Spring brings a sense of renewal and rebirth. It is a time when many students are graduating and embarking on their nursing careers. They are taking their first steps as professional nurses. Hopefully, their journeys will be filled with a sense of pride, accomplishment, and belonging.

May is the month in which many hospitals and healthcare organizations celebrate the profession of nursing. Individual nurses may be recognized for their contributions with "Nurse of the Year," "Best of the Best," or "Lifetime Achievement" awards (Modic & Schoessler, 2006). Their professional journey is recounted to highlight the influence of their presence, skill, and wisdom.

May is also the month when we remember Florence Nightingale's birthday and reflect on her innumerable contributions to the soldiers in Crimea, the citizens of London, and the society as a whole. Although very few of us will ever achieve the magnitude of influence of Florence Nightingale, we all have impacted the lives and well-being of thousands of people. Our professional identity has been shaped and reshaped by the people who love us, the patients who teach us, and the colleagues who support us. Every so often, it is important to take stock of our career and reflect on who helped form us and what life experiences shaped us.

The following is an exercise called "Steppingstones. (n.d.)" adapted from Ira Progoff's Intensive Journal Process and is designed to help individuals reflect on their professional careers, build relationships, and provide an opportunity to appreciate the similarities and differences in each other (http://www.lifejournal.com/articles/the-steppingstones-of-ira-progoff/). Nursing professional development practitioners and preceptors can use the following exercise when working with nurses in all phases of their careers to do just that.

Facilitator Introduction of Steppingstone Exercise

Acknowledging steppingstones is a way to harvest our gifts and our life experiences. It may also help participants sense the movement that is wanting to happen in their lives as they move ahead on their career journeys. This reflection is an invitation to share poignant steppingstones, linger on their impact, collect each other's stories, and appreciate the journeys of formation.

Materials

Five or six small stones of different colors, sizes, shapes, and textures for each participant. Place stones in small bowl.

Participant Directions

Step 1 (10 minutes)

1. Ask participants to take a few minutes to jot down five or six steppingstones (choice points, milestones, events) that brought them to where they are in their work as a nurse, leader, educator, or researcher, to sitting in this chair, here, now. To do this, encourage them to observe the flow of choices and events, direction, and detours that their work life or vocation has taken. The list might include significant people along their journey, places or events that marked a change in direction, or ideas (a book or insights) that gave them a new understanding of self in relation to their nursing vocation.

Ask participants to identify steppingstones in relation to an event, a person, an experience, or encountering an idea. Not all steppingstones are positive. We often learn as much from doors that close on us as we do from the new ones that open. This isn't so much a chronology as a snapshot: "today when I think about what contributed to who I am as a nurse, a professional, an educator, or leader, these particular things come to mind. Tomorrow it might be different."

2. Ask participants to write a couple of sentences about each steppingstone after they are satisfied with their list. List something about its significance.

3. Ask participants to notice if there are any threads or themes that run through these steppingstones; to notice which ones came about because of someone or something outside them recognized their gifts and abilities and encouraged them; and to notice if they identified steppingstones that resulted from claiming their own gifts, identity, and integrity, which then drew them in a different direction or helped make a course correction.

Step 2: Groups of three (35 minutes)

1. Ask each participant to introduce him/herself, provide some brief background, and share the steppingstones they feel comfortable sharing, reserving any that they wish to keep private. Ask the other participants to listen to the explanations of each steppingstone shared. After listening to the steppingstones shared by the teller, encourage them to ask clarifying ques-tions. Repeat the process until all three participants have shared their steppingstones.

2. Ask participants to discuss what they noticed when they discussed their steppingstones and when they listened to others. What were the themes, differences, similarities, surprises, and lessons learned?

Step 3: Large group conversation (10 minutes)

1. Reconvene the large group.

2. Ask for volunteers from each small group to share their themes, surprises, and observations.

3. Acknowledge the similarities and differences of each small group (R. Frankel and P. Williamson stated that the steppingstone exercise was adapted from Ira Progoff's Intensive Journal Process, personal communication, December 30, 2015).

This exercise is extremely powerful. Listening to the stories of others: What events and people contributed to their professional growth is compelling. The opportunity to pause and reflect on the events and people who influenced our career is both illuminating and touching. Kevin Cashman, the author of the The Pause Principle, asserts that "self- reflection is the most important personality related aspect of leadership" (Cashman, 2012, p. 38).

As I participated in this exercise and reflected on my own professional career, six women emerged as my steppingstones: Shelia, Marge, Shirley, Meri, Michelle, and Joyce. Each left a lasting handprint on my professional identity and helped me step into the next phase of my career. I want to share their influence on me, so that you can use the steppingstone reflection to acknowledge your own remarkable teachers, mentors, and colleagues.

