ROLE INNOVATION AND SELF INDENTITY CHANGE IN STAFF NURSE TO NURSE LEADER TRANSITION. Pamela C. Hudson

Transcription

1 ROLE INNOVATION AND SELF INDENTITY CHANGE IN STAFF NURSE TO NURSE LEADER TRANSITION By Pamela C. Hudson Submitted in Partial Fulfillment of the Requirements for the First Year Conceptual Paper of the Executive Doctor of Management Program CASE WESTERN RESERVE UNIVERSITY June, 2005

2 ABSTRACT Transitions are a way of life and traditionally the transition from staff nurse to nurse leader is the natural promotion pathway or transition in one s nursing career. The transition from staff nurse to nurse leaders produces change in self identity and role innovation. This preliminary conceptual model uses the theory of possible selves in trying to explain the degree of self identity change and role innovation when the staff nurse transitions to nurse leader. As the staff nurse transitions to the role of nurse manager, the use of possible selves mediates the organizational and individual influences, as the independent variables, and role innovation and self identity change, as the dependent variables. Further qualitative research will be conducted as the author explores the different variables of the model. 2

3 Table of Contents Abstract 2 Table of Contents 3 Problem Statement 4 Conceptual Framework 8 Independent Variables 14 Mediating Variables 21 Research Questions 26 Conceptual Model 28 References 29 3

4 PROBLEM STATEMENT Traditionally, the healthcare environment has considered the step from staff nurse to nursing leader to be a natural promotional pathway for the expert nurse. The assumption of a leadership role in a healthcare environment requires a new set of skills, which includes rules about social norms and rules that govern the new role (Van Maanen & Schein, 1979). To date most healthcare institutions have adopted a policy regarding the success of the nurse leader s journey that resembles survival of the fittest. Not all young professionals are left to fend for themselves; some enjoy rich apprenticeship, but they are rare (Ibarra, 2000). Although most healthcare institutions have leadership training programs many nurses are ill prepared, lacking the skills to make them an effective leader (Heller, Drenkard, Espistio, Romano, Tom &Valentine, 2004). Costlyorganization based leadership development training provides little evidence that training effects long term changes in nurse leader s ability to lead effectively (Johnson & D Argenio, 1991). A respectable beginning effort has been made to describe the characteristics of a competent leader and have focused on the perceptions of this new role (Allen, 1998), but not on the process necessary to create a strong competent nurse leader. With healthcare being such a complex environment, the nursing leader needs a set of leadership skills to navigate the minefield. Those skills will be acquired if there is a clearly defined path of development. Ill-defined transitions will cause role ambiguity; role confusion and role overload (Dykstra, 2003). These role confusions lead to an erosion of self-confidence, which leads to poor leadership behaviors and loss of follower confidence (Allen, 1998). A theory by Hardy (1978) associated role stress with low productivity and poor performance. Without forging a new identity through the process 4

5 of role transition, the new nurse leader may be uncomfortable and ineffective in the new role (Robinson, Murrells & Marsland, 1977). Recently, healthcare institutions have been paying more attention to nursing leadership as the literature has revealed a relationship between retention and leadership effectiveness (Thyer, 2003). The current nursing shortage is at a critical level and is expected to increase to 29% by the year 2020 (National Center for Health Workforce Analysis, Bureau of Health Professions, Health Resources and Services Administration, US Department of Health and Human Services, 2002). The nursing profession is facing a number of profound challenges; however one of the greatest is the need for effective competent leadership, able to stem the tide of the nursing shortage (Heller, Drenkard, Herr, Romano, Tom, & Valentine, 2004; Buckingham and Coffman, 1999). Turning the tide of the nursing shortage will take strong competent leaders, who have reinvented themselves from the professional nurse expert. The process of reinvention may require professional and personal changes that will help internalize a new identity. Assuming a new professional identity can be gut- wrenching, self questioning experience (Ibarra, 2000). It is the navigation of the journey that may provide critical insights into how a staff nurse transforms into a competent leader. The new nurse leader may arrive at the beginning of this journey with a certain amount of insecurity. The need to have the answer may lead one to exude an air of arrogance, which may make followers reticent to share information, impeding the leader s ability to learn the true nature of a situation (Watkins, 2004). A different organizational culture and unfamiliar nursing practices can be intimidating for the nurse making the transition, but may also offer the opportunity to learn and develop intellectual 5

