Where do you go from here?
By Jo Manion, MA, RN, CNAA, FAAN
Are you at a crossroads in your career, wondering whether to stay where you are or move in a different direction? Do you feel stagnant, having done the same thing for a long time, or frustrated because no matter what you do, problems at work seem constant and often insurmountable? Have you put off thinking about your situation because you're not certain you have the energy to do anything about it? This article does not propose the answers, but it does offer questions to guide your thinking about whether or not it's time to make a change.
First, take some time in a quiet place to think. Be honest. Sometimes we don't allow ourselves to think clearly about our career problems, perhaps because we're afraid to face the truth. If you admit that you're in a work environment that demoralizes your spirit daily, or that you're bored with the work you are doing, you may feel compelled to take action. On the other hand, if you deny the truth of these things, you spare yourself the daunting prospect of making a major change in life. Acknowledging the truth of your circumstances is the critical first step.
QUESTIONS TO ASK
Six factors can guide your thinking about your career: the quality of the interpersonal relationships in your workplace; the extent to which you find your work meaningful; the opportunities for professional development; your degree of autonomy; your ability to experience progress, in your patients or in your organization, as a result of your work; and the pleasure or joy taken in your work. Once you have examined these factors you may decide you are where you need to be. But if you decide that it's time for a change, the next question is: "Where do I go from here?" First, let's examine the six key questions.
What is the quality of the interpersonal relationships in my work place?
Sociologists and organizational development researchers have found that an employee's organizational commitment--her stated intention to remain employed by the organization--is closely related to, and affected by, the quality of her relationships at work. Many of us have stayed at a job or in an organization longer than was professionally satisfying because of the people with whom we worked. Conversely, some of us have changed jobs because of unhealthy relationships.
A healthy working relationship is built on mutual trust in each party's ability and willingness to fulfill commitments and promises. In addition, the mutual respect that we extend to each other regardless of external and incidental factors (such as title, position, educational level, socioeconomic status, experience, and credentials) is vital to a healthy relationship.
In a healthy relationship we support one another. Most of us need more support when things aren't going well, when we have made mistakes or have exercised poor judgment. Yet this is often when others withdraw it. In a healthy relationship communication is predominantly favorable and encouraging, and is always open, honest, and direct. Ideally, of course, this would characterize all of our work relationships, but, in truth, most could stand some improvement.
Examine most closely the relationships that significantly affect your work life. For example, if you have an unsatisfactory relationship with a coworker on a different shift, and you only have to interact with her at the time of shift change, you might be able to tolerate such a peripheral relationship. However, if, as night charge nurse, you're having problems with the day charge nurse, it not only affects you daily, it may also reduce your effectiveness both as an individual and as a member of your department's leadership team. Consequently, the relationship with this one person may be quite important to you.
Take another example. A critical, verbally abusive physician admits patients to your department only infrequently, and you may therefore find this behavior more tolerable in her than you would in a surgeon whom you assist every day.
Is the work I am doing important to me?
Having meaningful work is important. Our spirits thrive on work that favorably affects others and betters the world. Apparently, these criteria are easily met in nursing--our work is meaningful both to our patients and to society. On closer examination, however, every job has aspects that demand a great deal of time and attention, such as paperwork. Such a circumstance can exist whether we're employed in an organization or working independently. In some cases it results in the fragmentation of the workday and reduces our effectiveness. Ask yourself: Are tasks of this nature obscuring the meaning of the work I do? If so, it may be time to move on.
How much freedom and autonomy do I have in my work?
Studies of intrinsic motivation have revealed that people enjoy their work most when they are given an appropriate level of autonomy.1 Do you have authority and resources adequate enough for the discharge of your responsibilities? Are your responsibilities in making decisions and your authority clearly delineated? These questions apply to decisions regarding your workplace as well as to your daily work. Are the employees in your department organically included in departmental decision making? Is there a structure, such as a governance model or a team, through which all employees are guaranteed the opportunity to participate in problem solving and decision making? Does this degree of participation exist on the broader organizational level? The absence of it at either level can be dissatisfying to a worker. Here's an illustration: Joan, a pediatric nurse practitioner in a large pediatric medical practice, experiences a high level of autonomy in her daily work and has clearly defined degrees of jurisdiction regarding hospital admissions and prescriptive authority. However, she is dissatisfied because, as a nurse, she's excluded from discussions and decisions about the management of the practice--matters that also affect the quality of her work life.
Are there opportunities for growth and development?
