CMSA-OK Leadership SummitCMSA-OK Leadership SummitRole Transitions: From Novice to Expert Role Transitions: From Novice to Expert

Carol A. Mannahan, Ed.D., R.N., NEA-BCCarol A. Mannahan, Ed.D., R.N., NEA-BCAssistant Professor, Oklahoma City Assistant Professor, Oklahoma City

University University camannahan@okcu.edu

Objectives for TodayObjectives for Today

1.1. Examine impact of changing roles on Examine impact of changing roles on health care consumers, professionals, health care consumers, professionals, and organizations. and organizations.

2.2. Formulate strategies to address both Formulate strategies to address both individual and organizational challenges individual and organizational challenges of role transition. of role transition.

3.3. Consider a variety of metaphors that are Consider a variety of metaphors that are useful for defining & describing role useful for defining & describing role transitiontransition. .

Guiding Thoughts…Guiding Thoughts…

The world we have created is a product of The world we have created is a product of our thinking; it cannot be changed without our thinking; it cannot be changed without changing our thinking. (Albert Einstein) changing our thinking. (Albert Einstein)

We think in generalities, but we live in We think in generalities, but we live in detail. (Alfred North Whitehead, British detail. (Alfred North Whitehead, British philosopher) philosopher)

WhereWhere does does

change change happen? happen?

“ “

Who are you?” said the caterpillar…Who are you?” said the caterpillar…””I hardly know, Sir”, just at present,” AliceI hardly know, Sir”, just at present,” Alicereplied rather shyly, “at least I know who Ireplied rather shyly, “at least I know who Iwas when I got up this morning, but I was when I got up this morning, but I think Ithink Imust have changed several times since must have changed several times since then.” then.” (Lewis Carroll, (Lewis Carroll, Alice in WonderlandAlice in Wonderland

WhereWhere does change happen? does change happen?(continued(continued)) ““Change your Change your

thoughts & change thoughts & change your world.”your world.”

(Dr. Norman Vincent Peale)(Dr. Norman Vincent Peale)

Only I can change Only I can change my life. No one can my life. No one can do it for me.do it for me.

((Carol Burnett)Carol Burnett)

WhereWhere does change happen? does change happen?(continued(continued))

““When we are no longer When we are no longer able to change a situation, able to change a situation, we are challenged to we are challenged to change ourselves.”change ourselves.”

(Victor Frankl) (Victor Frankl)

““Resolve to be a master of Resolve to be a master of change rather than a change rather than a victim of change.”victim of change.” (Brian Tracy)(Brian Tracy)

Nature of changeNature of change

““Know what’s weird? Day by day, Know what’s weird? Day by day, nothing seems to change, but nothing seems to change, but pretty soon…everything’s pretty soon…everything’s different.” (Calvin, different.” (Calvin, Calvin & HobbsCalvin & Hobbs))

Nature of Change Nature of Change (continued)(continued)

““If you want to make enemies, try to If you want to make enemies, try to change something.” change something.” (Woodrow Wilson)(Woodrow Wilson)

““It is not necessary to change. It is not necessary to change. Survival is not mandatory.” Survival is not mandatory.” (W. Edwards (W. Edwards Deming)Deming)

Why do we resist change?Why do we resist change?

““All changes, even the most longed All changes, even the most longed for, have their melancholy; for what for, have their melancholy; for what we leave behind us is a part of we leave behind us is a part of ourselves; we must die to one life ourselves; we must die to one life before we can enter another.” before we can enter another.” (Anatole (Anatole France)France)

Homeostasis – maintenance of the “steady Homeostasis – maintenance of the “steady state” state”

Like waves on the sandLike waves on the sand……

Out at Sea…Out at Sea…

Think about it:Think about it:

Can you identify at least 10 Can you identify at least 10 driving forces which create driving forces which create challenges to health care challenges to health care leaders today? (ex: growth in leaders today? (ex: growth in aging population) aging population)

Major Driving Forces: Major Driving Forces: Chaos & Complexity Chaos & Complexity

““I think that the next century (21I think that the next century (21stst) will ) will be the century of complexity.”be the century of complexity.”