6 flexibility (Kerfoot, 1997). The transition from nurse expert to nurse leader requires a paradigm shift and an orientation to continual learning in order to develop the nurse into a leader who effectively communicates and puts quality of patient care at the top of the agenda (Kerfoot, 1997; Porter- O Grady,1999). A good leader will not dictate or control but facilitate and support the staff. The purpose of this study is to explore the process which promotes leadership competencies in nurses experiencing a transition from practitioner to leader. There are distinct role differences between the professional nurse expert and the nurse leader (table 1). The role of the professional expert primarily involves the planning, directing and providing for the direct care of patients. That role s focus is assessing the patient s responses to therapies and treatment (Benner, 1984). It involves little or no interaction with hospital leaders, but rather is focused on the patient, family, physician, and peers on the nursing unit. The role of the nurse leader is to be a managerial generalist, orchestrating diverse tasks, a network builder getting things done through others (Hill, 2003). 6

7 A Staff Nurse Nurse Manager Item Education BSN BSN MSN recommended Certification Nursing Specialty Nursing Specialty/ Nursing Administration Authority Patient care area One or more assigned areas Fiduciary responsibility Responsible use of supplies Budget for assigned areas Specific responsibilities Direct care of the patient Direct supervision of assigned staff Supports team selection-works with other team members Recruitment, selection, retention, staffing, scheduling and assigning Participates in teams to develop polices with management oversight Empowers staff to develop policies with management oversight Cares for patients in assigned areas with other staff nurses and care givers Directs and manages personnel for assigned areas Change agent Participates in quality assurance teams to improve the care of patients. Participates in clinical decision making with management oversight Precision practice displayed with assessment skills and accurate problem solving. Understands the critical component of caring for a patient and their family. Delivers the care process. Organizes work for self Communicates therapeutically with family, physician and patients about the care and progress of the patient. Turns new behaviors into habits with individual patients Evaluates quality and appropriateness of healthcare delivery in assigned areas Empowers staff to participate in decision making Understands the critical requirements of organization, such as mission and values and care delivery process Organizes work for self and others to achieve results Focuses on key drivers of business and shares information with appropriate stakeholders. Turns new processes into unit habits. Relates reason for change to organizational goals. (ANA, 2003; ANA, 1997) It is the goal of the author to study the process experienced by the nurse expert who makes the transition to nurse leader. CONCEPTUAL FRAMEWORK Successful transition to leadership from role of staff nurse may be likely to produce a degree of personal identity change and a degree of role innovation. Transitions of this type are another form of socialization as new skills, behaviors, attitudes and 7

8 interactions may produce fundamental changes in self (Hall, 2002). Furthermore, work role transitions involve not only a personal change but also role innovation (Nicholson, 1984; West and Rushton, 1989; West and Nicholson, 1988). Role innovation has been defined by Nicholson (1984) as an individual shaping the role to better fit his/ her individual needs and preferences. An example of this is the succession of a political leader to an office where he or she imprints their identity and unique skills upon the role by changing the goals and the timetables for those goals for his constituents. Nicholson does, however, assert that some organizations may not permit large amounts of discretion when defining roles. While several studies have been conducted on job transitions (Kilduff and Day, 1994, Asforth and Saks, 1995; Ewens, 2003) only a few have dealt with the innovating of role and self identity change (Nicholson, 1984, Hill, 2003; Ibarra, 1999). This section will attempt to further define the transition from professional nurse to nurse leader with regards to personal identity change and role innovation. Identity Change Identity change can be a product of personal development. A study by Nicholson (1984) postulates that the adjustment to a new work role can take place through two forms of adaptation: adaptation of the person in response to the demands of the new role and manipulation of the environment to meet personal needs. Nicholson defined adaptation of the person as a reactive change in the individual, ranging from minor alterations in daily routines and habits, to major development in relationships and self image. A common example of this is a manager moving to a new office where the tasks and social environment are in sharp contrast to the previous experience. The person s 8

9 energies are dedicated to the task of assimilating new skills, and social behaviors to meet the demands of the new situation (Nicholson 1984; West and Nicholson, 1995; West and Rushton, 1989). Moving to an office from a clinical area, demands different social skills and decorum, even the change from being a non-exempt to an exempt employee presents challenges that influence self identity. When a nurse works with patients, his/her identity is connected more closely to the tasks and responsibilities occurring on a shift; after the transition to leader role, he/she becomes responsible for patient care on a 24 hours basis. Skills required to manage the team of care givers differ from those skills needed to manage individual patients (see Table 1). Changes in self identity could be as simple as a change of attire or as complex as learning self management skills, best demonstrated during a period of change. A change mandated from the top of an organization would be executed by the nurse manager. Implementation of a change in working schedules usually creates havoc in a nursing staff. Unlike the staff nurse, the nurse leader will attend to all concerns of the staff, most of which will be about why the change should not occur. In order to create sustainable change the nurse leader will need well developed self management skills (Goleman, Boyatzis, and McKee, 2002) that may be present in the nurse expert but must be publicly visible in the nurse leader. Personal adaptation changes the person s frame of reference, values or other identity related attributes (West and Rushton, 1989). The professional nurse s frame of reference has been a patient centered focus. Transition to a leader requires a shift from a small network to a larger more complex network of staff members, organizational business partners and the community outside of the organization (Hill, 2003). 9

