Critical reflection can be used to identify the key influences in a person’s career, their career progression, and personal and professional development (Johns, 2017). Critically reviewing one’s key influencers can be powerful in assisting future career progression and gaining insight into personal driving factors. Having specialised in Haematology throughout my nursing career, further subspecialising within Lymphoma, I have progressed and currently hold the position of Haematology Clinical Nurse Specialist (CNS) Team Leader where I have management and leadership responsibility for a team of nine CNS’s as well as a significant clinical workload. My growth within this specialty and my career progression has been impacted by several complex and intertwined influencing factors. These are rooted in my childhood and moulded by my personal and professional support network and the opportunities afforded to me during my career. I will examine two of these factors, my dyslexia and my self-confidence, and the role they have played in my development.
In my final year at secondary school, my English teacher suspected I had undiagnosed dyslexia. Following testing, I was provided with additional support resources and extra time for exams. Formal diagnosis wasn’t completed until I attended university. This was not an uncommon occurrence in the early 2000s and diagnosis of dyslexia later in education is a known barrier for people with dyslexia to fulfil their true potential (Wright, 2000).
The impact of dyslexia on undergraduate nurse training is well researched and the support requirements for both academic work and clinical placements are now well established (Illingworth, 2005, Price & Gale, 2006, Major & Tetley, 2019a, Cunningham & Lambert, 2020). The majority of this data is from 2000 to 2005 when there was an increase in the number of known dyslexic nursing students and nursing studies had moved from a vocational qualification to undergraduate degree programmes (Price & Gale, 2006). Having commenced my nursing degree in 2007 I benefited from the implementation of this research and was well supported throughout my undergraduate studies. I received extra time for exams and clinical placement mentors were guided as to how they could best support me in my learning. Via the Dyslexia Action charity, I received one to one tutoring from a dyslexia specialist, covering topics such as how to read, learn and understand nursing vocabulary, invaluable in assisting me to keep up with my peers. This dedicated support has shaped my nursing career well beyond my undergraduate study, giving me confidence in my ability to learn, tools to draw on during periods of stress (known to increase dyslexia-related difficulties) and improved insight into how I learn, therefore how I should approach future learning. Wright (2000) however, highlighted that there is significant variation in support provided and suggested a need for clarification of the specific dyslexia support needed in addition to extra exam time and IT equipment. This remains an issue across all areas of education (Clouder et al, 2020).
Research into how dyslexia impacts the registered nurse in practice was surprisingly slow to follow. Major and Tetley (2019a) published the most comprehensive qualitative piece of work examining this issue in 2019. Semi-structured interviews offered insight into the lives of registered nurses with dyslexia, albeit with small participant numbers (Wainer, 2000). The interviews identified five key factors when considering how dyslexia affects a nursing career, all of which resonate with me personally and professionally (Major & Tetley, 2019a):
- Career choice
- Decision to disclose
- Effect on practice
- Compensatory strategies
- Support from others
The decision to disclose dyslexia breaches one’s role in the workplace, extending into one’s sense of self. The diagnosis confers long standing negative connotations and I empathise with the many who are deterred from disclosing their disability upon fear of prejudice. In earlier work, Price and Gale (2006) noted that when nursing students disclosed their dyslexia, safety concerns were often raised. Wright in 2000 and Harriss and Cooper in 2005 had also raised this as an issue.. Contrary to any assumed patient safety risk, Price and Gale (2006) found that the awareness held by dyslexic students over their potential to make mistakes prompted strategies for increased checking, which actually increased patient safety. Starting my first job on a complex Haematology ward, I was acutely aware of drug safety. The number of unfamiliar medications was daunting and, having disclosed my dyslexia to my employer, I felt I had something to prove. I was able to use previously learned strategies such as filling out a blank drug chart with all new medications I encountered, which helped me learn the new words as well as familiarise myself with the drug chart layout, which was new to me.
After four years of shift work, I moved to a more senior role on a different ward, a Haematopoietic Stem Cell Transplant Unit. I was often in charge and due to staffing issues was rostered on an increased number of night shifts, often with agency staff to support. During this time, I experienced a number of physical symptoms that would occur just prior to starting the morning medication round at 4am. My work researching this piece has led me to realise that some of this was likely related to my dyslexia. Crouch (2019) highlighted that during periods of increased stress the pre-existing coping strategies can falter, leading to physical symptoms of anxiety (light-headedness, poor concentration, increased fatigue). Due to these unpleasant physical symptoms, I investigated career paths within Haematology where I would not have to work nightshifts. It was at this point I discovered the role of the CNS, and the next step in my nursing career. Had I been aware that these symptoms were related to my dyslexia I may have been more determined to “fix” the issue and build additional strategies, thereby changing my long-term career path significantly.
