You are to write a journal article (for mock publication) which will be published for newly graduated Registered Nurses as they enter into professional practice as an RN. The article will be titled: Continuing lifelong learning to enhance the individual scope of practice and clinical knowledge following the transition to the role of a registered nurse.
You will discuss the topic and provide relevant supporting current literature.The topic must have an Australian and ‘new graduate’ focus that relates to the experience of transition of an RN into an organisation:
- Introduction - description of the topic
- Significance of the issue - why the topic is important to an RN as they transition into practice
- Discussion – what do the key findings in the literature say about the topic?
- Evaluation – what significant strategies arise from the discussions that could be actioned in practice
- Conclusion – a summary of the main points
Challenges faced by new graduate nurses
The healthcare environment is ever changing. However, one of the things that never get changed is the demand for the nurses. The need of more nursing professionals in the healthcare sector has become important because of the lingering issues of nursing shortage felt by the nation. Firstly, one of the reasons identified by researchers is the increase in the number of chronic ailments among the citizens along with the increased average life expectancy of the people of the nation (Chang, 2015). The demand for healthcare services has increased the urgency of allocation of more nurses than before in the healthcare industry for curing this increased number of patients. Secondly, one of the studies by Lea and Cruickshank (2015) had also found that the clinical practices in the modern generation are under additional pressures for operating in a lean as well as efficient manner because of the shrinking reimbursements along with increased regulatory oversight and increased consumerism. Therefore, these forms of pressures have demanded that the education programs need to produce nursing professionals who would be work-ready from the very moment they flip their tassels. Every nursing professional are expected to be ready not only with efficient knowledge and skills but also emotionally and mentally. However, it has been seen that new nurses often face several of challenges that affect their practices increasing risk of poor quality and unsafe care delivery to the patients (Spector et al., 2015). Moreover, they are also seen to become burned out because of huge number of factors that affects their job satisfaction ultimately resulting in attrition. This article would be discussing about the different challenges that nurses face during their transition period to healthcare industry after completing their bachelor’s degree in nursing. It would also provide solutions to the issues faced by them so that modern day nurses can use them as guide for their own transitions as well.
The nursing transition is considered as an emotional journey. In the beginning, new nurses are seen to be full of excitements, anticipations, as well as enthusiasms for their nursing profession. Studies have found that new nurses who became the participants in the study had told that in the beginning, they used to be spurred on by their desire in making a positive contribution towards the lives of patients (Zerweck et al., 2017). However, they had also revealed that although the Bachelor of Nursing course design had equipped the student with the practical skills and even the theoretical knowledge required for being capable nurses, they are still not enough in truly preparing them for professional practices. Studies have stated that after a few shifts, the initial excitement might get accompanied by the feelings of incompetence along with feelings of insecurity, anxiety and exhaustion (Marcoux et al., 2017). It has also been seen that new graduate nurses start questioning their own skills, values, and competence level along with their decision-making ability. They may also feel overwhelmed by the demands of the role. A huge number of challenges are faced by new nursing professionals like that of theory to practice gaps as well as caring for increasingly complex patients with different multiple co-morbidities. Other challenges that are faced by them during the initial days of their transition to healthcare industry are medication administration, time management and even patient assessment skills. Different types of documentation skills, issues in effective collaboration with team members, limited proficiency in management and execution of technical skill are some of the other challenges that new nurses face after their transition (Cherry & Jacob, 2016). Other challenges are accountability issues, decision-making issues, shift works, and development of competency in planning and organizing. Performance issues and bullying often makes them emotionally unstable. Such issues need to be handled and managed with efficiency so that new nurses can have smooth transition and carry one their practices with confidence.
Strategies for successful transition
Ashwood et al. (2018) are of the opinion that new graduate nurses face different types of challenges when they are transitioning to workforce. These are seen to include handling of increased number of patients with different complex conditions and even different co morbidities. They also suffer from lack of access towards experienced coaches and mentors along with generational diversity in the workforce, bullying and even performance anxiety. Often such issues are seen to occur simultaneously thereby compounding the problem (Betz et al., 2016). Nurses are seen to develop fear, stress, and anxiety in due course of time because of these reasons making them fatigued. They are seen to lose their self-confidence and make them feel burned out. This affects their quality of care and prevents them from communicating effectively with patients and their family members. As a result, patients remain unsatisfied from treatment (Masters & Gilmour, 2018).