Chaos Theory: The universe is Chaos Theory: The universe is filled with unpredictable & random filled with unpredictable & random

events…(Hawking, 1987) events…(Hawking, 1987) . .

To survive, organisms must: To survive, organisms must: Must be self-organizing & adapt readily to Must be self-organizing & adapt readily to

change.change. Give up a permanent structure; tolerate Give up a permanent structure; tolerate

ambiguity, & respond to each day’s unique ambiguity, & respond to each day’s unique situation/environmentsituation/environment

Bottom line: Bottom line: Constant change results in little long-term Constant change results in little long-term stability. stability.

Complexity Science Complexity Science

The most current attempt by science to: The most current attempt by science to:

Understand & explainUnderstand & explain the behavior & the behavior & dynamics of systems composed of dynamics of systems composed of many interacting elementsmany interacting elements

Uncover the principles & processesUncover the principles & processes that that explain how order and change emerge explain how order and change emerge in these systems. in these systems.

Understanding systems…Understanding systems…

General systems Theory:General systems Theory: input, input, throughput, feedback, output throughput, feedback, output

Complexity Theory: Complexity Theory: concerned with concerned with behavior over time of certain behavior over time of certain complex systems; focus is on complex systems; focus is on systems that defy prediction systems that defy prediction

What Disciplines are Studying What Disciplines are Studying complexity Science? complexity Science?

BiologyBiology EconomicsEconomics Sociology Sociology Nursing Nursing MathematicsMathematics PhysicsPhysics AnthropologyAnthropology Management Management Medicine Medicine

What is a “complex What is a “complex adaptive system”?adaptive system”?

““System” implies:System” implies: Multiple partsMultiple parts Parts are Parts are

interdependent & interdependent & connectedconnected

Cells, organs, patients, Cells, organs, patients, families, communities, families, communities, health care professionals, health care professionals, & healthcare systems are & healthcare systems are all complex adaptive all complex adaptive systemssystems……

““Complex” implies:Complex” implies: DiversityDiversity Many elementsMany elements Large # of Large # of

connectionsconnections

““Adaptive Implies:Adaptive Implies: Capacity to alter or Capacity to alter or

changechange

Properties of CASProperties of CAS

Embeddedness:Embeddedness: Each Each CAS is made up of CAS is made up of other CAS & is part other CAS & is part of (embedded in) a of (embedded in) a larger CASlarger CAS

Example: heart; Example: heart; person; unit; person; unit; hospital; health hospital; health system system

Diversity: Diversity: A CAS has A CAS has many different many different elements; these elements; these help the CAS to help the CAS to changechange

Properties of CAS Properties of CAS (continued)(continued)

Distributed controlDistributed control Control is shared Control is shared

by many elements, by many elements, rather than rather than centralized in a centralized in a single command single command center center

Coexistence of order Coexistence of order & disorder& disorder

In a healthy, In a healthy, adaptive, system, adaptive, system, order and disorder order and disorder coexist coexist

Properties of CAS Properties of CAS (continued)(continued)

Outcomes are Outcomes are inherently inherently unpredictableunpredictable

CAS are nonlinear; a CAS are nonlinear; a small change may small change may produce a large produce a large effect or a large effect or a large change may change may product a small product a small effect effect

Butterfly Effect….Butterfly Effect….

Implications for health care? Implications for health care?

Complexity science helps us understand Complexity science helps us understand & work creatively…& work creatively…

With patients with multiple chronic With patients with multiple chronic diseases;diseases;

In our interactions with staff, patients & In our interactions with staff, patients & families; families;

To improve healthcare quality;To improve healthcare quality; With individual & system change.With individual & system change.Why???Why???

Reality ShockReality Shock(Kramer, 1974)(Kramer, 1974)

Reality shock: The total social, physical, & Reality shock: The total social, physical, & emotional response of a person to the emotional response of a person to the unexpected, unwanted, undesired, or even unexpected, unwanted, undesired, or even intolerable.intolerable.

A startling reaction to the discovery that A startling reaction to the discovery that school-bred (or personal) values conflict school-bred (or personal) values conflict with work-world values. with work-world values.

Follows a fairly consistent pattern with 4 Follows a fairly consistent pattern with 4 phases. phases.

