incorporate important aspects of advanced nursing. Moreover, opportunities should be given to experienced staff members to pass on their knowledge with staff members who are less experienced. Training has become essential to advanced nursing as it allows the transfer of values, knowledge, professional responsibilities and skills to new practitioners (Schober and Affara, 2006). Frakes and Evans (2006) further suggest that those who practice advanced nursing must be able to negotiate with their patient to provide both nursing and medical care. Those who will take up advanced nursing must develop professional values and related attitudes that can significantly influence policies in advanced nursing and reduce constraints to the practice including the implementation of reimbursement policies as well as prescriptive authority that will support their desired nursing outcomes and independent practice. Practitioners generally need to understand and learn the ways of being able to cope with the responsibilities of an APN position. They have to be capable of providing time as much as necessary with their patients for them to provide both nursing and medical care. It is also suggested for APNs that they agree on a contract that can provide them with time, reimbursements, and back up protections necessary to attend educational and training programs (Plager & Konger, 2007). Moreover, these practitioners must learn how to bring about change as well as improve communication skills that are necessary for supporting patient care in health care systems and improving the practice of advanced nursing. For those involved in nursing practice among rural areas, the entire concept and nature of rural practice must first be thoroughly presented to introduce students to rural theories and policies and allow them to evaluate the rural community. Support Systems during Transition Among human service professionals, there has been growing recognition of the importance of support systems. In many communities, it is normal for groups of individuals to exist in order to help each other in coping with various problems of daily living. These groups provide an attachment among individuals and promote competence to adapt to life crises and transitions (Baker, 2005). In order for me to succeed in the field of advanced nursing, support systems are essential. The support of my superiors is particularly critical to help me during decision making and crisis management. This has been supported by Tzeng and Yin (2008) who conducted a study among nurses and found out that these individuals demanded more support from their supervisors. I also believe that support systems, particularly one’s family, can significantly influence performance in the role. For example, if I am accorded stronger family and social support, it is likely that my level of stress in the practice will be reduced; thus effectually helping me achieve better performance. Ogus (1992) expresses that nurses with less social support are more prone to experiencing higher levels of burnout. Formal sources of support including agencies, institutions and other professionals are also necessary. I believe that through these groups of individuals, I will be able to fully understand the value of advanced nursing in the health care industry. Opportunities are also readily available especially when these support systems are also committed to providing continuous improvement and excellence in the field of nursing. Plan for Transitioning into the Advanced Nursing Role My plan in transitioning from a professional role to an advanced nursing role is to acquire as much skills and knowledge as possible through the right educational programs or learning interventions. Even before graduation, the more training and experiences I go through, the easier I may adjust to my new responsibilities and the better I can perform the new role. By the time I reach my first year of practice, I should develop a professional attitude, to use my skills and knowledge effectively to contribute to patients’ health gains. I also desire for professional advancement and focus more on sectors that are in need of complex care such as in primary health and home health care. In effect, the preparation to the new role entails the right beliefs, attitudes and behaviors. This implies developing the right competencies that will make me suitable for the new job. Apart from formal classroom training, I am likely to improve in my new job by reading up supplementary materials for improving both my technical skills and soft skills. Technical skills mean those that are directly related to advanced nursing practice. On the other hand, soft skills pertain to critical thinking, negotiation, building relationships, and the like. Since the role will require frequent interface with patients and other care providers, it is necessary to acquire skills in management and leadership. Yet another step for development may be mentoring, which suggests finding an expert in the advanced nursing practice who can patiently walk me through the nuances of the role. Speaking and buddying up with such experts will be a critical intervention for my transition. Hands-on training and realistic job previews will also help me in effective, future, job performance. This will represent the application phase of the knowledge and skills which I have acquired thus far. Constructive feedback from more experienced practitioners and colleagues during this on-the-job training is also commendable to see how others perceive my performance of the role, even during a ‘test’ or ‘pilot’ phase. By graduation, my plan of action is to focus on studying and evaluating our community, the standard of care that we have, the clients in our facility and community that are in need of both nursing and medical care, as well as the strengths and weaknesses that our association may have. Second, I intend to understand all information gathered, educate my membership and seek for coalitions in my community. From here, I can identify my goals and develop it into strategies, so I may concretely respond to the pressing issues and concerns that the community holds. Aside from these non-formal learning opportunities, I am also open to formal learning activities including training courses and programs. With these approaches, I can acquire evaluations such as certificates and feedbacks that will begin the self-evaluation process again and will lead to a continuous learning cycle. Though I will become an APN, I still believe that learning should be a continuous process. Readiness for Chosen Nursing Role If I were to evaluate my readiness for this transition role, I believe I am well prepared; however, I still need to adjust and cope with the new and more complicated responsibilities in advanced nursing. I feel like I am in between the “moving in” and “moving through” phase in which I have yet to adapt to the new setting. Though I have already learned the functional competencies necessary for advanced nursing, and right attitudes that go with it, there is still much room for improvement. In terms of my coping ability, I believe I am quite ready to take on a new role as I am purposively learning about the factors that can positively and negatively my transition process. Moreover, I should handle stress while undergoing this transition. This is the reason why I deem it important to understand the transition process- to learn the effect and significance of changes in our lives and to identify how I can cope with such changes. My deficits for the effective performance of the role can in fact be turned into opportunities. Through reflection, I shall reinforce the values that I advocate and the commitment that I have to the role. Moreover, I am able to effectually recognize and redefine the relationships around me, that contribute to my performance of this new post. Overall, the transition into an advanced nursing role may be a complex, personal change. However, with my resolute decision to cope effectively with this transition, I will succeed and eventually contribute to the better care of patients in as advanced nursing practitioner. References Ashforth, B. (2001). Role transitions in organizational life: an identity-based perspective. New Jersey: Routledge. Baker, F. (2005). The interface between professional and natural support. Clinical Social Work Journal, 5(2), 139-148. Bryant-Lukosius, D., DiCenso, A., Browne, G., and Pinelli, J. (2004). 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Burnout and coping strategies: A comparative study of ward nurses. Journal of Social Behavior and Personality, 7, 111-124. Phillips, S.J. (2007). Nineteenth annual legislative update. Nursing Practice, 32 (1), 14-20. Plager, K.A., and Conger, M.M. (2007). Advanced Practice Nursing: Constraints to Role Fulfillment. The Internet Journal of Advanced Nursing Practice 9(1), 10-24. Schlossberg, N.K. (1984). Counseling adults in transitions. New York: Springer Publishing Company. Schlossberg, N.K. (1997). A model of worklife transitions. In R. Feller and G. Walz (Eds.), Career Transitions in Turbulent Times. Greensboro: Eric Counseling & Student Services Clearinghouse. Schober, M. and Affara, F. (2006). Transitions: A Central Concept in Nursing. Oxford: Blackwell. Schumacher, K. (2007), Transitions: a central concept in nursing. Journal of Nursing Scholarship, 26(2), 119-127. Simons, J.S. and Roberson, E. (2002). Poor communication and knowledge deficits: obstacles to effective management of children's postoperative pain. Journal of Advanced Nursing, 40(1), 70-86. Tzeng, H.M. and Yin, C. (2008). Crisis management systems: Staff nurses demand more support from their supervisors. Applied Nursing Research, 21(3), 131-138. Top of Form Rew Read More