Challenges of Transitioning from Graduate Nurses to Professional Practice

The healthcare environment is an ever changing field due to the dynamic nature of the society (Parker, Giles, Lantry & McMillan, 2014). However, one thing that seems to remain constant is the need for ‘work ready’ nurses (Hofler & Thomas, 2016).At the beginning of Bachelor of nursing course, students are filled with excitement and also anticipation for the course. The course equips them with practical skills and theoretical knowledge in preparation for professional practice. The transition to professional practice can be a ‘stressful and difficult shift’ for a graduate nurse(Hofler & Thomas, 2016).Half the number of new nurses in their first year of practice become emotionally exhausted and majority of them experience ‘incivility’ at work(Laschinger et al., 2016). There is a gap between what the students are taught to expect and what they actually experience once they commence their practice. Chang and Daly (2015) describe this gap as a ‘reality shock’.

The experiences of nurses during the very first years of professional practice have great influence on their future career path (Parker et al., 2014).These first years of practice can be termed as a ‘vulnerable time’ because it is during this period that nurses make decisions that portray the intent to commit to the profession (Parker et al., 2014).The nurses might also decide to leave their profession during this time. There are some factors which influence the transition from a graduate nurse to a professional practice. First, the great difference between the graduate’s expectations and the actuality(Christensen, et al. 2016). The experiences that these nurses go through are different from what they perceived initially.

Many nurses experience performance anxiety (Hofler & Thomas, 2016).The nurses feel that their knowledge is not adequate. During the very first days of practice, they look at other staff who know exactly who they should talk to, what they ought to do and when to do it and this makes them feel incapable and self doubts starts. The nurses end up wishing that they could go back to college and learn more. Performance anxiety influences how well a nurse demonstrates mastery.

The personal qualities of a nurse like maturity, age and motivation can also influence the transition. A nurse who is known exactly what he or she wants to achieve in the career will put a lot of effort to grow in the profession. A nurse’s personality will affect his or her approach during difficult or even stressful experiences.

Skills Required for New Graduate Nurses in Professional Practice

The new practicing nurses experience a challenge when they have to manage the responsibilities for a number of patients simultaneously (Chang & Daly, 2015). There are many patients in the hospital and at the end of the day, the nurses are emotionally and physically exhausted. At times, the nurses have to work overtime and they were unprepared for this (Laschinger & Boamar, 2016).The burn out affects their work negatively. The nurses may disconnect from their work and colleagues (Hofler & Thomas, 2016). Burn out is a key factor that pushes a nurse to make the decision of leaving the job or even the nursing career (Laschinger & Boamar, 2016).

The new graduate nurses will need guidance during the beginning of their practice. He or she will ‘not work in isolation but within an organizational environment’(Mellor & Gregoric, 2016).

Maslach and Leiter’s areas of work life model and Greenhaus et al’s theory of work life balance can be adopted to ensure that graduate nurses will work effectively once they start professional practice(Laschinger & Boamar, 2016). Six areas of work life are considered. First, manageable work leads. This considers a nurse’s physical and emotional capabilities this reducing burn out. Secondly, controlling overwork. This is the ability of the new nurses to make important decisions. Thirdly, rewards for contribution. Nurses feel fulfilled once they achieve their expectations. Fourth, fair treatment in the working environment. Decisions made should be impartial. Fifth, sense of community. Nurses have to learn to work with other medical professionals to ensure better patient outcomes. Finally, congruence between organisational and personal values. The nurses must follow the values of their profession. Once these areas are looked into, the new nurses will be able to work effectively (Laschinger & Boamar, 2016).

In order to ensure a smooth transition from graduate nurses to professional practice, orientation is carried out. This is meant to prepare the nurses for their new roles (Liaw et al.,2014; Pasila, Elo & Kääriäinen, 2017).

There is a theory-practise gap in the nursing profession which can be as a result of challenges of the clinical learning environment (Salifu, Gross, Salifu & Ninnoni, 2018). First, the clinical activities are a routine and due to this, they become monotonous (Salifu, et al. 2018).The students eventually lose interest in what they are studying and this will influence their professional practice. The students end up not taking their career seriously and as  a result,  they end up feeling inadequate during their practice and might even wish to go back to study the course. The lecturers who teach these student nurses have a high expectation on the students regarding their competence (Salifu, et al. 2018). These lecturers assume that the students are simply prepared enough for practice. Another challenge with the clinical environment is that the learning outcomes during clinical placement are ‘vague’. Salifu et al argue that these outcomes lack full details thus whatever the students are left to expect is different from the reality.

Communication

New graduate students experience feelings of self doubt which can be referred to as transitional shock (Christensen, et al. 2016).This can be closely related to Imposter Phenomenon (IP) syndrome according to Christensen et al. (2018). Transitioning nurses have high personal expectations of what it means for them to be a registered nurse. In the working environment, the registered nurses are presumed to be capable of their new role (Christensen, et al., 2016). These puts pressure on the graduate nurses. They feel that they ought to know everything. It becomes a great challenge for them to ask for clarifications in the areas where they lack clarity because of the fear of being ridiculed.

