Challenges Faced By New Graduate RNs In Clinical Practice Essay.

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 a RN. The article will be titled: Experiences of the new graduate Registered Nurse transitioning to clinical practice in an ever-changing health care environment. 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 a RN into an organisation:

Preparedness of Graduate Nurses entering the workplace

For any occupation, the transition from the school environment and subsequent adaptation into the workplace prove hard for many people. This is usually the case as people have to develop competence and confidence to undertake their new responsibilities. Additionally, individuals find it shocking upon discovering that there lacks consistency between ideologies learned in school and the situations presenting at the work pace (Stabler-Haas, 2012). Nursing students are of no exemption to the aforementioned. Upon graduating as registered nurses, their entry into clinical practice presents to them the endless challenges of having to learn unfamiliar responsibilities and tasks as well as a changed environment and a new set of people.

Upon selecting their area of practice, new graduate registered nurses try their best to fit themselves into the healthcare setting that they are based. Simultaneously, they are to familiarize themselves with the policies of the particular organisation in addition to developing new and required clinical skills. However, due to limited exposure to clinical settings while in nursing schools, the entire process tends to be overwhelming. Undergoing externship programs is, however, a known way of increasing preparedness of graduate nurses entering the workplace (Cardillo, 2010). This is because nurses are able to develop self-confidence and advanced nursing skills.

For a new graduate RN entering into clinical practice, this topic will play a significant role in increasing their preparedness for their jobs. To begin with, gaining vivid awareness of the experiences that many new graduate nurses encounter upon entering into clinical practice will enlighten them on what to expect in the field. They will be able to boost confidence in their abilities and skills. Additionally, they will be able to learn how to cope with fear associated with entering into a new environment with new characters. New nurses will learn how lesser than ideal communication impacts the quality of their work. Subsequently, they will learn various techniques to deal with the issue should it present itself to them.

This topic will also highlight the various forms of horizontal violence that new nurses should expect upon entering into clinical practice. They will also know on which authorities to report should they be violated horizontally. Various ways of addressing professional isolation will also be brought into the limelight for the benefit of the New RN transitioning into clinical practice. It is also through digging deeper into this issue that new RNs will learn on how to survive in complex high acuity specialty units. Finally, new graduate RNs will learn how to handle and/or avoid contradictory information.

Experiences of new Graduate RNs in clinical practice

It is common for many graduates registered nurses entering the workplace to experience feelings of both fear and confidence. Nurses who are driven into the field by the passion for nursing work usually feel good and excited for being in the healthcare setting and for being with patients. Other nurses could experience a fusion, mix of fear for being held responsible for patients, and the challenge of utilizing the knowledge acquired in learning institutions to tackle all prevailing situations (Ebrahimi, Hassankhani, Negarandeh, Gillespie, & Azizi, 2016). Confidence is experienced when nurses believe in their abilities and skills as well as hoping that their emotional growth will be supported by existing organizational systems.

Graduate RNs transitioning into clinical practice are also bound to experience less than ideal communication with other nurses and physicians amongst other interdisciplinary crew affiliates (Dyess & Sherman, 2009). A nurse could, for example, try to report a lab value that is abnormal to the doctor in charge via a phone call. The doctor could, however, rudely dismiss the nurse and hang up claiming to be in his/her rounds and pressing on that the issue could wait until he/she is done. Expressions of disgust or use of gruff tones by other professionals could greatly heighten the lack of professional confidence felt by graduate RNs.

Frequent experiences of horizontal violence while in the workplace have also been reported by new graduates. These are any aggressive acts that a colleague could portray and includes criticism, innuendo as well as verbal, emotional and physical threats (Russell, 2016). It is also common for graduate nurses to encounter unkind and unsupportive nurses while in their settings of practice. In many healthcare facilities, leaders emphasize to new graduates that horizontal violence should be tolerated at zero level. New graduates, however, observe that such behaviors exist and nurse leaders at the unit level tolerate it, thus making it hard for them to report such behaviors.

