“Any transition serious enough to alter your definition of self will require not just small adjustments in your way of living and thinking but a full-on metamorphosis.”–Martha Beck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google ScholarSPRING IS UPON US once again! And though it is a short-lived transition to the long, hot days of a Georgia summer, it remains one of my favorite seasons. I always think of spring as that transition back to the land of the living. Flowers are in full bloom; the days are longer and warmer; plans are being made for summer vacations; and life just seems to take on a more pleasant and purposeful pace. Most of these transitions are smooth and insignificant, but transitions can bring with them a state of stress and unease.Life transitions are often positive in nature, but that does not mean they are without stress! Graduations, marriages, births, and new jobs can all bring excitement, but as Martha Beck notes, they also generally “alter your definition of self.”1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar The steady progression of a child from elementary to middle school is fraught with the stress of metamorphosis as the child blossoms into an adolescent, and the parents simply struggle to adapt and survive! Transitioning back to the role of student will also most definitely alter one’s sense of self, as all of the ASPAN editors have discovered since we enrolled in PhD programs in various parts of the country. Our lifestyles have undergone a huge metamorphosis, as most of our families and close friends will confirm. But more significantly, I think that advancing one’s education results in a metamorphosis in how one thinks of and perceives their profession.I believe that the nursing profession is also in a state of transition. We continue to struggle to define exactly what nursing is and what roles nursing encompasses. And we are also grappling to develop consensus as to who can become nurses and what education is needed to perform the various roles of nursing. What level of education is needed for bedside nursing, for administrative and patient management, and for advanced practice? What is advanced practice? Is a nurse a nurse, or will we become more specialized? What educational background does a nurse need? Does every nurse have to start out as an undergraduate in nursing? Or, can someone with an undergraduate degree in another field enter graduate level nursing education and practice as a nurse (as long as they can pass licensing requirements) without that undergraduate degree? Are you really a nurse if you are not in the practice/nursing academic setting? Are you a nurse if your practice is doing animal research in a lab?Nursing is changing … . . and must change to meet the health care challenges of the future. New masters level roles such as the Clinical Nurse Leader (CNL) are currently being developed. The American Association of Colleges of Nursing (AACN) recommends that advanced practice roles such as the CRNA, nurse practitioner, and clinical nurse specialist require a doctorate of nursing practice (DNP) by the year 2015.2American Association of Colleges of Nursing: AACN adopts a new vision of the future of nursing education and practice. Available at: http://www.aacn.nche.edu/Media/NewsReleases/DNPRelease.htm. Accessed February 18, 2005Google Scholar I had the privilege of representing ASPAN at a National Stakeholders’ Meeting on Advanced Practice Nurses3Nursing World: National nursing stakeholder’s meeting on advanced practice nurses. Available at: http://www.ana.org/news/apnmeeting.htm. Accessed February 18, 2005Google Scholar in December of last year. This meeting addressed this, and many other issues impacting advanced practice nursing. The profession is in the throes of a complete metamorphosis. And many are struggling with these changes. Martha Beck says that human metamorphosis occurs in 4 phases.1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar While these stages are very applicable to personal change, I think they may also apply to the transition taking place in nursing.Phase one: dissolvingBeck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar describes this first phase of transition as a “time when we lose our identity and are left temporarily formless.” It is a phase when individuals feel that their lives, or in this situation, their profession (or roles in the profession) are dissolving. Common responses include hysterics, fighting the change, and trying to recapture the past. There are individual nurses, and, unfortunately, one or two professional associations that are in still in this phase. It is a perfectly normal response. Beck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar recommends that you manage this phase by living one day at a time (focusing on what is happening now, and not in the future), talking to others that have undergone similar situations, caring for yourself, and letting yourself grieve. This can work professionally as well. Rather than focus on if your role in nursing will change, focus on doing the best job that you can now. And, from an organizational perspective, network with other professions who have undergone similar role changes. Many allied health professions such as pharmacy and physical therapy require a minimum of a master’s level of education for practice, and most have, or are moving towards, a requirement for doctoral preparation, so we are not alone.Phase two: imaginingPhase 2 is when you know your destiny and begin to reorganize into something new and different. You start to see the image of what you will become, and reorder yourself to meet that image.1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar Nursing, particularly from an advanced practice perspective, is rapidly progressing through this stage. While the details of the transition to a practice doctorate for advanced practice roles is still in development, agreement on the roles and core preparation for advanced practice nurses is progressing through the work of consensus groups