"Transition in and between Discourse Communities: One Nurse's Struggle"

Terrie Cole

Terri Cole graduated from Rhode Island College in 2012 with a bachelor’s degree in English literature and a minor in creative writing. She is 26 years old and currently teaches English at an all girls’ middle school in South Korea. Her academic interests are in composition and rhetoric studies, education and ESL. Her future plans are to apply to graduate school after teaching and traveling.

Contents

Introduction</p

Methods

A Framework for Studying

Writing in Nursing

Change of Shift and Genre

Results

Discussion

Conclusion

Works Cited

Findings: Lena's Cycle of Transition

Expectation

As mentioned previously, the expectation stage of Lena’s transition process is where she envisions herself working in a professional setting and either experiences apprehensions or idealizations about her working environment and her role in that working environment.

Lena’s desire to take a step toward a career path emerged directly out of college. Ideally, she would have liked to obtain a nursing position on a psychiatric unit, which is where she completed her clinical during the nursing program and would have felt more adapted, but also because she had an interest in psychology. Her feelings about becoming a nurse, in general, were somewhat apprehensive when I interviewed her. Lena states: “I was extremely nervous about starting my job at Sherwood Hospital. First, it was the start of my career and I was unsure what was expected of me. I felt unprepared and scared.” She demonstrates insecurities about applying her skills to the workplace and fears that she had not acquired enough knowledge to do her job well. For Lena, writing in the workplace was not something she even gave thought to. Despite the fact that she states “I feel with all the schooling I’ve had that writing is like second nature to me,” Lena does not identify herself as a workplace writer and does not actually enjoy writing.

Furthermore, Lena was worried that the nursing community she was entering would be filled with long-term nurses who would think she was unintelligent and not like her. However, when asked if she adapts easily to social situations, Lena responded: “Yes. I find myself to be courteous and attentive which makes it easy for people to interact with me when they first meet me.” It is clear that Lena felt her knowledge was inferior to long-term nurses. This insecurity coupled with obtaining a position on the Oncology Unit, one Lena was unfamiliar with and had only heard horror stories of, perpetuated a lack of authority and identity.

Disorientation

The disorientation stage is where Lena becomes disoriented and frustrated. She experiences a sense of alienated independence, where she feels she is expected to know unspoken guidelines and do things on her own. She also goes through two processes which I classify as negotiating priorities, where Lena struggles in prioritizing between her written and verbal tasks, and negotiating audience, where Lena encounters challenges with her co-workers.

Alienated independence:

Lena’s training period at Sherwood Hospital lasted twelve weeks and prepared Lena with knowledge specific to the Oncology Unit, such as protocols and training for the physical tasks she would encounter. However, Lena claims that documentation was not a strong focus of her training. In fact, the first time she engaged in documentation as a nurse was the first time she cared for a patient. Therefore, Lena’s frustration began after her training process, when she began to feel that she was suddenly expected to know the unspoken guidelines of documentation.

Lena’s alienated independence was furthered when she made note that the Care Plans she used to write for college are not the same she has to write for the workplace:

Most of the academic writing that I did [in college] was nursing Care Plans and occasionally research papers. The Care Plans varied from professor to professor, but for the most part they had similar formats. We would have to present one patient, explain their history, their reason for hospitalization, and what nursing interventions we were going to perform. For example, if I had a patient with a history of suicidal ideation hospitalized for a drug overdose, some nursing interventions would be to make sure she has a security person at all times, keep the room free of objects that can be used to inflict harm (cords, pens) and keep her neck and hands visible at all times. We were expected to make individualized Care Plans and have measurable outcomes. At Sherwood, these Care Plans are pre-made for us and we just have to print out which Care Plans fit the circumstance and check off boxes that say we have performed these nursing interventions. I feel like now in the real world, Care Plans are general for each patient and not as specific to the person.

Essentially, Lena’s situation relates to Gee’s (1989) discussion on discourse when he explains that if one is having difficulty adapting to a discourse community “they can use another perhaps related, secondary Discourse” (p. 6). Comparatively, this related secondary discourse would be Lena’s academic discourse, the discourse which is supposed to prepare her for the nursing community she is currently in. Yet, in regard to Care Plans, she cannot fully imitate and apply previous knowledge; the Care Plans are no longer individualized and the documentation has resulted to check boxes instead of narrative space. There is no familiarity with the Care Plan document. Subsequently, Lena lacks an authority she once had when performing Care Plans in the academic community.

Conversely, she does rely on her academic discourse community for abbreviations in the workplace community:

I feel like the thing that helped me the most [in college] that is helping me to this day is what I learned in Nursing 201, the basic level nursing course that we were all required to take. They taught us how to abbreviate, how to say things in a concise manner [and] not to ramble on about things. Keep everything short and sweet.

Consequently, what Lena felt helped her most in college conflicts with the appropriate communication Caroline Horton seemed to claim new nurses sometimes lack. Horton mentioned that new nurses adapt easily to the computers but often fail to communicate appropriately, stating: “They use text language and abbreviations to communicate with faculty.” The lack of personalization in computerized documents and “check box” structure could be reason for this inappropriate communication between new nurses and faculty members. This is not to say that Horton’s observations suggest that Lena only uses text language or abbreviations in communicating with her co-workers, but rather illuminates either the hospital or a nurse’s prior educational institutions’ de-prioritization of writing in order to train for the “more important” tasks.

Although Lena mentions her academic institution with a sensitive assessment, stating “I know that Stone Edge [a pseudonym] tried their best to prepare me for what was in store,” Lena tries to negotiate her familiar academic discourse community and the demands of her workplace discourse community but clearly struggles when she admits: “I was literally thrown into a new, scary, stressful environment from day one and I was expected to know so much.” Lena’s workplace expects her to enter the community already exemplifying the appropriate roles, thus Lena feels a sense of alienated independence.