10 Nurses are able to conceptualize themselves in new roles and are likely to seize an opportunity to grow and develop (Ewen, 2003). Needing to change identity in order to meet the challenges of new tasks and social environment, nurses must assume a new and different self identity, a change that can be self questioning and gut wrenching. Identity exploration has been associated with anxiety and self doubt (Kidwell, et al., 1995). The professional nurse can be considered a specialist or a doer who directly performs special patient care tasks and is strongly identified with those tasks. When changing identities and transitioning to a leader, the nurse s role becomes an agenda setter for others, someone who is directing and coordinating a number of tasks and strongly identified with a business or management profession. Hill (2003) explains the transformation of the manager from practitioner as transforming an identity, letting go of deeply held attitudes and habits. Hill defines successful identity transformation of a manager when that person moves from a specialist to a generalist. The leader orchestrates diverse tasks, including finance, product design and manufacturing. In contrast to the professional nurse who is strongly identified with patient care tasks, the manager is identified with the management profession. The nurse manager continues to keep the patient care as a critical focus, and see their role as serving the staff nurse, championing staff nurses as they deliver the care at the bedside (Anthony et.al., 2005). The professional nurse s primary responsibility is to care for patients and assess their response to therapies, requiring a highly specialized knowledge base with a hands-on approach to getting things done. On the other hand, the nurse leader s position requires competencies that are less specialized and projected at directing others to get things done. 10

11 The forging of a new identity has been studied and published in adolescent and adult literature. The use of possible or provisional selves to help individual form new identities has been proven to be successful (Dunkel, 2001; Ibarra, 1999; Markus and Nurius 1989). These studies show that the use of provisional or possible selves encourages growth in identity formation (Dunkel, 2001). Nurses who transition from professional experts to nursing leaders require identity change; the degree of identity change will be encouraged by the use of possible selves. Role Innovation Role innovation requires molding the new role to suit the requirements of the role innovator, ranging from minor initiative such as variation in work schedules to major role innovations such as changes in the main goals of an organization (Nicholson 1984; West and Rushston 1989). Role innovation can be defined as the leader making changes to the role, with regards to goal setting, communication methods, networking strategies, and decision making (Hill, 2003). Ashforth (2000) argued that role innovation could be functional or dysfunctional. Role innovation is more likely to be functional if the role is new; the means or ends are incompletely specified; creativity is expected; individuals are accountable for outcomes and expected to attain them; and if individuals have the skills, knowledge and ability to innovate effectively ( Ashforth, 2000). An example of such a person would be a political leader in a new office or an entrepreneur, who imprints the stamp of his identity and unique skills upon a role. Nurse leaders attempting to innovate roles would do so by setting targets for staffing ratios and being held accountable for such targets. This would require the nurse leader to decide how many licensed and unlicensed care givers needed, staying within the budget 11

12 that he created. In other words, the nurse leader would make the decision as to how many hours would be allocated to each patient and manage the care givers within that target. There would be no targets set by the executive team for the unit, nor would it be governed by an outside agency. Another example of a nurse leader innovating the role would be with regards to budget creation and management. The budgets created in institutions are usually started by the nurse manager and then escalated through the management levels for approval. After the approval, budgets are sent to the respective managers for execution during the year. The same is true for capital budget creation. A nurse manager who is attempting to innovate the role would have more latitude in budget creation and execution. For example, capital expense would be given as a pool of dollars and then the nurse manager would decide what was to be purchased during the year, without prior approval. The role of the nurse leader is constrained not only by the hierarchical structure of the healthcare system (Rushton & West, 1989), but also by the state nursing boards and organizations like the Joint Commission of American Healthcare Organizations. Such organizations, establish requirements and regulations that guide healthcare organizations during the process of role description writing. In addition, interpretation of the regulation or requirement may differ from organization to organization. Nurses who are restrained by the organization from developing the role usually seek other employment (Ewens, 2003). With regards to the nurse leader, transitioning from the nurse expert role, increasing the roles visibility through effective networking would innovate the role. In a more highly visible role, the nurse, may solicit more opportunities for the unit, for instance participation in research studies and new product trials. 12