In the current world, extreme chaos is experienced in healthcare environments. Graduate nurses could, therefore, feel overwhelmed in addition to being professionally isolated while working in these environments (Koutoukidis, Stainton, & Hughson, 2012). Previous researches have reported multiple occasions where nurses have perceived themselves as being alone while undertaking their nursing roles. Such perceptions and experiences have had negative impacts on their work quality. There are also many situations when a new graduate could get stranded without knowing the appropriate course of action to take in certain patient situations (Cardillo, 2010). Subsequently, lack of a more experienced nurse willing to guide them in such situations worsens the issue.

Communication challenges faced by new Graduate RNs

New graduate nurses usually find themselves working in specialty locales where some patients require care calling for decision-making skills of the highest level (Martin & Badeaux, 2018). For most graduate nurses, a typical working day involves handling multiple patients with demanding health conditions that require intensive and critical judgement (Kritek & Hickey, 2011). It is not an unusual ordeal for new graduate nurses to find themselves faced with the responsibility of caring for three dying patients. As a result, the nurse in question is always in a dilemma on which patient to attend to. New nurses could also find themselves in situations where they are required to make quick important decisions without sufficient time to think over them.

Upon entering into clinical practice, new graduate nurses have plenty of questions and usually seek advice from other practitioners within the facility. It is whoever a common phenomenon for the nurses to receive contradicting information from various professional regarding the same issue (Chang & Daly, 2015). In many clinical settings, the pace of operation is always high. New nurses are therefore required to make quick decisions relating to specific issues at hand. It is however hard for them to arrive at such decisions when viewpoints from colleagues are conflicting. Additionally, organizational procedures and policies that new nurses rely on for guidance are not always quickly accessible.

Typically, transition programs for new graduate nurses are designed to be undertaken in 3-6 months. To curb fear and boost confidence in new graduate RNs, suggestions are that opportunities for debriefing, skill set enhancement, and development of clinical judgement amongst other longer-term supports would suit the purpose (Stabler-Haas, 2012). As Duchscher (2008) proposed in his conceptual framework for graduate nurses transitioning, new graduate nurses should move through three different stages namely; knowing, doing and being. They are to accomplish the aforementioned during the first twelve months of clinical practice but with relevant support.

During orientation, new graduate nurses receive basic skills in interpersonal and interdisciplinary skills of communication (Arnold & Boggs, 2015). Such nurses also require training to enhance their communication skills such as conflict resolution and interdisciplinary role-play conversations. Additionally, the use of simulations for illustration as well as according new graduates’ opportunities for practicing professional and collegial communication would be helpful. It would also be of great significance if new graduate nurses are debriefed as well as given chances to convey feedbacks. Lastly, new graduate nurses should prepare themselves sufficiently for crucial conversations with other people in the workplace.

Horizontal violence experienced by new Graduate RNs

Upon entry into the workplace, graduate nurses expect maximum support and cooperation from colleagues. On the contrary, they are faced with untold horizontal violence which they are subsequently not ready to handle. It is therefore of great significance for leaders in healthcare facilities to share specific information related to horizontal violence as well as specific strategies for responding to it (Bartholomew, 2014). Additionally, scripted responses that graduate nurses could use when faced with such situations should be included in transition programs. Opportunities for role play and practice would also be of great help.

In a bid to curb the perception of being isolated professionally, developing a link to leadership for new graduate nurses would be a strong intervention. Developing and maintaining direct conversations and contact with nurse leaders have been proven to eradicate feelings of isolation. Similar to other affiliates in their millennial age cohort, new graduate RNs want transparency, visibility, and accountability from leaders within their facilities. It is through formal leadership links that graduate RNs are able to receive feedbacks of a constructive nature while simultaneously promoting mutual dialogues in a professional manner.

