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.
Nursing can sometimes be a difficult profession for many of the men and women who choose to give their lives to the service of others. However, many nurses bring additional challenges to their calling, such as physical and mental hurdles that extend beyond the nursing experience. Although physical disabilities can make nursing hard at times, mental roadblocks are just as common and essentially hidden from teachers, coworkers, and sometimes the nurses themselves.
The good news is, though, dealing with an invisible challenge isn’t insurmountable.
For example, attention deficit disorder (ADD) can cause difficulty focusing, brain fog, and trouble concentrating. Nursing school requires attention to detail and focused concentration. Yet, this is just one of the many challenges that nurses can overcome—and many have.
For instance, Carin Shollenberger, RN, CRNA, has had ADD since childhood. She wasn’t diagnosed until well into adulthood, and she could have let it hold her back.
“Not being diagnosed impacted my ability in succeeding to my highest potential in nursing school and anesthesia school,” Shollenberger says. “With ADD, the ability to focus on what you are told to focus on is nearly impossible.”
When nurses are drilled on how to use their senses to assess patients, those with ADD must marshal all of their will to get the job done. Success is doable, but it requires a strong effort and indefatigable motivation to overcome a brain that fights back.
It isn’t merely issues with focusing that can potentially stand in the way of a successful nursing career. Post-traumatic stress disorder, or PTSD, can make entering the nursing field complicated. Some of the tasks asked of nurses can trigger unwanted emotions and feelings.
Miranda Gallegos, RN, is one such nurse who has succeeded in nursing and even flourished while facing PTSD. Like most nurses—those who enter nursing with relatively few challenges and those who have to work harder to attain the same goals—she dedicated her life to making nursing work for her no matter what.
In fact, Gallegos states, “I found nursing school to be a welcome distraction and almost a period of remission. I had no interest in my peers so I could 100 percent focus on my studies. I did have a tendency to zone out or dissociate in times of stress.”
Gallegos, a hard worker, took refuge in the high attention to detail that nursing requires. In her case, her PTSD symptoms could help her to push through and succeed.
And this is the point: nurses who are faced with physical and mental challenges can become excellent nurses. Nursing may seem intimidating, especially to someone who is struggling. Nursing can sometimes seem impossible as a profession with a diagnosis of an attention disorder.
Yet these two women have shown what can happen with effort.
“My tip to prospective nurses would be to seek professional help sooner,” advises Shollenberger. “I would have told my past self that it was not normal to procrastinate nor was it normal to have the inability to focus on school work while most everyone else could. I didn’t know that I could be helped!”
Gallegos agrees: “I found that nursing school really empowered me to get help. Once I got help for my conditions my grades went from B’s to A’s. I didn’t know I had something wrong at the time until through school I learned about these disorders and realized I fit into a lot of these categories and symptoms.”
Surely, early detection is key. If you are having trouble with focusing or intense anxiety, these are symptoms worth checking out. Nursing is hard enough as it is, and no one should work with any hindrance that can put a patient in danger. Examine yourself. Know yourself. Discover what your needs are to make nursing a success.
Shollenberger found that both nursing school and anesthesia school could prove challenging before she knew about her ADD.
“In nursing school, I did not have a husband or kids. My friends in the dorm got a visit from me several times a day when it was time to study. In anesthesia school, it was even tougher with a family. I wish I would have been diagnosed and treated early on…it wouldn’t have been so stressful.”
Gallegos found that her PTSD actually helped her be a better student and a better nurse.
“PTSD has a known symptom of hyper vigilance and I use that to my advantage. I am able to quickly scan whole pictures and scenarios to develop my assessments and my priorities,” she explains.
These nurses have documented challenges they faced when they entered the profession. Both faced them head on and used their diagnoses to make their skills better than they may have been without them. Although they both walked a hard road at times, they have succeeded well in the profession.
What is it that helps them overcome what could be a daunting challenge? What should other nurses know about traveling down this road?
“My tips for other nurses is to just keep your head down, study, and do your work,” Gallegos explains. “Focus on lots of self-care, whatever that means for you. Don’t worry about what other people are doing.”
Nurses tend to compare themselves to others, trying to be the super nurse that doesn’t need any help. For someone facing additional challenges, this could be disastrous. Focus instead on introspection and using your unique skills to make yourself the best you can be.
Shollenberger sums up her positive nursing journey this way: “Before my diagnosis, I felt like a failure because even though I got good grades, my struggle to get them was real. I felt even more of a failure in anesthesia school because I couldn’t skate by the skin of my teeth anymore. Once I had the diagnosis, a lot of what happened in my life made sense, but I still had to work to overcome the adversity. Medication helped but knowing in my mind that I could overcome this was an even bigger push to succeed.”
Both nurse practitioners (NP) and physicians embrace the concept of “Do no harm” yet cannot seem to support and respect one another.
