My goal one year from now is to be able to look past the technical skills required by patients and be an expert at identifying and addressing patients who are in distress. I plan on obtaining this goal by practicing my assessment skills using Betty Neuman’s theory. I plan on developing my therapeutic communication skills and learning about other cultures so that I can develop better rapport with my clients. As a five-year goal, I would like to be certified in end of life care, also known as palliative care. I feel that taking care of people who are dying and their families identifies the true essence of nursing. My leadership preceptor, Commander Aubin-Kelly, stated, “When medicine fails, that’s when nursing shines in all its glory” (M. Aubin-Kelly, personal communication, April 2, 2002). My objectives for accomplishing this goal are to educate myself regarding palliative care and to able to effectively use therapeutic communication with patients and their family members. My plans for achieving my objectives include searching for opportunities to attend conferences regarding palliative care, reading articles in professional journals, taking continuing education tests if available, watching videos of actual nurse-patient interactions, and computer software. I also plan to have discussions with my colleagues regarding how they handle communication with patients and families.
Leadership
My early ideas of a nurse’s role as a leader formed during my sophomore year in college. I felt that a nurse must be a leader by virtue of the fact that he/she has so many responsibilities. At the Fundamental level, I saw the nurse as a leader in a simplistic sense. A nurse must demonstrate Universal precautions to prevent the spread of infection. A nurse must lead the health care team during assessment of an individual as that is the database the healthcare team will be using. As a senior, I now know that the leadership role is much more complex than being responsible for your own actions. According to Allen (1998), the “effective nurse leader must be able to navigate successfully in the current turbulent health care environment” (p.15). Professional nurses are tasked with more responsibilities than I initially thought. As I observed my preceptor as charge nurse during my Independent Practicum, I asked myself why anyone would ever want to take on that job. My preceptor demonstrated her use of interpersonal relationship skills, communication skills, critical thinking, and organization skills. Allen (1998) states that the “unique attributes of the healthcare industry make the work of nursing leadership challenging and complex, requiring diverse expertise and knowledge, superb critical thinking skills and exceptional interpersonal capabilities” (p.15).
A goal that I have set to achieve in one year is first to be an active member of a professional nurse organization. I would also like to be able to identify positive leadership characteristics of my mentors and those that I develop. My objectives include passing the board exam for professional nurses, gaining employment as a Registered Nurse, and obtaining membership into Guam Nurses’ Association. My specific plans to achieve these objectives include reviewing for my board exam using computer software and books. I plan on taking the board exam within three months of graduating from the College of Nursing. Once employed, I will carefully examine my surroundings and evaluate positive leadership traits of my coworkers and of those that I achieve. My five-year goal is to be able to take on supervisory roles at my place of employment as well as serve on the executive board of one of the nursing organizations. My objective for reaching these goals include observing those in the positions I seek and familiarizing myself with their job descriptions. I plan to master the art of becoming a charge and head nurse before looking at becoming a nursing supervisor. I also plan to become a chairperson for committees of a professional organization to demonstrate and develop my leadership skills.
Change Agent
As I compare my perception of the nurse’s role as a change agent, I see that my initial views centered on the nurse-patient relationship. With a nurse’s knowledge of various areas, they could affect anything from teaching a new mother how to breastfeed to convincing a teenager to stop smoking. I also felt that the personality of an individual has a direct impact on the effectiveness of their ability to affect change. It was not until my senior that I began recognizing the many changes that could be made to improve the quality of care delivered by the agency. This care has potential for improvement under the direction of the nurse as a change agent. My initial view of the nurse as a change agent compared to now was like the metamorphosis of a caterpillar to a butterfly. As I stated before, I strive for the best. Learning how the nurse could be a change agent stimulated my critical thinking. Every time I walk into a health agency now, I am always analyzing what could be improved. Kerfoot (1996) explains that “we must not only personally embrace and work effectively with change, but we must create a culture that values and supports change so our staff can see change as an exciting challenge and as an energizing opportunity” (p.367). I have learned that change is a topic that may not be inviting to staff members who are set in their ways. Nurses utilize theories such as Kurt Lewin’s Social Change Theory that includes Unfreezing, Movement and Refreezing. Nurses have to be able to use their leadership and interpersonal skills to motivate others to accept change.
In one year, I plan to be employed at a health agency. My goal is to identify possible changes that can be made to enhance the quality of patient care, safety and professional development within the organization. My objectives include reviewing policies and procedures of the unit I am working at and communicating with staff about what they perceive as needing improvement. To meet these objectives, I plan to obtain copies of the handbook on policies and procedures of my specific unit, evaluating the staffs’ recommendations of possible change projects, and their perceptions on change. My five-year goal is to have successfully implemented at least two changes that will have a positive impact in my place of employment. My objectives include finding an opportunity for change, organizing a team to work on the change, clarifying knowledge of the current process, identifying alternate solutions, implementing the change and evaluating it. I plan to use the same process I used in my Leadership Practicum outlined for my chance project..
