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This paper provides critical information aimed to help Nursing Students to plan out their career and have a better understanding of Reflection Nursing in the health care industry. The paper is separated into two different parts. As a nurse, individuals are exposed to several number of employment positions during the working life. The paper consists of two specific areas related to the industry. The success of a nursing career depends on gaining experience, skills and competencies to climb the ladder with different roles at higher and higher levels (Vallano, 2006). Therefore, the first part of the paper provides the reader with a Career Development plan along with an analysis of the main skills and attributes requires for a nurse to have in them. The second part of the paper focuses on Reflection Nursing, discussing the aspects of this practice, including the importance of it, even though it is a criticized area in the health industry itself. This paper will focus on the technicalities behind starting off a Nursing Career and also, discuss aspects of the industry that involves constant reflections, critical thinking and analysis.
1. A Nursing Career Plan
According to Vallano (2006), one must manage your career like a business. In order to pursue in nursing, a career plan is an essential tool for professional development, job satisfaction and illustrates commitment to your discipline. The career as a nurse is a rewarding career with plenty of room for advancement and development (Waddell, Donner, & Wheeler, 2008). My long term goal to achieve is to be a nurse who leads an entire ward of a health institute. However, to get there, I need to have a strong foundation. Therefore, within the coming 3 years, through hard work and continuing education, I would like to become a registered nurse and start working in an established health institute.
The main attribute that attracted me towards this career is because being a nurse requires you to be intimately involved with another human being (Waddell, Donner, & Wheeler, 2008). I once read that “Nursing affords the opportunity to make a difference in the lives of others. You can earn good money, but you can also make a difference” (Vallano, 2006). This was the main aspect that drove me towards a nursing career in general. This career requires you to be involved in people's most important life moments, such as birth, death or even surgery (Hartung & Subich, 2011). Along with this, in the nursing career, there are always chances for more advancement and diverse ranges of specialty.
In order to reach my goal to be a nurse in a leadership role, there are few processes I have to go through. The first is to pursue my Bachelor's Degree of Science in Nursing. As an undergraduate, I would be able to study and familiarize with areas such as medical technology, patient care procedures, math, anatomy and biology, along with any specialized areas I might consider in the future, such as surgical nursing, obstetrics nursing. The completing of a nursing degree takes a minimum of 2 years.
While pursuing my nursing degree, I want to join an internship program at a hospital. This would be a chance for me to earn while learning. By joining an internship program, I will be able to demonstrate the understanding and competence in technical skills and procedures related to my specialty while being provided with an opportunity to apply sound clinical judgment and critical thinking throughout the process in the management of patient care (Turner, 2007). In short, I will be able to gain a knowledge base and skill set needed to transition to competence in clinical nursing practice.
After the completion of my 2 year degree program, the biggest step I need to take is to pass the national licensing test in order to earn my Registered Nurse Credentials. This test would be where my theoretical and practical skills will be tested in order to ensure that I have the required qualifications to become a Practical Nurse. Passing this test would set the path to the starting off of my nursing career.
Most new nurses begin their careers in emergency rooms, ambulatory care units, and general hospitals (Garrison & Duncan, 2008). Hence following the passing of the licensing exam, I would apply to work as an emergency room nurse, starting off my practical career. From here onwards, I would work my way up the ladder, to reach my long term goal, pursuing my continuing education along the way.
While this would by plan for the coming three years, I plan to stay active in my career development throughout my whole career in order to stay successful. This is because many nurses' careers burnout or stagnates with time without considering long-term strategies (Donner & Wheeler, 2004 ).