such as the meeting that I attended. One of the primary recommendations that Beck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar has for working through this phase is to let yourself daydream and imagine the metamorphosed future. For some of you, this may be a bit scary, as you may actually be worrying about what will happen to you … . . and wondering if you will be qualified to continue to function in the role that you currently hold. Remember, these transitions are to provide for our future, not to eliminate those that are so crucial to the present. The Stakeholder’s group that met in December, while interested in moving the profession forward, also wanted to assure that any system for advanced practice nursing provides for flexibility and evolution of practice and career development, and that it “does no harm to any nurse in times of transition.”3Nursing World: National nursing stakeholder’s meeting on advanced practice nurses. Available at: http://www.ana.org/news/apnmeeting.htm. Accessed February 18, 2005Google ScholarPhase three: re-formingPhase 3 is the actual implementation of the transition process.1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar It is when you go beyond dreaming and actually take action. The important thing to remember about this phase is that failure (and sometimes multiple failures) will occur. One must therefore be prepared to expect things to go wrong, be willing to start over, be willing to adjust as needed, but most importantly, be determined to persist. The nursing profession has taken tentative steps in this re-forming phase. While a few DNP programs are available in some parts of the country, many more are being developed and the transition of advanced practice roles to a DNP format is being further explored. CNL programs are also being developed and implemented around the country. All of these programs will undergo re-examination and frequent revisions in the early years of implementation, so, when entering such programs, one must be prepared to be flexible. We must also be prepared to provide honest feedback on these new programs as they are implemented, with the goal of providing the best possible education available.Phase four: flyingBeck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar defines Phase 4 as the point when your new identity is fully evolved and you are ready to fly. The current transition in nursing has a way to go before we are fully formed and ready to fly, but we are making progress. This process will most likely take many years as we bring in the new and transition out the old. But I do think that the next generation of nurses and the patients that they care for will be better for all of the work that we are doing now.Nursing is in the complete throes of metamorphosis, and the future of nursing as a leader in the provision of health care is at stake. We can fight to maintain the status quo, and see our future dissolve as the best and the brightest of the next generation look elsewhere to find fulfilling careers. Or we can embrace the future and contribute our knowledge and experiences to impact this transition in a positive way. Change is coming. Will you hide in your cocoon and hope that it will go away, or will you sprout your wings and fly? The future waits for your decision! “Any transition serious enough to alter your definition of self will require not just small adjustments in your way of living and thinking but a full-on metamorphosis.”–Martha Beck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar SPRING IS UPON US once again! And though it is a short-lived transition to the long, hot days of a Georgia summer, it remains one of my favorite seasons. I always think of spring as that transition back to the land of the living. Flowers are in full bloom; the days are longer and warmer; plans are being made for summer vacations; and life just seems to take on a more pleasant and purposeful pace. Most of these transitions are smooth and insignificant, but transitions can bring with them a state of stress and unease. Life transitions are often positive in nature, but that does not mean they are without stress! Graduations, marriages, births, and new jobs can all bring excitement, but as Martha Beck notes, they also generally “alter your definition of self.”1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar The steady progression of a child from elementary to middle school is fraught with the stress of metamorphosis as the child blossoms into an adolescent, and the parents simply struggle to adapt and survive! Transitioning back to the role of student will also most definitely alter one’s sense of self, as all of the ASPAN editors have discovered since we enrolled in PhD programs in various parts of the country. Our lifestyles have undergone a huge metamorphosis, as most of our families and close friends will confirm. But more significantly, I think that advancing one’s education results in a metamorphosis in how one thinks of and perceives their profession. I believe that the nursing profession is also in a state of transition. We continue to struggle to define exactly what nursing is and what roles nursing encompasses. And we are also grappling to develop consensus as to who can become nurses and what education is needed to perform the various roles of nursing. What level of education is needed for bedside nursing, for administrative and patient management, and for advanced practice? What is advanced practice? Is a nurse a nurse, or will we become more specialized? What educational background does a nurse need? Does every nurse have to start out as an undergraduate in nursing? Or, can someone with an undergraduate degree in another field enter graduate level nursing education and practice as a nurse (as long as they can pass licensing requirements) without that undergraduate degree? Are you really a nurse if you are not in the practice/nursing academic setting? Are you a nurse if your practice is doing animal research in a lab? Nursing is changing … . . and must change to meet the health