Phases of Reality Shock Phases of Reality Shock

1.1. HoneymoonHoneymoon

2.2. Shock & rejectionShock & rejection

3.3. RecoveryRecovery

4.4. Resolution Resolution

Goal: Seek to integrate cultures; Goal: Seek to integrate cultures;

become bicultural! become bicultural!

Novice-Expert: Novice-Expert: Stages of Development Stages of Development (Benner, (Benner,

1984) 1984)

1.1. NoviceNovice – no experience – no experience 2.2. Advanced BeginnerAdvanced Beginner – some – some

experience; marginal performanceexperience; marginal performance3.3. CompetentCompetent – feels mastery but lacks – feels mastery but lacks

speed & flexibilityspeed & flexibility4.4. ProficientProficient – sees the “whole” of – sees the “whole” of

situations; picks up on nuancessituations; picks up on nuances5.5. ExpertExpert – has intuitive grasp of – has intuitive grasp of

situations; deep understanding of total situations; deep understanding of total situation; performance fluid & flexible situation; performance fluid & flexible

Change & TransitionChange & Transition

ChangeChange is situational is situational Move to a new home Birth of a baby New job

TransitionTransition is psychological is psychological Requires adjustment Not optional!

Transition ModelTransition Model(Bridges, 2003) (Bridges, 2003)

Transition Shock: Initial Stage of Transition Shock: Initial Stage of Role Adaptation Role Adaptation (Duchscher, 2007) (Duchscher, 2007)

Phases of Role TransitionPhases of Role Transition(Gray, 2007)(Gray, 2007)

Intimate RelationshipIntimate RelationshipDatingDatingCommitmentCommitmentHoneymoonHoneymoonDisillusionmentDisillusionmentResolutionResolutionMaturationMaturation

Role TransitionRole TransitionPreview Preview AcceptanceAcceptanceExplorationExplorationDiscrepancyDiscrepancyDevelopmentDevelopmentInternalizationInternalization

Focus Areas for Effective Focus Areas for Effective Role Transition Role Transition

PhysicalPhysical Emotional Emotional IntellectualIntellectual DevelopmentalDevelopmental

Tying it all together…Tying it all together…

Fire, change, & transition Fire, change, & transition Context for health care delivery Context for health care delivery Chaos TheoryChaos Theory Complexity science Complexity science Kramer, Benner, Bridges, Duchscher & Kramer, Benner, Bridges, Duchscher &

GrayGray Strategies for effective role Strategies for effective role

transitiontransition

Response to ChangeResponse to Change

““The only man I know who The only man I know who behaves sensibly is my tailor – behaves sensibly is my tailor – he takes my measurements he takes my measurements anew each time he sees me. The anew each time he sees me. The rest go on with their old rest go on with their old measurements and expect me to measurements and expect me to fit them.” (George Bernard fit them.” (George Bernard Shaw). Shaw).

References References 1.1. Benner, P. Benner, P. From novice to Expert: Excellence and From novice to Expert: Excellence and

Power in Clinical Nursing.Power in Clinical Nursing. Menlo Park, CA: Menlo Park, CA: Addison-Wesley; 1984. Addison-Wesley; 1984.

2.2. Bridges, W. Bridges, W. Managing Transitions; Making the Managing Transitions; Making the Most of Change. Most of Change. 22ndnd ed. Cambridge: DaCapo ed. Cambridge: DaCapo Press; 2003. Press; 2003.

3.3. Duchscher, J. (2008). Transition Shock: the initial Duchscher, J. (2008). Transition Shock: the initial stage of role adaptation for newly graduated stage of role adaptation for newly graduated registered nurses. registered nurses. Journal of Advanced NursingJournal of Advanced Nursing. .

4.4. Gray, J. (2007) in Gray, J. (2007) in Leading & Managing in Nursing. Leading & Managing in Nursing. 44thth ed., author: Yoder-Wise, P. ed., author: Yoder-Wise, P.

5.5. Hawking, S. (1987). Hawking, S. (1987). A Brief History of TimeA Brief History of Time. . London: Bantam PressLondon: Bantam Press

6.6. Kramer, M. Kramer, M. Reality ShockReality Shock. St. Louis: CV Mosby . St. Louis: CV Mosby Company; 1974. Company; 1974.