2. Skills & Attributes needed for a Nursing Career
According to Vallano (2006), nursing is a service profession which requires me to have a combination of several skills. Nursing career is an integral part of the healthcare profession which calls for skill, hard work and devotion. While there are several skills required to be in a nurse, there are certain skills that takes priority which are:
- Professionally Competent - knowledge based skills and ability to answer questions feasibly (Waddell, Donner, & Wheeler, 2008)
- Developed Interpersonal Skills - communication and observational skills (Waddell, Donner, & Wheeler, 2008)
- Emotional Skills - be able to deal with emotionally charged situations and ability to offer advice (Waddell, Donner, & Wheeler, 2008)
Being professionally competent is defined as ‘the knowledge and skills of the nurse to make decisions and prioritize care, and includes competence in relation to physical or technical aspect of care' (Garrison & Duncan, 2008). As a nurse I need to be organized and be effective in multitasking. While taking care of patients, nurses interact a lot with them, sometimes more than the doctors themselves. So, in order to answer any question the patient or their family might have, I would need to have a deep knowledge and understanding of the conditions of the patients (Turner, 2007).
A strong background in Science is required to understand most aspect of this area since it helps me understand better what is wrong with the patients. Since nurses are responsible for recording patient's information such as the medical history accurately, it is important for a nurse to be intuitive to ask the right questions without missing out any critical part. Along with working with patients, a nurse has to work with different kinds of machines and medications during work (Hartung & Subich, 2011). In order to work with these tools harmoniously, a nurse requires being fluent in math. Being familiar with math includes being fluent with both the standard and metric system of measurement, specifically while dealing with medications (Turner, 2007). According to Turner (2007), patients describe competent nursing practice as a combination of technical care and nursing knowledge, but it is only when technical care is assumed that interpersonal attributes become the more important indicators of quality nursing care.
Another main kill that is required for nurses to have is a well-developed set of interpersonal skills. As a nurse, I would have to work with doctors, patients and a team of other nurses communicating with them in a very fast paced environment (Garrison & Duncan, 2008). Poor interpersonal communication by a nurse can be profound and often increases the vulnerability experienced by patients. As a nurse, it's crucial to be a good at listening as well as talking. With the patients, this is important to make them and their loved ones feel secure leaving their care in your hands and this skill proves important with doctors and your peer because without communicating with them, carrying out the task of patient care will be impossible. Nurses also have to be constantly alert to changes in patients' conditions and the implications in terms of care (Waddell, Donner, & Wheeler, 2008). They have to be able to spot anything out of the ordinary or basically anything that doesn't seem right. These changes need to be communicated back to the doctors clearly and concisely in order to ensure the patient's well-being. With poor interpersonal skills, barriers might occur in this communication process which might include misunderstandings and even lack of information provided to certain parties involved in this communication process. In healthcare, these are errors that might lead to grave problems. Effective communication requires a combination of good verbal and non-verbal skills (Donner & Wheeler, 2004 ). Therefore, as a nurse, I would have to be able to understand gestures and facial expressions of my patients, peers as well as doctors, especially during an emergency.
Emotional skills can be considered as the next main attribute a nurse is required to have. Empathy and compassion are foundation of nursing care (Turner, 2007). As a nurse, I would be able to see people at their worst days and also at their best. This involves me to have developed traits such as caring, understanding, being non-judgmental and have a strong ability to empathize with the patients from all the walks of life (Hartung & Subich, 2011). At times of crises, a nurse is required to play a key part in helping patients and their loved ones come through these crises and manage distress within a very distressed environment. This requires very strong emotional stability in a person. Since I plan to start off my career from an emergency room, this skill set needs to be extra strong in me. This is because in the emergency room of a hospital, nurses have to deal with people who are very sick, disabled, or experiencing any number of physical, mental and emotional issues and even major accidents (Donner & Wheeler, 2004 ). In an environment as such, I would have to be emotionally strong enough to provide the patients with the help they require without letting the situation affect my judgment or quality of work. In order to gather emotional skills, I would have to learn take care of myself in order to be balanced enough to provide care to other since I will encounter difficult staff members, angry physicians, non-cooperating patients and disgruntled family members as well (Turner, 2007).