13 Whether changes in role are either painful or exciting depends on the culture of the organization supporting the role change (Ewens, 2003). Role innovation could have a profound impact on the care of patients, if the nurse is permitted the discretion to innovate the nursing leader role. Choice of goals and means, to for achieving these goals is the hallmark, of role innovation (Nicholson, 1984); nursing leaders who choose goals, direct patient care and measure results of quality care will improve care of the patients and during that process innovate their roles. Not all nursing leaders choose the goals; some use goals to deliver care and the means to achieve them provided by critical pathways, policies and procedure determined by institutions and best practice. Ibarra (1999) studied financial analysts who transitioning to client advisory roles. Role and identity change occurred over a period of time, during which the participants described a use of provisional selves. Her study describes strategies used to expand a person s adjustment to the expanded role. In her study adaptation is predominantly the result of personal experiments where the person strives to improve the fit between themselves and the role (Ibarra, 1999). Hill (1992) studied individuals in sales positions as they moved into manager roles. The transition took upward of a year and was described as successful when they altered their self identities and styles of interaction. She describes the new manager at first trying to replicate his/her past strategies, only to find that success occurred after the change in self and some role innovation occurred. In a study by Ewens (2003), nurses transitioned from a professional expert to an advanced practice nurse. She reported that nurses approaching a new role were ready and willing to take on the new role, so much that they had conceptualized themselves in the 13

14 roles before they began. She felt they most likely based the new role conceptualization on public images, writings, and dialogues about the new role. In another study by Ewen (1998), graduate nurses moving into professional roles reported that the nurses became more comfortable in their new roles as adaptation to the new role occurred, as the role and self concept became integrated and a new advanced professional nurse emerged. Transitions are a pervasive part of life. The transition from direct care giver to leader produces changes in self identity and role innovation. The successful adjustment will cause the professional nurse to behave differently in the new role. In the next section factors will be discussed which are believed to influence the degree of self identity change role innovation as nurses transition form staff to leader roles. INDEPENDENT VARIABLES The transition to leader can produce a radical change in self identity or role; how radical will depend on the organization and the individual in the leadership role. From an individual perspective, the degree of role innovation and self identity change can be predicted from role requirements, personal motivation, and prior occupational socialization. In addition the degree of change of self identity and role innovation are caused by socialization within the organization. For the purpose of this study the independent variables will be divided into two groups; organizational and the individual. ORGANIZATIONAL FACTORS Socialization Socialization is not a single sided process imposing conformity on an individual but rather an adaptation where people strive to improve the fit between themselves and their environment (Schein, 1978; Ashford &Taylor, 1990; Beyer &Hannah, 2002). 14

15 Socialization does not occur in a vacuum; any person crossing boundaries and adapting to a new role will need clues on how to proceed. Expectations from colleagues, superiors, subordinates and other work associates will support, guide or push the individual who is learning the new role (Van Maanen, 1978; Ashforth, 2000). During the adaptation, people negotiate for themselves the identities they create as they assume the new role (Ibarra, 1999). New situations impose demands and suggest models, so individuals begin to conceive who they are and who they would like to be in the future (Markus & Nurius, 1986). Nurse leaders who have transitioned from staff nurse have expectations thrust upon them from many directions. Changes in attire, meal partners, and meetings attended are activities where the organization is socializing the nurse leader. Clothing attire will change as the new role requires business clothes rather than uniforms. In addition, the new nurse leader may have eaten lunch with other nurses while in his/her staff nurse role and now lunches with other nurse leaders and executives. In the staff nurse role, he/she may attend staff meetings and quality assurance meetings, however in the new role the nurse leader will attend meetings centered around operational activities. These changes, although very concrete, represent the types of changes thrust on the nurse leader by the organization. Van Maanen (1978) identifies seven aspects of socialization which affect individuals as they enter new roles in organizations. Three of the strategies predict role innovation and self identity change. They are serial (disjunctive), sequential (nonsequential) and investiture (divestiture) socialization strategies. A serial socialization strategy is where experienced members groom new members for similar roles in the organization. This strategy is the best to guarantee that organizations will not 15

16 change over a period of time (Van Maanen, 1978). Stability of behavior from generation to generation and decrease in role innovation is common in serial socialization. Organizations subscribing to this type of socialization are apt to stifle role innovation, but will maintain institutional history. Serial socialization is the process of having a role model, or having an experienced mentor groom an up and coming prospect. When serial socialization is employed as a people processing strategy, it guarantees stable patterns of behavior generation after generation (Schien, 1979). On the other hand Van Maanen (1978) points out a new leader who does not have a predecessor will experience a socialization strategy labeled disjunctive, or a state that allows invention but may end in confusion and complication. In other words, the new leader who does not have a predecessor may be on his own to define his role. This gives the new leader a chance to be innovative and original. A nurse leader in a newly created role, without a predecessor, would not have access to other nurses who had shared the unique set of problems. The presence of a role model or incumbent may suppress the activity of role innovation, and the absence of a role model may create confusion or present an opportunity for the nurse leader to innovate the role to suit his or her own needs. Van Maanen (1978) defines sequential socialization as a number of specific steps though which an individual must pass in order to make the transition to a new role in an organization. This is a process of cumulative learning, a succession of steps building on each other. Non-sequential processes are accomplished in one transitional stage (Van Maanen, 1978; Jones, 1986). The person must master each sequential stage, finding himself different at the end of the transition. The role of charge nurse could be 16

