Career Development STEPS TO

Jane C. Rothrock, RN

ACHIEVING YOUR GOALS

nurse has completed her degree require- ments for a master’s degree in nursing A administration and begins to look for a

management position. After eight years of perioperative nursing experience in a major teaching hospital, she is ready to write her resume listing all her qualifications, but does not know where to begin. She calls a colleague for some advice and asks what she should put in her resume to emphasize her potential.

The colleague asks, “Are you a member of our AORN chapter? I haven’t seen you at meetings.” No, the nurse responds, she isn’t a chapter member. She is then asked what she has done to illustrate her ability to assume a management role. After

Jane C. Rothrock, RN, MS, CNOR, D an associate professor of allied health and curriculum coordinator for perioperative nursing at the Delaware County Community College, Media, Pa. She earned her master’s degree in nursing and a BSN at the University of Pennsylvania, Philadelphia She is a diploma graduate of the Bryn Mawr (Pa) Hospital School of Nursing.

a brief question and answer session, it becomes apparent that the caller has not been making regular deposits in her career bank as a professional nurse. She never thought of career development; she thought the master’s degree would be enough to get her into a management position.

Then and Now

here was a time when having many years of OR experience was a guarantee of T moving into a management position. If a

nurse stayed at one facility long enough, she or he would eventually be promoted. Historically, OR managers promoted from within the staff, and tenure and stability were significant criteria in selecting candidates for promotion.

Eventually, advanced education became part of the criteria for promotion. Sometimes the educational requirement was continuing educa- tion; sometimes it was a bachelor’s degree. In the 1970s, management recruiters began looking for master’s prepared nurses to fill top echelon positions. but by the 1980s a master’s degree became common criteria for many management positions. Today, it is not enough to have OR experience or a specific degree. Recruiters and personnel directors are looking for nurses who have appropriate experience, advanced education, and management potential.

All nurses have opportunities to nurture their careers and to develop themselves professionally. The traditional operating room work setting offers a rich and varied pool of opportunities from which perioperative nurses can select strategies to

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enhance their marketability. This article addresses how perioperative nurses can groom themselves for advancement.

Select a Career Goal

t is never too soon to start thinking about where you might like to be someday, and what I you might like to be doing when you get there.

Workshops on values clarification help people to identify what they would like to do “if only they could.” The point is that once the wish or goal is identified by the individual, it then becomes clear that there is no reason to wait. Things happen through careful planning and self-development, not through wishing.

Think about the position you want to have at the pinnacle of your career, and then consider what is necessary for that role. Begin now to market yourself. If you are thinking about being a perioperative educator, teaching skills will be one of the most critical areas in your self- development process. Teaching comprises 70% to 75% of the work of nurse educators; it is the most outstanding assessment area in an educator’s performance appraisal.

If you are thinking about management, analyze what it is that managers need to be effective. In the competitive health care arena, such factors as productivity, cost containment, staff motivation, people skills, and marketing abilities are most important. After you have identified the area in which you would like your career to grow, start nurturing the growth process.

Make u Deposit in Your Career Bunk

ny number of opportunities are career enhancers. Select activities that will A specifically contribute to your growth and

marketability in your career direction. What you are doing is developing the background to be able to say to a future employer, “Here are some of the things I have done in my experience in the OR. Although I have not held this type of position before, I have done many of the things that are expected in the position.”

Clinical competence is the absolutely essential requirement for many positions. You cannot teach it or manage it if you cannot do it. Strive to have outstanding clinical abilities. If you have only worked in a specialty, try to get more general surgery experience. Take call and keep up with new clinical developments. Go to continuing education programs that deal with areas outside of your specialty to keep yourself up to date. If your facility has a clinical ladder system, know the criteria for advancement and work toward achieving them.

One of the significant achievements of anyone wishing to claim clinical competence is being certified in a clinical specialty. If you have not taken the CNOR examination, make it one of your goals. Professional certification is appearing in advertisements for many middle management and staff positions.

Committee work indicates a person’s level of participation in an institution, his or her commitment, and provides experience that is expected in management or teaching positions. Most ORs have many standing or ad hoc committees. Begin by getting appointed to a committee; progress by chairing a committee.

