Many organizations are moving towards an annual mandatory Personal Development Plan (PDP), also referred to as an Individual Development Plan, as a way of not only identifying avenues of interest for employees, but as a succession planning tool. No matter the agenda for the organization’s necessity for this document, nurses, and especially nurse leaders, should be using this tool to identify and track both career and personal aspirations. Thoughtful and intentional time spent on your PDP can make the difference between a career that happens to you and a career that happens for you.
A typical personal development plan asks the participant to identify numerous career and personal goals to achieve over a set time period. Many organizations, such as Kaiser Permanente, also require that the goals be aligned to the strategic initiatives of the company such as patient care, safety, or financial acumen. It is also not unusual for establishments to require the employee to record a set number of goals in the PDP document. If there is no requirement from the organization, nurses should choose at least three goals for their PDP tool; one short-term professional, one long-term professional, and one personal.
All goals should be written in the S.M.A.R.T. format: Specific, Measurable, Achievable, Relevant and Time-bound. For example, using this format, a goal for completing a master’s of science in nursing (MSN) degree would read, “Complete MSN at Emory University by June 2020.” The relevancy need not be described in the goal as most PDP tools will ask the writer to describe how the goal will relate to or affect the organization. These sections are included in many PDP tools:
Goal/learning/development to achieve
Action required to achieve the goal
Relevance to the organization
Evidence of completion
Target date of completion
Nurses are expected to engage in professional development not only as a means to stay current in nursing practice, but as a commitment to nursing as a profession. The PDP is an excellent tool to capture and record these developmental goals and can be used as an atlas to guide your career. Many people underachieve in their career aspirations by simply failing to plan their path. A well-crafted PDP provides the blueprint for how to build your ideal career, clarifies resources needed to meet your goals, and enlists the support of your leaders.
The professional development plan is not a one-and-done task to be completed each year. A strong PDP should be a living document that is updated at least every quarter to keep you accountable to your desired career trajectory. Ways in which a PDP is useful include:
Clarity – The document should be able to keep you accountable to what you have achieved so far and where you want to take your career.
Motivation – By updating and streamlining your PDP several times a year you will be able to answer the “why am I doing this?” question in order to stay focused and aligned to your goals.
Action – By setting written goals in the PDP for both short and long-term accomplishments, you can move backwards from the goal to create monthly, weekly, and daily actionable items that will move you towards your end game.
Performance – Keeping your PDP current will also allow you to track your performance in any given focus area, which is another good reason to have multiple goals of varying timelines. This also allows you to “toot your own horn” when the time comes for the annual self-evaluation.
Nurses with intentions to move into a leadership role or another specialty area should have this conversation with their manager, unit leader, and mentor. There are many ways in which the manager can assist the aspiring nurse, such as selecting them for committees that provide exposure to other departments and other managers, providing direct coaching on communication styles, and/or sponsoring the nurse for introductory leadership roles within the organization. By setting intentional goals in the PDP tool, nurses can ask managers and leaders for support in meeting these professional targets. To put it in more simplified terms, leaders cannot help you if they are unaware of your intentions.
By sharing your professional goals with your leader, you are also assisting the organization with succession planning as the need for replacing retired RNs will be at a critical state by the year 2022. Whatever your professional goal is as it relates to the company should be of great interest to them as they plan for the mass exodus of the baby boomers over the next decade, given that all areas of nursing will need to be covered. From leadership roles in specialty areas such as intensive care, labor and delivery, emergency services, recovery, cath lab, GI, or neonatal intensive care to advanced practice nursing roles including NPs and clinical nurse leaders, your institute can plan accordingly by knowing where you intend to take your career.
Personal goals are also important to include in your PDP. This not only helps you stay accountable and provides all the benefits listed above, but it also allows your direct leader and administration to see you as a whole person and not just as the career employee. Are you planning to run a marathon? Do you have a goal to serve on an overseas charity project utilizing your nursing skills? Starting a blog or podcast about your nursing specialty? If it is important to you, it should be important to your leader to support. You never know when opportunities or networking can arise from allowing people a glimpse into your personal aspirations.
The personal development plan is a dynamic tool that is created to provide a roadmap for your career and personal goals. Thoughtful, intentional, and frequent time spent on the creation and maintenance of this document should be viewed as an opportunity to take purposeful control over your future.
You may have heard the term moral injury more frequently these days than ever before. Between the TEDx talks, the YouTube rants, and the LinkedIn articles, moral injury is being compared to post-traumatic stress disorder (PTSD) symptoms and is heading to replace one of our favorite words in the nursing world: burnout. However, there is a growing movement that believes that moral injury is the root-cause of burnout and PTSD. In other words, if burnout or emotional exhaustion is organ failure, moral injury is sepsis.
In the August 2018 issue of STAT News, Dr. Simon Talbot and Dr. Wendy Dean associated the term moral injury as the true cause of burnout; the cynicism, emotional or physical exhaustion, and diminished productivity that can be prevalent in many health care organizations. However, burnout implies that the clinician is not resilient enough to manage the components of the job, or perhaps is not participating in enough hot-yoga-self-care practice, whereas the actual root cause of the emotional discord is moral injury.
Historically, moral injury is associated with military personnel who have witnessed, participated in, or failed to prevent transgressions against humanity or acted contrary to “deeply held moral beliefs and expectations” according to a study published in 2009 in Clinical Psychology Review. While civilian clinicians in the U.S. are not necessarily bearing witness to the horrors of war, they are attempting to provide care, compassion, and healing in health systems that are broken and, oftentimes, focused on compensation rather than the patient or clinicians.
