professional maturity: the stages of developing self-esteem

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FEBRUARY 1989, VOL. 49, NO 2 AORN JOURNAL Professional Maturity THE STAGES OF DEVELOPING SELF-ESTEEM Carol A. Mannahan, RN any nurses are unaware of the powerful effect their self-esteem has on their M professional lives. Consider the follow- ing examples. An OR staff educator in a large community hospital is bored with her job; however, she hesitates to change jobs because “you just never know how the change will work out.” A cardiovascular nurse specialist in a teaching hospital consistently takes on more responsibility than he can comfortably handle. As a result, he feels frustrated and angry and complains of being used. A staff nurse loves her job but tiny errors or negative feedback shake her confidence. At the root of those problems is a familiar phenomenon-low self-esteem. It is an important concern because self-esteem affects one’s thinking, emotions, values, and goals. Self-esteem for the nurse develops gradually and is greatly influenced by coworkers and colleagues. There are many reasons nurses may have low self-esteem: difficulty combining work and home responsibilities, resolving conflicts with other members of the health care team, dealing with pressure to return to school, and struggling to deliver excellent patient care. Whatever the reason a nurse feels insignificant or insecure, it robs that nurse of much personal and professional pleasure and satisfaction. In addition to the personal toll of low self- esteem, the cost to the profession is staggering. Many experts blame the negative nursing image for the severe shortage of qualified nurses and for decreasing nursing school enrollments. As nurses air their grievances through the media, one can understand how the public might see nursing in a negative light. What may have started as a personal problem (low self-esteem) can become a problem for nursing as a whole. An answer to the problem may be for nurses to use their knowledge of human growth and develdpment and apply it to their professional lives. Professional Development uman development offers guidelines for understanding professional development. H Most nurses, although quite familiar with human growth and development, would be surprised to learn that their professional devel- opment closely parallels human development. This is especially true when considering the develop- ment of self-esteem. By considering the phases of growth and development, a person can determine where one is on the maturity continuum and respond accordingly. This knowledge can be of immense value to nursing educators seeking to prepare nurses for practice, to nurse managers working Carol A. Mannahan, RN, MSN, was an instructorfor the department of nursing, Central State Universit,), Edmond, Oklahoma, when this article was written. She has a diploma of nursing from St Luke3 Hospital School of Nursing, Cedar Rapids, Iowa, und both bachelor of science and master of science degrees in nursing from Oklahoma University, Oklahoma City. 593

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Page 1: Professional Maturity: The Stages of Developing Self-Esteem

FEBRUARY 1989, VOL. 49, NO 2 AORN JOURNAL

Professional Maturity THE STAGES OF DEVELOPING SELF-ESTEEM

Carol A. Mannahan, RN

any nurses are unaware of the powerful effect their self-esteem has on their M professional lives. Consider the follow-

ing examples. An OR staff educator in a large community hospital is bored with her job; however, she hesitates to change jobs because “you just never know how the change will work out.” A cardiovascular nurse specialist in a teaching hospital consistently takes on more responsibility than he can comfortably handle. As a result, he feels frustrated and angry and complains of being used. A staff nurse loves her job but tiny errors or negative feedback shake her confidence.

At the root of those problems is a familiar phenomenon-low self-esteem. It is an important concern because self-esteem affects one’s thinking, emotions, values, and goals. Self-esteem for the nurse develops gradually and is greatly influenced by coworkers and colleagues.

There are many reasons nurses may have low self-esteem: difficulty combining work and home responsibilities, resolving conflicts with other members of the health care team, dealing with pressure to return to school, and struggling to deliver excellent patient care. Whatever the reason a nurse feels insignificant or insecure, it robs that nurse of much personal and professional pleasure and satisfaction.

In addition to the personal toll of low self- esteem, the cost to the profession is staggering. Many experts blame the negative nursing image for the severe shortage of qualified nurses and for decreasing nursing school enrollments. As

nurses air their grievances through the media, one can understand how the public might see nursing in a negative light. What may have started as a personal problem (low self-esteem) can become a problem for nursing as a whole. An answer to the problem may be for nurses to use their knowledge of human growth and develdpment and apply it to their professional lives.

Professional Development

uman development offers guidelines for understanding professional development. H Most nurses, although quite familiar with

human growth and development, would be surprised to learn that their professional devel- opment closely parallels human development. This is especially true when considering the develop- ment of self-esteem.

By considering the phases of growth and development, a person can determine where one is on the maturity continuum and respond accordingly. This knowledge can be of immense value to nursing educators seeking to prepare nurses for practice, to nurse managers working

Carol A . Mannahan, RN, MSN, was an instructor for the department of nursing, Central State Universit,), Edmond, Oklahoma, when this article was written. She has a diploma of nursing from St Luke3 Hospital School of Nursing, Cedar Rapids, Iowa, und both bachelor of science and master of science degrees in nursing from Oklahoma University, Oklahoma City.

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Page 2: Professional Maturity: The Stages of Developing Self-Esteem

AORN JOURNAL FEBRUARY 1989, VOL. 49, NO 2

Like human development, periods of regression can occur during professional development that may be related

to times of change or unusual stress.

to utilize the talents of the nurses in their organization, and to individuals who can better understand their own professional growth status.

In the discussion that follows, “age” refers to the number of years as a practicing professional. Throughout the professional development (or age) of a nurse, the levels of maturity are distinct and play an integral part in a nurse’s total development.

For the developing nurse, birth is identified as that time when the student begins to identify with the nursing profession. This most often occurs during the first exposure to nursing courses.

Early development encompasses part of the educational process and the first six to 12 months of practice. Adolescence may last from one to three years after graduation. The adult level of maturity begins after that and usually continues for the remainder of one’s career.