Projessional activities indicate a person’s career orientation and professional allegiance. AORN is one of the associations to which you should most certainly belong. You should also consider membership in state councils of operating room nurses, state nurses’ associations, other specialty nursing associations, and nursing honor societies. Belonging is not enough; you need to participate. What better way is there to market your leadership ability than to be an active member of your professional associations? Volunteer for committees; run for office; meet the criteria to be a chapter delegate to the AORN Congress; attend a Congress.

Sometimes people fail to get involved because they are unsure about whether they are good enough, or they think that polite people do not vote for themselves. When you are developing your career, you must make activities meaningful. Join your association, raise your hand, and get involved. If you do not, you will have no way of realizing the payoffs or experiencing the

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Management competence does not magically appear with an appointment

to a management position.

enjoyment participation brings. Management competence is not something

that magically appears with an appointment to a management position. There are a number of ways you can start developing yourself as a manager without having the title. Consider being in charge when the head nurse is off or on vacation. Some nurses complain about having to take charge without getting paid for it, and although there is something to be said about being remunerated for worth, there is also an advantage of using being in charge as evidence of your administrative ability. When you can say that you have run the schedule, planned for staffing and patient care requirements, made assignments, and collaborated in administering the daily activities of the department, you demonstrate management skills. If you do not get paid extra now, you may be able to collect interest on the experience in the future.

You can also accept responsibility for a specialty area in the OR. People in charge of specialties can document their ability to order and inventory supplies and equipment, participate in the budget process, be accountable for costs, and teach new personnel. All of these experiences are deposits in your career bank.

Teaching competence does not accrue only from experience in academia or formal classrooms. Develop yourself in the teaching role by acting as a preceptor for a new employee. Participate in the department’s in-service education program by being part of the orientation process. Get involved in staff development by making a presentation to your coworkers about a new aspect of patient care or new equipment. Get involved in your AORN chapter’s Project Alpha group or participate in the supervision of students who come to your OR for a clinical learning experience.

Get involved with patient teaching. Consider offering a program to ambulatory surgery patients as a group lesson. Nurses teach a good deal of

the time; they just do not give themselves credit for it. Know what kind of teaching you have done and use it to underline the potential you have for a teaching position.

Speaking engagements often frighten and intimidate people. But no one knows OR nursing better than perioperative nurses, so why do we let other people speak about it for us? You can start small and work big in this area. Start by offering to do a chapter educational session; work with a colleague to diffuse some of the uncertainty and trepidation that accompanies first speaking engagements. Or offer to give a session with an experienced speaker. Offer to speak to consumer groups, to nurses, or to a group of students.

If you are committed to professional develop ment, take a course in public speaking. Expert speakers did not learn all of their strategies from their mothers; they took courses and practiced making presentations. When you are ready to think big, consider working with your AORN chapter or nursing colleagues on a proposal for a Congress program. This is one of the professional highlights for perioperative nurses and it is attainable for you. Congress is a great place for an aspiration.

Writing for publication is another area where nurses often say “I couldn’t’’ when they have not even tried. You do not have to consider a journal the only place to publish. Write something for your hospital newsletter about the operating room. Read your nursing journals and write a letter to the editor; it does not have to be a critical analysis-letters of praise and support are also welcome. If you have something you are truly interested in, consider a short guest editorial. Do you have a strong opinion about the need for an all professional staff! About the need to do patient teaching? About the new titling proposal? Try writing it down and see if your thinking is logical and persuasive. If you think it is, consider submitting it for publication.

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During the interview present what you can do and how

well you can do it.

You can also write something for your AORN chapter newsletter. Again, this does not have to be a research article or long paper; the goal is to begin writing something you wish to share with your colleagues, not something that will be eligible for the Pulitzer prize.

Advanced educational preparation is essential if you are working on career development. Most institutions have some form of tuition reimbursement as an employee benefit. Use it to benefit yourself instead of looking at it as something negative that someone else is making you do. Education is a lifelong process; take a course toward an advanced degree. It may be stimulating and motivating, and you may find that the educational ambience often positively affects other aspects of your life. If the course is viewed as one course at a time instead of a degree no one ever told you you would have to have, it becomes emotionally more manageable. When it is perceived as a career enhancer, it becomes even more palatable.

Other career development strategies include research, community service, and consulting. Whatever you choose to market yourself, remember how these can all be deposits in your career bank. Plan to be able to draw on them in the future.