It is important for nurses to adopt certain clinical and non-clinical skills in order for them to succeed in the profession. One of these skills is communication. This will facilitate therapeutic and professional relationships. Therapeutic relationships can be described as a key factors of all health care interactions (Kornhaber, Walsh, Duff & Walker, 2016).The relations influence  the improvement of a patient. The registered nurse on practice is required to not only listen but also respond to the patient. This way, the patient’s emotional health is catered for. A graduate nurse should be in a position of answering all the questions, anxieties and doubts of not only the patient but also their families. During these interactions, it is the duty of the nurses to guide the patient’s in the right direction as they make decisions that will have an impact on their health. The skill of clinical reasoning will be required in this situation . A challenge that faces the relationships is that it can be viewed as a task and thus not done effectively by the nurse (Kornhaber et al,2016).A nurse has to improve his or her communication skills so that they can interact properly with the patients.

Clinical  reasoning is acquired through reflection of past experiences (Nursing and midwifery board of Australia, 2017). A student should reflect on the experiences during initial clinical placement. In the classroom setting, students always work in groups. This teaches them how to work in groups. These teamwork skills are necessary for a graduate nurse. He or she will have to work with other medical professionals in the career. A student who works well with other members of his or her group will also work effectively in the hospital setting. A student should be able to communicate with ease with others group members and also ask questions in areas where they lack clarity. Problems may arise in the hospital once the graduate starts working and problem solving skills will be useful. One needs to tackle the problems on time and effectively.

Clinical Reasoning

Conclusion

There is a gap between what is taught during the study of nursing and the actual experiences in the profession. As a result, graduate nurses go through stressful working conditions at the start of their career. This has a negative impact because some of them may decide to leave the job or career. The factors which affect the transition from a graduate nurse to a professional practice include personal anxiety and self doubt, challenges in the clinical education, unclear role expectations, high expectations of the student’s abilities by the lecturers during learning, by medical professionals at the onset of practise and by the students themselves. Orientation has been identified by different scholars as a means of ensuring smooth transition for the students.  A graduate nurse needs certain skills in order to succeed in professional practice. Most of these skills are acquired from reflection classroom experiences. These skills include clinical reasoning, problem solving, teamwork, research and communication. Even though the transition from a graduate nurse to a professional practice is stressful at first especially due to theory-practise gap, determined nurses demonstrates mastery as they continue with their profession (Chang & Daly, 2015).

References

Chang, E. and Daly, J. (2015). Transitions in Nursing. 4th ed. Elsevier Health Sciences APAC, pp.3-18.

Christensen, M., Aubeeluck, A., Fergusson, D., Craft, J., Knight, J., Wirihana, L., & Stupple, E. (2016). Do student nurses experience Imposter Phenomenon? An international comparison of Final Year Undergraduate Nursing Students readiness for registration. Journal of advanced nursing, 72(11), 2784-2793. Doi: 10.1111/jan.13034

Hofler, L., & Thomas, K. (2016). Transition of New Graduate Nurses to the Workforce: Challenges and Solutions in the Changing Health Care Environment. North Carolina Medical Journal, 77(2), 133-136. doi: 10.18043/ncm.77.2.133

Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: An integrative review. Journal of Multidisciplinary Healthcare, 9, 537-546. doi:10.2147/jmdh.s116957

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Liaw, S., Koh, Y., Dawood, R., Kowitlawakul, Y., Zhou, W., & Lau, S. (2014). Easing student transition to graduate nurse: A SIMulated Professional Learning Environment (SIMPLE) for final year student nurses. Nurse Education Today, 34(3), 349-355. doi: 10.1016/j.nedt.2013.04.026

Mellor, P., & Gregoric, C. (2016). Ways of Being: Preparing Nursing Students for Transition to Professional Practice. The Journal Of Continuing Education In Nursing, 47(7), 330-340. doi: 10.3928/00220124-20160616-10

Nursing and midwifery board of Australia (2017). Registered nurse standards for practice.Retrieved 24^th October 2018 from content://com.sec.android.app.sbrowser/readinglist/0915200344.mhtml

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Pasila, K., Elo, S., & Kääriäinen, M. (2017). Newly graduated nurses’ orientation experiences: A systematic review of qualitative studies. International Journal Of Nursing Studies, 71, 17-27. doi: 10.1016/j.ijnurstu.2017.02.021

Salifu, D., Gross, J., Salifu, M., & Ninnoni, J. (2018). Experiences and perceptions of the theory-practice gap in nursing in a resource-constrained setting: A qualitative description study. Nursing Open. doi: 10.1002/nop2.188