Transitioning

Whether you are a new graduate or an experienced nurse, at some point in your career you will transition. Nursing is a great profession which offers a vast range of career opportunities and allows nurses the ability to transition into various roles and settings. Transitioning occurs during various stages of a nurse’s career: inexperienced new graduates, skilled registered nurses, and advanced practice nurses, transition.  Some nurses elect to remain in their specialty for years, others opt to change role or specialty frequently. Reasons for transitioning are usually related to both personal and professional reasons and may include: improved work-life balance; better work hours; flexible work arrangements; different setting; a new role: reaching a plateau in your current position; feeling undervalued in your current role and, last but not least, burn-out.

In preparing for the transition, first, one should perform a self-evaluation and purposefully examine the reasons for the change. Transitioning sometimes result in moving from an expert to a novice role, however this should not be viewed as a barrier. “Sometimes to move forward, it requires that you take a few steps backward”, and this is ok. Once self-evaluation is completed, and an area of preference is defined, you may then begin a comprehensive inquiry. Explore your options and research specialties, roles, organizations, and role requirements. Search job-sites and utilize social media sites to engage with other nurses in other specialties. Networking is fundamental for successful transitioning. It allows you to gain relevant insights and provides you with invaluable opportunities to prepare for career goals. Recognize, also, that some positions may require additional education. Update your resume, contact recruiters, and ask to shadow providers in the area of interest. These steps will help to guide your decision process, in choosing a specialty that befits your personality and aligns with your career goal.

Change is daunting, as we are taken out of our comfort zone, however, note that change precedes growth. The process may be overwhelming, and seem impossible, however it is achievable. Fear of the unknown can be gut -wrenching and paralyzing, however reframe your thought process, and channel your fear into a driving force. Seek guidance from your colleagues or find a mentor to help you to navigate through the process. Continue to be supportive of each other, and remember that progress is impossible without change.

Stay FAB: Fearless, Affectionate, & Bold

Code Status

Code status refers to the level of “medical intervention” a patient wishes to have implemented in the event of a cardiopulmonary arrest. Discussions are sometimes brief, and excludes the necessary elements to promote patient’s autonomy. Code status should be addressed early on, particularly in the outpatient setting, and as well as during the admission process. Frequently, clinicians have a tendency to avoid these discussions due to time constraints, and other factors. However, the lack of effective communication can compromise care, and may lead to needless anguish to patients and their families.

Establishing the patient's desires with respect to resuscitation is extremely important. The challenges encountered by all parties involved in a medical emergency can be daunting. If a cardiopulmonary arrest occurs, there is no opportunity to ask the patient, their wishes, therefore it is imperative that a code status is in place. Individuals should be active participants in their decision making. They may choose to be Full Code or Do Not Resuscitate (DNR), which may also be documented on a form known as a Physician’s Orders for Life Sustaining Treatment (POLST. The POLST form summarizes the patients’ treatment desires in the event of a medical emergency, where the patient is unable to speak for him /herself. Patients may also have an advance directive which is a legal document with varying governing laws from state to state. An advance directive allows individuals to document future medical care, if they are unable to communicate, for reason such as coma, or too ill to speak. Both documents are not set in stone, and patients may revise and update the contents as often as they wish.

Although we may have various biases in regards to code status, such as age, and the patient’s presenting clinical status, the patient’s decision should always be respected. Remember it is not our decision to make. The role as providers is to be respectful, and uphold the wishes of the patients. Nurses play a crucial role in caring for patients, and ensuring that providers carry out the wishes of patients and families. A key component in providing appropriate care, is having a clear understanding of the patient’s wishes and confirming that the patient’s wishes are aligned with the plan of care. Nurses should also seek clarification for ambiguous language, and be familiar with advance directives in place. Finally, continue to advocate on your patient’s behalf and remember that you are, and will always be an integral part in providing high quality patient-centered care.

Stay FAB: Fearless, Affectionate, and Bold