care challenges of the future. New masters level roles such as the Clinical Nurse Leader (CNL) are currently being developed. The American Association of Colleges of Nursing (AACN) recommends that advanced practice roles such as the CRNA, nurse practitioner, and clinical nurse specialist require a doctorate of nursing practice (DNP) by the year 2015.2American Association of Colleges of Nursing: AACN adopts a new vision of the future of nursing education and practice. Available at: http://www.aacn.nche.edu/Media/NewsReleases/DNPRelease.htm. Accessed February 18, 2005Google Scholar I had the privilege of representing ASPAN at a National Stakeholders’ Meeting on Advanced Practice Nurses3Nursing World: National nursing stakeholder’s meeting on advanced practice nurses. Available at: http://www.ana.org/news/apnmeeting.htm. Accessed February 18, 2005Google Scholar in December of last year. This meeting addressed this, and many other issues impacting advanced practice nursing. The profession is in the throes of a complete metamorphosis. And many are struggling with these changes. Martha Beck says that human metamorphosis occurs in 4 phases.1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar While these stages are very applicable to personal change, I think they may also apply to the transition taking place in nursing. Phase one: dissolvingBeck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar describes this first phase of transition as a “time when we lose our identity and are left temporarily formless.” It is a phase when individuals feel that their lives, or in this situation, their profession (or roles in the profession) are dissolving. Common responses include hysterics, fighting the change, and trying to recapture the past. There are individual nurses, and, unfortunately, one or two professional associations that are in still in this phase. It is a perfectly normal response. Beck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar recommends that you manage this phase by living one day at a time (focusing on what is happening now, and not in the future), talking to others that have undergone similar situations, caring for yourself, and letting yourself grieve. This can work professionally as well. Rather than focus on if your role in nursing will change, focus on doing the best job that you can now. And, from an organizational perspective, network with other professions who have undergone similar role changes. Many allied health professions such as pharmacy and physical therapy require a minimum of a master’s level of education for practice, and most have, or are moving towards, a requirement for doctoral preparation, so we are not alone. Beck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar describes this first phase of transition as a “time when we lose our identity and are left temporarily formless.” It is a phase when individuals feel that their lives, or in this situation, their profession (or roles in the profession) are dissolving. Common responses include hysterics, fighting the change, and trying to recapture the past. There are individual nurses, and, unfortunately, one or two professional associations that are in still in this phase. It is a perfectly normal response. Beck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar recommends that you manage this phase by living one day at a time (focusing on what is happening now, and not in the future), talking to others that have undergone similar situations, caring for yourself, and letting yourself grieve. This can work professionally as well. Rather than focus on if your role in nursing will change, focus on doing the best job that you can now. And, from an organizational perspective, network with other professions who have undergone similar role changes. Many allied health professions such as pharmacy and physical therapy require a minimum of a master’s level of education for practice, and most have, or are moving towards, a requirement for doctoral preparation, so we are not alone. Phase two: imaginingPhase 2 is when you know your destiny and begin to reorganize into something new and different. You start to see the image of what you will become, and reorder yourself to meet that image.1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar Nursing, particularly from an advanced practice perspective, is rapidly progressing through this stage. While the details of the transition to a practice doctorate for advanced practice roles is still in development, agreement on the roles and core preparation for advanced practice nurses is progressing through the work of consensus groups such as the meeting that I attended. One of the primary recommendations that Beck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar has for working through this phase is to let yourself daydream and imagine the metamorphosed future. For some of you, this may be a bit scary, as you may actually be worrying about what will happen to you … . . and wondering if you will be qualified to continue to function in the role that you currently hold. Remember, these transitions are to provide for our future, not to eliminate those that are so crucial to the present. The Stakeholder’s group that met in December, while interested in moving the profession forward, also wanted to assure that any system for advanced practice nursing provides for flexibility and evolution of practice and career development, and that it “does no harm to any nurse in times of transition.”3Nursing World: National nursing stakeholder’s meeting on advanced practice nurses. Available at: http://www.ana.org/news/apnmeeting.htm. Accessed February 18, 2005Google Scholar Phase 2 is when you know your destiny and begin to reorganize into something new and different. You start to see the image of what you will become, and reorder yourself to meet that image.1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar Nursing, particularly from an advanced practice perspective, is rapidly progressing through this stage. While the details of the transition to a