Experiences of therapy radiographers in extended roles.

Angela EddySenior Lecturer- Sheffield Hallam University

BackgroundBackgroundMinimal empirical evidence around role

extension/advanced/consultant practice in therapy.

Limited evidence around the process of learning and professional development (Donovan and Manning 2006).

Need to explore perceptions and experiences for new roles (Probst &Griffiths 2007)

Functioning in any new role is acknowledged as difficult and stressful (Johnstone 2007, Gerrish 2000)

Know that the transition experiences will be different to the experiences of those established in roles (Williamson 2006)

Research question:What is the developmental process of the

neophyte therapy radiographer working in an extended role? 

Aims: To examine the perceptions of therapy

radiographers who have been working in extended roles for up to 2 years.

Gain an understanding of their professional development by exploring the nature and dynamics of the experiences that inform practice.

 Objectives: Undertake open interviews using grounded theory. Develop a substantive theory which explicates the

stages and processes of professional development for extended role therapy radiographers.

Story so far…10 interviews Story so far…10 interviews done 11 to go!done 11 to go!

NameName Role/scope of practiceRole/scope of practice Length of time in Length of time in rolerole

Length of time qualifiedLength of time qualified

Participant 1 Patient assessment and review.

2.5 months 3 years

Participant 2 Clinical trials/research. 3 months 16 years

Participant 3 Site specialist 2 years 34 years

Participant 4 Breast Mark up. 1year 4 years

Participant 5 Site specialist 18 months 2 years

Participant 6 Patient assessment and review.

18 months 35 years

Participant 7 Site specialist 2 years 14 years

Participant 8 Site specialist 6 months 4 years

Participant 9 Site specialist 2 years 25 years

Participant 10 Breast Mark up 3 months 20 years

Early analysis and initial Early analysis and initial themes. themes.

Development of Confidence Development of Confidence is an overarching theme.is an overarching theme.Links into other themes.

◦What makes someone confident and how does that link into the stages and processes of professional development?

Professional confidence◦Task/role orientation and knowledge

based skills.Personal confidence

◦Interpersonal and communication skills. ◦ Emotional intelligence (Goleman 1997)

Theoretical Framework◦Bandura “self efficacy” Framework

(1982)

Banduras framework has Banduras framework has four dimensionsfour dimensionsWhat influences the development

of confidence/ self efficacy ?◦ Enactive mastery of experiences.

Learning the skills to perform in the role.◦Modelling.

Role models and mentors.◦ Social persuasion.

Working environment, communities of practice.

◦Physiological states. Stress, anxiety, and “burn out”

Enactive mastery- skill Enactive mastery- skill acquisitionacquisitionClinical skills

◦Development – stage progression to autonomy. Not having to refer on. repetition and having done it time and time again

so if you come across a problem you can recognise it”

◦Underpinning knowledge – education in the first year not to underestimate the

knowledge required” “ Even though I 've got a lot of years experience,

having the M level study to underpin what I do gives me the confidence and I will argue the toss in a very confident manner"

Enactive mastery- skill Enactive mastery- skill acquisitionacquisitionLeadership and management

◦ Some peoples leadership skills came from outside the NHS or from previous experience as Supts.

◦ Learning and developing their own style: “learnt not to impose, motivate rather than be dictatorial”

Interpersonal skills – working across boundaries

◦ “communication skills and negotiation”

◦ “ I deliberately don’t have an ego, and make sure I am seen to not be empire building”

Modeling – role models and Modeling – role models and mentorsmentorsWho were their role models and

mentors:◦Mentorship/task and skill acquisition based

assessments were done by Oncologists. Case studies and problem based learning tasks

◦However most had sought peer support and review from other professional groups: “good ideas from other professions – we can be too

insular” “using clinical supervision with a nurse helped me

to find the confidence to deal with difficult situations and anxious patients

Mentorship – what Mentorship – what worked?worked?Challenging but supportive model in a

time protected environment◦ Someone who……“Would not stand over you and tut”

Identifying support and learning needs early in the process, not always easy◦ " having come from a technical background to a very

patient orientated background was quite a change for me so…..it was about having someone to talk to, and reflect on situations"

Social persuasion- Social persuasion- developing a supportive developing a supportive learning communitylearning communitySupportive working environment

-Communities of practiceEstablished teams in established roles

◦“I enjoyed it because we could discuss things and it gave me confidence”

VersusSolitary role and a loss of identity

◦“Feeling of professional isolation”

Social persuasion – group Social persuasion – group workingworkingRole of MDT’s

◦ “steep learning curve, thrown in at the deep end”◦ "need to crack this relationship because its how the

medical profession perceive you…its still a patriarchal system“

◦Knowing the organisation – getting past information gatekeepers

◦ “working in a small department means I know everyone , not sure that’s the same in a bigger place“

◦ “wasted time, a lot of information is not shared – it’s a power thing”

Physiological states and Physiological states and stress /burn outstress /burn outPersonal resilienceIn established roles:

◦“actual transition into the role was straightforward

New Roles:◦“The first 6 months is a baptism of fire”◦“need to grow a second skin”

Moved along to by the end of the 2 year period◦“Not accepting boundaries” but felt burnt

out.

Physiological states and Physiological states and stress /burn outstress /burn outRole and scope of practiceNo clear scope of practice… two perspectives:

◦“that’s a good thing because I can shape the role” However….

◦“if you are over ambitious its very easy to try and be involved in all bits but you cant do that”

◦Role boundaries:◦“tensions between Superintendents and us as

they cant see where we fit, where their boundaries finish and ours start”

Physiological states and Physiological states and stress /burn outstress /burn outStructure and organisation when implementing the

role.

◦ “ had regular meetings and a structure and a plan with reviews built in”

◦ “3 months to get it organised and if I did not , it would be squashed”

◦ “Here is the key to your office, see you!”

Role security and sustainability of role

◦ concerns about long term career plans

◦ “Can this role be done by a nurse”

So…..what are the stages and So…..what are the stages and processes of professional processes of professional development for extended role development for extended role practitioners?practitioners?There maybe trigger points in the

process.Can there be one overarching process?

◦ It may be different depending on the nature of the role, the dynamics of the organisation and personal characteristics?

◦ Is there room for the development of a professional self assessment inventory which may help identify aspects of personal and professional development.

◦Watch this space…………….