Tuesday, October 13, 2009

The Nursing MS Degree in Management Addendum

By: Gary J. Salton, Ph.D.
Chief: Research & Development

Professional Communications, Inc.

The conclusion of the Nursing MS Degree in Management research blog briefly outlined a Migration Strategy. This is a process to help nurses migrate from their current approach to one more compatible with a management perspective. This blog outlines the process in more detail.

The migration strategy helps a nurse evolve her "I Opt" profile into one that is better aligned with that of management. It offers a systematic process a nurse can use to modify her approach in a non-threatening, staged process. The reason a profile is important lies in the purpose that it serves in the conduct of life.

Anyone can do anything if they focus intensively enough on it. However management, like life, is typically conducted “on the fly.” Nothing would get done if everything were evaluated against all possible options (e.g., should I analyze it, act spontaneously, use standard method, or generate a new option?). There is simply not enough time. Instead we use our strategic profile as a guide to diagnose and act on the situations we confront.

A change in strategic profile can happen relatively quickly. But this will typically be accompanied by considerable stress, errors in judgment and organizational dysfunction. A more practical process is migration. The nurse is led into her new perspective in stages. These stages can be designed to generate improvement along the way. This can help reduce the “cost” to the nurse, co-workers and the hospital.

Profile migration is a challenging task under any circumstance. A new dimension of “reality” becomes increasingly visible. For example, if the nurse is detail sensitive, she will begin to see the value of focusing on wholes rather than particulars. If she is detail adverse she will begin to see the value of particulars. And this is just one dimension of many.

Whatever her position, the new dimension will conflict with one she has firmly held in the past. The nurse will experience tension as she acts in a way that seems “wrong.” She must reconcile these conflicting perspectives before the
"I Opt" profile will change.

Each person’s profile is unique. That means that each person is sensitive to different dimensions of “reality.” Different dimensions mean that different conflicts will arise. There is no common denominator across all
"I Opt" styles. This means that there can be no general solution. The nurse herself must find the path.

While the path cannot be pre-specified, some aspects can be outlined. One of these is that the nurse’s commitment to an existing style or pattern (a combination of styles) will affect transition time. The higher the commitment, the more time will be required. A high commitment reflects strongly held values. The conflicts that the nurse experiences will be more intense. Reconciling them will take more time.

Experience indicates that a firm transition typically requires 18 months to 2 years. A 3-year path is not unusual. The fastest we have ever witnessed is 6 months. The hospital or other medical facility should probably plan their programs around these expectations.

The first step in a migration strategy is obtaining the nurse’s commitment. A change in strategic profile cannot be imposed. It must carry the personal commitment of the nurses involved. The reason is that the change will affect all elements of her life.

In information processing terms, there is no such thing as a “work style.” People who are cautious at work will probably be cautious at home. People who are action oriented at work are unlikely to become deeply thoughtful when they walk out the door. Again, the reason is simple. It is too expensive to change the way you process information to accommodate all of the different situations typically encountered. So people don’t do it. They adopt a profile that works in all of the venues that they regularly occupy. This has implications.

The conflicts mentioned in the previous section can appear anywhere—at home, with friends, at professional gatherings or in any of the other venues that the nurse regularly navigates. Without a personal commitment the nurse will tend to revert to their “regular” style when they leave work. This will slow or stop the migration.

In final analysis the commitment is required because the nurse will need it. She will draw on it to reconcile the conflicts she will experience as her profile shifts. Without the commitment the countervailing forces outside of the medical facility will impede the migration process.

The migration strategy envisions a staged process. The nurse focuses on one behavior at a time. As one is mastered another is undertaken. The series of behaviors reinforce each other in the direction of the desired profile. The issue becomes where to get the list of behavioral changes to begin working on.

"I Opt" Advanced Leader Report offers a viable starting point. It offers a concise, fully justified list of vulnerabilities generated by the nurses’ current profile. The nurse only need review her list and select one. This will become the starting point for the change process.

Other behavior traits can be added if desired. But the focus must be kept on behaviors.
"I Opt" profiles (i.e., information processing patterns) are the result of “doing,” not talking or thinking. Patterns are born by success in practice.

It is not enough for the nurse to simply work to offset the vulnerability. Specific action(s) that will be used when the vulnerability becomes a real exposure are needed to guide development.

For example, a nurse might be inclined to pay too little (or too much) attention to detail. This can be offset with a tool focused on downside risk. If an error has serious penalties, the plan might call for data collection and careful assessment. This rule could cause a fast acting nurse to pause and consider things more deeply. If an error has small consequence, the nurse might forgo research and simply act on what is known. Using such a rule would gradually wean the nurse from unneeded detail.

Initially it may be difficult to devise a needed rule. Forming groups where members’ help each other formulate offset strategies might be a useful aid. Alternatively, an instructor or a coach could serve as a support or sounding board. Anyway that it is done, the process of rule formation sensitizes the nurse to the vulnerability. This alone advances the desired change.

