The Need for Adequate Preparation in Nursing Practice
In recent years, the nursing profession has established itself as a distinct and indispensable profession. Similar to other countries, the Australian healthcare continues to experience shortages in the health care workforce, which requires nurses to step up and fill the gap as primary care providers. However, baby boomers are retiring, and the responsibility of providing primary care to populations falls to fresh and registered graduates. Even so, new graduate nurses have to transition from being students to real professionals. While the education institutions do an incredible job preparing nursing students to professional roles in practice, the transition stage to nursing practice has garnered attention worth consideration. The lack of adequate preparation on what constitutes actual practice introduces uncertainties and ambiguities that impact on patient safety and anticipated healthcare outcomes. Often, nurses have reported feeling unprepared for the nursing profession. As such, clinical practices have to take the mandate of preparing nurses for professional practices. Strategies such as preceptorship, team-based healthcare delivery, and established communication channels have proven to be effective in the transition period. These strategies are needed to equip nurses with the confidence they need to execute their duties and contribute to improved patient safety, experiences, and outcomes. As diseases increase in complexity, and baby boomers retire, new graduate registered nurses have to step-up and serve diversified patient populations. With effective transition programs, nurses can practice to the full extent of their education and profession, and reduce the healthcare disparities likely to be impacted by populations by the retiring workforce and doctors opting for specialized care.
Transition to Practice: Experiences of the New Graduate Registered Nurse Transitioning to Clinical Practice in nn Ever-Changing Health Care Environment
Transitioning from a Newly Graduated Nurse to a Registered Nurse has never been a smooth sail for anyone (Murray?Parahi, DiGiacomo, Jackson, & Davidson, 2016). From copying with demanding workloads, to calibrating to the ever-evolving and challenging institutional customs, newly graduated nurses have to cope with a lot of pressure that heavily contribute to poor performance and a broad range of common clinical slip-ups (Brown & Crookes, 2016). Much is yet to be known on how transitioning from a clinically supervised nursing student to a practicing nurse dealing with work anxiety generally affect their overall performance and ability to adjust to actual working condition (Brown & Crookes, 2016; Ebrahimi, Hassankhani, Negarandeh, Gillespie, & Azizi, 2016).
Worth noting is that newly graduated nursing students have been reported to make common medical errors, with a majority pointing out their lack of medical expertise to tell if a complication is chronic enough to warrant an immediate medical intervention (Unver, Tastan, & Akbayrak, 2012). Mostly affected by this is the overall turnover of Registered Nurses in their first year of actual practicing. Considering that medication safety is a paramount issue in healthcare, and new RNs report feeling inadequate in that skills, there is need need for effective transition in the healthcare settings (Unver et al., 2012).
Challenges of New Graduate Registered Nurses in Clinical Practice
To put it briefly, nursing students tend to be most exhausted in their first year of working. It is during this time that nurses are expected to be even more vigilant than they will ever be in their line work.
Newly graduated nurses face so many challenges when transitioning from nursing school to work force (Ebrahimi et al., 2016; Hofler & Thomas, 2016). Examples include dealing with an increased number of patients with multiple comorbidities and complex conditions, generational diversity at the place of work, lack of direct access to coaches and mentors, bullying, and performance anxiety to name a few (Brown & Crookes, 2016; Wong et al., 2018). Core to this is that most of these problems occur simultaneously. The result of which nurses may end up feeling stressed and extremely fatigued, when pushed past their breaking point, forced to drop out (Murray?Parahi et al., 2016; Wong et al., 2018).
It is nurses’ responsibility to manage patients, and, at the same time, going out of their way to also manage the relationship the underlying patients have with their families, providers, and inter-professional team (Brown & Crookes, 2016; Wong et al., 2018; ). This calls for a greater deal of support, and whenever a newly registered is not accorded enough support, he or she may end up feeling extremely overwhelmed with work, and if the problem persists, they may suffer from work anxiety and eventually break down (Ebrahimi et al., 2016; Wong et al., 2018).