Like human development, periods of regression can occur that may be related to times of change or unusual stress. It must be remembered that individuals are unique and progress at their own rate.

The following stages should serve only as a guideline for understanding the levels of profes- sional maturity. As always, individual assessments are essential.

Early Stages

he developing student/new nurse, like an infant, depends on support systems for T survival. The nurturing received by the

“young” nurse exerts a powerful influence on that person’s level of self-esteem. If the nurse’s needs are met (ie, questions answered, skills demon- strated, and anxiety minimized), a sense of well- being occurs and a basic sense of trust emerges.

Consistency and continuity are particularly beneficial to the young nurse. If roles and responsibilities are clearly defined and the hospital policies provide dependable guidelines, the nurse

feels a sense of security and will gradually progress toward the next level of development.

Praise is an especially powerful form of reinforcement to the young nurse. Eager to please and gain acceptance, the nurse tries to learn everything possible from basic to advanced skills. As a nurse demonstrates mastery of terminology and skills, prompt, positive, and specific feedback from others is essential for positive growth.

Contrary to what many believe, criticism also is a valuable form of recognition. Constructive criticism, however, requires careful observation of the person and situation. It also requires that the critic choose the right time (a calm moment), the right place (private), and the right approach (understanding, kind, firm). In fact, constructive criticism represents a commitment to the professional growth of the young nurse. This commitment to the person also contributes to the nurse’s overall sense of professional self-esteem.

The young nurse, like the child, is seeking to gain control of his or her environment. While sharing experiences and mastering skills, the nurse develops predictability and a sense of control. Through teaching and nurturing, the young nurse can correct deficiencies, strengthen abilities, and progress to the adolescent stage.

A doiescence

he young nurse enters this stage after mastering basic nursing skills. The “ado- T lescent” nurse seeks to establish his or her

own identity and style based on what works and is comfortable.

At this developmental stage, the nurse’s self- esteem faces its greatest challenge. As adolescent nurses seek independence, it is easy for others to get frustrated and reject them. Because of inexperience, the adolescent nurse may seek to define limits by challenging authority, sometimes in an abrasive manner. Some may view the nurse

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Page 3: Professional Maturity: The Stages of Developing Self-Esteem

AORN JOURNAL FEBRUARY 1989, VOL. 49, NO 2

at this stage as a troublemaker or a know-it-all. Harsh and demanding expectations along with angry responses to the nurse’s behavior, however, can lead to self-doubt and feelings of despair in the adolescent nurse.

Perhaps the greatest form of communications with the adolescent nurse (or the teenager) is listening. When someone spends quality time listening, it reinforces one’s sense of importance and value. Someone to serve as a sounding board, rather than an advice giver, is of great value to the adolescent.

The individual working with an adolescent nurse must remember that, as it is with teenagers, the struggle for independence and autonomy is an important part of the process to acquire independence and autonomy. The challenges are, in fact, tools that help to develop good judgment and independence.

As the adolescent nurse reaches for indepen- dence, takes risks, and experiences success, role identity is achieved. During this stage, the nurse continues to develop self-esteem, which provides much of the energy to move into adulthood.

Adulthood

n this stage, the upheavels associated with the adolescent stage are past. The “adult” nurse I accepts responsibility for all areas of his or

her life and lives according to conviction. The nurse is comfortable with accountability and is less dependent on others. The adult nurse, however, values colleagues highly, so it is important that professional meetings allow time for casual socialization. The mature nurse also benefits from personal time for renewal and self- development.

At this stage of professional maturity, the nurse’s self-esteem is at its most positive level. The individual’s ability to accept his or her role within the system and to commit to beliefs and ideals enhances personal self-esteem and results in a sense of calm. Adulthood also represents the most productive time in a nurse’s career.

The ability to perform a role with confidence and to help others also makes the adult nurse an effective mentor. The adult nurse’s self-esteem

can be enhanced by peer evaluations and self- evaluations. The nurse generally will appreciate open and honest communication and accept criticism nondefensively.

For the “older adult” nurse, the teaching role can be very beneficial to the profession. In some cases, nurses move into educator roles as a natural progression and find great satisfaction with formal and informal teaching. Often, just their sharing of wisdom or relating past events can provide principles for solving present problems.

The self-esteem of the older adult nurse is influenced, as always, by coworkers and col- leagues. Of course, recognition for past successes is greatly appreciated and contributes to the nurse’s identity as a role model and mentor.

Conclusion

elf-esteem is a central variable in human behavior. Individuals with positive self- S esteem usually function more effectively in

their personal and professional lives. A nurse with a positive self-esteem is less likely

to remain in an unrewarding or stressful job. The nurse will be assertive, less likely to feel used, and will gladly try out new ideas. Change, so inevitable in nursing, will not appear threatening but rather serve as a welcome challenge.

By applying knowledge of human growth and development to their professional growth and development, nurses can better understand themselves and help one another toward profes- sional maturity. 0

Suggested reading Erikson, E H. Childhood and Sociev, second ed. New

York W W Norton Co, 1964. Kramer, M. Real@ Shock: Why Nurses Leave Nursing.

St Louis: C V Mosby Co, 1974. McKay, M, Fanning, P. Self-Esteem. New York City:

St Martin’s Press, 1987. Meissner, J E. “Nurses: Are we eating our young?“

Nursing 86 16 (March 1986) 51-53. Silber, M B. “Nursing management starts and succeeds

with self-esteem.” Supervisor Nurse 12 (March

Woolf, P. “Increasing self-esteem through self- evaluation.” Journal of Nursing Education 23 (February 1984) 78-8 1.

1981) 42-46.

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