CMSA-OK Leadership Summit Role Transitions: From Novice to Expert

1. CMSA-OK Leadership SummitRole Transitions: From Novice to Expert Carol A. Mannahan, Ed.D., R.N., NEA-BC Assistant Professor, Oklahoma City University camannahan@okcu.edu

2. Objectives for Today • Examine impact of changing roles on health care consumers, professionals, and organizations. • Formulate strategies to address both individual and organizational challenges of role transition. • Consider a variety of metaphors that are useful for defining & describing role transition.

3. Guiding Thoughts… • The world we have created is a product of our thinking; it cannot be changed without changing our thinking. (Albert Einstein) • We think in generalities, but we live in detail. (Alfred North Whitehead, British philosopher)

4. “ Who are you?” said the caterpillar… ”I hardly know, Sir”, just at present,” Alice replied rather shyly, “at least I know who I was when I got up this morning, but I think I must have changed several times since then.” (Lewis Carroll, Alice in Wonderland Where does change happen?

5. Where does change happen?(continued) • “Change your thoughts & change your world.” • (Dr. Norman Vincent Peale) • Only I can change my life. No one can do it for me. • (Carol Burnett)

6. Where does change happen?(continued) • “When we are no longer able to change a situation, we are challenged to change ourselves.” • (Victor Frankl) • “Resolve to be a master of change rather than a victim of change.”(Brian Tracy)

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

8. Nature of Change (continued) • “If you want to make enemies, try to change something.” (Woodrow Wilson) • “It is not necessary to change. Survival is not mandatory.” (W. Edwards Deming)

9. Why do we resist change? • “All changes, even the most longed for, have their melancholy; for what we leave behind us is a part of ourselves; we must die to one life before we can enter another.” (Anatole France) • Homeostasis – maintenance of the “steady state”

10. Like waves on the sand…

11. Out at Sea…

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

13. Major Driving Forces: Chaos & Complexity “I think that the next century (21st) will be the century of complexity.”

14. Chaos Theory: The universe is filled with unpredictable & random events…(Hawking, 1987) . To survive, organisms must: • Must be self-organizing & adapt readily to change. • Give up a permanent structure; tolerate ambiguity, & respond to each day’s unique situation/environment Bottom line: Constant change results in little long-term stability.

15. Complexity Science The most current attempt by science to: • Understand & explain the behavior & dynamics of systems composed of many interacting elements • Uncover the principles & processes that explain how order and change emerge in these systems.

16. Understanding systems… General systems Theory: input, throughput, feedback, output Complexity Theory: concerned with behavior over time of certain complex systems; focus is on systems that defy prediction

17. Biology Economics Sociology Nursing Mathematics Physics Anthropology Management Medicine What Disciplines are Studying complexity Science?

18. “System” implies: Multiple parts Parts are interdependent & connected Cells, organs, patients, families, communities, health care professionals, & healthcare systems are all complex adaptive systems… “Complex” implies: Diversity Many elements Large # of connections “Adaptive Implies: Capacity to alter or change What is a “complex adaptive system”?

19. Embeddedness: Each CAS is made up of other CAS & is part of (embedded in) a larger CAS Example: heart; person; unit; hospital; health system Diversity: A CAS has many different elements; these help the CAS to change Properties of CAS

20. Distributed control Control is shared by many elements, rather than centralized in a single command center Coexistence of order & disorder In a healthy, adaptive, system, order and disorder coexist Properties of CAS (continued)

21. Outcomes are inherently unpredictable CAS are nonlinear; a small change may produce a large effect or a large change may product a small effect Butterfly Effect…. Properties of CAS (continued)

22. Implications for health care? Complexity science helps us understand & work creatively… • With patients with multiple chronic diseases; • In our interactions with staff, patients & families; • To improve healthcare quality; • With individual & system change. Why???

23. Reality Shock(Kramer, 1974) • Reality shock: The total social, physical, & emotional response of a person to the unexpected, unwanted, undesired, or even intolerable. • A startling reaction to the discovery that school-bred (or personal) values conflict with work-world values. • Follows a fairly consistent pattern with 4 phases.

24. Phases of Reality Shock • Honeymoon • Shock & rejection • Recovery • Resolution Goal: Seek to integrate cultures; become bicultural!

25. Novice-Expert: Stages of Development (Benner, 1984) • Novice – no experience • Advanced Beginner – some experience; marginal performance • Competent– feels mastery but lacks speed & flexibility • Proficient – sees the “whole” of situations; picks up on nuances • Expert – has intuitive grasp of situations; deep understanding of total situation; performance fluid & flexible

26. Change & Transition Change is situational • Move to a new home • Birth of a baby • New job Transitionis psychological • Requires adjustment • Not optional!

27. Transition Model(Bridges, 2003)

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

29. Phases of Role Transition(Gray, 2007) Intimate Relationship • Dating • Commitment • Honeymoon • Disillusionment • Resolution • Maturation Role Transition • Preview • Acceptance • Exploration • Discrepancy • Development • Internalization

30. Focus Areas for Effective Role Transition • Physical • Emotional • Intellectual • Developmental

31. Tying it all together… • Fire, change, & transition • Context for health care delivery • Chaos Theory • Complexity science • Kramer, Benner, Bridges, Duchscher & Gray • Strategies for effective role transition

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

33. References • Benner, P. From novice to Expert: Excellence and Power in Clinical Nursing. Menlo Park, CA: Addison-Wesley; 1984. • Bridges, W. Managing Transitions; Making the Most of Change. 2nd ed. Cambridge: DaCapo Press; 2003. • Duchscher, J. (2008). Transition Shock: the initial stage of role adaptation for newly graduated registered nurses. Journal of Advanced Nursing. • Gray, J. (2007) in Leading & Managing in Nursing. 4th ed., author: Yoder-Wise, P. • Hawking, S. (1987). A Brief History of Time. London: Bantam Press • Kramer, M. Reality Shock. St. Louis: CV Mosby Company; 1974.