Hospitals are registering a heightening number of patients with chronic health conditions (Wong et al., 2018). Rates of common health conditions such as cancer, diabetes, heart diseases, obesity, mental health deterioration, and renal diseases have significantly increased. While there may be other variables playing into this, different studies pinpoint the lack of proper primary care, limited care funds and inadequate or lack of preventive care as the chief culprits.
Uninsured patients or their underinsured equals have a tendency of absconding care or will only seek for it when their condition has worsened to warrant immediate evaluation, at which point the only resource fit to handle their escalated situations may have moved to acute care setting (Wong et al., 2018).
Like other healthcare systems around the world, Australia is in dire need of experienced nurses (Dawson, Stasa, Roche, Homer, & Duffield, 2014). Reason being, the industry is losing a significant number of them due to retirement, declining resources, increase in ambulatory opportunities, and diminishing resources. This, coupled with the fact that organizations are finding it hard to leverage their seasoned staff in a desperate attempt to both guide and direct new graduates, make the working condition unfavorable to newly graduated nursing students.
Strategies to Equip Nurses for Professional Practice
It is no secret that new nurses need coaches and mentors during their first year of work (Hezaveh, Rafii, & Seyedfatemi, 2014). This is essential for a smooth transition. It, however, necessary for organizations to first sort out the issues relating to generational diversity before can go ahead and establish a mentoring relationship between their novice staff and experienced ones.
A good chunk of newly graduated nurses happens to fall on the millennial side of the spectrum while experienced ones are the full-grown bunch (Mills, Chamberlain-Salaun, Harrison, Yates, & O’Shea, 2016). While experienced nurses can handle pressure on their own, millennials thrive with a structure, and if an organization fails to set one up, they should anticipate a high turnover.
Work-related fatigue is a serious problem and must be addressed with the seriousness it deserves, more so as it leads to burnouts among nurses (Dawson et al., 2014). Different studies suggest that every time professionals insinuate to be burnout, they get disconnected from work and colleagues, the result of which they also become detached from their work. Research indicates that detached nurses perform poorly, thus impacting negatively on the health of patients they are supposed to be helping (Dawson et al., 2014; Hezaveh et al., 2014).
Workplace bullying is also a common problem among new nurses (Dawson et al., 2014; Hofler & Thomas, 2016). In most cases, there will be nurses bullying other nurses in what appears like an attempt to retain control of how they work and their work environment. Only a few organizations have gone to the great length of protecting their nurses from being bullied at the place of work. So in most cases, those who get bullied suffer in total silence, as they do not know the right channel to follow while addressing their grievances (Dawson et al., 2014; Hofler & Thomas, 2016).
Those on the leadership front of any health organization are bestowed with the responsibility to ensure the work environment is not only safe but also sound enough to ensure proper health and wellbeing of its patients and staff. In other words, it is every organization’s responsibility to at all times protect its staff from workplace bullying (Dawson et al., 2014; Hofler & Thomas, 2016).
Every single one of the challenges mentioned above can prove to be problematic to a new graduate and even detrimental to their budding career. If the staff comes together without adequately laying down the strategies needed for their mitigation, then new graduates face a common problem that will see to it that they have a rough time transitioning from school to workplace. This may lead to poor performance on their part, and consequently, loss of lives from patients whose lives and health, in general, depend on how rightfully these nurses function at their place of work (Dawson et al., 2014; Hezaveh et al., 2014; Hofler & Thomas, 2016).
Impact of Effective Transition Programs on Patient Safety and Outcomes
New graduates can recalibrate and adjust themselves to circumvent some of these hurdles and position themselves for an even smoother first year of work. Among the strategies suggested is enrolling for mentoring programs (Kaihlanen, Lakanmaa, & Salminen, 2013). According to a series of recent studies, mentoring programs reduce the rate of nurses giving up by close to a half. All an organization ought to do to come up with a robust mentoring program is come up with a structured way to curb some of these problems with the sole aim of increasing newbie nurses’ intent to stay (Kaihlanen, et al. 2013; Thomas, Bertram, & Allen, 2012).
