Arte sutilísima

This section describes the journey of transition that they have all made, from a position as a direct caregiver, to a position in the world of business. Stories include decisions to transition and their associated feelings about coping with the transition. Each exemplar is followed by the page number for the corresponding transcript. They describe moments that they clearly became committed to making the change. They go on to describe how they feel about change. Those feelings include tension associated with personal relationships and mutual experience of support that they feel for one another. Early in the focus group, the facilitator asked the participants to think about and share how it

was that they made the shift to industry. Each participant seemed to be able to recall the moment when they made the decision to transition to industry and each was eager to share their memories.

(Fay) I know the exact moment, (verbal agreement with laughing all around) I was in, direct patient care I was called repeatedly for 3 months in 1998 and decided, O.K. this is not a joke, I’m going to go for an interview and I took the plunge. (9)

Fay was giggling while telling her story and when she was asked what prompted her to make the switch, Fay responded . . .

(Fay) Uhm . . . a combination of things. One, I was totally floored that someone was seeking me out because I didn’t apply for a job. The other thing was I’d been through a major . . . of course emotions are just flying because I’m having to recall this . . . a major life altering event that was devastating for me and my family and to take care of my family it was an accept. So . . . (9)

Here is an emotional moment for Fay that is as evident by her body language as by her words. She expressed surprise and disbelief that she had been sought out by an employer when she had not been job searching. Fay’s body posture was with arms folded in front of her on the table, lips pursed, head nodding back and forth. As she was telling her story it became evident from the emotional tone and quiver in her voice, that this had been a major life decision prompted by an event that impacted her and her family. Yet, here she was feeling comfortable enough to be with her peers at the table, in a sort of kinship with them. As she finished her story, she unfolded her hands, waving them up and away from her chest as if physically relieving herself of her emotions as she ‘relives’ her experience in words. With a shrug of her shoulders, it seems as if she is saying there was no other choice for her. Iona jumps in next with her story of transition below.

(Iona) I always had a reputation of changing jobs every 2 ½ years. I mean that’s the way I’d been ever since I was in nursing. I wanted to do everything I hadn’t done. I didn’t want to miss anything. So I’d done nursing home, I had done

hospital, I had done psych and you know, it was about that 2 ½ year mark and I had these 2 guys who owned a nursing home and they came to me, they wanted to start a DME company and at the same time they wanted me to open . . . back then there were no LTACs, no wound care centers but they wanted to start a 6 bed

wound care center in a nursing home and for me to do both of those. The pay was right, and it just was a new opportunity, couldn’t pass it up . . . intriguing. (9)

Iona mentions compensation for the first time. With a change in professional role it would seem logical that compensation would enter into the decision, although no other participant speaks of it. It seems as if each participant who is sharing a story incorporates an element of the novelty of change as one of the factors they acknowledge. Iona’s memory still reflects on that decision with ‘intrigue’ after all these years that have passed. Smiling like the Cheshire cat who ate the bird, Iona with her head nodding back and forth, elicits affirmation on the faces around the table as they join in smiling and reflecting a shaking of their heads in affirmation. There is note taking by Cate.

Like Iona, Gwen shares feelings about the transition that are focused on wanting to try something new and different.

(Gwen) Yeh, I was in private practice when I got approached back then by (X Company). They were looking for consultants for their Part B Medicare billing division. And because I was used to being self-employed, it was one more thing, and I thought O.K. this will be fun, this will be different, things I didn’t know about. And it basically segwayed into a full time job after a couple of years when my mentor at that company left and they created a position for me. And it just felt like the right move at the right time. (10)

Here Gwen mentions the timing of the opportunity by acknowledging ‘it was the right move at the right time’. Cate shares a bit of a different angle, but the bottom line comes down to taking on a challenge. Cate appears to reach out to Fay and Dora when she tells her story.

(Cate) And so when this opening came up and my rep told me about it and he knew that it would give me opportunity to talk . . . which is probably my only gift in life (laughing) but I guess I’m O.K. at it and uhm, so I took the job. Had to move out of town, I had just gone through a divorce a few years before that. So, it was that kind of thing, O.K., this is a life changing decision. I’m driving, granted, only 200 miles away from home, but I’m in a car by myself, driving to Kansas City, going “You’re 60 years old – What in the name of God are you doing? You know one person in Kansas City.” But it’s that challenge and that thing, you know, when you

go through something life altering, you just go well, it’s either sink or swim. And I just don’t feel like sinking, so it’s kind of you know, kind of a cool thing. So I’m glad you brought that up, both of you, about being you know, well, just a little bit, got to make a change in life. (13)

Below, Iona and Gwen talk about the adventure associated with the transition to the role, the diversion, the lack of regime, the spontaneity of performance in industry. The spoken word is accompanied with vigorous body language of the hands and the eyes, connecting with the other participants.