It’s Just Inflammatory
In 2017, an op-ed was posted on a social media network by a physician that was provocative about NPs:
“Nurse practitioners are not, I repeat, not physicians. They lack education, IQ, and clinical experience. There is no depth of clinical understanding. They are useful but only as minions. Not politically correct, but true. Who would you want your family member seen by—a nurse or a physician?” —Doximity.com, 10/2017
One’s initial response may be to get angry after reviewing that. Yet, instead of remaining angry, perhaps the use of emotional intelligence and research could be of more benefit with analyses of the social media post.
A Little History Lesson
In 1965, Henry Silver and Loretta Ford, a physician and a nurse, developed the first training program for NPs. The course of instruction focused on disease prevention, health promotion, and was in direct response to a national shortage of primary care physicians of that time. The deficit was especially concerning in rural, urban, and undeserved communities. This sounds eerily similar to current health care accessibility issues of today. Ford and Silver met much opposition with the development of the first formal program for NPs.
Surprisingly, the opposition was not only from physicians but also nurses. Some claim nurses believed that the title of “Nurse Practitioner” would be deceptive and somehow damage the nursing profession; meanwhile, it is believed that some physicians felt that NPs simply did not have the skills to take care of the public health needs without supervision (e.g., oversight). What is captivating, however, is how a nurse and a physician identified a need and were able to work in concert to try to address the concern.
“Nurse practitioners are not, I repeat, not physicians.”
Merriam-Webster defines a physician as: “A person skilled in the art of healing.” Thus, this could be considered offensive to a physician who has gone to school for many years and has done an average of 10,000-15,000 hours of clinical rotation. In contrast, the NP goes to school for many years too but only averages 600-1,200 clinical hours. Humbly, if one is being honest, the sheer number of clinical hours that physicians do may suggest their training is better. Does that mean that they are superior? It should stand to reason that if one’s course of study includes more hours that their training is superior, but this does not mean that a NP is not essential in their own right. Therefore, it is understood that a NP is not a physician.
“They lack education, IQ, and clinical experience. There is no depth of clinical understanding. They are useful but only as minions. Not politically correct, but true.”
It has been documented that IQ tests do not test intelligence but can simply demonstrate that one is a good “test taker.” Hence, one should understand that having a high IQ does not constitute knowledge, nor is the IQ the only predictor for one’s success. The language used in the op-ed may be viewed as crude to some and offensive to others; however, if one could look past the words and get to the root of what was being said it might be helpful. Checking egos at the door and realizing that medicine is not a power structure—it should simply be patient-centered. As such, there may be some value to the thought that NPs need oversight to practice.
What’s wrong with collaboration, anyway? This should be viewed as a valuable tool that assists with the care and safety of patients who may not otherwise have access to adequate health care. This should not degrade the NP’s worth but prove valuable for the public.
For those arguing about NPs and their worthiness—are they willing to work in rural, urban, and undeserved areas? Who does this argument really hurt? To meet the current health care demands, there would need to be a tremendous supply of willing physicians. Where are they? Additionally, some studies imply women and children suffer the most in medically underserved areas, Who will serve them? Is that physician you?
“Who would you want your family member seen by—a nurse or a physician?”
Qualifications and experiences are probably the central reasons for patients preferring a provider no matter what their title. But physicians may be more often preferred for their skills, whereas NPs may be favored for their social skill and ability.
Maybe fear, lack of confidence, and overwhelming need as a NP to validate worth could make them seem unworthy. But this should not be confused with lack of skills or professionalism of the NP. Oversight should not indicate a servant-to-leader relationship but rather a teamwork concept to support and respect one another. One cannot reasonably argue with the number of hours of study a physician puts in—it is commendable. Having said that, this does not belittle the course of study for the NP, either.
Physicians and NPs are all valuable, and working together can be nothing but good for all around. So, in the words of Rodney King, “Can’t we all get along?” Let’s work together in concert to direct a beautiful symphony called safe patient health care.
Nurses need to be prepared for every eventuality in patient care: they welcome life into the world, and hold patients’ hands as their lives come to an end. The core job duties are physically, emotionally, and spiritually taxing — and sometimes dangerous — so it’s no surprise that nurses experience burnout at an alarming rate.
In fact, the National Nursing Engagement Report for 2019 found that 15.6% of all nurses were feeling burned out at the time of reporting, with 41% of nurses who reported themselves as feeling unengaged also reporting feeling burned out. But many nurses also know they can’t leave — or even take time off — because the nursing shortage is so critical that every hour counts.
We’ve written before about how to combat nurse burnout, but it’s just as important to recognize the dangerous signs of burnout when it starts.
What Are the Signs of Burnout?