The Interview

ou have two marketing strategies during the interview: the resume and the person- Y to-person relationship. Professional servi-

ces can help with writing your resume, but you must have the material organized for them to describe. Resumes should be typed or typeset, current, and in an acceptable format. Devise a cover letter to help interpret the assets described in your resume and to highlight why you are qualified for the position.

During the interview, you have the opportunity

to personally impress the interviewer. One strategy is to go prepared with questions. Remember, you are looking for a promotion as well as a commitment and a challenge, so there are aspects of the job you need to be aware of so that you can determine if the job is going to fit you. Find out what the interviewer is looking for in a candidate. What does he or she consider the primary responsibilities of the job? What is the philosophy of nursing in the institution and in the OR? What does he or she identify as the assets and problems of the department in which you will be working? Of the problems, which will be priorities for the new manager or educator in the coming year? Are there written policies and procedures, and are they clearly communicated?

Ask to see the policy and procedure manual. What kinds of financial resources are available to support equipment purchase, travel, and staff development? What are the physical resources? What is the OR environment like? Is there adequate storage space? Office space? What kinds of staff resources will be available? Is there a staff development person? Who is on the management team? Are there consultants available? Are colleagues supportive of each other? What is the educational preparation and work experience of the OR staff? Are there identified learning needs? Is this a staff with growth potential? How do staff members view their jobs? Do they complain of stress-related problems?

Ask questions that will help you decide how you will fit in. How does your future superior perceive your role in the heirarchy? What kind of evaluation system exists? Who gathers, analyzes, and evaluates the data? What is the overall purpose of the evaluation process-salary increments, promotion, the measurement of output and efficiency?

During the interview, present what you can do and how well you can do it. Emphasize your

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productivity and accountability. Describe what specific contributions you can make in this work setting. Relate the factors in your job history that may be impressive; talk about your stability in employment situations or your movement in employment situations. If you have changed jobs frequently, emphasize your openness to change. Be sure to present this in a positive light in terms of being a person who explores options, who is flexible and adaptable, and how willing you are to make a commitment to a position.

Share your administrative philosophy with the interviewer. Are you a team administrator? Do you value institutional performance and the people involved? How would your management or teaching style facilitate staff performance in terms of quantity, quality, and job satisfaction? What

kind of problem solver are you? Talk about your people skills.

If you are marketing specific aspects of yourself, be able to back them up with appropriate references. If you are explaining your people skills, have a reference from someone who can document your interpersonal abilities and the nature of your collaboration with others.

End on a positive note. Reiterate why you want to be a member of the team. If you have found the interview process stimulating, say so. Find out what the next step in the process is and when decisions will be made. Leave your resume and your card if you have one. Leave knowing that all of the deposits you have made in your career bank will pay off, either in this opportunity, or in another one. 0

New Technology Rivals Cardiac Catheterization Cardiac catheterization has long been used as the standard for assessing valvular heart disease. That standard, however, is now being challenged by two-dimensional echocardiography with Doppler ultrasound that costs one-tenth as much, is nonin- vasive, and has fewer complications.

This new technology gives complete informa- tion about the walls of the heart, the motion of the heart, the size of the chambers, and the pres- sure gradients across valves, according to the arti- cle in the Feb 10 issue of Medical World News.

Despite that, the new technology has failed to make a substantial dent in the number of cardiac catheterizations. More than 500,000 are done in the United States each year. Echo-Doppler is less than two years old, so authorities presume that its lack of use is largely because physicians do not know about it.

Two-dimensional echo with Doppler has gone head-to-head with cardiac catheterization in trials of more than 1,OOO patients, and simultaneous pressure gradient measures made with the two techniques varied less than 10%. For 90% of all patients, Doppler pressure gradient measure- ments were as accurate as cardiac catheterization.

When good quality tracings cannot be obtained or coronary artery anatomy must be studied before surgery, cardiac catheterization is still necessary. Catheterization also produces better results for patients who have barrel chests from chronic lung disease.

The primary use of echo-Doppler, however, would be aimed at diagnosing valve disease. Cur- rently, 20% of the 508,000 cardiac catheteriza- tions done are aimed at doing that. The advan- tage in using echo-Doppler would be reduced cost. A complete cardiac catheterization runs into thousands of dollars, but the average cost of a two-dimensional echocardiogram with Doppler is $300 to $400.

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