The Transition Student To Graduate Nurse
The new graduate nurses (NGN) are faced with various issues and challenges especially in their first year of nursing practice. The period of transition from a student to a graduate nurse is a demanding period that is filled with new experiences and there are several concerns and factors that can affect the transition process. The research into the issues has recommended some strategies that can be utilised to ease the transition process from being a student to a professional practicing nurse.
Exhaustion, reality shock and time management are some of the factors and issues that the new graduate might encounter during their first year in their career. There are several recommended programs, which have been developed to address the issues that influence the transition period such as mentoring, support networks and time management planners. This essay will discuss in detail the range of issues, as well as the strategies and resources to facilitate the adjustment to the new role of a new registered nurse. Romyn et al.
(2009) states some factors that influence the transition period from a student to a graduate nurse and how quickly newly graduate nurses are able to demonstrate mastery of their new role including personal qualities of the individual registered nurse such as age, previous work experience, maturity and aspirations. It was found that students who have worked as nursing assistants seemed to do better in their role as they had early hands-on experience. Other factors include the quality of educational preparation received during their pre-registration nursing program and the period of clinical experiences.
Also, the duration and quality of transition programs for new graduates which is provided by institutions of employment, the attitudes and behavior of the more experienced nurses in employing institutions as well as the demands been placed on the registered nurse in clinical situations (Chang & Daly, 2012). Fink, Krugman, Casey and Goode (2008) found that the transition of graduate nurses from a student into a professional practice setting is a concern, which is long-standing and widely recognised as a period of stress, reality shock and role adjustment.
This is often due to the fact the students are been observed by a nurse when performing clinical tasks. Once the student graduates, they experience reality shock, when they try to adjust to their new role. Reality shock is a term used to describe a gap between what the students are taught to expect, and what is actually experienced during their early stages of work and often the shock occurs when the new graduate nurses discover it difficult to integrate the knowledge obtained in the university into their daily professional practice.
Moreover they discover there is a theory- practice gap as the theory they have been taught in lectures differs to the theory required in a clinical setting (Vieira da Silva et al. , 2010). Duchscher (2008) states that the discrepancies between what graduates understand as nursing from the real world of delivery of health care service compared to their education leaves the new nursing graduates with a sense of groundlessness.
The nursing environment moves the new graduates away from the nursing practice adopted in their educational process towards a more productive, efficient and achievement-oriented context that places importance on institutionally imposed social goals which leads to role ambiguity and internal conflict. Duclos-Miller (2011) identified that role stress, role overload and role ambiguity all contribute to transition issues. Role stress is the incongruence between perceived expectations, role and achievements, which occurs due to the status change from a student to graduate nurse.
Furthermore, difficulty experienced from the challenges of the new role, such as lack of consistent and clear information about the behavior expected from them, lack of clearly specified responsibilities, lack of confidence, as well as coping with the beginning level of competence as a registered nurse (Duclos-Miller, 2011). Role ambiguity is the lack of information needed for role definition and behavior that is expected in their new role, which includes the psychological, social aspects of role performance.
Whereas, role overload includes learning of new roles, difficulty with time management and prioritising task. Also other stressors include the feeling of not being competent, encountering new procedures and situations, fear of making mistakes due to increased workload and working with experienced staff nurses that are unwilling to assist (Duclos-Miller, 2011). West, Ahern, Byrnes and Kwanten (2007) indicate that the new graduate nurses may have not worked full-time in the past; given that graduate nurses begin their career with a full-time job can lead to exhaustion.
It was discovered that shift work leads to desynchronisation of physiologically determined circadian rhythms which has a major psychobiology effect and it is commonly perceived the effects of shift work contribute to graduate nurses attrition rate. The NGNs often have a high level of stress due to disturbed sleeping patterns, as they find to adaption to shift work or rotating work hours difficult. Eventually, it leads to feelings of lack of job satisfaction, exhaustion and spending of less time with their friends and family, which can eventually could lead to burnout (West et al.
, 2007). Dyess and Sherman (2009) found that new graduate nurses expressed concerns about their ability to delegate and supervise other nurses or unlicensed assistive personnel as they felt unprepared to deal with any type of conflict, they tend to avoid any type of situation rather than confront the situation, as they felt unequipped to explore to conflict professionally. Another issue encountered by the NGN is the ability to communicate with physicians and other members of the multidisciplinary team of which interactions with physicians were a source of anxiety and stress.
Moreover, the lack of professional confidence that new graduate may feel can be heightened, when another professional expresses disgust or uses a gruff tone. This is a safety issue because a sense of insecurity can contribute to the NGN avoiding contact with the physician, unless a patient experiences an extreme physiological decline (Dyess & Sherman, 2009). Morrow (2009) states that most graduate nurses experience horizontal violence in their first year of practice, they felt undervalued and neglected by other nurses and experienced rude and humiliating verbal statements and unjust criticism.