Rule making has another effect. In designing the offset the nurse learns to construct and use tools that are objective in character and non-threatening in manner. The skill can become generalized and can be used as a tool to offset other vulnerabilities that may arise in the future. The ability to construct behavioral tools is a valuable skill in and of itself.

A trigger is a mechanism to signal the need to deploy the rule that was created. It can be anything. It might be a situation. For example, a particular procedure or a process typically encountered. The trigger can even be a bodily state. For example, a feeling of anxiety can cause a Hypothetical Analyzer to retreat into ever more assessment. That feeling might be used as a trigger to engage a rule that calls for immediate action on the issue. That action can be anything. The idea is to substitute “doing” for “thinking.”

The kind of triggers that might be used is endless. Location (e.g., ward, unit), size of the involved group (e.g., small versus large), scope of decision (number of areas affected), pressure for response, and on and on. The nurse devises a trigger to fit the circumstances of her particular life. What is important is that the trigger be encountered in her life situation and that it causes the rule to be used.

The trigger is a device to remind the nurse of the rule. But the
"I Opt" profile is in constant use. A vulnerability can become an exposure without activating the trigger. Ideally the nurse will activate the rule even when a situation does fully trigger the rule. Reminders can help keep awareness high—the more, the better. Things like meetings or coaching sessions can help insure that this awareness remains at a high level.

This is the key for any profile transformation. Profiles are adopted because they work in the life of the person using them. The transitional behaviors will become incorporated into the profile to the extent that they are used and prove successful. A Migration Strategy can be designed to aid this process.

Transitional nurses can be given situations where the opportunity to practice the desired behavior offers itself more frequently. For example, a behavior might require a group participation (e.g., offering analysis rather than commanding action). In this case the nurse might be given a role in a project team. Or if the behavior involves shifting from methodical to spontaneous action a hospital might arrange for assignments in or frequent interactions with the Trauma Center.

Another option is to “grow” a nurse into a job using “on the job” training methods. Having the role will provide ample opportunity to exercise the needed perspective. If his option were chosen, it would be wise to employ a sponsorship model. The sponsor could coach to make sure that it is the nurse is the one changing and not the job. Authority always carries an element of discretion. There is a probability that the nurse will attempt to change the job to fit her profile rather than changing her profile to fit the job.

If the “on the job” option is elected, the hospital should also consider the effects on the people being led. They can act to impede or facilitate the nurse’s transition. Using
"I Opt" tools like TeamAnalysis and LeaderAnalysis can help to make the process transparent to all involved. The nurse will be made aware of what she confronts. The staff could be alerted to the likely affects of new leadership. Transparency breeds trust and gaining trust is one of the initial hurdles that a new leader must surmount.

There is no unambiguous signal that a new behavior has been absorbed. When the nurse feels comfortable employing the new behavior and when others see a perceptible difference, it is time to pick out another vulnerability to work on. The problem is to figure out exactly when this occurs.

Without a firm metric signaling when to add another behavior to the repertoire the decision will be somewhat arbitrary. Discussions in group sessions, conversations with a coach or sponsors or other form of mediation is probably a good idea. The
"I Opt" profile works all of the time, including the time when the judgment on absorption is being made. It is easy for someone to inadvertently deceive themselves. Involving other people limits this possibility.

The vulnerabilities identified in the Advanced Leader Report and other "I Opt" sources appear to be independent of each other. They are not. They are all being generated by the same process. They are all linked. What this means is that their effect will be cumulative. In other words, the transition process will accelerate as the Migration Strategy proceeds.

The only certain way to measure the results is through the
"I Opt" survey. This should be done with care. The survey is short and simple. This makes it economical to administer. It also makes it easy to manipulate. If administered too frequently there is a probability that the nurse will remember her past responses. Since she knows that the purpose of the training is adjustment of the profile, there will be a temptation to show success—whether or not it has occurred.

The possibility of manipulation can be offset (but not eliminated) by spacing the retake of the
"I Opt" survey. A typical transition will take 18 months. Therefore spacing the survey retakes at a minimum of 1 year will probably yield a reliable result.

The migration strategy is simply a framework within which a nurse can experiment with and practice behaviors that will equip her for greater responsibility. It has the merit of being sensitive to and taking into account the nurses present strategic profile. In other words, the Migration Strategy is tailored exactly to the nurses’ starting point and targeted destination.

The premise of the Migration Strategy is simple and compelling. People use behaviors that work in their lives. The migration program shows the nurse that her personal circumstances improve as a result of using a particular approach. That nurse is likely to incorporate that behavior into her repertoire. As she does, her information flows will change and her
"I Opt" profile will adjust accordingly. There is no mystery as to what is happening. It is just common sense.

Adding the Migration Strategy to the management-training curriculum will not completely remedy the shortage of nurse managers. But it will improve it. In addition, the nurses assuming managerial positions will be more likely to be successful. Since management affects all other specialties in a hospital, the benefit is likely to be enjoyed widely.