17 considered a sequential step to nurse leader. The charge nurse has responsibility for daily management of the team caring for patients, but is not accountable for other parts of the nurse leader role, such as staff scheduling and fiscal management. The intermediate stage of charge nurses experience can be said to have sequential process, as there is a learning experience of being charge nurse that will expand self identity. Opposing this socialization process is non sequential socialization, where the training is disjointed, without the intermediate step of charge nurse; the role may be more innovated as the nurse attempts to fit the role to meet his/her needs. Self identity may be enhanced with sequential forms of socialization, when steps involve cumulative learning (Nicholson, 1984). However the degree of role innovation will increase when learning is random and the role does not have cumulative steps in development (Ashforth & Saks, 1996; Jones, 1986). The third socialization process defined by Van Maanen (1978) which affects self identity is divestiture. Divestiture is the process of stripping away or dismantling the identity of the new leader, frequently requiring the new leader to redefine old relationships. Investiture however is the process of not changing oneself but using characteristics to innovate the role (Van Maanen, 1978). Organizations hire new leaders for the talents they possess and expect them to take those skills and innovate the new role. Interestingly enough, nurse experts are promoted to nursing leaders based on the skills possessed as a clinician; however they leave clinical skills behind to acquire new skills as a leader when transitioning to the nursing leader role. Nurse leaders are not blank tablets awaiting the organization to work on them. They play an active role in changing self and innovating roles. However, it appears that 17

18 socialization process that will have the greatest negative effect on role innovation are random, i.e., without cumulative learning, are disjunctive, i.e., without role models and involve investiture, i.e., the affirmation of identity (Schein, 1978). In comparison to the socialization processes that greatly affects personal development which are sequential, i.e., involve cumulative learning, are serial, i.e., there are role models, and involve divestiture, i.e., abandonment or redefinition of status and attributes (Van Maanen, 1978). The constellation of socialization strategies most common in the nurse leader are sequential, serial and divestiture. The new nurse leader experiences sequential steps like assuming role of charge nurse; usually has role models in the institution, and leaves learned clinical skills behind to acquire new leadership behaviors. Although socialization is an important aspect of this study it should not be over emphasized because motives, expectations, and prior occupational experiences can exert influence over role innovation and self identity. Role requirements The second determinant of role innovation and self identity change is role requirements. This has two components; discretion and novelty. Novelty refers to the perceived similarity of one s new role to previously held roles (Ashford & Saks, 1995; Nicholson, 1984; West & Nicholson 1988). Novelty also refers to the degree to which role permits the use of prior knowledge, skills and habits. Usually novelty determines the scope for personal development. Low novelty requires little change in one s job related capabilities or identities, but high novelty places great pressure to change. Nicholson (1984) argues highly novel jobs necessitate personal development. The professional nurse transitioning to nurse leader requires many new skills and knowledge 18

19 that will create self identity change. The skills used as a clinician to care for patients at the bedside will not be sufficient to lead groups of licensed and unlicensed healthcare providers. New skills, knowledge and habits will have to be incorporated in order to be a successful leader. Therefore Nicholson (1984) would identify this transition as highly novel, resulting in self identity change. Discretion is the second role requirement argued to affect role innovation and self identity change. Discretion refers to ones ability to alter task related characteristics like capacity to choose goals, methods, and timetables of achieving goals (Nicholson, 1984; Ashforth & Saks, 1995). Low discretion provides little opportunity for role innovation and little latitude for the new operator to change work practices. Conversely, high discretion makes it impossible to conform to job specifications. If there are no incumbents, newcomers lack adequate data to base to develop the role. Motivation An additional independent variable or determinants of role change and self identity change are the desire for feedback and the desire for control. Personality has an impact on the work role adjustment. Nicholson (1984) argues that the desire for feedback is associated with the degree of personal change. Individuals with a strong desire for feedback will be attuned and responsive to the influence and communication of others (Ashforth & Saks, 1995). Such individuals will take cues about appropriate behavior from various sources (Ashford & Cummings, 1983, 371). Change in behavior will result from feedback. In other words, the nurse leader who wants to change self will seek out feedback and change behavior accordingly. Those nurse leaders who desire feedback will make significant changes in behavior and morph their self identity. 19