Between the long hours, the demands of the job, and just being human, most nurses will experience either the signs of burnout or full Burnout Syndrome (BOS) at some point during their careers. As the National Nursing Engagement Report showed, even fully-engaged nurses report these symptoms. The first step to combating BOS is to recognize the symptoms.
Perhaps the first sign and highest predictor of burnout is emotional exhaustion. Nurses know what it’s like to be tired, but emotional exhaustion leaves you feeling completely drained as a result of the stress of your job. In addition to feeling fatigued in every way, people who are emotionally exhausted often feel like they’ve lost control of their lives — they often report feeling trapped in their situation, whether it’s at work or in an outside relationship.
Another sign of burnout is depersonalization. When you become so exhausted that you have to detach from your surroundings to survive, then you are burnt out. Your outlook may be negative or even calloused, and it can express itself in unprofessional comments directed at colleagues, feeling nothing when a patient dies, or even blaming patients for their problems.
The final major predictor of burnout is a reduced feeling of personal accomplishment. You may not feel that you’re a good nurse or that you make any difference at all in patients’ lives. Nurses working in high-intensity settings, like the ICU or emergency room, may experience this more often as they receive a greater proportion of cases where little can be done for the patient.
Why Burnout is Dangerous for Nurses and Patients
Burnout is more than having a bad day; it’s an impaired outlook on nursing and life in general. Experiencing burnout doesn’t mean you don’t love your job, nor does it mean that you aren’t good at what you do. In fact, this reality makes it even more difficult for nurses who experience burnout because leaving is just another impossible choice.
At the same time, burnout is as dangerous for nurses as it is for their patients. A nurse in the throes of BOS is both less likely to have life satisfaction and more likely to provide a poorer standard of patient care. In a study published in Research in Nursing & Health, researchers explored the correlation between the quality of care and nurse burnout among 53,846 nurses from six countries. They found a strong correlation between higher levels of burnout and nurse-rated quality of care.
In other words, burnout can become a self-fulfilling prophecy. Burnout can result in lower standards of patient care, which further informs the reduced feelings of personal accomplishment. As nurses make mistakes, they feel even lower job satisfaction and an even greater intensity of burnout, which goes around again to manifest itself once again in patient care.
How Nurses and Nursing Leaders Can Combat Burnout
Nurses are caught between a rock and a hard place — the nature of the job is stressful, but if you love what you do, you can’t quit. Although almost all nurses will go through burnout at some point, there are things that both practitioners and health care organizations can do to stave it off and help re-engage burned-out nurses.
Education is one of the critical ways that nurses can empower themselves and avoid burnout. Pursuing further education can renew your passion for what you do and help you overcome roadblocks. It also puts you in a better position to provide the latest evidence-based care to patients, which correlates to better patient outcomes and increased job satisfaction.
Nursing leaders and administrators also have a strategic role to play, as the environment in which nurses practice needs to be a supportive one. Creating a positive work environment that limits unnecessary stress and allows nurses to care for themselves and recharge can do wonders in both reducing burnout and igniting engagement.
Those same leaders and administrators can also take notes from other industries’ workplace safety practices. You can’t just say you have a safety culture, you need to commit to it by formalizing the ways in which you intend to create and maintain the culture and creating avenues to accept employee input.
There’s Always More Work to Do to Prevent Burnout
Nurses can’t get rid of the high-stress, high-stakes environments they work in. They can’t wave a magic wand and save every patient no matter how severe their condition, and they can’t stop feeling to cope.
In other words, burnout is a given part of being a nurse. While these feelings are normal, nurses also need support in preventing the bad (and downright dangerous) days from outweighing the good ones. Nurses and administrators can and must work together to prevent burnout — and while the challenge is a significant one, it is achievable if we all listen to each other.
As 2019 winds to a close, several issues in the nursing industry remain prominently in the news and in the ongoing conversation around nursing as a profession.
What are some of the top issues of 2019 that will carry over into 2020?
80 Percent in 2020
The next year marks the end goal time period for the 2010 Future of Nursing report by the Institute of Medicine that called for 80 percent of registered nurses to have BSN credentials by 2020. According to the Campaign for Action, the ambitious goal won’t be met, but that doesn’t mean it hasn’t made a difference. The recap says that RNs with a BSN are at the highest percentage ever with 56 percent having the degree. That’s a seven percentage point increase since the initial report was issued. Even though the goal hasn’t been realized, there’s progress and that bodes well for the entire nursing industry.
Violence in the Workplace
The rate of violence against healthcare workers is skyrocketing. The thought of healthcare providers helping people and becoming targets of violent acts from patients and their social circles, disgruntled workers, or even random perpetrators is terrifying. Luckily, the government has recognized the problem and introduced H.R.1309 – Workplace Violence Prevention for Health Care and Social Service Workers Act to require organizations to develop and implement plans to protect workers. This bill passed in the House in November and is now under consideration by the Senate.
