Reflecting is science observing the art of nursing.

Self-knowledge is a deep pool but we can only see the surface, unless we dive deeper.

While recently attending the Inaugural 'Clinical Nurse Consultant/Clinical Midwifery Consultant (CNC/CMC) Professional Development Day' hosted by The Nursing and Midwifery Directorate of Northern Sydney Local Health District I used an opportunity, that arose whilst there, to be reminded of my pathway to this current leadership role. Many worthy topics arose from the day - further reflective posts will be forthcoming on topics such as 'Functional well-being and Spinal Cord Injuries (SCI)', 'How to include Planetary Health in Quality Improvement (QI) Projects', and 'Exploring transition shock in SCI patients' - the latter could be a Case Study, worth looking further into soon.

Back to the point of the moment which was to see how everyone's trajectory to CNC linked to their New Graduate rotations and whether any insights could be gleaned from those memories to support current New Grads with their transition from student to professionals - a topic already well-studied by such as Hampton, Smeltzer & Ross (2021) who found organisations may do preceptorship and orientation well but often novice nurses are still not prepared for real life nursing work. I echo that sentiment as I felt so welcomed by the first ward I experienced, and it impacted on me so much that I returned to it once my New Grad rotation was finished, yet I felt barely supported enough by the preceptor process and certainly was encouraged to direct my own learning needs by peers and the nurse educator. My lack of personal (and professional) motivation led to near twenty years of little professional growth beyond longevity, so with the sudden leap from RN8 to Acting CNC3, with little useable skill to differentiate me from my peers and lots of faith from my peers that I actually could transition into it, I succeeded in permanently winning the role at last.

Reflection is a valuable tool which can generate positive insights for personal and professional growth. Making reflections an everyday part of my practice is, while not a new skill, a refined skill now. There are many formats for reflection. Firstly, the sooner one can perform the reflective practice, the fresher, more relevant, and authentic the recollection will be (RCN 2023). A useful format to reflect with is stating what I remember happened, why did it resonate in me, or what issue did it raise, and what have I learned from it or what will I do differently going forward?

1. What happened was the nurse leaders of the same rank, from around the local health district (LHD) compared how they got to where they are today.

2. The themes of transition shock and self-motivation were discussed.

3. I realised I had suffered from very minimal self-motivation and too much laissez-faire attitude. It had taken other people's view of me and my competence to encourage me to put myself forward for a position I knew I was under-qualified for.

4. What I would do differently now is encourage junior nurses and emerging nurse leaders to consider further education, CEA pay, and e-portfolio development.

Reflecting upon reflecting for professional practice.

There is a significant barrier to reflecting as a regular tool:

• Time constraint. Being a parent, home-owner, and a part-time worker, (only recently a part-time student, too) the time to sit and think is a very poor commodity. This e-portfolio is an excellent modern tool for documenting my professional, and personal, reflections. Previously I had hand-written on a paper template I downloaded from a work website and kept all the papers in a large file. That was the old portfolio, which had been submitted to my late former nurse manager for approval to regrade to CNCS1 from RN8 because I was doing the secondment to CNC3.

• Simplicity of access. It was so simple to grab a pen and the template I had copies of. I could write it down while the memories were still fresh. A downside of this electronic blogging of a memory is having to create the time to log in, wait for pages to load, collect fresh references, write the blog, and lastly, post it. I have interruptions from family, pets, phone, work offering overtime, neighbours popping in, all sorts. Sometimes one has to find a moment and, asking forgiveness, ignore the interruptions.

Introspecting

I still love my preceptor, and have had many preceptees of my own - we fondly call it our family tree - but I was basically left to bring myself up at work. I was an unsophisticated and self-centered youth. I had not thoroughly learned to apply myself to a difficult project to gain personal or professional recognition. Despite working hard at work, I did not see any reason to work hard outside of it. I was having a great time spending my money and living life outside work. It felt like having the best of both worlds. I had a well-paid job and lots of things to do and see. One could say I demonstrated a laissez-faire leadership attitude whereby I led with minimal direction and supervision, my co-workers were knowledgeable enough to direct and lead themselves and I trusted them. As I grew in seniority and became a preceptor, and was exposed to being a team leader more often, my leadership style morphed into a more situational nurse leader. This leadership style leaves room for both leaders and staff members to take initiative or suggest ideas (Sadler 2023). I discovered different leadership styles can apply in different situations within healthcare. No one style fits, though transformational leadership is desired since it inspires and motivates staff to find better ways to achieve their goal (Sadler 2023).