With these skills and many others put in consideration, I will be able to achieve my goal into becoming a successful registered nurse.
In the nursing practice, reflection is a process of reviewing an experience of practice in order to describe, analyze and evaluate and so inform leaning from practice (Holland & Rees, 2010 ). Reflection is undoubtedly an important concept, which has succeeded in stimulating debate and investigation, and influencing nursing education around the world (Lumby, 1991). This process involves focusing on how the individuals interact with their colleagues and with the environment to obtain a clearer picture of their own behavior (Saviski, 2003 ). Reflective thinking highlights the intermingling of practitioner's feelings and emotions, and acknowledges this interrelationship with actions as well as the importance of intellectual thinking thus providing a vehicle for legitimizing professional knowledge that develops from the realities of practice and challenges more traditional form of knowing (Johns, 2010)
The process of reflection in nursing aims to develop professional actions that are aligned with personal beliefs and values. Current thinking in nursing advocates the need for nurses to be educated in ways that develop their autonomy, critical thinking, sensitivity to others and their open-mindedness (Oermann, 2008). Nursing is a practice discipline and effective preparation of nursing requires that we are able to care competently for our clients and continue to develop our skills and knowledge over a professional lifetime. They are responsible for providing care to the best of their ability to patients and their families (Orem, 1995 ). In order to achieve this, it is vital for nurses to focus on their knowledge, skills and behavior to ensure that they are able to meet the demands made on them by this commitment. According to (Lumby, 1991), nurses develop competence through a process of critical reflection on experience; they examine their work and the contribution their nursing and nursing generally makes socially. She also states that in turn, nurses also consider the effect social forces have upon themselves and their work.
Through the process of reflection, nurses are able to gain a heightened awareness of the variety of factors that shape their practice resulting in informed practice (Holland & Rees, 2010 ). Grasping the idea that reflection is a combination of thinking, emotion and commitment to action is not an easy one (Holland & Rees, 2010 ).
The process of achieving reflection in a field such as nursing can be seen as a challenge. These skills required to achieve reflection was stated by (Saviski, 2003 ) as self-awareness, description, critical analysis, synthesis and evaluation. But while the competent nurse just beginning to utilize the reflective practice is unlikely to be able to use all of these, this stems in part from the limitations of the level of performance which may be efficient and complex but is based on deliberate planning (Hartung & Subich, 2011). Reflective practice is part of the requirement for nurses constantly to update professional skills. As a nurse, professional competency is a vital attribute to ensure efficiency in their daily works. Using reflective practice, portfolio offers considerable opportunity for reflection on ongoing development. Annual reviews of their self and skills allow nurses to identify their own strengths and areas of opportunity for future development (Lumby, 1991). Reflection on personal attitudes, feelings and values as well as reflection on life and educational experience is a critical process in nursing education; it is a critical process in becoming a nurse (Lumby, 1991).
However, there are some cases where it has been identified that reflections of the nurses as taken-for-granted assumptions that rarely acknowledge that ‘doing' as a nurse is more important than thinking or reflecting (Oermann, 2008). For reflection to be really meaningful, it must being with a shared overall aim to achieve effective learning and positive experience. Nurses face ethical dilemmas, and both professions are characterized by specific moral discourses and practiced. In nursing, it is importance to practice a professional identity and practice of personal behavior bound up with notions of ‘moral agency': empathy, compassion, understanding (Orem, 1995 )It is imperative that self-reflection be developed early in the educational experience and continued in nursing practice (Oermann, 2008). Reflective practice potentially provides a way to justify the importance of practice and recognizes the interrelationship between theoretical and practical knowledge, embracing the intermingling of thinking, emotion and action (Holland & Rees, 2010 ). This appeals to nurses especially because it they are able to identify with this aspect of reflective thinking since it provides a justification for practice knowledge.
