Introduction

Role transition involves transforming one’s professional identity. A new graduate makes a transition from the student role to the nurse role. Expectations of students are clearly specified in course and clinical objectives. Expectations for a new nurse as an employee may not be so clear. The new graduate nurse faces the first of several professional transitions. The Literature Perspective and Research Perspectives on p. 539 provide further information on role transitions for new graduate nurses, which are helpful for new graduates, their co-workers, and their managers.

Consider the staff nurse who becomes a nurse manager. The staff nurse performs tasks related to the care of patients. As a follower, the staff nurse has accountability and responsibility for the work that is accomplished. A staff nurse who becomes a nurse manager must transition into the new role as a generalist, orchestrating diverse tasks and getting work done through others.

A staff nurse who moves from an acute care setting to a home health agency must also undergo a role transition. Instead of balancing the needs of multiple patients, the home health nurse can focus on one patient at a time. Yet, when a collegial opinion is needed during a visit, peers with whom to consult are not readily available. Registered nurses who transition to nurse practitioner roles and other advanced practice roles experience this same type of role transition.

Organizations play a key role in assisting employees through role transitions. Changes in roles can be either painful or exciting and depend largely on the work culture and support provided. According to Sewell (2008), “role transition is a hurdle encountered by every nurse entering the workforce. A host of new experiences await the neophyte beyond the clinical experiences of nursing school” (p. 49).

Knowing what to expect during the transformation can reduce the stress of accepting and transitioning into a new role and result in quality outcomes. After an overview of the roles of leader, manager, and follower, this chapter describes the process of role transition, with an emphasis on strategies that can be used to ease the transition.

Types of Roles

Accepting a management position dictates accepting three roles that involve complex processes. The roles of leader, manager, and follower are complex because they involve working through and with unique individuals in a rapidly changing environment. Examples of the people with whom you interact and the processes involved in each role are shown in Table 27-1. In nursing, each of these roles relates to patients and clients.

The transition from a staff nurse role to a nurse manager/leader role can occur overnight. The nurse moves from the clinical work of patient care to lead a group of employees. Clark (2008) notes that “leadership is not simply granted to individuals and is not about responding passively to events. It is about creating possibilities that were absent before” (p. 30). McConnell (2008) says that a healthcare professional who takes on a manager position is taking on a second occupation. “The professional who enters management must wear two hats” (p. 278). One role is as the professional on technical and clinical matters, and one is as a generalist manager.

The role of follower involves respecting the authority of others and working within the system to contribute to the organizational outcomes. Managers as followers recognize their accountability to the persons above them on the organizational chart. Within a team, the manager recognizes the leadership being provided by others and supports decisions made by the group.

In the evolving healthcare environment, the nurse providing direct patient care also must function as a leader, manager, and follower. As leader, the nurse recognizes the uniqueness of each patient and provides feedback on clinical progress. As manager, the nurse links the patient to the resources to achieve clinical outcomes. Medical information is translated into a format that the patient can use to make informed decisions about treatment and self-care. Through referrals, the nurse facilitates continuity of care within the larger system. As follower, the nurse is accountable to the team and the supervisor for completing the work that is assigned. The nurse as a follower practices within the policies and procedures of the organization and the standards of the profession.

Learning the leader, manager, and follower aspects of any new role can be overwhelming. Another approach to the complexity of role transition is the acronym ROLES, in which each letter represents a component common to all roles.

Roles: The ABCs of Understanding Roles

Acronyms help us retain and organize information. “ROLES” (Box 27-1) is an acronym that is useful in role transition.

R stands for responsibilities. What are the specified duties in the position description for the new position? What tasks are to be completed? What decisions must the person in this position make? For example, the job for a nurse manager might include 24-hour accountability, whereas a job description for a nurse practitioner may involve direct care in a primary care setting. Every position has specific tasks for which the position holder is responsible.

O stands for opportunities, which are untapped aspects of the position. In the employment interview, the nurse executive may have said that the previous manager did not encourage the staff nurses to participate in continuing education. Or, while touring the unit, a manager observes that the report room lacks amenities. Maybe there is a new method of delivering patient care that is appropriate for the unit. These possibilities represent opportunities for a manager to influence organizational and unit goals.

L represents lines of communication, which are at the heart of every leadership role. No matter what role an individual is in, there are relationships with multiple individuals including supervisors and peers. Roles incorporate patterns of structured interactions between the manager and people in these groups. The nurse manager receives and sends messages. Being a skillful listener can be more important than being skillful in sending messages. Skill is required to communicate both the content and the intent of the message effectively. Only through practice can one develop skill. In Chapter 18, techniques of effective communication are described that are extremely important to a new manager in building the team.

E stands for expectations. Expectations vary depending on your goals. Colleagues may expect a new nurse anesthetist to be on call every weekend. Staff nurses have specific expectations of their managers and particularly want the manager to be a facilitator and a leader. The nursing executive or administrator will likely have expectations about how managers spend their time on the job—even about how much time they spend at work. Nurse executives’ expectations evolve from their perspectives of the manager’s accountability and duties.

Finding out in advance what the explicit and implicit expectations are of the people involved can facilitate a smoother role transition by decreasing role ambiguity (Hardy, 1978). Hardy’s work with role theory suggests a strong relationship between role ambiguity (one type of role stress) and role strain. The major concepts of role theory are presented in the Theory Box above.

Theory Box

Hardy’s Role Theory

THEORY/CONTRIBUTOR	KEY IDEAS	APPLICATION TO PRACTICE
Hardy (1978) is credited with applying role theory to healthcare professionals. Role is the expected and actual behaviors associated with a position. Role expectations are the attitudes and behaviors others anticipate that a person in the role will possess or demonstrate. Role stress is a social condition in which role demands are conflicting, irritating, difficult, or impossible to fulfill. Role strain is the subjective feeling of discomfort experienced as the result of role stress.	Role stress is a precursor to role strain. Role stress is associated with low productivity and performance. Role stress and role strain can lead a person to withdraw psychologically from the role. Clear, realistic role expectations can decrease the role stress for a new nurse manager.	Clear, realistic role expectations can increase productivity.

Data from Hardy, M.E. (1978). Role stress and role strain. In M.E. Hardy & M.E. Conway (Eds.), Role theory: Perspectives for health professionals. New York: Appleton-Century-Crofts.

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