"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

Negotiating Audience

In order for Lena to function in her workplace community, she needs to obtain an appropriate social role. As mentioned previously, this means she must acquire nurse “lingo” and learn to apply knowledge in the workplace in a socio-normative way, thus, she needs to understand and adapt to her audience. Acquiring these skills often occurs in the beginning of training, where the new employee takes on the persona of the trainer. In this case, Lena adopts her preceptor’s method until she develops her own:

During my orientation, my preceptor, who is supposed to be a role model of how to do things by the book, had told me that I was writing too much, in too much detail. I was sitting down to do a [progress] note like I had initially been trained to do by another preceptor. I, of course, went into great detail and took quite a while to do these notes. In the middle of my notes my preceptor had informed me that "Nobody really writes those notes like that. No one really reads them anyways." I quickly followed suit and stopped right then.

By “practicing” with one nurse, Lena is learning only that nurse’s discourse and in some way takes on that person’s identity and authority in the workplace, thus creating a pseudo-authority and/or identity for the self.

Additionally, a similar situation occurred again between Lena and her preceptor when Lena was writing the SBARP (which she would later have to verbalize to someone else). Her preceptor told her that she did not need to write so much and to hurry up. Lena’s preceptor then left the building, consequently leaving Lena alone to give report. However, in this case Lena asserted authority and began to develop her own method: “I wrote the information down anyway because I thought it should be included.”

Considering the information written and thus verbalized on an SBARP is subject to the nurse’s own interpretation of what is and is not important, Lena also encountered a situation where she was criticized for not providing seemingly important information:

One day I forgot to write down the results for one of patients. The nurse [I was giving report to] was saying "Well you know you should know this. Why are you sitting giving report when you could be looking this up right now? You should know what’s going on with your patient." She made me feel like I didn’t know anything and was doing everything wrong.

Lena’s situation parallels Athwal, Fields and Wagnall’s (2009) statement that “Experienced nurses also verbalized frustration with the new nurses because they did not know what was important to present in report or what was important to write down while receiving report” (p. 144).

Although Lena’s co-worker criticizing Lena’s verbal report seemingly is not making a personal attack on Lena, but rather the lack of information she has written on her SBARP, writing remains a reflection of identity, and in this discourse community a position of authority and therefore, the criticism is personal from any angle. Lena feels the personal attack because her writing and verbal communication has negated essential information expected by her audience.

Lena however, does appear to recognize that the SBARP is a document that requires her to negotiate her audience. She states:

You have to kind of know who you’re talking to. Some nurses will just take whatever you say and just do their own research and learn about the patient on their own but some nurses kind of drill you and you know, make you feel stupid if you didn’t know a certain thing, didn’t write something down from earlier in the day. You kind of feel inferior to that nurse because you weren’t prepared for her questions.

In some way each SBARP is like a new genre each time it is written because it is dictated by the preconceived impressions or knowledge of the nurse who will be receiving the report—meaning that one nurse may expect report to be conducted a certain way; they may want every small detail. Another nurse may not care or (if the nurse is new) may not even know information is missing. Furthermore, there is no regulated “preparation” for writing an SBARP. Lena, and other newcomers to the community, must adapt to an inconsistent genre as well as evaluate her audience while still (in the case with her preceptor) trying not to fully compromise her own intuition.

Negotiating Priorities

In my section “Writing in Nursing” above I mention that nurses have multiple, shifting roles between their physical and documentation tasks. Considering nurses are not specifically trained to document during training, the physical tasks tend to take precedence over documented ones. For Lena, negotiating her priorities in many ways ties into negotiating her audience. As seen in the examples in the above section where one nurse chose to verbalize her frustration to Lena about her lack of proper information, another nurse may have been okay with her report. Thus, negotiating priorities can depend on your audience.

In the same situation where Lena’s co-worker felt she did not provide necessary information, Lena struggled to find balance when becoming overwhelmed by her physical tasks and forgetting to document information:

Some patients go down for tests, x-rays and cat-scans or whatever, and it’s the nurse’s job to read the doctor’s note and see what the results are so you can pass it on to the next nurse, but you know, being a new nurse you’re busy the whole time. You don’t really have time to do anything besides what the bare-minimum of requirements are and one day I forgot to write down the results for one of my patients.

In an occupation where an outsider can say “everything is a priority,” it is understandably difficult for a neophyte to balance the continual shift in rhetorical situations coupled with the continual shift in physical tasks, especially if during the training process one task surpasses the other in terms of priority.

Transition and Resolution

In this stage Lena begins to establish a role in her community and “finally integrates experience and reflects on the intellectual changes afforded by writing in the new context” (Anson and Forsberg, 1990: 208). Throughout Lena’s disorientation stage, awareness is formulated through her process of negotiations. Lena acquires new knowledge, recognizing that “You have to kind of know who you’re talking to.” She understands that socially, who her audience is and what they want to know matters in order to perform appropriately in the workplace community. Moreover, Lena attempts to assert her authority in this situation with her preceptor and the SBARP form, yet only to have her authority compromised again when another co-worker makes her feel inferior. This demonstrates that the Cycle of Transition does not happen linearly but in a circuitous fashion. Lena’s workplace identity is in constant transition and therefore in a constant process of evolution.

However, Lena congruously constructs a social role in order to more easily adapt to her workplace community by engaging in outside affairs with co-workers. For instance, she attends the workplace Christmas party and participates in Secret Santa. She also formulates an acquaintanceship with another new nurse, someone who could relate to her frustrations, and she currently attends a program offered by Sherwood Hospital where new nurses can discuss overall experiences. Although communication issues arose between Lena and her preceptor regarding appropriate documentation, Lena amends this by writing a thank you card and buying a gift certificate for her preceptor. Essentially, Lena takes on greater initiative to adapt to her workplace community.