Role Transition Paper

It was due on September 30th. I turned it in on time, but somehow I forgot to publish it "for your reading pleasure"...or possible displeasure. Anyway, here goes "something". I HAD to turn in something...

Abstract

While carefully considering how the role of a registered nurse differs from that of a paramedic, how I perceive this change in roles, what I have gained in trying to make this transition, and where I see this transition potentially taking me in my future career, I realized that I am undergoing a role transformation tantamount to a partial metamorphosis. I know it is not as if I am undergoing a molting and shedding my outer coat, but there definitely is an element of evolution in my professional-development life cycle. Therefore, I suspect that those who are scrutinizing my actions and behaviors will soon perceive me differently, and as a result, may become more confident in me. As I transition into the role of a registered nurse, the shift in paradigm will encompass five critical areas of changes. The first area of change will involve the environment and the routines under which I will perform my duties. The second significant change will be my becoming a collaborative member of a team of healthcare professionals (Medical-Surgical Nursing, Patient-centered Collaborative Care, Sixth Edition, p.3). The third change will be an opportunity to interface with the patient and their family on a basis beyond the initial entry into the healthcare system. The fourth change will be undertaking the responsibility to educate the patient and their family about their current illness or conditions and actions they can take to improve their overall wellbeing. Finally, as a fifth change, there will be vast choices in terms of employment options and educational advancement opportunities.

Role Transition Paradigm Shift

            According to the “taketheleap” website, you should “think of a paradigm shift as a change from one way of thinking to another” (http://www.taketheleap.com/define.html). In preparation for the role transition from paramedic to that of a registered nurse, I am adjusting my way of thinking for this fast approaching paradigm shift. Aware that many changes in thought processes must occur, I am shifting my mannerism from that of a paramedic’s to that of a registered nurse’s. While critical thinking processes will continue to govern my intellect, my actions now must comply with guidelines of a new scope of practice, and my mind-set must adhere to a new set of rules, regulations, policies and practices as I undertake this paradigm shift. The five critical areas of change that I anticipate assuming in my transition pertain to:

1-     the environment and the routines under which I will perform my duties

2-     becoming a collaborative member of a team of healthcare professionals

3-     opportunities to interface with patients and their families on a prolonged basis

4-     the responsibility to educate patients and their families about their current illnesses or conditions and actions they can take to improve their overall wellbeing

5-     vast choices in terms of employment options and educational advancement opportunities

            The first major change I anticipate in this role transition is environmental and performance related. As a paramedic responding to emergencies in a variety of environments, on many occasions conditions were less than favorable, and often they were hostile and dangerous. My primary focus and responsibility was to utilize my skills, knowledge, protocols, standing orders, and the limited equipment that I had available to me on the ambulance to assess and provide emergency interventions in an effort to resuscitate, ameliorate, or stabilize patients while on-scene and when transporting them to the hospital. Due to the inherent nature of the risks involved in such a variety of potentially hazardous environments, it always seemed to be a windfall if we could do this, arrive alive, and be well upon termination of the call. As a field paramedic, I sometimes had extra personnel in terms of first-responders/fire-fighters, occasionally may even have another EMT or paramedic to assist on-scene or enroute to the facility, and I always worked with a partner. However, when transporting, my partner was generally driving, so I usually had only myself to rely upon to perform whatever care measures the patient needed. Because I desired that patients have the best outcomes possible, actions usually were initiated on an impromptu basis; having the luxury of awaiting for orders was not a viable option. Touting over a quarter-century of experience and a history of sound judgment, supported by standing orders and personal recognition from doctors who would later sign for treatment rendered, as a paramedic I usually performed procedures and administered medications without hesitation or consultation. Nevertheless, those actions were all undertaken as a paramedic working in the field under standing orders. Now I recognize the limitations that govern a registered nurse’s scope of practice, and I realize that while working in a “controlled environment”, I must abide by a new set of rules and perform in accordance to the role into which I am transitioning. That means I now must wait for the doctor to do (or order) what I previously had done (under standing orders) on my own.

            The second major change I foresee with this role transition is my becoming a collaborative member of a team of healthcare professionals. The role of the registered nurse is multifaceted and intertwines with numerous health-team members. Guiding the patient and their family through an illness or injury and ensuring all members of the care team have correctly assessed and provided appropriate care is tantamount to providing the patient with the best care possible. Developing a relationship with the patient and establishing trust so that accurate assessments are completed is a critical nursing intervention skill needed for a successful outcome. This trust allows the patient to share private information and to feel secure that their confidentiality will be maintained. The registered nurse is the “relationship builder”. In order to match the needs of the patient with the appropriate services, the registered nurse must build a meaningful relationship with the entire team of healthcare professionals. Good relationships can translate into quality care for the patient. Good relationships with the patient and their family helps them to be more open to the education the nurse can provide, and to be more compliant with following instructions, thereby leading to better healthcare outcomes.  Developing a good understanding of all of the resources available in the work setting is critical to the success of the registered nurse and to the survival of the patient. Critical thinking includes knowing how to pull all of the needed resources and interventions together into a plan that will best meet the needs of the patient, and is a primary role of the nurse. The knowledge I have gained over the course of the nursing program will provide the foundation for assessing the needs of the patient, and will guide me in seeking appropriate interventions through collaboration with other healthcare professionals.

