Additional Learning Exercises and Applications
DISPLAY 11.4 Benefits of Professional Certification
DISPLAY 11.4 Benefits of Professional Certification
Provides a sense of accomplishment and achievement
Validation of specialty knowledge and competence to peers and patients Increased credibility
Increased self-confidence
Promotes greater autonomy of practice
Provides for increased career opportunities and greater competitiveness in the job market May result in salary incentives
Improved patient outcomes
Increased levels of perceived empowerment creating more positive work cultures
Source: Huston, C. J. (2017). Assuring provider competence through licensure, continuing education, and certification. In C. J. Huston (Ed.), Professional issues in nursing: Challenges & opportunities (4th ed., pp. 317–331). Philadelphia, PA: Lippincott Williams & Wilkins.
Reflective Practice and the Professional Portfolio
Reflective practice has also been suggested as a strategy for promoting personal growth and continued competence in nursing. Reflective practice is defined by the North Carolina Board of Nursing (NCBN, 2016) as “a process for the assessment of one’s own practice to identify and seek learning opportunities to promote continued competence” (para. 8). Inherent in the process is the evaluation and incorporation of this learning into one’s practice. Such self-assessment is gaining popularity as a way to promote professional practice and maintain competence. Often, this is done through the use of professional portfolios for competence
assessment.
For example, North Carolina now requires RNs to use a reflective practice approach to carry out a self- assessment of his or her practice and develop a plan for maintaining competence (NCBN, 2016). This assessment is individualized to the licensed nurse’s area of practice. RNs seeking license renewal or
reinstatement must attest to having completed the learning activities required for continuing competence and be prepared to submit evidence of completion if requested by the board on random audit (NCBN, 2016).
A professional portfolio, which all nurses should maintain, can be described as a collection of materials that document a nurse’s competencies and illustrate the expertise of the nurse. The professional portfolio typically contains a number of core components, such as biographical information; educational background;
certifications achieved; employment history; a resumé; a competence record or checklist; personal and professional goals; professional development experiences, presentations, consultations, and publications;
professional and community activities; honors and awards; and letters of thanks from patients, families, peers, organizations, and others.
All nurses should maintain a portfolio to reflect their professional growth throughout their career.
Maintaining a professional portfolio avoids lost opportunities to save documents because professional nurses should always have documentation readily available to pursue a promotion, to consider a new position, or to
apply for another position in their present employment. Sinclair, Bowen, and Donkin (2013) note, however, that for the professional portfolio to truly have value, it must be more than just a collection of evidence of accomplishments; it must include reflection and be actively used as a tool to promote professional growth throughout one’s career. Only then will it promote a continuous cyclic process of professional development that supports the maintenance of continued competence.
LEARNING EXERCISE
11.5
Creating a Professional Portfolio A S S I G N M E N T:
1. Identify the categories of evidence you would use to organize a professional portfolio if you were to create one today.
2. Identify specific evidence you could include in each of these categories. What evidence currently exists and what would need to be created?
3. How would you incorporate reflection in creating a personal professional portfolio?
Career Planning and the New Graduate Nurse
During the recent economic downturn, many new graduates rushed to find a “job”—any job—in nursing, forgetting that even early employment decisions are critical to the achievement of their long-term career plans.
New graduates must select their first employment wisely and seek work in a facility with a strong reputation for shared governance, positive work cultures, and a reputation of excellence in multiple arenas.
Finding work in a facility with orientation programs, internships, residencies, and fellowships is also important to the new graduate because it takes time to gain the expertise and self-confidence that is a part of being an expert nurse. Mentors and preceptors should also be available to support the new graduate nurse and to role model high-quality, evidence-based decision making and clinical practice. If the new graduate has a positive, nurturing first employment experience, he or she is much more likely to take future career risks, to pursue lifelong learning, and to have the energy and commitment to become involved in the bigger issues of their profession.
New graduates also have responsibility during the crucial first few years of employment to gain the expertise they need to have more opportunities for career divergence in the future. This includes becoming an expert in one or more areas of practice, gaining professional certifications, and being well informed about professional nursing and health-care issues. This is also a time where participation in professional associations has great value as a result of the opportunities for mentoring and networking. Finally, all new graduates should consider at what point, continued formal education will be a part of their career ladder and professional journey.
Transition-to-Practice Programs/Residencies for New Graduate Nurses
Arguments have grown over the last decade regarding the need for transition-to-practice programs (also known as residences, externships, or internships) for new graduates of nursing programs. Jones and West (2017) note that new graduate nurses often begin working with little more than a few weeks of orientation, in contrast to most other professions, which require formal and often standardized internships or residencies.
This is largely a residual outcome of the traditional nursing educational system that was grounded in
apprenticeship and hospital-based training programs, which led to the student receiving a diploma in nursing.