Client Advocate
My initial translation of nurse as client advocate was simply looking out for a client as an older brother would protect a younger sister. If a nurse felt something regarding a patient’s care was wrong then they should do all they could to clarify and settle the issue. My initial understanding of client advocacy in comparison to my current understanding has not changed very much. Perhaps it is because I have yet to study the nurse’s scope of practice in definition in terms of advocating for clients. However, I do know that nurse are in the best position to advocate for clients. In a literature review on advocacy in nursing, Mallik (1997) identifies that “at a political and functional level, nurses are well placed in the division of health care labour , and can act as natural mediators because of their location within the health care team” (p.134). Nurses often times form unique relationships with their patients and this encourages nurses to act as patient advocates. According to my readings, education and actual training are the best ways to prepare nurses to become a client advocate.
My one-year goal as client advocate is to recognize situations of when and how to advocate for a patient. My objectives include familiarizing myself with any resources that may help me to develop advocating skills. Written materials such as case studies and activities such as case-reviews would be very helpful. My five-year goal is not to become a specialist practitioner in patient advocacy. Rather, I would like to achieve an internal satisfaction that I have done what I could to educate myself and actively advocate for my clients whenever it is needed. To reach my goal, I plan to continue to educate myself regarding patient advocacy issues and seek advice from my mentors.
Political Activist
I began to think of the nurse’s role as a political activist when I was a sophomore. I recognized that there were many nursing issues that should be brought up to the legislature and I rarely saw any nursing issues in the local media. I recognized that salaries and morale were low, but I hardly saw any nurses writing their comments in the newspaper, protesting, or actions by any nursing associations. I was aware thatt Lou Leon Guerrero was a nurse–senator, but I was not cognizant of any activities that she did to promote nursing’s interests. I received some exposure to policy making during my Community Health nursing course, but I feel it was not enough to enable me to depict a significant change from my initial ideas of the nurses as a political activist. Conger (2000) cites that nursing students are not prepared to take active roles in the health care delivery system. Conger (2000) feels that nursing programs should promote “political participation and range from instilling awareness in nursing students to fostering candidates from the nursing ranks for political office” (p.100). In recent months, Guam nurses have become very active in advocating for themselves. An increase of forty-four percent to nursing salaries is underway. Unfortunately, this is due to the nursing shortage and the exodus of nurses in protest of low salaries. However, I have seen groups such as the Commission of Nurse Leaders working towards providing information to entities that have the power to affect nursing salaries. I have also recently seen Nurses protest inadequate salaries and difficult workloads.
My one-year goal is to acquaint myself with the political issues that nurses may have influence over. My objectives include becoming more cognizant of health issues at the policy level and acquainting myself with the issues that nurse politicians involve themselves with. I plan on achieving these objectives by attending public hearings, reading the newspapers, and interacting with other nurses who stay current with political issues. In five years, I hope to begin my graduate program and work toward becoming a leader in healthcare reform. My objectives and plans include researching and implementing quality patient care. I also plan on acquainting myself with those in the government responsible for health policy.
Research Consumer
As I reflect on my initial ideas on the research consumer, I realize that there is a big difference in my understanding of this nurse’s role now compared to then. I used to think of research as just looking into my textbook and finding rationales for nursing interventions to write on my care plans. The realization of the importance of a nurse’s role as a research consumer became evident during my Research in Nursing class. I discovered that there was a whole process to analyzing research work. Nurses are trained to learn skills and these are strengthened if they are based on research. Research is constantly providing evidence for changing the procedures for various skills. If a nurse does not take the responsibility to keep up with the most current research-based practices, they may not be providing the highest standard of care. My initial idea of nurses as research consumers are similar to the nurse’s current role in that the reason for being a research consumer is to have evidence for performing a certain skill.
My one-year goal is to be more mindful of the roles professional nurses take as research consumers. My objective is to identify what is expected of nurses regarding research and I plan to assess how nurses utilize current research. My five-year goal is to be knowledgeable of the most current research in my specific area or nursing and become a source for providing that information to my unit. I plan to subscribe to various Professional Journals, utilize library sources and regularly visit nursing websites to maintain current information.
Conclusion
My four years of nursing school have helped me to develop more accurate concepts of the nurse as caregiver, leader, change agent, client advocate, political activist and research consumer. Writing this paper has helped me to reflect on what I have learned about nurse roles. It has also helped me to discover that I still have much to learn regarding these roles and that experience is going to be the best avenue to help me identify these roles more in depth. In doing so, I imagine that I will be able to set more goals to achieve in the future.
References
Allen, D. (1998). How nurses become leaders: Perceptions and beliefs about leadership development. Journal of Nursing Administration, 28(9), 15-20.
Barter, M. & McFarland, P. (2001). BSN by 2010: A California initiative. The Journal of
Nursing Administration, 31(3), 141-144.
Conger, C. & Johnson, P. (2000). Integrating political involvement and nursing education. Nurse Educator, 25(2), 99-103.
Kerfoot, K. (1996). The process of change. Dermatology Nursing, 8(5), 367-368
Mallik, M. (1997). Advocacy in nursing- a review of the literature. Journal of Advanced
Nursing, 25(1), 130-138.
Morse, J. (2000). On comfort and comforting. American Journal of Nursing,
100(9), 34-37.