(Iona) Kind of like a sense of adventure. (giggling) When you move in this direction you have to have this sense of adventure. I want to see something new everyday, I want to go somewhere different everyday. (14)

(Gwen) No two days alike. No two days alike, I’ve been saying that for 20 years. No two days alike. In my situation, I am only the boss of myself. I don’t have a team that I’m in the boss of. (14)

Fay uses the analogy of the snowball effect to talk about her experiences.

(Fay) The new challenge is, it’s like a snowball, it takes you to another one (level). (15)

When speaking of advice given to her by her boss at the time Fay was making the decision about her career change . . .

(Fay) She said they’re going to call you at this time tomorrow and you’re going to take the call. She said because this is your next step in evolution. She said, “I don’t want to lose you, but this is what you’re supposed to do. Honestly, this is where God wants you.” I took the call and the rest is history. (16)

Below is a very different take from Dora about her career change decision. She shares her feeling of ‘awe’ about WOC Nurses in industry. She seemed to feel as if she could not aspire to fulfill such a role. Dora frames her decision around being brave and being driven to do something new by the fear of not taking a challenge. It sounds like her fear moved her to action.

(Dora) For me the transition was, mostly out of fear. My fear was to speak in public. So I was in my nursing WOC role I was given the opportunity to speak in front of physicians and I threw myself into the conference role, went out there to speak so I was building that path and I was always in awe of the clinicians the WOC nurses who were in the industry world. I never thought I could even get there, I didn’t think I was worthy of that because I looked up to them. So when an

opportunity came it was amazing and I really didn’t think I was going to get the job. It was mostly out of what you said Iona, the change, to do something brave and to see if you could do it. If you failed, you failed, and you could always do something else. So, that was why . . . what was the question? (laughing) (13)

Even after two years, Dora still speaks about how amazing she feels that she is actually performing this role in industry. Beth adds to the stories of transition by sharing her lived experience that influenced her decision to move into industry. She viewed the lecture by the pharmaceutical nurses as positive role models to aspire to. Being out of her comfort zone was attractive to her because as she states below, it offers her an opportunity for learning and sharing.

(Beth) I’ve see a lot of autonomy in the hospital as a WOCN. And I loved what I did when I did it but it was time to do something new. And I watched two

pharmaceutical nurses, they were from Schering Plow, and I watched them give us a lecture one day, and I can remember the product too, and I thought, I think I want to do that. So it is a challenge and you learn something everyday and you are out of your comfort zone everyday with something or someone or a certain group of people and that’s part of the challenge and that’s what makes it fun and

interesting. (15)

The comment chain continues with references to autonomy, which become more descriptive of the role, rather than the simple transition or move to industry. Attributes of the role or inducement to career change, perhaps it is the promise of attributes of the role which draw the participants to make a life altering change. It sounds like Gwen is saying that the promise of something new around the corner each day, is part of the allure drawing her to the role.

(Gwen) I love autonomy. And yes, I work from home but yes, I travel a lot too. Uhm, there’s good and bad points about that, but yes, I think really, there’s always something new around the corner. (14)

This story of transition is part of the larger conversation on identify and role, while this comment below speaks to the way that Iona feels about the actual transition or mobility of members of this group. The quote below is meaningful on many levels. It sounds like Iona is drawing an allegory below.

(Iona) And I really think the only drawback comes when you realize you really have packed that suitcase and you really did leave home. And now how do you . . . I love what I’m doing on one hand, I’m very happy with that situation, but then I think most of us had to go through a short period of how to deal with home. (37)

When the WOCNII takes on this new identity, he or she does set out on a new journey for which there is no precedence in the literature and everyone who sets out does leave home and starts a transition to a new identity and a new role. What does ‘home’ symbolize? It is far more than an address – home is the familiar and packing that suitcase might symbolize a packaging of the specialty knowledge and skill set – to transition to a new role or a new context for practice.

Their identity and this role is mobile, it is transitional in the twofold sense that the role is literally mobile, with participants traveling from place to place, speaking in different voices, acting roles on multiple stages, while their identity is in transition; how do these CWOCNIIs tell their story of transition when they interact with social and professional networks who really do not know what they do and how they do it or even why they do what they do? What is happening here in this focus group is that these participants are acting on an opportunity to tell stories of who they are, where they’ve been and where they might be going in the future. These stories are more about the quality of the journey, rather than the details of exactly what they do.