By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Nurse leaders are concerned about the number of new graduates who enter their practice settings and immediately start an NP program. Consider the story one leader shared on a recent webinar.
Several new graduates I recently hired have approached me about schedule changes to accommodate their “graduate school” plans. These days, everyone seems to want to be a Nurse Practitioner, and all other nursing roles are not even considered. I am shocked at these graduate programs accepting new graduates who are struggling with basic nursing skills and critical thinking into programs that prepare them for roles that require a high level of accountability and knowledge. What is happening here, and how can we change this trajectory?
In most nursing programs today, the faculty teaching are NPs, so it is not surprising that they serve as student role models. But here is the challenge: not everyone is a good fit for that role, and students are not exposed to the many career options available in nursing.
There is something we can do as part of our residency programs. I call it a career exploration exercise. In their book Decisive: How to Make Better Choices in Life and Work, well-known leadership authors Chip and Dan Heath suggest that our thinking is often flawed, and we fail to consider various options. The Heaths argue that humans are hampered by four “enemies” of decision-making rooted in our unconscious behavior: narrow focus, confirmation bias, short-term emotion, and overconfidence in the outcome. Too many of us look at the information before us and trust our guts too much when making decisions. We also fail to consider all of our options. The solution to better decision-making is to expand your thinking. The authors suggest using a model that they label as WRAP to improve our decisions.
The 4-Step WRAP Model
W = Widen Your Options
In our decision-making, we often turn our choices into either/or without expanding our options. The Heaths suggest that you ask yourself, ” If I could not choose this option, what else would I do? – to avoid narrowing your options. So, let’s use the example of a new graduate who wants to be an NP. What if we asked these reflective questions posed by the Heaths? If the NP role was not an option, what other roles in nursing might you be interested in pursuing?
R = Reality-Test Your Assumptions
Many of us regularly consult rating sites such as Amazon, Trip Advisor, or Yelp before we buy a product, use a hotel, or visit a restaurant. Unfortunately, we don’t always test our assumptions about roles we might be interested in. We need to seek and listen closely to dis-confirming opinions. Allow the new graduate to have shadowing experience with an NP, and recommend that they interview at least two actively working NPs to learn more about the role. Ask them to develop three pros and three cons of being an NP based on interviews with those currently working in the role.
A = Attain Distance Before Deciding
Recommend that new graduates put some time between themselves and their career decision to take the short-term emotion out of it. We can be too easily influenced by what feels familiar to us because it is what we have planned for our lives and our potential loss aversion. If it is a critical decision, suggest asking themselves how they will feel about a possible choice in 10 minutes, in 10 months, and in 10 years.
P = Prepare to be Wrong
Even when taking the three above steps, only some decisions you make will be right. I have talked with numerous students who began an NP track and discovered that the role does not play to their strengths. We must prepare to be wrong about some of today’s decisions.
Teaching new graduates to use a process to help them make decisions is extremely helpful. We all need to pay close attention to disconfirming information, look for alternate ways to frame the problem, and be prepared to act if things go unexpectedly well or poorly. The process described by the Heaths in their book doesn’t guarantee a good outcome, but it sets guardrails to keep you from falling into common decision-making traps.
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