There is a lot of media attention on a projected nursing shortage over the next decade. As Baby Boomers continue to age and require more healthcare services, nurses will be a big part of that picture. According to the National Center for Biotechnology Information, U.S. National Library of Medicine (NCBI) the nursing workforce is also aging, spurring a shortage as it also provides a fantastic job market for nurses of almost any specialty. The issue will continue to attract attention.
Given the topics that are prominently in the news about nursing, it’s no surprise that nurses experience sometimes crippling job stress and burnout. When there aren’t enough nurses to care for a rising number of patients with increasingly complex conditions, the stage is set for nurses taking on too much. When that happens, their physical and mental health can suffer and that means patients aren’t getting the best care possible. This topic garners lots of attention by nurses themselves and by the organizations who recruit, hire, employ, and want to retain them.
Nursing as a Vibrant Profession
Nurses have professional pull. Routinely ranked as the most trusted profession, the nursing industry enjoys good salaries, opportunities for professional growth, respect, and increased independence. As an industry, nursing is committed to a more diverse, more educated, and more representative workforce and takes steps to meet those goals.
With 2020 on the doorstep, let’s see how these topics gains team in the next year.
With medical errors making national headlines, it is no secret that both training and experience are integral to success as a new nurse. Almost all nurses enter the field with a college degree, but recent research shows that novices make a large percentage of the errors caused by nurses. To avoid mistakes and build a strong foundation for your nursing career, here are three essential skills to prioritize during your first year as a nurse.
1) Developing Strong Instincts for Patient Safety
Patient safety is one of your primary responsibilities as a nurse. Safe medication administration is an imperative skill to master in your first year. You are the final check between the prescribing provider and the administration of a medication to the patient. If something feels “off”—maybe the dose seems too high based on doses you have given before or the medication doesn’t seem to fit your assessment of the patient—take a timeout and ensure the prescription is accurate. Mistakes happen even in computer-driven processes, whether a decimal point is missed, a duplicate therapy is accidentally prescribed, or a medication is placed in the wrong slot of a medication dispenser. Before giving any medication, ask yourself, “Are all of the correct pieces in place for me to give this medicine right now?”
Learning to safely calculate medication dosages goes far beyond a textbook. Learning tools like UWorld’s Clinical Med Math allow students to practice and perform dosage calculations without the risk of patient harm if they make a mistake. This tool is meant to be a hands-on resource to help students study for drug calculation exams during school, but it also provides fantastic experience to prepare you for real-world nursing.
Another major safety concern is patient falls. Precautions here may include rounding on older patients more frequently or enabling a bed alarm for high-fall risk patients. You should also utilize a mental checklist every time you walk into a patient’s room, such as:
- Is the floor clear, especially the path to the bathroom?
- Can the patient reach the call light?
- Is the bed in the lowest position?
Adding these seemingly small things together develops a strong instinct for safety so when you enter a room, you automatically sense if something is out of place.
2) Forming Clinical Judgment
Your first year as a nurse builds clinical judgment on the foundation of all the knowledge you acquired in school. The ability to recognize potential or current complications that could cause harm is a strong asset to cultivate. This skill involves understanding the pathophysiology behind different disease processes and identifying the signs of improvement or decline. From there, the priority is determining the most important action you can take in the moment to ensure the best outcome for your patient. A textbook cannot teach you how to anticipate patient needs or develop clinical reasoning. You develop clinical judgment by applying your classroom knowledge to the actual patients in front of you.
As you refine your ability to assess patients and interpret clinical data, you reach the point where you can look at a patient and know something is not right—the monitors might look fine, but your assessment and instincts say otherwise. This is an important part of clinical judgment, and it is your job to dig deeper and advocate for your patients. Of course, this critical thinking must occur while also keeping up with scheduled medications at the same time that you are admitting a new patient and discharging another. Developing clinical judgment to juggle these moving pieces takes time.
3) Mastering Time Management
Time management is another key skill to learn in your first year of nursing. You should be able to look at your whole shift and plan a timeline based on medication schedules, planned procedures, and provider rounds. If all four of your patients have medications due at the same time, how do you organize your time so everyone receives their medications within an appropriate window? Many nurses have their own system of handwritten notes that they keep in their pocket to help organize their day. Asking to see your preceptor’s note system is a great way to get ideas during your clinical rotations in school or during the internship at your new job.
Structuring your day in the most efficient way possible helps develop a “clustered care” mindset where you complete a few tasks together so you don’t leave a room, only to return 15 minutes later. These organizational choices help you accomplish tasks in a seamless, resourceful way. The skill of effectively planning an entire shift comes with time. Do not be afraid to ask questions and learn from other nurses. Pay attention to colleagues who seem particularly organized and solicit their advice—even the smallest tip or trick can make your nursing practice stronger!