Ashford University Patient Financial Constraints & Nursing Legacy Discussion

Ashford University Patient Financial Constraints & Nursing Legacy Discussion Ashford University Patient Financial Constraints & Nursing Legacy Discussion Many nurses throughout history have left long and distinguished legacies of excellence in a variety of ways. What impact might you have on the patients with whom you come into contact every day? The past and current challenges to nursing and health care have been and are being met by exemplary nurse leaders. Each has exhibited or is exhibiting enhanced focus and ideation, enriched values, purpose, and grit! The successful nurse leader must prepare to be an effective thinker, communicator, motivator, and champion of personalized health care. Nurses have built and will continue to build upon a rich legacy of innovations and commitment to meet issues of nursing and health care. Florence Nightingale, for example, was highly educated, focused on a path of lifelong discovery, and dedicated to knowledge and science in the service of others. Her legacy made us a better society. Ashford University Patient Financial Constraints & Nursing Legacy Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Your individual nursing legacy is an integral part of the legacy of nursing as a whole. Think about how you want to be remembered at the end of your nursing career. Envision what you want to leave to the profession in the areas of practice, education, and research. Make a conscious decision to plan deliberately what your legacy will be, rather than just letting it happen. Review the Learning Resources and write at least 350 words addressing one of the following Discussion topics. In this Discussion, you have the opportunity to begin considering your own personal nursing legacy. To prepare Review the Discussion Post Tips Document in the Writing Resources and Program Success Tools for this week. Your initial post must be 2 paragraphs and at least 350 words. Review the Laureate Education video titled Issues and Trends in Nursing: Introduction (2009a) provided in this week’s Learning Resources. Explore this week’s Writing Resources and Program Success Tools, specifically: Academic Writing Expectations (AWE) Checklist, Weeks 1–3 “Common Course Assignments: Discussion Posts” (Walden University, n.d.-e) “Paragraphs: Overview” (Walden University, n.d.-h) “Using Evidence: Overview” (Walden University, n.d.-o) Review the following articles, provided in this week’s Learning Resources: “The Empty Carriage: Lessons in Leadership From Florence Nightingale” (Heege, 2011) “Creating a Career Legacy Map to Help Assure Meaningful Work in Nursing” (Hinds et al., 2015) BY DAY 3 Post a 2-paragraph response (of at least 350 words) to one of the options below. Develop and post cohesive paragraphs and use evidence to support your ideas. Option 1 Describe at least two current and/or future challenges in nursing and the solutions that are being proposed to meet those challenges. Explain how furthering your education will enable you to build upon your personal nursing legacy in meeting these types of challenges. Ashford University Patient Financial Constraints & Nursing Legacy Discussion OR Option 2 Describe a nurse colleague or current nurse leader who inspires you. Identify and describe how this person’s actions have led to positive outcomes related to patients, peers, and/or supervisors. What do you see yourself doing similarly or differently? career_legacy.pdf db19e1abe5526d218a0baa367af3.doc carriage.pdf discussion_tips.pdf Available online at Nurs Outlook 63 (2015) 211e218 Creating a career legacy map to help assure meaningful work in nursing Pamela S. Hinds, PhD, RN, FAANa,b,c,d,*, Dorienda R. Britton, BSa,c, Lael Coleman, BAa,c, Eileen Engh, MSN, RN-BC, CPNa,c, Tina Kunze Humbel, MSN/MHA, RN-BC, CPN, CCRNa,c, Susan Keller, BS, MLS, MSa,c,d, Katherine Patterson Kelly, PhD, RNa,c,d, Johanna Menard, BSN, RN, CPNa,c, Marlene A. Lee, MSN, RNa,c,e, Renee Roberts-Turner, DHA, MSN, RN, NEBC, CPHQc,f, Dory Walczak, MA, MSHI, RN, NE-BC, CPHQa,c a Department of Nursing Research and Quality Outcomes b Center for Translational Science c Children’s National Health Systems d The George Washington University e The Clinical and Translational Science Institute at Children’s National f Department of Professional Practice and Magnet article info abstract Article history: Received 16 November 2013 Revised 15 July 2014 Accepted 4 August 2014 Available online 8 August 2014 When nurses declare a professional legacy (or what they intend to be better in health care because of their efforts), they are likely to maintain a focus on achieving their legacy and to experience meaning in the process. We depict the legacy and involved steps in creating a legacy map, which is a concrete guide forward to intended career outcomes. Informed by the “meaningful work” literature, we describe a legacy map, its function, the process to create one, and the application of a legacy map to guide careers. We also describe an administrative benefit of the legacy mapdthe map can be used by team leaders and members to secure needed resources and opportunities to support the desired legacy of team members. Legacy mapping can be a self-use career guidance tool for nurses and other health care professionals or a tool that links the career efforts of a team member with the career support efforts of a team leader. Keywords: Career guidance tool Career legacy map Legacy planning Meaningful work Cite this article: Hinds, P. S., Britton, D. R., Coleman, L., Engh, E., Humbel, T. K., Keller, S., Kelly, K. P., Menard, J., Lee, M. A., Roberts-Turner, R., & Walczak, D. (2015, APRIL). Creating a career legacy map to help assure meaningful work in nursing. Nursing Outlook, 63(2), 211-218. j.outlook.2014.08.002. “Efforts and courage are not enough without purpose and direction.” dJohn F. Kennedy September 17, 1960 (The American Presidency Project;¼74076) Individuals who choose careers in nursing are commonly motivated by a desire to help others through improved clinical care, care systems, and care outcomes (Donner & Wheeler, 2001; Henry & Henry, 2005). The motivation and the intended end points of care improvements represent a career legacy or a * Corresponding author: Pamela S. Hinds, 111 Michigan Avenue, NW, Children’s National Health Systems, Washington, DC 20010. E-mail address: [email protected] (P.S. Hinds). 