As a CNS, I have found a role that challenges me while playing to my strengths. There are two probable reasons that I stayed within Haematology. Most importantly, I find it interesting; a mix of technical and personalised nursing with continually evolving treatment possibilities. However, it is also very likely that I came into Haematology nursing due to my positive experience during my undergraduate study and I stay because I now know it well. Both Crouch (2019) and Major and Tetley (2019b) highlight that nursing students with dyslexia are likely to be drawn to work in an area where they had a positive student experience, whether influenced by a supportive mentor or other clinical support. Whilst my experience conforms to these findings, I think it’s important not to tie my every action to my dyslexia. It is common for newly qualified nurses to seek employment within areas where they had a good student experience with research showing 60% of student nurses reporting this (Wareing, et al., 2018).
Crouch (2019) concluded that dyslexia could impact both negatively and positively on different elements of nursing practice. Clinical support mentors reported dyslexic nurses as ‘creative’, ‘caring’, ‘well organised’ and ‘confident’ with ‘good interpersonal and observational skills’ (Crouch, 2019). This echoes much of the feedback I have been given about my own clinical practice from patients, their family members, and colleagues. Confidence in clinical ability is echoed as an attribute of nurses with dyslexia, by a number of researchers who have investigated the impact dyslexia has on nursing ability (Illingworth, 2005, Price & Gale, 2006, Major & Tetley, 2019b, Crouch 2019). This is incongruent to the common perception of nurses with dyslexia that continues to focus on safety concerns and potential issues with medication administration (Harriss & Cooper, 2005, Major & Tetley, 2019a).
When considering the key influencing factors that have shaped my nursing career, the confidence I have in my own nursing ability is an area that interests me. I am not a naturally confident person outside of the workplace, although I am sociable and approachable. My work-based confidence has likely arisen from gaining an in-depth knowledge of my specialist area, which is known to improve professional competency and self-efficacy (McMullen, Holbrook & Cantwell 2016). Stringer and Chen (2020) showed that it is not only an increase in knowledge and competence within a field that can increase confidence, but equally the reinforcement of pre-existing knowledge and competence. By staying in the field of Haematology, I have experienced both an increase and a reinforcement of my specialist knowledge over the years. McMullen, Holbrook and Cantwell (2016) reviewed the impact of specialist training on building professional confidence. They reported that nurses who completed specialist training within their field of practice developed greater professional confidence and were more likely to make the move from novice to specialist nursing roles (McMullen, Holbrook & Cantwell 2016). However, confidence in ones’ own ability must be equal to one’s professional competence. An inflated view of one’s own ability and competence is a dangerous situation in healthcare (Gasalberti, 2014). The imbedding of critical reflection in clinical practice can assist in ensuring that confidence and competence are kept equal by providing opportunity to reflect on specific encounters and clinical experiences (Rolf, 2011).
It has been interesting to discover that the timing of my dyslexia diagnosis may also have affected my career progression. Major and Tetley (2019b) highlighted that learning completed with appropriate support for learning needs promotes self-confidence around learning, whereas learning completed without the appropriate support tools can drive feelings of inadequacy, and poor self worth. This is disputed by Knight and Crick (2021) who feel this is too simplistic in it’s view of what is in reality a very complex set of factors, with one of the main contributing factors being the support of those around you. Throughout my nursing training I was very well supported, I had good personal relationships with the academic staff providing support and a family/social support network that believed in my ability. It is possible that the changed learning style I adopted following my dyslexia diagnosis prevented my self-doubt, experienced throughout previous education, from imbedding itself in my nursing practice and potentially preventing me from advancing my career in the way that I have. However, it is also possible that I simply found an area of learning that interested and fitted well with my personal attributes. My drive to learn and develop, along with the confidence I have in my ability to do so, may also be linked to my dyslexia and the person I have become due to being dyslexic. Crouch (2019) highlighted that the “drive to prove” is not an uncommon attribute within the dyslexic nurse population.
Preparing this critical reflection has increased my awareness of the importance of getting my own dyslexia diagnosis at the time that I did and receiving the support throughout my nurse training that has then set me up to continue to learn and develop throughout my career. I cannot imagine where would I be without the diagnosis, potentially feeling like I wasn’t able, defeated by my inability, lacking understanding as to how I learn and how to overcome the challenges my dyslexia brings.
Dyslexia is known to impact nurse training and practice and my own dyslexia diagnosis is likely to have impacted my career choice and progression to date. It is likely that the timing of my dyslexia diagnosis influenced my experience of nursing education and my willingness and ability to continue to study and enhance my knowledge within Haematology and advanced nursing. The confidence I have of my knowledge and ability at work is different to how I see myself outside work but directly relatable to an extended career within a specialist area where I have continued to enhance and consolidate my clinical knowledge and understanding.