Studies have found out that when new nurses feel fatigued, it becomes important for healthcare authorities to identify them and propose them with solutions to make them overcome the burn out feelings (Demeh & Rosengren, 2015). Role ambiguity is one of the significant contributors for developing burnouts among nurses. This makes them more disconnected from their work as well as their colleagues and makes them to perform in ways that are more detached (Cherry & Jacob, 2016). Hopkins et al. (2016) had stated that when nurses become detached and stressed, they exhibit poor work performance which eventually result in severe patient safety events.
Studies have found that workplace bullying is one of the most significant obstructions that make new nurses display their best talents. It also affects the appropriate socialization of the new nurses (Cherry & Jacob, 2016). It has been seen that often, senior nurses bully the new nurses for maintaining control of their work environment. Regan et al. (2017) are of the opinion that organizations that do not protect any new nursing professionals from bullying are silently promoting different types of unprofessional behaviors. Healthcare leaders have obligations in providing a work environment that would help in contributing to the health as well as well-being of the patients as well as staffs and address workplace bullying to provide an encouraging environment for new nurses.
Owen (2017) had put forward an article that offers strategies in positioning the new nursing professionals towards the success. Nurse mentoring programs need to be implemented as it helps in increasing the intent of the individuals in staying and maintaining the retention rates. The paper has talked about the importance of achieving competency, autonomy, and confidence by the new nurses and for this; they suggest that organizations need to develop a structured approach for developing mentors. Bauman et al. (2017) had proposed a mentorship model that includes about three important phase. The first phase is the initiation phase, which would mainly include establishment of effective communication skills for establishing interpersonal relationships. This is then followed by collaboration phase during which the mentor and the novice would be collaborating. Finally, during the autonomous phases, the novice is seen to gain more independence.
Importance of advanced degrees
Another of the study had talked about the importance of the nurses in attaining advanced degrees for developing their clinical and non-pharmacological knowledge that align with higher quality, confident and evidenced based healthcare services. Studies have stated that advanced degrees for the nursing professionals are associated with developed critical thinking skills as well as ability for implementing translational researches. Heightened leadership capabilities along with understanding of the different changes in the healthcare landscapes along with effective understanding of the significance of quality care are also found to be associated with new nurses who have undertaken advanced degrees. Mellor et al. (2017) had supported such claims and had stated that understanding of one’s role in continuum of care, improvement of job advancement opportunities and even improved understanding of the decision-making skills in clinical settings are also the benefits of advanced educational programs. In such situations, leaders should help new nurses by setting goals, clear expectations as well as implementation of procedures that support employee achievement through higher education (Cherry & Jacob, 2016).
Another study by Clipper and Cherry (2015) had put forward another strategy for successful transition of nursing professionals to their professional practices. The authors are of the opinion that shared governance needs to be promoted as this helps in giving the new healthcare professionals a better platform in discussing the issues that affect their practices. It has been found when the new nurses are involved in making decisions that affect their practices allowing them in effectively managing the complexities for the healthcare environment today and coping with stress. The evidences also suggest that nurses who have active roles in making decisions feel empowered which have positive impacts on their confidence and self-esteem resulting in increased staff management. Inter-professional decision-making also helps in promoting a professional atmosphere encouraging respect and thereby enhancing confidence (Cherry & Jacob, 2016).
“Support” is one of the most important components that help in ensuring a smooth transition period from student life to professional lives. In such arenas, preceptor programs and mentoring are found to be excessively important as well as effective in offering support to new nurses. Studies have found that preceptor programs are extremely helpful in ensuring more positive outcomes in the first six months of transitioning into the position of the registered nurses. This had been found to be helpful as it helps in reduction of the culture shock and even integration and linking of the theory with that of the practices (Demeh & Rosengren, 2015). Such mentoring programs also provide support to the graduates by allowing them in working closely with another experienced nursing professional. This ultimately helps in developing the confidence, competence and even gradually gaining autonomy in the patient care. The preceptor or mentors would support the new professionals by guiding them in their clinical learning procedures but also with their professional and even personal growth (Spector et al., 2015).