0029-6554/$ – see front matter Ó 2015 Elsevier Inc. All rights reserved. 212 Nurs Outlook 63 (2015) 211e218 formal declaring of what will be better in health care as a result of planned steps to create or contribute to the desired improvements (Hinds et al., 2013). Together, the declared legacy and the identified steps to achieve the legacy comprise a legacy map. Ashford University Patient Financial Constraints & Nursing Legacy Discussion The map is a depiction of the declared legacy and includes a plan that serves as a guide forward with measureable metrics to the desired improvements. In this way, legacy mapping in nursing is done with a sense of purpose and intentionality to contribute to the well-being of others through purposeful and meaningful work engagement. We have created, implemented, and refined a process to create the legacy map and its use that serves both motivational and practical purposes. We describe here the process, its use, and its outcomes. We acknowledge that our use of the word legacy differs from its more common usage of a bequest or gift given from a predecessor. We use it here to mean the nurses’ plan to contribute knowledge, practice changes, or other aspects of health care to benefit those who receive nursing care. Background There are two important and distinct discussions in the professional literature regarding career development, one focused primarily on achieving work goals and the other on achieving work meaning. London (1993) describes the individual’s realism and clarity of career goals including the ability to achieve the goals. Messmer (2003) and Manson (2009) define career success as goal accomplishment or achievement of an objective and career persistence achieved by overcoming goal challenges. Related literature examines the correlates to career clarity and decision making with particular emphasis on career self-efficacy and decision-making anxiety (greater career self-efficacy being associated with lower decision-making anxiety; Niles & Sowa 1992) and proactive career self-management (i.e., an individual setting goals and developing relevant skills with less reliance on employers; Strauss, Griffin, & Parker, 2012). In this literature, career mapping is a tool used to engage professionals (nurses) in developing a career goal such as achieving promotion and specifying incremental steps (Shermont, Krepcio, & Murphy, 2009). An institutional approach to foster goal accomplishment in nursing is the use of career or clinical ladders. The ladders are comprised of levels of activities selected by the institution as meriting recognition financially and by titling to represent career advancement. The ladders tend to be for nurses in direct care and not nursing leadership (Adeniran, Bhattacharya, & Adeniran, 2012; Buchan, 1999; Donley & Flaherty, 2008). Certainly, this literature with its emphasis on goal achievement is helpful for career development, but it risks being insufficient if the more humanistic values of meaning, purpose, and professional fulfillment are not considered. Lieff (2009) describes the pursuit of meaningful work as part of effective career decision making in academic medicine and specifically addresses the importance of feeling effective, creative, and balanced in a career. Emphasis is placed on the importance of achieving self-realization or authenticity through a meaningful career (Brown & Gundermann, 2006; Svejenova, 2005) and the benefits to an organization when employees find meaning in their work (i.e., greater commitment to the setting, lower intentions to leave, and higher job satisfaction; Duffy, Bott, Allan, Kik, & Torrey, 2012). One segment of this discussion, the constructivistsocial-constructionist perspective, gives far greater emphasis to work meaning by viewing careers as vehicles for individuals to live personally meaningful lives that contribute to improved social conditions for others (Hartung & Tabler, 2013). The work meaning literature also speaks to higherorder goals reflecting purposefulness (described as having intentionality and directedness to work behavior) and the experience of meaningfulness in work (or the significance to an individual of their work efforts). More pointedly and of particular relevance to nursing, work meaning includes the intention of making a positive difference in the lives of others (Barrick, Mount, & Li, 2013; Grant, 2007).Ashford University Patient Financial Constraints & Nursing Legacy Discussion These higher-order goals are theorized to be more enduring than goals specific to achieving a certain role or career opportunity because they are causally linked to a sense of professional wellbeing. In nursing, such goals are helpful to all but considered to be critical to retaining midcareer nurses in the nursing discipline (Donner & Wheeler, 2001). Importantly, relationships are key to individuals finding work meaning; the relationships can be with peers, supervisors, or those who benefit from work efforts such as patients and their families (Grant, 2007). McNeese-Smith and Van Servellen (2000) specifically recommend that career planning between nurses and their employing organizations occur to prevent disengagement of nurses from their work, less commitment, and lower job satisfaction. Lieff (2009) recommends specific exercises to assist individuals in identifying meaningful work. The exercises include writing a brief autobiography