Jones and West (2017) suggest the ever-changing health-care delivery care system, with its increasing complexity of patient care, evolving technology, and focus on patient safety, has raised the bar in terms of expectations for new graduate nurses. New graduates must now hit the ground running with well-developed
critical thinking and problem-solving skills, the ability to exercise clinical judgment with know-how to practice from an evidence-based and outcome-driven perspective, and the ability to develop effectively from a novice to an expert in competency.
Such high expectations accompanied by inadequate advanced apprenticeship training often leads to high turnover rates for new graduate nurses. In addition, patient safety and quality of care are at risk if new graduates do not have the critical thinking skills or competencies needed to apply critical judgments to patient situations. Jones and West (2017) suggest that transition-to-practice programs bridge the gap by providing the new graduate opportunities to take the learning from nursing school and apply it in an expanded, intensive, and integrated clinical learning situation while providing direct patient care—much in the same way that the internship of physicians is based on applying academic learning to actual care of patients and transition into the professional role.
A well-designed transition-to-practice program strengthens new graduates’ skills and competencies and prepares the new nurse for the demands of caring for patients. Furthermore, a systematic approach to transition not only facilitates “on-boarding” (integration into staffing on the nursing unit to provide direct patient care) but also reduces the turnover of unprepared and dissatisfied new graduates.
Jones and West (2017) suggest that employers and academe share the obligation to provide bridges from student to practicing nurse and that the inclusion of transition-to-practice programs is increasingly considered an expectation of the nursing education process and career development. Indeed, the IOM (2010) report The Future of Nursing identified transition-to-practice programs/residencies as one of the eight key
recommendations to actualize nursing contributions to the demands of health-care reform. The IOM suggests
“state Boards of Nursing, accrediting bodies, the federal government, and health care organizations should take action to support nurses’ completion of a transition-to-practice program (nurse residency) after they have completed a pre-licensure or advanced practice degree program or when they are transitioning into new clinical practice areas” (p. 280).
Multiple types of transition-to-practice programs exist (Jones & West, 2017). There are programs that begin in the final year of nursing school and continue through licensure, although these programs are generally not intended to take the place of employer-based residencies, which often extend to 1 year and have a planned structured, mentored experience. Most transition-to-practice programs are employer-based “new graduate classes” within a hospital or employer (hospital) based programs that take up to a year to complete. Still, others are for new graduates who have yet to be hired, so they may gain skills in order to become more employable.
Traditional transition-to-practice programs (residencies) are funded and provided by employers (usually hospitals). The hospital hires a group of new graduate RNs and provides a curriculum over the first 6 months to 1 year of their employment. The new graduate hires may receive partial to full pay, although they do not have a full patient load for some time into their residency. Transition-to-practice programs are also found, however, in nonacute settings, such as primary care clinics, behavior health clinics, long-term care, home health, corrections, school of nursing, and public health, and they provide exposure to career paths that new graduates may not have previously considered and also provide an opportunity for nonacute employers to consider hiring new graduate nurses (Jones & West, 2017).
LEARNING EXERCISE
11.6
Addressing Nurse Residency Concerns
J
ones and West (2017) note that although many groups are actively working to assure that nurseresidences exist to provide a solid foundation for successful career development in nursing, many questions continue to exist about resource allocation (human and fiscal).
A S S I G N M E N T:
Select any two of the following four questions and write a one-page essay defending your answers.
1. Schools have voiced concerns that transition-to-practice programs are taking preceptorship slots that have been historically allocated to prelicensure students. Do you support this reallocation of resources?
2. Should transition-to-practice programs/residencies be a requirement for completion of nursing education?
3. Residencies have historically been a cost hospitals or employers have assumed. Should this cost be shared and why?
4. Would you participate in a school-based transition-to-practice program without an associated stipend if it could help you gain experience? Would you pay to participate?
Resumé Preparation
Despite the best efforts of organizations to help subordinates identify career needs, wants, and opportunities, it is how employees represent themselves that often determines whether desired career opportunities become a reality. Creating a positive image often depends on having well-developed interviewing skills (see Chapter 15) and a well-prepared resumé. “Few documents are more important to your professional career than a resumé, since a high quality resumé is necessary to distinguish yourself from the mass of applicants, and express to the employer what makes you special and why you will succeed” (Resumé 2015, 2015/2016a, para.
1). The resumé is also a screening tool used by employers to select applicants and make promotion decisions;
therefore, maintaining a current, professional resumé is a career-planning necessity for health-care professionals and should not be undertaken lightly.
Resumé Format
Various acceptable styles and formats of resumés exist. However, because the resumé represents the professionalism of the applicant and recruiters use it to summarize an applicant’s qualifications, it must be professionally prepared, make an impression, and quickly capture the reader’s attention. General guidelines for resumé preparation are shown in Display 11.5. A sample resumé is shown in Figure 11.2.