20 The desire for control is the individual feeling the need to master their task environment, attempting to change the role to suit them (Nicholson, 1984, Ashforth & Saks, 1995). The nurse leader with a high desire for control will adopt an external focus rather than internal, meaning he/she will try to innovate the role rather than changing herself to suit the role. There is a paternalistic and hierarchical nature in healthcare that socializes the nurse leader into a position of custodial orientation, more or less accepting the status quo of the role and changing the self identity rather than the role (Ashforth & Saks, 1996; Van Maanen, 1978 & West & Rushton, 1989). Prior Occupational Socialization Another predictor of role and personal change during work role transitions is prior occupational experiences. Kohn and Schooner (1983) concluded that occupational experience cumulatively affected psychological functioning. For example, individuals attracted to low complex jobs have been found to have limited flexibility and capacity for self direction. One who is experienced in low discretion jobs passively accepts the environment and undergoes self change rather than attempting to change the role. Nicholson (1978) further develops this by saying that the experience of low discretion jobs predisposes one to generalize to a new role the same low discretion even if the role requires higher discretion. The new nurse leader who has had limited opportunity to alter role and relationships, due to the paternalistic and hierarchical nature of the organization (Ashby,1980), will be predisposed to low role development, even if the role requires high discretion. In other words, the nurse expert will select to change self rather than role due to prior experience that dictated self change over role change because the organization restricts the change of role. 20

21 MEDIATING VARIABLES People are proactive aspiring organisms not just reactive ones (Bandura and Locke 2003). The use of role models, experimenting with role models and feedback are factors which are used during the creation of possible selves (Ibarra, 1999). Each individual has many identities which are defined by present circumstances and hopes for the future. Change of self identity or role will occur when the individual is presented with an opportunity to work the role or identity through experimentation and feedback (Ibarra, 2002). Observing Role Models Recent research has presented role models in a new context, as active cognitive constructions created by individuals to build their possible selves based on their developing needs (Ibarra, 1999). Observing role models begins with either a holistic or collage approach (Ibarra, 1999). The holistic approach can be defined as using a single role model and focusing all attention on one role model. The nurse leader would identify one role model in the setting who he felt was worth observing. In contrast, the collage method uses pieces of different people to develop a repertoire of behaviors used. Using the collage approach would require the nurse leader to select numerous models to observe, taking behaviors from each based on the strengths and traits (Ibarra, 1999). According to Ibarra (1999) the collage approach was more effective simply because the more behaviors there are to observe, the more possible selves emerge. The reason is simple; by observing a multitude of personalities and picking out specific behaviors, one accumulates a large number of possible selves (Ibarra, 2000). In a study of professionals done by Ibarra (1999), professionals used role model observation in both 21

22 collage and holistic methods, observing roles before beginning to experiment with them as they transitioned from technical and managerial work to client advisory roles. In the case of new nurse managers, there should be a number of role model possibilities, from the nursing profession and other senior executives in the environment. Establishing a wide range of possible selves will assist observers in finding behaviors that fit who there are, who they want to be, and what they can do ( Markus & Nurius, 1986). If the new nurse manager has restricted access to other nursing leaders or executives, the likelihood of using the collage method is slim. Experimentation The process of acquiring new behavior skills, such as learning leadership skills of nursing management, is different than learning factual skills, such as giving a bed bath (Bandura, 1977). Experimentation with different roles is another mediating variable which will affect the degree of role innovation or change in self identity. After accumulating a number of role models, the nurse leader proceeds by trying on the new role or experimenting with the new behaviors she has observed. Experimenting with possible selves can follow two strategic paths. One strategy would be to assume a possible self that was completely different than the nurse s usual self. An example of this is the nurse leader who is quiet in meetings and does not voice any opinion although he/she has many thoughts and ideas. He/she would select a role model or numerous role models, who are skilled regularly introducing their thoughts at meetings. During the experimenting process the new nurse leader would try out some of the more vocal behaviors observed from the role model. This activity would be considered trying on a new possible self. 22

23 Another example would be a new nurse leader, who does not see himself/herself as equal partners with the physician. In this case a possible self experiment would be to approach the physician with confidence, calling the physician by his first name, would be a change for many nurse leaders. Ibarra (2000) would label this strategy as being a chameleon; this would require the nurse to depart from his/her comfort zone. Not wanting to change self but innovating role to suit the nurse would necessitate the use of the second strategy, Ibarra (2000) labels true-to-self. The use of the true-to-self strategy springs from the need to be authentic. Authenticity is defined as the degree of congruence between what one feels and what one communicates in public behavior (McIntosh, 1989). Individuals choosing true-to-self strategies when experimenting with possible selves are more apt to use behaviors that worked in the past. The nurse leader who chooses true to self strategies will try to innovate the role, remaining faithful to behaviors that worked in the past. On the other hand the nurse leader who chooses the chameleon strategy will change self identity. Feedback Feedback is a key informational resource and an important aspect of adaptation (White, 1974). Adaptation to new roles depends not only on experiential learning but also on ways for individuals to evaluate results and modality behavior. Feedback can be used as a reward and to motivate performance or can be used to regulate behavior (Payne & Hauty, 1955). The type and quality of feedback will mediate the degree of role innovation and self identity change experienced by the new nurse leader (Ibarra, 1999; Nicholson, 1984). Feedback can be experienced internally and externally. Feedback 23