At no time, during this professional growing process, did I take the opportunity to formally further my education or seek greater remuneration. I did the occasional course, some of which I paid for our of my own money as had not been taught to claim it from work yet, and made sure my mandatory learning was up to date. I was unaware that my position could earn more by having a post-graduate degree under one's belt. It's known as the Continuing Education Allowance (CEA), described below. I really think I would have entertained a Graduate Certificate, as some of my co-workers did, or even a Graduate Diploma, as I have recently completed.

As per the Policy Directive (New South Wales (NSW) Health 2023):

CONTINUING EDUCATION ALLOWANCES - PUBLIC HEALTH SYSTEM NURSES' AND MIDWIVES' (STATE) AWARD

For the purposes of communicating eligibility for the CEA only, the nursing/midwifery

classifications are described below in four groups.

3.1 Group 1

In this group the following classifications are eligible to receive the CEA:

• Registered Nurse/Midwife (years 1 to 8);

Continuing Education Allowances - Public Health

System Nurses’ and Midwives’ (State) Award

PROCEDURE

PD2018_008 Issue date: February-2018 Page 4 of 17

• Clinical Nurse Specialist/Clinical Midwife Specialist Grade 1;

• Nursing Unit Manager/Midwifery Unit Manager;

• Nurse Manager/Midwife Manager Grade 1and 2

• Nurse Manager/Midwife Manager Grade 3 and above

where the employer is satisfied that they are engaged in clinical work for more than 50% of their time.

To be eligible for the CEA, nurses/midwives in this group must hold a continuing

education qualification in a clinical field (in addition to the qualification leading to registration).

These nurses/midwives are eligible to receive the CEA for the following qualifications:

• a post-registration hospital certificate;

• a post-graduate certificate;

• a post-graduate diploma or degree (other than an undergraduate nursing degree);

or

• a masters degree or doctorate.

Now it happens I am not entitled for the CEA when working the two shifts as a CNC3, having the further education is mandatory for that role. Where I remain entitled is demonstrably in my CNS1 role, worked once a week plus any part-time extra shifts.

What now?

Now it remains to see if imparting the knowledge of how to perform modern professional reflection, extolling how further education can increase your pay, and using my key leadership roles to promote thriving and flourishing of emerging leaders to support transitional nurses from experiencing transitional shock as they leave the new graduate programs, will better patients' experiences and outcomes as they progress through their rehabilitation post-acquiring a spinal cord injury.

Should this blog interest you please subscribe, and watch as both it and I improve with more use and exposure.

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References

Hampton KB, Smeltzer SC & Ross JG 2021, The transition from nursing student to practicing nurse: An integrative review of transition to practice programs, Nurse Education in Practice; 52:103031.

NSW Health 2023, CONTINUING EDUCATION ALLOWANCES - PUBLIC HEALTH SYSTEM NURSES' AND MIDWIVES' (STATE) AWARD, available at <https://www.health.nsw.gov.au/careers/conditions/awards/nurses.pdf>

Royal College of Nursing 2023, Eight Ways to Improve Your Reflection, visited 20/10/2023, available <https://www.rcn.org.uk/professional-development/revalidation/Eight-ways-to-improve-your-reflection#:~:text=If%20you%20like%20verbalising%20-%20record%20your%20reflections,one%20of%20these%20frameworks%20on%20the%20RCN%20website>

Sadler, F 2023, 7 Leadership Styles in Nursing — Which Is Yours? Accessed 22/10/23, available <7 Leadership Styles in Nursing — Which Is Yours? | Relias>