            Having opportunities to interface with patients and their families on a prolonged basis is the third major change I predict upon transitioning to the nursing role. As a paramedic responding to emergency calls, there was minimal initial contact with the family, and often that contact ended once a report was given and the patient had been handed over to the care of emergency room personnel. It was not always that simplistic though, for many calls did involve non-emergency transports, hospital-to-hospital transfers, and hospital discharges to residential locations, so family contact sometimes was sometimes markedly increased. However, I believe while functioning in the role of the registered nurse, there will be far more opportunities afforded to interface with both the patient and their caregivers than what was available to me as a paramedic, and that these contacts will benefit the outcome of the patient in a variety of ways. For example, for hospitalized patients, the registered nurse may function as the bridge between the family and the doctor after the family was not available when the doctor-patient contacts occurred.

            The fourth major change I look forward to is the responsibility to educate patients and their families about their current illnesses or conditions, and actions they can take to improve their overall wellbeing (Fundamentals of Nursing, 7^th Edition, p.10). As I transition into being a nurse, my responsibilities will encompass teaching the patient and their family. As a paramedic, I voluntarily advanced my knowledge level, became an instructor in several disciplines, and taught for several years. However, I mostly only taught allied health professionals basic and advanced life support classes and all of the teaching was optional; never was any of it expected as a job responsibility. I enjoy teaching and sharing knowledge with others. Therefore, I look forward to helping patients develop a better understanding of their illnesses, injuries, or conditions, and I yearn to teach them how they can improve their overall wellbeing. Not only are educated patients more receptive to their care, but family members who were instructed by a nurse also have a better understanding of the patient’s needs and are more apt to assist the patient in being compliant with their care (Maternal-Child Nursing, Third Edition, p.799). Teaching the patient and their family is one of the main job responsibilities of a nurse, and I anticipate giving my best efforts in that regard.

            The fifth and final main change I recognize in the transition from the paramedic role to a registered nurse role is the vast choices in terms of employment options and educational advancement opportunities. Because I knew the pay and the hours were better, there always were many more job offerings, the working conditions were less hazardous, and the physical requirements were less strenuous, for several years  I have advised disgruntled or frustrated paramedics who were either burnt-out (or otherwise unhappy with their current employment) to consider nursing as an optional opportunity of advancement. According to information published by the U.S. Bureau of Labor Statistics, “Employment of registered nurses is expected to grow 26 percent from 2010 to 2020, faster than the average for all occupations” (Occupational Outlook Handbook, 2012). Now knowing a lot more about nursing than I did when I began this bridge program, I am still convinced of each of those benefits to transitioning from a paramedic to a registered nurse. I also now realize there are numerous areas of expertise within the nursing field to specialize in, and several avenues to continually advance within each of those fields.

             In conclusion, the final shift that I need to address is where do I go next? The possibilities are vast. The United States Bureau of Labor Statistics, Occupational Outlook Handbook, predicts a twenty six percent-growth rate in the need for registered nurses over the course of the next ten years.  Nursing is predicted to be one of the biggest growth markets in our country. I am still undecided regarding my exact next steps. My entire focus has been on getting to the end of this long and challenging journey. I have learned through some preliminary exploration that some doors are closing in the hospital arena for nurses who hold an associate’s degree. Many hospitals have set deadlines for nurses to obtain bachelor degrees. I have worked to not be discouraged by this, but rather to see it as another step in my journey. The future holds the promise of being able to touch the lives of patients and have an impact on their health and wellbeing. I long for this challenge. My transitioning from performing according to the roles of a paramedic into the realm of responsibilities expected of a registered nurse reminds me of the renowned words of Neil Armstrong, “That’s one small step for man, one giant leap for mankind” (http://www.space.com/17307-neil-armstrong-one-small-step-quote.html). However, I do not feel as if my transition is equivalent in importance to his accomplishment, for in my opinion, my transition ranks more along the humble lines of, “That’s one giant leap for (this) man, one small step for mankind”. 

References

Ignatavicius, D.D., & Workman, M.N. (2010). Medical-Surgical Nursing, Patient-Centered

            Collaborative Care, Sixth Edition. St. Louis, MO. Saunders

McKinney, E.S., James, S.R., Murray, S.S., & Ashwill, J.W. (2009). Maternal-Child Nursing,          

            Third Edition. St.Louis, MO. Saunders

Potter, P.A., & Perry, A.G. (2009). Fundamentals of Nursing, 7^th Edition. St. Louis, MO. Mosby

Unknown, A. (23 Sept 2012). Occupational Outlook Handbook. U.S. Bureau of Labor

            Statistics, http://www.bls.gov/ooh/healthcare/registered-nurses.htm

 Unknown, A., (23 Sept 2012). Paradigm Shift, Moving From One Thought System to Another.             http://www.taketheleap.com/define.html

Wolchover, Natalie (23 Sept 2012).‘One Small Step for Man’: Was Neil Armstrong Misquoted?.         SPACE.com, http://www.space.com/17307-neil-armstrong-one-small-step-               quote.html