Growth and development are important to most professionals. Does your work stimulate and challenge you? Are frequent opportunities provided for learning and keeping current in your practice? Are your coworkers' skills and knowledge up to date? How supportive is the organization? Institutional financial support of employee attendance at continuing education programs or tuition fee reimbursement is ideal, but both practices have declined in recent years. If either is available to you, take advantage of it.
There are even more fundamental sources of support to consider. Is continued education valued and pursued in your workplace? Are people acknowledged for reaching a milestone such as certification or an advanced degree? Do coworkers involved in educational pursuits talk openly and enthusiastically about them? Take the example of Natalie, who believes that she lost a job because of her pursuit of a master's degree. She's now in a doctoral
program and afraid to tell her supervisor for fear that she may lose her current job. And there is Mary, a nurse member of an executive team who is ridiculed by other members because she reads and brings in books and articles for the others to consider. What is the climate in your workplace? Resources may not be available to support employees' educational pursuits, but a warm and encouraging climate may be just as important, or even more so.
Does the institutional climate support innovation? Many people are natural innovators, if the system allows it. Those who are employed in a system and have an entrepreneurial cast of mind are often referred to as "intrapreneurs." These people tend to function best in a system that offers ample opportunity to try new things and to implement creative ideas.
Do I see that there is progress as a result of my work?
To nurses who work directly with patients the answer to this question is usually and easily, "Yes." Nurses witness the results of their work in their patients' progress toward recovery. Even in specialties in which patients show slower progress, such as rehabilitation medicine, the nurse finds signs of improvement rewarding.
The nurse who is no longer at the bedside, however, may find this question difficult to answer. It's more
difficult to discern progress on a departmental or an organizational level. It's easy to feel hopeless when the same problems, such as staffing and supply shortages, high turnover, lack of resources, and unhealthy staff relationships, persist year after year. One cause of frustration most frequently identified by nurse managers, executives, and leaders is the perception that there has been no progress or improvement as a result of administrative efforts. Few people have the inclination and fortitude to remain in a situation such as this.
Do I regularly experience pleasure in my work?
Many great thinkers and writers have expressed the belief that work is inherently joyful. When was the last time you experienced this through your work? Even difficult and emotionally painful work can be joyful. A significant portion of our lives is devoted to work, and, indeed, most of us spend more of our waking hours at work than we do at home. Life is too short to spend at dissatisfying work or in demoralizing environments.
WEIGHING THE OPTIONS
These questions don't hold the same importance to everyone, and only you can determine which is of highest priority to you. Of course, as no workplace is perfect, one will always encounter liabilities as well as benefits to any one of them. For that reason, answers to each of these questions tend to lie within a continuum. Moreover, your answers may vary with time. Plotting your reactions to these questions may give you a graphic sense of where you are (See Where Am I?, above).
Ultimately, of course, only you can determine whether you are in the right place. Other people can help by listening and responding, but if you're honest with yourself, you know whether you are happy where you are.
Am I neither miserable nor thrilled?
Perhaps a more difficult decision is whether to remain in a work environment that simply is no longer stimulating. When do you know that it's time to leave?
The first step is to question your assumptions about why you are staying. You may tell yourself that you need the income it provides, or that you won't be able to find a comparable job elsewhere. Examine those assumptions individually.
If you choose to stay in a workplace that has one or two adverse aspects, create a plan to correct or overcome them. For example, perhaps the only problem you have at your current job is working with one of the surgeons. It may be possible to transfer to another team. This may require that you learn a new set of skills, and maybe it's time for that anyway. Departments often differ in tone and climate, so if you're unhappy in yours, consider transferring to another one within the organization.
If you want more opportunity for growth and development, start seeking it out. If your manager is not helpful, look elsewhere in the organization, such as your community outreach and education departments. Or see whether these needs can be met through activity in your professional association or your community.
If you decide that it's time to leave, several paths are open to you. You might pursue comparable work in a different organization if you want to stay in a particular specialty or practice area. Or, it may be time to change what you're doing and move to a different practice setting. Another possibility is a change of orientation to education, case management, or another clinically related support function. Remember that you don't have to remain in the new role forever, and even a temporary change can broaden your perspective. Or, it may be time to go back to school. A mentor once told me, "If you plan to work another 10 years, you need the next higher degree." *
Reference
1. Thomas KW. Intrinsic motivation at work: building energy and commitment. San Francisco: Berrett-Koehler; 2000.
Jo Manion is the owner of and principal consultant at Manion & Associates, in Oviedo, FL, a company that provides development services for health care organizations nationally.