Due to endless changes in the healthcare environment, new graduate RNs previously assigned to general surgical-medical units are now being assigned to high acuity specialty units. It is therefore upon healthcare organizations to offer support, specialized education on disease management, and technology during the first year of practice (Kritek & Hickey, 2011). In addition to the aforementioned, new nurses should also be accorded opportunities to emotionally process some intense patient conditions that they encounter in high acuity units. It is through periodic professional evaluations that new graduates will be able to acclimate to the clinical practice environment.

For new graduate RNs, being assigned to one individual increases the consistency of information and experience from the preceptor. Working with one preceptor also reduces the disappointment of having to sift through loads of contradicting information in the search for the most appropriate course of action to take (Chang & Daly, 2015). By having one preceptor, new graduates are able to share positive comments, accomplishment stories, as well as professional validation emanating from the preceptors. Lastly, new graduates should be given copies of organizational policies, procedures, and guidelines that they can refer to in times of need until they are accustomed to the same.

Conclusion

It has been identified that transitioning from the school environment into clinical practice is a quite challenging experience for new graduate RNs. New nurses could feel confident in their abilities and skills but in many circumstances, fear of actual practice dominates their minds. To curb the aforementioned, leaders in any healthcare facility should avail support to new graduate RNs during the first year of practice. It will also be common for new nurses to find themselves entangled in communication situations that are less than ideal. Subsequently, they are called upon to develop relevant interdisciplinary skills of communicating.

Horizontal violence has also been identified as another issue that new nurses encounter. They are therefore to learn and acquit themselves with responding techniques when faced with such situations. Professional isolation being another challenge, new nurses are called upon to develop and maintain strong formal links with leaders in the organisation. Graduate RNs will also find themselves in complex units where they will be required to make critical decisions. Transition support should, therefore, be accorded to such nurses. Lastly, new nurses are bound to receive contradicting viewpoints when consulting on certain issues. They should, therefore, find themselves consistent preceptors who will ready and willing to help.

References

Arnold, E., & Boggs, K. U. (2015). Interpersonal Relationships: Professional Communication Skills for Nurses (7, illustrated ed.). Elsevier.

Bartholomew, K. (2014). Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other (2 ed.). Hcpro Incorporated.

Cardillo, D. (2010). Your First Year As a Nurse, Second Edition: Making the Transition from Total Novice to Successful Professional (revised ed.). Crown Publishing Group.

Chang, E., & Daly, J. (2015). Transitions in Nursing - E-Book: Preparing for Professional Practice (4 ed.). Elsevier Health Sciences.

Duchscher, J. B. (2008). A process of becoming: The stages of new
nursing graduate professional role transition. The Journal of Continuing Education in Nursing, 39(10), 441-450.

Dyess, S., & Sherman, R. O. (2009, September). The First Year of Practice: New Graduate Nurses’ Transition and Learning. The Journal of Continuing Education in Nursing · September 2009. doi:10.3928/00220124-20090824-03

Ebrahimi, H., Hassankhani, H., Negarandeh, R., Gillespie, M., & Azizi, A. (2016, March 1). Emotional Support for New Graduated Nurses in Clinical Setting: a Qualitative Study. Journal of Caring Sciences, 5(1). doi:10.15171/jcs.2016.002

Koutoukidis, G., Stainton, K., & Hughson, J. (2012). Tabbner's Nursing Care - E-Book: Theory and Practice (6 ed.). Elsevier Health Sciences.

Kritek, P. B., & Hickey, M. (2011). Elsevier Health Sciences. Springer Publishing Company.

Martin, J. L., & Badeaux, J. (2018). Sepsis, An Issue of Critical Care Nursing Clinics of North America E-Book. Elsevier Health Sciences.

Russell, M. N. (2016). Lateral Violence Among New Graduate Nurses. Gardner-Webb University.

Stabler-Haas, S. (2012). Fast Facts for the Student Nurse: Nursing Student Success in a Nutshell. Springer Publishing Company