that emphasizes values linked to career success, developing a list of personal values for use in career decision making, reflecting on peak experiences at work, and purposefully examining the match between personal and work values. Similarly, others recommend self-discovery workshops for nurses that are instructive regarding personal reflection as a way to renew career commitment (Donner & Wheeler, 2001; Price, 1998). Reflection is inherent to the process of legacy mapping. Legacy planning and legacy mapping incorporate the aspects of the career goal planning literature but additionally include career meaning and purpose, which emphasize a career that both “gives back” to others and satisfies self. Legacy planning and mapping facilitate an interactive process with others who commit to supporting the declared legacy, thus Nurs Outlook 63 (2015) 211e218 creating a shared experience. Although a legacy can be given without awareness or intent, it can be planned and made explicit with a legacy map. Achieving a desired role or a promotion is a notable career metric but may not result in the betterment of others. A career legacy, on the other hand, is fully intended to better the conditions, experiences, and outcomes of others. A career legacy in nursing is intended to promote the health of individuals, families, systems, and nations. In this article, we describe the legacy mapping process that purposefully gives primary emphasis to career contributions that are meaningful for the nurses who engage in this process. Creating a Legacy Map At the beginning of the process, the mapmaker answers the following questions: 1. What do you want to be better in nursing because of you and your efforts? 2. What would you like best to be known for by others? The answers to these questions constitute the declared legacy; the mapmaker can declare one or more legacies. The declared legacy is placed in a box at the far right side of a blank screen or paper. The mapping process continues with a query similar to “what have you done to date or have in process that will in positive ways directly or indirectly contribute to your legacy?” The individual activities are placed on the far left side of the screen or paper. The mapping continues now in more detail with queries about “what needs to happen next to move this activity on the left closer to your legacy?” The responses represent intermediate and future steps and are placed into boxes in locations near the middle of the screen or paper. An additional part of the legacy map is labeled “other” and contains the list of career activities that compete with efforts to positively influence the declared legacy. A careful examination of the completed list of competing activities is conducted to identify if one or more activities could be ended, handed off to another person who could benefit from assuming the activity, or done differently so that it would be less time consuming. Certainly, some of these activities may be inherent in the current role and thus cannot be ended, but there may be other ways to complete these activities not previously considered. A step-by-step guide to creating a legacy map is in the insert. Ashford University Patient Financial Constraints & Nursing Legacy Discussion A skeleton template of a legacy map reflecting the components of a declared legacy, current activities, future planned steps to approximate or achieve the legacy, and the section for “other” activities is depicted in Figure 1. A map can be modified as needed (i.e., changing circumstances, availability of new and relevant technologies and knowledge, and access to new opportunities) and is recommended to be updated at 213 least annually for purposes of individual career decision making and for annual review purposes involving individual team members with team leaders. To be a legacy map, the depiction needs to be an accurate and honest representation of (a) what is important to the individual creating the map and (b) the contributions the individual is now giving and plans to contribute in the future to the legacy. Creating the legacy map involves an interactive process that tends to be initially between a team leader (who is in a position to support the declared legacy in instrumental and encouraging ways) and the team member who is creating the map. The mutuality of this process enhances the commitment to the declared legacy of both the team leader and member. The process of creating the map relies strongly on focused queries about current and planned future steps and listening to the responses from the team member to ensure that each map component is defined sufficiently and is measureable. Drawing the map is concurrent to the dialogue that purposefully invites reflective engagement of the team member. Individual Team Member Use of the Legacy Map Individuals who have created legacy maps report that limiting the map to a single page enforces precision and concise descriptions of each component that help in articulating the declared legacy to others. Additionally, the specified linkages between current and planned actions toward achieving the legacy directs the individual team member’s attention to the importance of the actions that will move efforts closer to the declared legacy. At the same time, the map directly calls attention to the activities that compete with achieving the legacy. The latter awareness becomes a clear basis for avoiding involvement in activities that dilute legacy efforts. Self-review or review with one or more colleagues in the same work setting can also help to ensure that there is an alignment of the legacy and its related steps with the priorities of the work setting. The map is a visual aid that quickly conveys the current status of legacy efforts and what needs to occur next to advance efforts closer to the legacy. Maps can range in detail (Figures 2e4). An example of a legacy map that helped a