Garrison & Duncan (2008) discusses the importance of design, evaluation and outcomes of a reflective practice intervention that can be used to train critical care nurses on how to incorporate family intervention into their nursing practice. The befits and problems of reflective practice are many and most beneficial aspects include improvement of professionalism and better ability to tackle similar situation leading to professional development through experience in nursing (Johns, 2010). Reflection practicing relates to a nurse's experience and learning from the experience, helping them to change their attitude towards critical care especially in family and enhanced their communication and ability to build proper relationships with families bringing in a new way of understanding family stress or appreciating family values.
Reflection helps nurses face practical problems encountered related to role integration, professional autonomy, legal and consent issues, non-medical prescribing and role evaluation. Considering the benefits of changing nursing attitudes and developing professionalism through reflective practice, many researchers have emphasized the need to use reflective practice as a training method within nursing education (Saviski, 2003 ). Guidelines could be developed according to the theoretical framework of reflective practice and can give a new direction nursing education. Reflective thinking has become a popular word in nursing education worldwide, but its meaning and effective use remains debatable because of lack of clarity in its meaning (Holland & Rees, 2010 ).
(Freshwater, 2002)suggested that the capacity to reflect on action so as to engage in a process of continuous learning was one of the defining characteristics of professional practice. Nurses should consider the ways in which they interact and communicate with their colleagues. Communication as discussed in Part A of this paper is a vital attribute to a nurse in the face paced environment they work in. And using reflective practicing in order to harmoniously communicate with the peers help create a more efficient working environment along with developing their personal skills as well. They should aim to become self-aware, self-directing and in touch with their environment (Rolfe, Freshwater, & Jasper, 2001) rather than depending on their peers to carry out certain works during their daily work. This allows the nurses to provide efficient service to the clients/patients more feasibly through reflective thinking. It allows the nurses to think out of the box rather than stick to traditional methods and moving forward in their career themselves. This goal can be achieved by making full use of the opportunities available to them via the feedback using the impact on patients, their families, colleagues and the organization as a whole (Bulman & Schutz, 2008).
Hospitals over the millennium have developed relinquishing their role as the recognized hub of care delivery, while delivery of health care services at home, at work, at play, in schools and churches, online with the World Wide Web through the internet, and on the telephone continues to increase. In order to stay on course with these developments, nurses have been challenged to re-conceptualize their roles within the complex and changing medical contexts (Bulman & Schutz, 2008).
Reflective Practicing can be used as a feasible tool against such as discriminatory practices. This tool can be used as a framework for professional development by analyzing the current, past and future actions of the individuals to avoid going against the strong ethical codes set for nurses. Evaluations along with alternatives to similar situations can be provided using reflective practice to ensure that problems do not arise in behavior of professionals (Freshwater, 2002). While there are no set rules to developing a reflective framework, with experience an efficient framework can be developed incorporating not only reflections on actions but ethical, political and broader social issues that develop for a given experience (Lumby, 1991). This helps bring together a reflective solution that works for an organization in whole, ensuring more efficient processing of daily works within the organization.
Comments that reflective practice is regarded by many authors as particular importance to continuing professional excellence which has lead to an almost unquestioned element in professionalism; the room to excellence is through reflection (Bulman & Schutz, 2008). Reflection in nursing leads to the individuals in developing their skills in leadership and provide stability to deal with difficulties and complexities within a stressing environment such as a hospital. As discussed above, there is enough educational research and theory that advocates the importance and effectiveness of learning through reflective practicing (Freshwater, 2002). Through constant questioning, we see more clearly just who we really are, and what remarkable resources we have access to. We will also see more clearly, what is really facing us, and we will become more capable of accepting and responding to change (Ferguson, 2010).
In conclusion, the Nursing Career is clearly a career with chances for development and allows individuals to continue their education as they progress through their career. During their career, nurses needs to develop extensive skills during their daily basis and also use their intelligence to climb up the ladder in their career. With long-term planning and reflective practicing in hand, it is obvious that one could become very successful in a career such as nursing.