The slope of document-for-maximum-reimbursement vs. document-the-excellent-care-provided is slippery. The fact is, health care is a business. To take it one step further, given the publicly reported information on patient satisfaction scores, readmission rates, infection rates – not to mention social media – health care is a commodity and patients can trade their provider with the click of a mouse. Organizations simply must maximize revenues from the ever-changing world of insurance coverages to keep the doors open, let alone to fund strategic initiatives to make improvements or plan for growth.
Clinicians find themselves in the middle of the battle between care and compensation. For example, when a patient presents with a wound and, after they are seen and treated, the nurse knows the patient cannot afford the appropriate dressings, but the organization does not allow staff to offer long-term supplies (brown-bagging). Or a patient who needs an expensive biologic medicine that the clinician knows is the best on the market for the diagnosis yet is required to order the cheaper medication that is on formulary. These betrayals to the calling of medicine to provide excellent care in and of themselves are not impactful. But numerous and repeated injuries to the morality of health care takes a toll.
Cases of moral injury occur at all levels of the health care organization. While working as a Certified Nursing Assistant (CNA), Doug McGann experienced emotional exhaustion. “I felt very undervalued in my role as a nursing assistant. I knew that I worked hard and provided compassionate care, but the organization really didn’t do anything to recognize the role. In fact, when they removed tasks from the assistants, like measuring and recording vital signs, it felt insulting. We were providing less support to the team when most of us wanted to contribute more. Eventually, I left the role as it became too mundane and repetitive and went to nursing school.”
How do clinicians guard themselves against moral injury? What can organizations do to combat the insult? The answers are still being hypothesized and churned by many articles in the health care space. One answer could be to encourage clinicians to embrace nurturing practices such as meditation and other stress-relieving activities while acknowledging that self-care means something different to each person. But a “Code Lavender” approach to increasing stress is not always that simple, and once again puts the onus on the clinician to improve their coping mechanisms.
What needs to improve are the institutional patterns that perpetrate the moral injuries. Organizations need to reduce the competing demands on health care workers and strive to treat each discipline with the respect it deserves so that providers can practice at the top of their scope. Institutions should provide, advertise, and encourage employees to utilize employee health services that include a behavioral medicine practitioner for debriefing and centering. Also, there is strong data emerging related to the effects of supportive, competent, and empathetic leadership on reducing the effects of moral injury.
By changing the language and mindset of how we approach burnout to address the root of the issue, the business of health care can move away from moral injury and into a place of mutual respect, acknowledgement, and empowerment towards all levels of the medical team.
Higher institutions of learning are responding to the demands of society in the need for additional Registered Nurses (RNs) by offering accelerated degrees in nursing. These programs are designed for those who hold a Bachelor of Arts (BA) degree or Bachelor of Science (BS) degree in areas other than nursing. Many schools offer an accelerated, or direct entry, program for a BA/BS to Bachelor of Science in Nursing (BSN); fewer schools offer a BA/BS to Master of Science in Nursing (MSN) or BA/BS to Doctor of Nursing Practice (DNP) degree.
There has been a steady increase in the number of RNs with a bachelor’s degree over the past several years. One reason for this increase could be attributed to the fact that nurses with a bachelor’s degree report earning an average of $10,000 more per year than those nurses with a diploma or Associate’s Degree in Nursing (ADN). Additionally, many institutions are requiring their staff nurses to hold a minimum of a BSN even for direct patient care or charge nurse positions. In turn, these facilities are paying higher wages to attract and retain the bachelor’s-prepared nurse.
Accelerated nursing programs require a rigorous commitment to the program, which can run anywhere from 12 to 24 months, depending on the institution. Most schools offer traditional or hybrid tracks where courses are delivered on-campus with a few courses completed online. Those schools with traditional (weekday courses on the campus) tracks discourage their students from working during the accelerated program to foster an environment of less distractions and to aid in the overall success of completing the demanding coursework and clinical requirements.
Tuition for accelerated programs may vary from school to school. Public institutions, such as California State University, Fullerton, run close to $23,000 for tuition and fees. Private schools like Emory University in Atlanta, Georgia, charge over $80,000 for their 15-month program. These tuitions and fees do not include other necessary items such as books, lab fees, uniforms, transportation to clinical sites, etc. Students must plan for several more thousand dollars to cover these additional items.
Prerequisites for accelerated programs also vary according to the school. For example, Samford University in Alabama requires those applying for the accelerated BSN program to hold a bachelor’s degree from an accredited college or university in the past 10 years with a minimum Grade Point Average (GPA) of 2.5. Additionally, the program requires the applicant to have completed a number of science courses including anatomy, physiology, microbiology, and chemistry. Most nursing programs also required students to complete the TEAS test and/or Critical Thinking tests prior to admission.
Coursework for the accelerated programs remains fairly stable as set forth by the American Association of Colleges of Nursing and the requirements for accreditation through the Commission on Collegiate Nursing Education. Courses may include:
Adult Health I, II, III
Health Assessment and Promotion
Women’s Health Nursing
Child and Adolescent Health Nursing
Epidemiology for Population-Based Care
Inter-Professional Health Care Practices
Leadership in Nursing
Public Health Nursing
In addition to the coursework, nursing students will also complete over 1,035 hours in clinical rotations through a variety of medical settings such as critical care, medical/surgical, emergency rooms, labor and delivery, pediatrics, psychiatry, and community health.
For those students who have completed a bachelor’s degree in another field, and now see the value that nursing has to offer, options such as accelerated nursing programs allow them to pursue that career at any stage in their life path. Accelerated nursing programs are an excellent way to complete a degree in nursing, in a short period of time, for a lifetime of reward and benefit.
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