24 generated by individual's thoughts and feelings is called internal feedback, while external feedback is how others perceive an individual s behavior (Greller & Herold, 1975). The degree of self change and role innovation will be affected by the type and amount of feedback given. Possible selves have an affective component that individuals use to evaluate their actions and to the extent that individuals can or cannot achieve particular self-conceptions or identities, they feel wither positively or negatively about themselves (Markus & Nursius, 1986,960). Self conceptions play a major role in creating a new self since it is a mental representation of self that individuals carry from one situation to another (Beyer & Hannah, 2002). The use of possible selves stimulates the use of internal feedback as the individual tries to achieve congruence between the imagined future self and the professional he was (Ibarra, 1999). Emotional dissonance will be created if discomfort results if the internal feedback senses too much self incongruence. The result will be the new nurse leader retreating to his/her natural style and trying to innovate the role rather than changing self identity. External feedback involves others validation in shaping identity and role (Markus & Nurius, 1986; Ibarra, 1999). By gauging others reaction to behavior individuals learn quickly about whom they are and who they would like to become (Ibarra, 1999). As the new nurse leader receives feedback from the external environment the response will drive either more role change or more personal change. If the new leader has chosen behaviors that are a departure from his normal self and receives positive feedback from others he/she is likely to change identity. However if negative feedback is encountered in response to the new behavior then he/she will retreat and try to innovate the role. 24

25 CONCLUSION Transitions are a way of life and traditionally the transition from staff nurse to nurse leader is the natural promotion pathway or transition in one s nursing career. Role transition involves self identity change and role innovation. The transition from staff nurse to nurse leaders produces change in self identity and role innovation. Navigation of this journey may provide insights into how a staff nurse transforms into a competent leader. Socialization or the expectations of colleagues, superiors, subordinates, and other associates will push, guide or pull the individual along the new role. The desire for feedback and job novelty will determine the personal change experienced by the staff nurse, where desire for control and job discretion will determine the amount of role innovation created by the transitioning leader (Nicholson, 1984). Individual are proactive aspiring beings not reactive ones, hence they search out ways to navigate the transition, and in the case of this conceptual model, the nurse uses possible selves to adapt during the transition from staff nurse to nurse leader. The staff nurse transitioning to the nurse manager role will experience many iterations of possible selves while attempting to adjust to the new role. The model suggests that the adjustment process is several iterative cycles consisting of role observation, experimenting and evaluation, in the form of feedback. This conceptual model is attempting to describe how the use of possible selves mediates organizational and individual influences, as independent variables, resulting in role innovation and self identity change, as dependent variables. Further qualitative research will be conducted as the author explores the different variables in the model. 25

26 RESEARCH QUESTIONS 1. To what degree and in what ways does the staff nurse who has transitioned to nurse leader change his self identity? 2. To what degree and in what ways does the staff nurse who has transitioned to nurse leader innovate the role? 3. If the nurse manger innovates the role, how is that manifested? 4. What factors affect self identity and role change in the staff nurse who has transitioned to nurse leader? 5. Does socialization affect self identity change and role innovation in the nurse who has transitioned from staff nurse to leader? 6. How did the nurse manager learn his new role? 7. Which is the more significant change; role innovation or self identity change? 26

27 CONCEPTUAL FRAMEWORK TRANSITION OF STAFF NURSE TO NURSE LEADER Independent Variables Socialization Novelty Desire for feedback Job Discretion Desire for Control Possible selves Mediating Factors Observing role model Experimenting Feedback Dependent Variables Degree of Role Innovation Degree of Self Identity Change 27

28 References Allen, D How nurses become leaders: Perceptions and beliefs about leadership. Journal of Nursing Administration, 28(9): ANA Role of nurse in managed care. Issues and Trends, 2(5); ANA Nursing administration. Standards of Scope and Practice. Anthony, M., Standing, T., Glick, J., Duffy, M., Paschall, F., Suer, M., Sweeney, D., Modic, M. & Dumpe, M Leadership and nurse retention. Journal of Nursing Administration, 35(3): Ashforth, B. E., & Saks, A. M Work-role transitions: A longitudinal examination of the Nicholson model. Journal of Occupational & Organizational Psychology, 68(2): 157. Ashforth, B. E., & Saks, A. M Personal control in organizations: A longitudinal investigation with newcomers. Human Relations, 53(3): Ashforth, B. K., & Saks, A. M Socialization tactics: Longitudinal effects on newcomer adjustment. Academy of Management Journal, 39(1):