practice doctorate for advanced practice roles is still in development, agreement on the roles and core preparation for advanced practice nurses is progressing through the work of consensus groups such as the meeting that I attended. One of the primary recommendations that Beck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar has for working through this phase is to let yourself daydream and imagine the metamorphosed future. For some of you, this may be a bit scary, as you may actually be worrying about what will happen to you … . . and wondering if you will be qualified to continue to function in the role that you currently hold. Remember, these transitions are to provide for our future, not to eliminate those that are so crucial to the present. The Stakeholder’s group that met in December, while interested in moving the profession forward, also wanted to assure that any system for advanced practice nursing provides for flexibility and evolution of practice and career development, and that it “does no harm to any nurse in times of transition.”3Nursing World: National nursing stakeholder’s meeting on advanced practice nurses. Available at: http://www.ana.org/news/apnmeeting.htm. Accessed February 18, 2005Google Scholar Phase three: re-formingPhase 3 is the actual implementation of the transition process.1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar It is when you go beyond dreaming and actually take action. The important thing to remember about this phase is that failure (and sometimes multiple failures) will occur. One must therefore be prepared to expect things to go wrong, be willing to start over, be willing to adjust as needed, but most importantly, be determined to persist. The nursing profession has taken tentative steps in this re-forming phase. While a few DNP programs are available in some parts of the country, many more are being developed and the transition of advanced practice roles to a DNP format is being further explored. CNL programs are also being developed and implemented around the country. All of these programs will undergo re-examination and frequent revisions in the early years of implementation, so, when entering such programs, one must be prepared to be flexible. We must also be prepared to provide honest feedback on these new programs as they are implemented, with the goal of providing the best possible education available. Phase 3 is the actual implementation of the transition process.1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar It is when you go beyond dreaming and actually take action. The important thing to remember about this phase is that failure (and sometimes multiple failures) will occur. One must therefore be prepared to expect things to go wrong, be willing to start over, be willing to adjust as needed, but most importantly, be determined to persist. The nursing profession has taken tentative steps in this re-forming phase. While a few DNP programs are available in some parts of the country, many more are being developed and the transition of advanced practice roles to a DNP format is being further explored. CNL programs are also being developed and implemented around the country. All of these programs will undergo re-examination and frequent revisions in the early years of implementation, so, when entering such programs, one must be prepared to be flexible. We must also be prepared to provide honest feedback on these new programs as they are implemented, with the goal of providing the best possible education available. Phase four: flyingBeck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar defines Phase 4 as the point when your new identity is fully evolved and you are ready to fly. The current transition in nursing has a way to go before we are fully formed and ready to fly, but we are making progress. This process will most likely take many years as we bring in the new and transition out the old. But I do think that the next generation of nurses and the patients that they care for will be better for all of the work that we are doing now.Nursing is in the complete throes of metamorphosis, and the future of nursing as a leader in the provision of health care is at stake. We can fight to maintain the status quo, and see our future dissolve as the best and the brightest of the next generation look elsewhere to find fulfilling careers. Or we can embrace the future and contribute our knowledge and experiences to impact this transition in a positive way. Change is coming. Will you hide in your cocoon and hope that it will go away, or will you sprout your wings and fly? The future waits for your decision! Beck1Beck M. Growing wings.O, The Oprah Magazine. 2004; (January. Available at: http://www.oprah.com/omagazine/200401/omag_200401_beck_e.jhtml. Accessed February 17, 2005)Google Scholar defines Phase 4 as the point when your new identity is fully evolved and you are ready to fly. The current transition in nursing has a way to go before we are fully formed and ready to fly, but we are making progress. This process will most likely take many years as we bring in the new and transition out the old. But I do think that the next generation of nurses and the patients that they care for will be better for all of the work that we are doing now. Nursing is in the complete throes of metamorphosis, and the future of nursing as a leader in the provision of health care is at stake. We can fight to maintain the status quo, and see our future dissolve as the best and the brightest of the next generation look elsewhere to find fulfilling careers. Or we can embrace the future and contribute our knowledge and experiences to impact this transition in a positive way. Change is coming. Will you hide in your cocoon and hope that it will go away, or will you sprout your wings and fly? The future waits for your decision! Vallire D. Hooper, MSN, RN, CPAN, is a Clinical Nurse Specialist in Surgical Services at St. Joseph’s Hospital and a Clinical Assistant Professor for the School of Nursing at the Medical College of Georgia, Augusta, GA