Nurses in Transition

Definitions of Transition Any event or non-event that results in changed relationships, routines, assumptions, and roles, often requiring new patterns of behavior Not so much a matter of change as of the individual’s own perception of the change A transition is a transition only if it is so defined by the person experiencing it Schlossberg, N.K., Waters, E.B., & Goodman, J. (1995) Counseling adults in transition: Linking practice with theory (2 nd ed.) p. 28

Types of Transitions Anticipated—expected events (marriage, birth, first job, retiring) Unanticipated—usually crises or unexpected occurrences (being fired, illness, death of a child) Non-event—expected, but did not occur (the marriage that never occurred, the child who was never born, other unfulfilled expectations

The Transition Process Endings, Neutral Zones, and Beginnings (Wm. Bridges) “…endings are the first phase of transition. The second phase is a time of lostness and emptiness before ‘life’ resumes an intelligible pattern and direction, while the third phasse is that of beginning anew” (1980, p. 17)

Bridges’ Model of Transition Ending phase—the individual must “let go” of the past Disengagement-separate from previous familiar settings or roles Disidentification-loss of self-definition Disenchantment-understanding that the individual’s world has changed Disorientation-sense of confusion that occurs with change

Other Phases Neutral Zone--Individual has moved from the old to the new, at least superficially Requires new perspectives on the role Requires acceptance of changed relationships New Beginnings—Individual is ready to move forward Acceptance of new knowledge, values, attitudes, and behaviors associated with role change Finding support can help

Spencer and Adams’ Model of Transition Seven Stages: Losing focus Minimizing the impact The pit Letting go of the past Testing the limits Searching for meaning Integration

Seven Stages Stage 1: Losing focus—individual has difficulty keeping things in perspective and experiences feelings of being overwhelmed Stage 2: Minimizing the impact—individual feels the need to go back to what was normal or comfortable and tries to avoid the full effect of the change Stage 3: The pit—individual experiences self doubt and may grieve over losses

More Stages Stage 4: Letting go of the past—a move toward optimism, a stage of forward vision Stage 5: Testing the limits—new identity is established; new behaviors & skills are tried Stage 6: Searching for meaning—self- reflection and finding meaning in the experience Stage 7: Integration—individual experiences satisfaction and self-confidence

Factors that Influence Transitions: The 4 S System The Situation Variable What is happening? The Self Variable To whom is it happening? The Support Variable What help is available? The Strategies Variable How does the person cope?

Situation Variable Trigger—What set off the transition? Timing—How does it relate to one’s social clock? Control—What aspects can one control? Role change—What is involved? Duration—Permanent or temporary? Previous experience—What are the stresses? Assessment—How does the individual view the transition?

The Self Variable Personal and demographic characteristics socioeconomic status, gender, age and state of life, state of health, ethnicity Psychological resources Ego development, outlook (optimism and self- efficacy), commitment and values

Support Variable Types of support Intimate relationships, family units, networks of friends, and institutions and/or communities Functions of support Affect, affirmation, aid, honest feedback Measurement of support Convoy—a person-centered network of support delivery

Strategies Variable: Coping Responses that modify the situation Negotiation, optimistic action, self-reliance vs. advice-seeking, exercise of potency vs. helpless resignation Responses that control the meaning of the problem in order to neutralize the threat Positive comparisons, selective ignoring, substitution of rewards Responses that help manage stress Emotional discharge, self-assertion, passive forbearance

From Novice to Expert: Excellence and Power in Clinical Nursing Practice By Patricia Benner, RN, PhD University of California, San Francisco School of Nursing (1984)

Stages of Clinical Practice Expertise Stage 1: Novice Stage 2: Advanced Beginner Stage 3: Competent Stage 4: Proficient Stage 5: Expert

Stage 1: Novice “Beginners have had no experience of the situations in which they are expected to perform” (p. 20). Behavior is rule-governed

Stage 2: Advanced Beginner Need support in the clinical setting Can demonstrate marginally acceptable performance because they s/he has coped with enough real situations to note (or to have pointed out to them by a mentor) recurring meaningful situational components

Stage 3: Competent Typified by the nurse who has been on the job in the same or similar situations 2-3 years Develops when the nurse begins to see his or her actions in terms of long-range goals or plans of which he or she is consciously aware Has a feeling of mastery and the ability to cope with and manage the many contingencies of clinical nursing

Stage 4: Proficient Perceives situations as wholes and the nurse perceives its meaning in terms of long-term goals Learns from experience what typical events to expect in a given situation and how plans must be modified in response to these events Decision making is less labored because the nurse now has a perspective on which of the many existing attributes are the important ones

Stage 5: Expert With an enormous background of experience, the nurse has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions (p. 32).

How do you experience transition? Change in role as student? Change in responsibilities at home? Change in workplace? Finding new sources of support Investing in yourself