29 Bandura, A., & Locke, E. A Negative self-efficacy and goal effects revisited. Journal of Applied Psychology, 88(1): Benner, P Novice to expert: Excellence and power in clinical nursing (first ed.). California: Addison Wesley. Beyer, J. M., & Hannah, D. R Building on the past: Enacting established personal identities in a new work setting. Organization Science: A Journal of the Institute of Management Sciences, 13(6): 636. Cross, S., & Markus, H Self schemas, possible selves and competent performance. Journal of Educational Psychology, 86(3): Drake, B. Meckler, M. Stephens, D Transitional ethics: Responsibilities of supervisors for supporting employee development. Journal of Business Ethics, 38(2): Dunkel, C Possible selves as a mechanism for identity exploration. Journal of Adolscence,23(4): Dunkel, C The role of possible selves: A short term longitudinal study. Journal of Adolescence, 24(6): Dykstra, K Making the transition: staff nurses to front line manager. Canadian Journal of Nursing Leadership, 16 (3):

30 Ewens, A Role perceptions of students in integrated courses in community health care nursing. University of Reading, Reading UK. Ewens, A Changes in nursing identities: Supporting a successful transition. Journal of Nursing Management, 11(4): Fisher, C Organizational socialization: an integrative review, In K Rowland & G. Ferris (Eds), Research in personnel and human resources, Vol.4: Greenwich, CT: Jai Press. Goleman, D., Boyatzis, R. & MacKee, A Primal leadership. Harvard Business Press, Boston, MA. Greller, M & Herold, D Sources of feedback: a preliminary investigation. Organizational Behavior and Human Performance, 13(2); Hall, D.T Careers in and out of organizations (1st ed.). Thousand Oaks, CA: sage. Hardy, M.E Role theory: Perspectives for health professionals (first ed.). New York: Appleton-Century-Crofts. Heller, BR, Drenkard, K., Esposito-Herr, MB, Romano, C., Tom, S., & Valentine, N Educating nurses for leadership roles. Journal of Continuing Education in Nursing, 35(5):

31 Hill, L Becoming a manager: mastery of a new identity. Boston Mass; Harvard Business School Press. Hill, L Becoming a manager.boston Mass: Harvard Business School Press. Ibarra, H Making partner. Harvard Business Review, 87(3): Ibarra, H Provisional selves: Experimenting with image and identity in professional adaptation. Administrative Science Quarterly, 44(4): Jones, Gareth R Socialization tactics, self-efficacy, and newcomers' adjustments to organizations. Academy of Management Journal, 29(2): 262. Kerfoot, Karlene Leadership: When success leads to failure. Nursing Economic$, 15(5): Kilduff, M. & Day, D Do chameleons get ahead? The effects of self monitoring on managerial careers. Academy of Management Journal, 37(4): Kohn, M.& Schooner, C Work and Personality. Abeix, Norwood NJ Markus, H.& Nurius,P Possible Selves. American Psychologist, 41(9): McIntosh, P Feeling like a fraud: part II. Stone Center Working paper no.37, Wellesley College. 31

32 Mitchell, T & James, L Theory development from situation versus disposition factors competing explanation behavior. Academy of Management Review, 14(5) National center for Workforce analysis Projected supply, demand and shortage of registered nurses, Nation Center for Health, Rockville, MD. Nicholson, N The transition cycle: A conceptual framework for the analysis of change and human resource management. In Ferris, Gerald Rowland, Kendrith (Ed.), Research in personnel management, vol. 1: Greenwich Conn: JAI Press. Nicholson, Nigel A theory of work role transitions. Administrative Science Quarterly, 29(2): 172. Payne, R. & Hauty, G The effect of psychological feedback on work decrement. Journal of Experimental Psychology, 80(3), Porter- O Grady. T Quantum leadership: new roles for a new age. Journal of Nursing Admiistration,29(1): Robinson, Sarah, Murrells, Trevor, & Marsland, Louise Constructing career pathways in nursing: Some issues for research and policy. Journal of advanced nursing, 25(3):

33 Schein, E Career dynamics, matching individual and organizational needs (1st ed.). Reading MA: Addison-Wesley. Thyer, G. Dare to be different: transformational leadership may hold the key to reducing the nursing shortage. Journal of Nursing Management, 11(2) Van Maanen, John Schein, Edgar Toward a theory of organizational socialization. In Staw, B.M Cummings, L (Ed.), Research in Organizational Behavior, vol. 1: Greenwich Conn: JAI Press. West, M., Nicholson,N. & Rees, A Transitions in newly created jobs. Journal of Occupational Psychology, 60(1): West, M. & Rushton, R Mismatches in the work-role transitions. Journal of Occupational Psychology, 62(3): White, R Strategies for adaptation. In G.V. Coelbo, D.A. Hamburg and J.E. Adams (Eds), Coping and adaptation, New York, Basic Books. Watkins, Michael Strategy for the critical first 90 days of leadership. Strategy & Leadership, 32(1):