The most common form of horizontal violence was in form of psychological harassment, which includes intimidation, exclusion, and innuendos. The cumulative impact may lead to absenteeism and frustration that may lead to the consideration of leaving the nursing profession (Morrow, 2009). In order for the factors and issues that surround the transition from a student to a graduate nurse to be addressed, certain strategies needs to be implemented that can ease the transition period.
An Important strategy that can be implemented to assist the graduate nurses to assimilate into a professional working environment is a graduate program. It will aid to build the confidence of the new graduate nurse through the provision of support and mentorship during their period of adjustment, and assist the new nurse to assimilate into the hospital environment, think critically and problem solve which will allow the graduates to deal with obstacles encountered in patient care and prepare them for a lifelong learning and also help them in the integration of theory to practice (Davey & Vittrup, 2009).
The creation of formal preceptor and mentorship is an effective strategy to facilitate a successful transition. A preceptor is an assigned role in which a capable employee assists with the development and orientation of the new graduate; they are usually responsible for evaluation and supervising the work of the preceptee. However, a mentor actively supports the graduate nurse with personal and career development, personal support, counseling and acceptance. Also, they help the novice nurse to raise their confidence and recognise their limitations.
In addition, mentors help novice nurses in setting realistic goals by recommending appropriate courses of action (Ellis & Hartley, 2012). NGN require resources and information that are designed to facilitate their adjustment in a clinical area, which will enable them to gain skills and knowledge to perform satisfactorily in their job. Resources such as an orientation program involves the induction of a NGN to the organisational mission and vision statement, as well as an introduction to the procedures and policies related to nursing activities such as medication administration.
An appropriate orientation and induction program will ensure that a NGN can safely plan and conduct patient care. In addition, with an appropriate orientation program the NGN is aware of the overall culture of the hospital, which can make the NGN to feel accepted and part of a team in a clinical environment, which can promote overall positive outcomes with workplace satisfaction of the NGN (Burgess & D’ Hondt, 2007).
Effective strategies that enhance the time management skills which is one of the above mentioned issue for new graduates are to arrive to work much earlier, avoiding distractors such as focusing on issues of co-workers, assess patients to note if any extra supplies will be needed to carry out clinical procedures, keeping shift record on track and to chart during the shift and not at the end of the shift and prioritise task to be performed (Booth, 2011).
However, to prioritise task the novice nurse needs to learn how to delegate. First, to enhance the skill the nurse should consider how others have delegated to them, consider their body language when delegating by maintaining eye contact, being pleasant and leave any room for suggestions, but ensure they are not intimidated by writing a list of task and posting it at the nurses station, it leaves little room for a misunderstanding (Cherry & Jacob, 2008).
Debrief is a form of retrospective analysis of critical incidents that are encountered in nursing, it is a critical incident-reduction technique that incorporates, structured phases of group discussion. It enables the NGN to learn from their mistakes. Debriefing sessions provides NGN with access to peer support and allows the individual to reevaluate a situation in a different perspective, which can enhance a new graduates learning opportunity and is also an effective way to reduce stress and anxiety in a NGN (Cant & Cooper, 2011).
According to West et al. (2007) exhaustion as the result of shift work is common amongst new graduate nurses, strategies that can be utilised to lessen the effects of stress encountered as a result of a new graduate trying to adapt to shift work is to incorporate shift work into the clinical placements of an undergraduate nursing degree to enable new graduate nurses to be prepared for the effects of shift work in order for an effective work
and sleep schedule to be determined and also a negotiation with their intended workplace to achieve the best possible outcomes for the both parties (West et al. , 2007). The strategies for responding to horizontal violence should be part of a new graduate orientation program as NGN are unlikely to be prepared to react appropriately to acts of horizontal violence. Specific information such as scripted responses for the NGN to use when a scenario is encountered and an opportunity should be provided for role-play and practice (Dyess & Sherman, 2009).
Parker, Gilles, Lantry and McMillian (2012) states that new graduates are less likely to be bullied or experience horizontal violence, when they have access to a workplace with empowering structures such as access to resources, information, support, strong work alliances, job discretion and the opportunities to learn and grow. The transition from a student to a graduate nurse can be a stressful and difficult time in the career of a graduate nurse. However, several factors have been mentioned that can impact on how the NGN can cope during the period of transition.
The implementation of research strategies that has proven to be effective in easing the transition of a student to a graduate nurse can be utilised to counteract the factors and issues that are encountered during the transition period. The provision of adequate support and incorporation of effective strategies in organisations, the problems and issues of the NGN can be resolved and all NGN will experience a positive transition process which can facilitate a positive adjustment to their employment as a registered nurse.