Shelia Pittman, MSN, RN, was my first nurse manager. She had been promoted to the role two months before I started working. I was in awe of her. Shelia seemed to know everything! She seemed to float effortlessly between emergencies, crises, and conflicts and manage them with ease. When I watched her interact with patients, I knew I was observing a sacred moment between two people. Her ability to walk into a patient's room and provide immediate comfort was amazing to me. She modeled confidence, competence, and compassion. She was also patient and encouraging with me. She created an exceptional orientation for me-rich in learning and affirming in feedback. The steppingstone Shelia gave me was the gift of potential.

Marge Verbic, MSN, RN, was my first real mentor. I was brand new into the world of staff development (that's what we called professional development in the 1980s), and she was a clinical director overseeing diverse clinical areas. I remember the very first day I met her; I was struck by her wisdom! She was overseeing the implementation of a new orientation strategy called precepting. I and another colleague were charged with creating the curriculum, and Marge the infrastructure. I remember being annoyed by someone as I was trying to move this new orientation program forward and complaining incessantly to Marge. Marge said to me, "Mary Beth, what are you planning on doing about this situation?" I think I said "Nothing." She then said to me, "You must either have a conversation with this person or let it go. Complaining about her is unbecoming to you." She then gave me the book by the esteemed Carol Gilligan, In a Different Voice. We discussed Dr. Gilligan's research over the next year. The steppingstone Marge gave me was the gift of investment.

Shirley Moore, PhD, RN, FAAN, who is now the Associate Dean for Research and the Edward J. and Louise Mellen Professor in Nursing at the Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, Ohio, was my second manager as a young staff development instructor. Shirley brought order to a chaotic and disorganized department. She was a breath of fresh air. She was knowledgeable, smart, and politically savvy. She expected excellence and created the environment to meet that expectation. She was the person who encouraged me to pursue my MSN, and made it possible by bringing a graduate nursing program to our organization. She was also the person who made it possible for me to become a working mother. She allowed me to work part time as I attempted to navigate the gratifying but tumultuous world of parenthood. The steppingstone Shirley gave me was the gift of opportunity.

Meri Armour, MSN, MBA, RN, who is now the President and CEO of Le Bonheur Children's Hospital in Memphis, Tennessee, gave me my first position as a clinical nurse specialist. Meri was exuberant, tender, and genuine. She had a gift for bringing disparate groups together and bringing out the very best in a person. She spoke of relationship-centered care long before it became vernacular. On her daily rounds, staff nurses would seek out her counsel regarding clinical dilemmas. She taught me the art of questioning. She also afforded me autonomy and opportunities to try out my ideas, and she supported me even if the ideas were not embraced by others. She bore witness to some of my most professional and personal accomplishments and one of my most excruciating personal losses. The steppingstone Meri gave me was the gift of presence.

Michelle Dumpe, PhD, MS, RN, is now an Associate Professor of Nursing at Akron University. She became the director for the inpatient clinical nurse specialist group and my direct supervisor. She, too, had an ability to foster collegiality. She was gracious, humble, and thoughtful. She recognized the importance of the clinical nurse specialist role and advocated for more positions demonstrating the cost savings in prevention of CLABSI, CAUTI, VAP, pressure ulcers, and patient falls. She applauded my research activities and helped me to disseminate my findings. We collaborated and presented our outcomes at national meetings. She encouraged discernment and sophistication of thought. She nudged me to pursue my certification as a diabetes educator. The steppingstone Michelle gave me was the gift of community.

Joyce Fitzpatrick, PHD, MBA, RN, FAAN, is the Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Joyce was my professor and chaired my committee for my DNP scholarly project. She has boundless energy, a global network of colleagues, and an "everything is negotiable" attitude. On the night before I was to defend my scholarly project, she called to check on me to see whether I had any questions about the proceedings. I told her that I thought I was as prepared as I was ever going to be. I then began to thank her over the phone for all of her help and guidance. I will never forget Joyce's response to me. "It sounds like you are saying goodbye to me[horizontal ellipsis]. This is not goodbye, but just the beginning of our exciting collaboration." After my defense, Joyce was the first person to call me Dr. Modic. And what a collaboration it has been over the last 3 years! We have presented our research results in South Korea and disseminated our research through publications. When I occasionally experience a misstep, her advice to me is "Onward." The steppingstone Joyce gave me was the gift of the world.

Potential. Investment. Opportunity. Presence. Community. The world. These steppingstones have helped me take thousands of steps in my career. They helped me walk, run, jump, and leap into the future. Where have your steppingstones taken you?

References