team member recognize competing activities is depicted in Figure 3. This team member used the map to eliminate certain professional activities that did not align with her desired legacy and then replaced those with activities that directly contributed to her legacy. The legacy map has also been useful in helping team members explain the focus of their work to others. A benefit of the visual nature of the map is the ready representation of progression toward the legacy and a clear reminder of relevant and related projects now in place. The depiction can also help individuals recognize new opportunities that are quite relevant to their legacy. An additional benefit of the visual nature of the 214 Nurs Outlook 63 (2015) 211e218 Figure 1 e Template of a legacy map. map is that it can help guide future connections with others who could support the efforts to achieve the legacy. Ashford University Patient Financial Constraints & Nursing Legacy Discussion Finally, the map captures and conveys the individual’s past achievements and steps taken, current efforts, and future aspirations. Team Reviews of Individual Team Member Legacy Maps With agreement from all team members, legacy maps can be shared with each other. In our experience, as individuals presented their maps and offered narrative to support the meaning of the declared legacy and the planned activities, they were able to clarify the intention of map components. The process also engaged other team members in their colleague’s legacy aspirations. Discussion about possible career junctures and how they might alter the map also occurred with team sharing of individual team member’s maps. The longerterm benefits of sharing maps with the team included team members’ recognition of opportunities for each other that would support the declared legacies or the identified contributing activities and ongoing mutual support related to desired career contributions. Team Leader/Team Member Use of the Legacy Map The process of creating and using the map immediately engages both the team leader and team member 215 Nurs Outlook 63 (2015) 211e218 Legacy Map Quality Outcome Team member Nursing Quality Fellowship Co-chair a nursing shared leadership council Present at Central Nursing Orienta?on CPQH cer?fica?on Team Leader for Quality Project Ini?a?ve Faculty member for Nursing Quality Fellowship Represent the Nursing Quality Department at various levels within the organiza?on Podium presenta?on at a na?onal conference Integrate the importance of quality outcomes to drive and lead change at the bedside to improve care and the pa?ent/family experience Team Lead for Magnet Narra?ve Consult on councils directly ?ed into a nursing quality ini?a?ve Write manuscript for Pathway Project and disseminate Figure 2 e Example of a minimally detailed legacy map. in what matters to the team member and in the plan to help advance career aspirations closer to the declared legacy. We have used the legacy map on a quarterly basis to make certain that the map is guiding decisions, assignments, and opportunities. We also use the map during the formal annual performance review so that the map directly influences the goals that are developed for the new performance period. An example of this use was a team member’s declared legacy to promote nurse satisfaction in the care system with the nursing role. Several strategies were jointly identified between the leader and member, and steps and resources were put in place to support the planned strategies. One of the strategies was to move into a higher-level leadership role to more directly influence nurse satisfaction. Graduated activities and opportunities (i.e., leading committees within one discipline, leading projects that involved multiple disciplines, providing verbal reports to hospital leadership, and leading multisite projects) were initiated and contributed to this nurse being immediately nominated to move into the desired leadership role when it became available (Figure 4). Assessing the Experience of Legacy Mapping To assess the individual experience of creating, using, and sharing legacy maps, members of our department were asked to respond to two open-ended questions. At the time of completing the questions, each departmental member had used legacy mapping for 1 to 4 years, and 9 of 10 members responded to both questions. The two questions and their major themes (coded using a qualitative approach to key phrases) were as follows: 1. Please describe your personal experience (thoughts, emotions, behaviors) when you interact with your legacy map. a. Feeling challenged: initial reactions to the experience included discomfort secondary to inexperience of being asked about career meaning, fear of inadequate progress toward a legacy, and others judging the declared legacy. b. Having an opportunity to reflect: a recognition of having a chance to consider what is meaningful and important to self in terms of a career. c. Creating a new focus: choosing a direction that had not been firmly identified previously and recognizing which current activities do not add to this chosen direction. 2. Please describe the impact on you (use, outcomes, change at any level of thought, feeling, or perception) of creating and/or using your legacy map. a. Filtering out: experiencing a carefully thoughtout basis for not engaging in certain activities that previously would have been almost automatically accepted for involvement and being able to offer this explanation to others making requests. b. Being pleasantly surprised: seeing advances made toward the declared legacy and feeling satisfaction or pride in that. c. Using the map to help others: finding that the process and product of declaring a legacy is useful to …Ashford University Patient Financial Constraints & Nursing Legacy Discussion Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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