References
Clouder, L., Karakus, M., Cinotti, A., Ferreyra, M.V., Fierros, G.A. and Rojo, P., (2020) Neurodiversity in higher education: a narrative synthesis. Higher Education, 80(4), pp.757-778.
Crouch, A.T. (2019) ‘Perceptions of the possible impact of dyslexia on nursing and midwifery students and of the coping strategies they develop and/or use to help them cope in clinical practice’, Nurse Education in Practice, 35, pp. 90–97. doi:10.1016/j.nepr.2018.12.008.
Cunningham, S., Lambert, N. (2020). Inclusive Learning, Diversity and Nurse Education. In: Cunningham, S. (eds) ‘Dimensions on Nursing Teaching and Learning’ . Springer, Cham. https://doi.org/10.1007/978-3-030-39767-8_5
Gasalberti, D. (2014) ‘Developing a Professional Self-confidence to Last a Lifetime’, Journal for Nurse Practitioners, 10(8), pp. 630–631. doi:10.1016/j.nurpra.2014.05.019.
Harriss, A., and Cooper, R. (2005) ‘Dyslexia in the workplace’, Occupational Health, 57(3), pp. 25–32. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=106626569&site=eds-live (Accessed: 7 August 2022).
Johns, C. (2017) ‘Imagining Reflective Practice’ in Becoming a Reflective Practitioner 5th Ed Edited by Johns, C. Chichester: Wiley Blackwell
Knight, C., and Crick, T. (2021) ‘The assignment and distribution of the dyslexia label: Using the UK Millennium Cohort Study to investigate the socio-demographic predictors of the dyslexia label in England and Wales’. PLOS ONE, 16(8), e0256114. https://doi.org/10.1371/journal.pone.0256114
Major, R. and Tetley, J. (2019a) ‘Effects of dyslexia on registered nurses in practice’, Nurse Education in Practice, 35, pp. 7–13. doi:10.1016/j.nepr.2018.12.012.
Major, R. and Tetley, J. (2019b) ‘Recognising, managing and supporting dyslexia beyond registration. The lived experiences of qualified nurses and nurse academics’, Nurse education in practice, 37, pp. 146–152. doi:10.1016/j.nepr.2019.01.005.
McMullen, P., Holbrook, A., and Cantwell, R. (2016). ‘Professional Confidence: A Powerful Enabling Mechanism in the Transition to Becoming a Specialist RN: Qualitative Findings from a Mixed Method Study’. International Journal of Practice-Based Learning in Health and Social Care, 2(1), 20–34. Retrieved from https://publications.coventry.ac.uk/index.php/pblh/article/view/307
Price, G.A. and Gale, A. (2006) ‘How Do Dyslexic Nursing Students Cope with Clinical Practice Placements? The Impact of the Dyslexic Profile on the Clinical Practice of Dyslexic Nursing Students: Pedagogical Issues and Considerations’, Learning Disabilities - A Contemporary Journal, 4(1), pp. 19–36. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=asx&AN=20193757&site=eds-live (Accessed: 7 August 2022).
Rolf, G. (2011) ‘Models and frameworks for critical reflection’ in Rolf, G., Jasper, M., and Freshwater, D. Critical Reflection In Practice – Generating Knowledge for Care 2nd Ed London: Palgrave Macmillan, pg: 31-51
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Stringer, K. and Chen, P. (2020) ‘What Do Reinforcement and Confidence Have to Do with It? A Systematic Pathway Analysis of Knowledge, Competence, Confidence, and Intention to Change’, Journal of European CME, 9:1, DOI: 10.1080/21614083.2020.1834759
Wainer, H. (Ed.). (2000). Drawing Inferences From Self-selected Samples (1st ed.). Routledge. https://doi.org/10.4324/9780203774786
Wareing, M., Taylor, R., Wilson, A. & Sharples, A. (2018) ‘Impact of clinical placements on graduates’ choice of first staff-nurse post’, British Journal of Nursing, 27(20), pp. 1180–1185. doi:10.12968/bjon.2018.27.20.1180.
Wright D (2000) ‘Educational support for nursing and midwifery students with dyslexia’, Nursing Standard, 14(41), pp. 35–41. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=107126306&site=eds-live (Accessed: 7 August 2022).
Additional information
The Royal Marsden School encourages prospective and current students to inform us of any additional learning needs or support they may require. This can be disclosed during the module/ programme application process and then at any time during their study with us. If students do not have a formal diagnosis, of Dyslexia, for example, but are concerned that they may have some form of learning disability, we encourage them to contact their GP for an educational psychologist referral, or their Occupational Health Department.