Monday, April 16, 2018

Your Nursing Career's Differential Diagnosis

In medicine, nursing, and healthcare, a differential diagnosis refers to the process of differentiating between two or more conditions sharing similar signs and symptoms. In the context of your nursing career, this process can be equally elucidating. Is there a careful career examination in your future? If so, what would your differential diagnosis be?

your nursing career's differential diagnosis
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It All Begins With Assessment

Whether you're examining a patient or dissecting the state of your own nursing career, you always begin with an assessment. The gathering of data is the first step in the nursing process, of course, and it's the same thing in almost any situation: you need accurate and timely information in order to make a diagnosis and proceed to the development of a plan of intervention or treatment.

The "problems" with your nursing career may specifically lie with your employer, the institution where you work, the team as a whole, or the workplace culture. The problem may also be more internal -- you may be unhappy simply because this particular area of practice no longer calls your name and you need a fresh professional pasture in which to graze.

You must also consider that it may be the challenges in your personal life that are impacting your ability to be present at work, perform to your potential, or excel in your area of nursing expertise. A messy divorce, an abusive spouse, disabled elderly parents, or children with special needs can all divert your attention from your work and career. And remember that your health has direct influence over your general sense of contentment and your ability to work joyfully and willingly. If you've been diagnosed with leukemia, chronic fatigue, or any other chronic illness, work will become less important as you focus more on your own survival. This can color how you feel about work, and also create tension between what you need for your own health and the demands that your career makes on you.

Where your nursing career is concerned, taking a deep dive is the only way to truly get to the heart of what's going on. And there's nowhere else to start but with gathering the information that will give you a more comprehensive, bird's eye picture of the landscape of your life.

Making the Diagnosis

This process calls for honesty, clarity, and an intrinsically curious nature that truly seeks answers, no matter how uncomfortable they may be. Avoiding looking for cancer because you're afraid to find it is a fool's errand, and we all know that catching cancer early is good preventive care. In your career, being open to whatever diagnosis raises its ugly head will allow you to make decisions about a treatment plan that will hopefully deliver the outcome you're seeking. 

As you gather data, begin to formulate a differential diagnosis. And in this process, you may find that it's not as cut and dry as in medicine. The "cancer" at the center of your career may very well be a dysfunctional and ineffective manager who you simply can't stand and who fails to lead your team appropriately. However, it may actually have as much to do with the fact that your father was a drunk who couldn't take care of his family, and your buttons are easily pushed by incompetent people who don't know how to show up and do their part. 

Not to become overly psychoanalytical, but our perceptions of what's outside of us are powerfully influenced by whatever is happening on the inside. Sometimes, when we do the inner work, our perception of the outer world can change. And if, for instance, you learned as an adult how to talk back to that incompetent father like you wish you could have done when you were younger, you may develop the skills to sit down with that awful boss and tell him what you need and what your vision for the team or unit may be. This can't always work, but the more insight you have into your own "stuff", the more you can approach the outer world with intellectual rigor, compassion, curiosity, and creative solutions. 

Whatever your diagnosis, make it count and make it real, and then come up with a treatment plan and execute it with an eye towards a positive outcome and openness to a change in course if things go south. 

Treat or Amputate? 

If you treat the symptoms of a disease without going for the root of the problem, you may assuage the symptoms for a while, but the disease may crop up again when you're otherwise engaged. The same with your career -- you can use Bandaids, or you can do some more comprehensive surgery once you have the diagnosis nailed down. After all, if your car has a battery that has to be jump-started every morning, it would be smart to replace the battery rather than waste precious time and energy jumping the battery on a daily basis.

If you're slogging away in a workplace that's rife with bullying, gossip, back-stabbing, poor management, high nurse-patient ratios, and low morale and employee attrition, you have a few choices to make. On the one hand, you can put your head down, place your nose on the proverbial grindstone, and attempt to just miserably survive and do your job without losing your mind (or your nursing license). This is always a choice, and many nurses seem to make it every day for a variety of reasons. Financial duress, ennui, or lack of confidence regarding finding a new position can all deter the distressed nurse from saying "enough is enough" and exiting, stage left.

On the other hand, you can choose to take action, join a committee, meet with the CNO and nurse manager, lodge your complaints, and offer to be part of the solution. This may or may not bear fruit, and there's no way to estimate the toll that the struggle for positive change may take along the way.

If you feel it in your heart to champion change in a negative and dysfunctional workplace, good for you -- change agents are needed, and you may be the one to pull it off. In certain situations, it can be done, and it's up to you if it's worth your blood, sweat, and tears to drag everyone with you on the road to a new paradigm. There will certainly be resistance and the predictable naysayers and pessimists; given that reality, are you still willing to shoulder the Herculean burden and give it a go? You may end up feeling like Sisyphus as the boulder you've been pushing uphill all day just rolls back to the bottom once again, but you may also meet with small and large successes. The outcome is uncertain, but the task ahead of you is bound to be enormous.

Finally comes the decision to amputate a place of employment from the body of your career. I speak with many nurses who are on the precipice of absolute burnout and utter personal and professional misery, and I always wonder what it will take for them to pull the lever of their ejector seat and escape the unhappiness in which they're mired. Of course, when you have a mortgage, dependents who count on you, and other factors to consider, saying "take this job and shove it" is more easily said than done. However, if you really want to leave, there are ways to find or create new opportunities, and that's why I love providing career coaching to nurses -- it opens the mind to possibility and creative problem-solving in your professional life.

Consistently Reevaluate and Recalibrate

We all know that the course of treatment can change over time based on what we're assessing in terms of signs and symptoms and the reaction to the initial treatment. A tumor may first respond to one chemotherapy regimen, but the patient may not be able to tolerate that treatment for long. So, when the symptoms or side effects become untenable, we have to come up with a new game plan.

Similarly, your career and life situations are fluid, and things can change. A boss is replaced, a new CEO comes on board, your personal life improves in a significant way, or some other factor shifts. Keep your finger on the pulse and consider if you need to recalibrate your original plan.

There's no cookie-cutter solution to any one problem, and no treatment plan will work 100% of the time. Be nimble, curious, and creative, and be willing to ask the tough questions. And then sit back, observe, gather more data, and take inspired action when your heart and mind know that action is called for.


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Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is the host of The Nurse Keith Show, his solo podcast focused on career advice and inspiration for nurses. From 2012 until its sunset in 2017, Keith co-hosted RNFMRadio, a groundbreaking nursing podcast.

As of May of 2018, Keith is the host of Mastering Nursing, an interview-style podcast showcasing inspiring, forward-thinking nurse thought leaders and innovators. 

A widely published nurse writer, Keith is the author of Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century and Aspire to be Inspired: Creating a Nursing Career That Matters. He has contributed chapters to a number of books related to the  nursing profession. Keith has written for Nurse.com, Nurse.org, MultiBriefs News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog, NursingCE.com, American Nurse Today, Working Nurse Magazine, and other online and print publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, keynote speaker, online nurse personality and social media influencer, podcaster, holistic career coach, writer, and well-known nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives, and his adorable and intelligent cat, George.
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