New nurses all over have been found to be even more competitive after they have undergone a well-structured mentoring program (Kaihlanen, et al. 2013). The first step should involve pairing the student with a trusted mentor, especially one that perfectly matches their personality and has clinical experience of at least two years. The coach or mentor will then be re required to undergo a didactic course for coaching, and a 4-hour assessment under a nursing manager. This should help solidify the relationship between the coach and the nursing students under their wing. Mentoring programs have been tested and found to be pivotal in getting new students acquainted with their new working environment, thus making conducive for them to offer their best and perform with utmost productivity (Kaihlanen, et al. 2013; Thomas et al., 2012).
Freshly graduated nurses need a supportive environment that provides enough opportunities for growth (Hofler & Thomas, 2016). In a supportive environment, there is open communication that facilitates reporting of mistakes and professional development. The new nurses can assess their clinical progress by inferring to the patient outcomes they have handled in clinical settings. In general, a supportive environment is one in which the nurse feels comfortable to communicate and shared ideas. The experienced nurses should be encouraged to guide newly graduated RNs for an effective transition (Liang, Lin, & Wu, 2018). The support from experienced nurses ensures that new nurses are aware of what is expected of them and have the guidance to work towards the realization of the expected goals.
The need for healthcare delivery teams has been established, and new RNs should be introduced to these teams to facilitate their transition to professional practice (Brown & Crookes, 2016). The experienced nurses should invite new nurses to their multi-disciplinary or interdisciplinary team as a show of support. By observing how experienced nurses provide health care, they too can learn how to handle patients, increase their confidence, and gain team-playing abilities.
Healthcare organizations should provide an orientation program for new RNs before they commence as nurses (Hofler & Thomas, 2016; Liang et al., 2018). The orientation program should inform the nurses of what is expected of them set realistic goals for them. Additionally, the new RNs should be provided with training opportunities that will facilitate their clinical practices. For example, they can receive help in time management and planning so that they can plan their transition phase more effectively.
In addition to the solutions mentioned above, organizations are expected to have direct access to demand and supply data both at the state level and institutional level (Hofler & Thomas, 2016; Liang et al., 2018). This should help to conclusively link them up with nurses that snugly meet the needs of their patients. Such data also helps organizations come creative and innovative ways to help fresh graduate adopt to their practice environment, as well as plan for their day while adjusting their career lives for the future.
Conclusion
Current and compelling evidence indicates an urgency on role transition from newly graduated RNs to professional nurses serving as primary care providers. While new RNs know to inform practice, they lack the preparedness to deliver high-quality care. Coupled with ever-changing healthcare, retiring baby boomers, and physicians opting for specialized care, there is every need to adequately prepare newly graduated RNs for practice. One of the most acclaimed methods of preparing nurses is preceptorship. Under the guidance and supervision of advanced nurses, freshly graduated RNs can acquire the clinical competencies they need without exposing patients to harm. Preceptors can also play the role of mentors, where they mentor RNs into achieving the required competencies. The importance of a supportive environment in facilitating transition cannot be disregarded. Such environments ensure that nurses develop their clinical and patient management skills thereby encouraging their confidence and preparation for the nursing profession. Other established methods of providing a smooth transition are orientation programs for new RNs, open communication among providers and leadership, appropriate guidance from permanent staff, and continuing nurse-development opportunities such as training and seminars. These strategies are essential because newly graduated RNs can provide value to healthcare, but only if they are adequately prepared for the role.
References
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Hezaveh, M. S., Rafii, F., & Seyedfatemi, N. (2014). Novice Nurses’ Experiences of Unpreparedness at the Beginning of the Work. Global Journal of Health Science, 6(1), 215–222. Doi:10.5539/gjhs.v6n1p215
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