Promoting shared governance
It can be also found that development of a supportive environment can help in smooth transitioning of the nursing professionals from their student lives to their professional lives. A supportive environment needs to be developed in ways so that they can provide opportunities for the new nurses to develop their not only clinical skills but also patient management skills. This would ensure bringing out effective outcomes of their work in practices and this would help in encouraging further confidence and their ability. Researchers are of the opinion that being part of the supportive environment should be allowing the new nurses in feeling comfortable in raising any issues as well as concerns during the transition periods (Spector et al., 2015). This helps any potential problems to be identified and managed early. This helps in reduction of the anxiety as well as stress. Some of the examples of supportive environment would be developing an organizational culture where anti-bullying policies are followed, supportive environment for reporting of errors and omissions are encouraged, open-constructive feedback sessions are promoted and many others. Zero-tolerance policies for gender discrimination, encouragement for participating in continuous professional development, transformational leadership and similar others can all help in developing a supportive environment for smooth transitioning of nurses from student to professional lives (Zerweck et al., 2017).
Proper planning is also found to be helpful for the nursing students to develop a proper understanding and awareness of different types of the potential challenges and issues that they may commonly face during the transition period. This had been found to be helpful in encouraging the nurse for preemptively devising different strategies that would assist them in their transition before the problem occurs (Demeh & Rosengren, 2015). This would help them in making their adjustments experiences that are more positive. Many of the researchers have evaluated the different studies and have concluded that self-care is also an important aspect for smoother transitions. Self-care is also found to be significant during the time of transition where they need to care for themselves which would be focused on ensuring a healthy balance between their new role as a registered nurse and their lifestyle (Zerweck et al., 2017). The transition from student to that of nursing professional life can prove to be a turbulent tile personally as well as professionally and this would help in serving to only compound feelings of exhaustion and anxiety. Mindfulness based therapies, yoga and meditations had been found to be fruitful in helping new nurses to manage their resilience and self-regulation skills (Chang, 2015).
Importance of support and mentoring
From the above discussion, it becomes clear that new nurses who have undergone transition from their student life to professional lives might face various forms of challenges. This would include developing stress and fatigue from bullying, feeling incompetent on work-floor, burdensome shift-works, performance anxiety and similar other challenges. In such cases, mentorship programs or preceptor programs are found to be highly beneficial. Moreover, undertaking effective participation in advanced degrees would help in enhancing their confidence as well as their clinical and non-pharmacological knowledge reducing their anxiety. Moreover support programs from the organizations, anti-bullying properties, encouraging organization culture, blame-free environment and similar others have been found to be extremely helpful. Moreover, nurses also need to be well aware about how to take care of their own selves in order to balance their personal and professional lives. Participating in different types of therapies like mindfulness based therapies; yoga and meditation can help them in controlling their self-regulation capabilities as well as help them in developing attribute of resilience. All of them help in ensuring smooth transition from student lives to the professional lives of registered nurses.
Ashwood, L., Macrae, A., & Marsden, P. (2018). Recruitment and retention in general practice nursing: What about pay?. Practice Nursing, 29(2), 83-87. https://doi.org/10.12968/pnur.2018.29.2.83
Baumann, A., Crea?Arsenio, M., Hunsberger, M., Fleming?Carroll, B., & Keatings, M. (2018). Work Readiness, Transition and Integration: The Challenge of Specialty Practice. Journal of advanced nursing. https://doi.org/10.1111/jan.13918
Betz, C. L., O'Kane, L. S., Nehring, W. M., & Lobo, M. L. (2016). Systematic review: Health care transition practice service models. Nursing Outlook, 64(3), 229-243. https://doi.org/10.1016/j.outlook.2015.12.011
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