HNB1001 | Nurse | The Experience Of The Newly Graduate Nurses

You are to write a journal article 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.

Introduction:

The health care industry of the present time has evolved innumerable times since the time it has started its journey, the advancement oriented revolution of the system of the health care industries have shaped this industry as one of the most demanding public service sector of the present times. Furthermore, the environment of the health care industry is changing rapidly and continuously, with the aim of addressing the variety of complex care needs of the human society. However, in this ever-changing health care environment the only constant that remains unchanged is the ever-rising demand for health care staff, especially the nurses. As a result of the complete metamorphosis of the health care system into a more efficient and technology oriented service delivery scenario, the nurses are require to practice in a lean efficient manner in accordance with the changing systems (Kuokkanen et al., 2016).

Holler and Thomas (2016) stated, striking reimbursements, enhanced regulatory oversight and ever-increasing consumerism continues to add on to the pressure that the nurses practice under. Hence, for the nursing students that are transitioning into practice with no or very limited real world practical knowledge or understanding of handling patients, discovering or addressing care needs, advocating patient needs and working in a multidisciplinary team scenario becomes a tumultuous experience for the nurses, where the newly graduating nurses struggle to cope with the stress and it soon overshadows the euphoria of commencing on their career journey or any sense of accomplishment (Tuckett, 2015). This essay discusses the exact experience of the nurses newly graduating and transitioning into practice and recommend strategies to address the challenges predominant in the scenario.

n: justify;">Significance of the chosen issue:

In the course of obtaining the educational degree, the nurses have to select ands area of expertise and then attempt to gain extensive clinical knowledge and skills regarding the area so that they care effectively care for the sick and ailing patients; after obtaining the degree on the other hand, the newly graduate nurses attempt to integrate themselves in to the clinical setting as per their area of practice (James, Beattie, Shepherd, Armstrong & Wilkinson, 2016). Similarly, they also attempt to attain familiarity with the organizational policies all the while attaining real world practice based clinical skills. Along with that, there are a number of different guidelines and best practice protocols which monitors and ensures that the care delivery is safe, effective, patient centred and meeting the quality benchmarks set by the health care authorities, both local and global. Along with that, nursing professionals also have to work under extreme pressure and multiple shifts due to the alarmingly low nurse patient ratio in the care facilities. As a result coping with this sudden monumental stress becomes more than just a challenge for the newly graduating nurses and they often suffer from burnout, withdrawal, panic, and a deep sense of incompetency (El Haddad, Moxham & Broadbent, 2017).

On a similar note, the Wang, Jin, Feng, Wang and Ren (2016), have mentioned an increasing number of patients with complex conditions and multiple comorbidities, lack of access to experienced mentors and coaches, generational diversity in the workforce, performance anxiety, and bullying also contributes to the challenges. Now the impact of these challenges arte multidimensional, it not only affects the professional experience of nurses but also effects the mental and behavioural health of the nurses. The challenging experience endured by the graduating nurses has been reported to effect the confidence, competence and even the mental sanity of the nurses as well. The inability to cope with the work stress or match up to the standards of the rest of the nursing staff led to lack of self-worth and eventually depressive disorders and withdrawal symptoms, forcing many of the nursing professionals to abruptly discontinue practice. Hence, undoubtedly, this is a grave professional issue which is affecting the already low nurse patient ratio, there is need for strategies to address these challenges effectively (Penconek, 2015).

Discussion:

The experience of the newly graduating nurses had been a considerable priority for the health care industry and there has been a variety of different research studies which has devoted time and efforts in discovering the extent of the risks and protective factors that play in the scenario of transition into clinical practice and there are various themes that have emerged from the extensive research. For instance, Hezaveh, Rafii and Seyedfatemi (2014) have mentioned that unpreparedness of the novice nurse while they are transitioning into practice lead directly to the reduction of the quality of care which inevitably adds to the moral burden of the nurses that are carrying out the care activity. Elaborating more, the authors have depicted the sensitivity of the health systems, especially the mentors providing training to these transitioning nurses and the nursing managers have a significant role in the experience that the nurses have while implementing clinical care first time.

On a similar note authors Walker, Costa, Foster and de Bruin (2017), have attempted to examine the impact of the transition and integration experience of the Australian graduating nurses focusing on the first year of their employment. The primary aim of the article had been to discover the common features that positively impact the transition and the challenges or issues that negatively impact successful integration into the workplace. The data findings of the article indicates that mounting work responsibilities such as multiple shifts and ward rounds, handling a variety of different patients from different demographics, acquiring complex patient assessment and handling skills, multiverse work readiness including theoretical versus practical training and orientation and workplace culture including unprofessional behaviour, role discrepancy and bullying or social isolation served as the most delimiting factors in the entire transition experience. However, as per the data findings of the article suggests that the support from the workplace acts as a protective factors as well helping the nursing professionals cope with the stress of the transition and build resilience and competence.

Delving deeper into the issue faced by the nurses, researchers are of the opinion that the experience of the newly graduating nurses are even critical for those that start practice in any clinical specialty. The authors Hussein, Everett, Ramjan, Hu and Salamonson (2017) has explored the experience of the newly graduating nurses in the acute care settings and how the challenges and the extreme complexity and workload of the acute care settings complicates the practice environment and transition process of the graduating nurses. The results of this convergent mixed method study indicates that proper orientation with clearly demonstrated job roles and responsibilities to the nurses and transition support program acted like the foundations for successful integration in the work environment.

It has to be mentioned that in acute care setting the patient care needs are complex and it demands relentlessly competent performance from the nurses, in spite of the mounting physical and emotional burnout. Hence it has become the need of the hour for the health care industry to discover strategies or interventions that can address the challenging factors that complicate the transition process for the nurses and enhance the impact of the protective factors that are facilitating the smooth transition into their chosen arena of practice for the newly graduating nurse.

Strategies to address the challenges:

As per the research of available valid and relevant literature that has been elaborated in the discussion section above, all the different studies reviewed have a very similar theme of data findings. There is mounting evidence that indicates that the process of the transition into practice for the newly graduate nurses are laden with a variety of challenging factors. A few notable contributor to the negative experience of these nurses as per the research includes workplace discrimination extreme workload, unclear and overlapping job responsibilities and the disparity between the theoretical knowledge and practical applicability. These complications weigh the new nurses down and acts on their soft skills along with affecting their mental sanity leading to depression, irritability and many other related mental health concerns (Penconek, 2015). The stress of the transition can be very potent if there are no protective factors acting at the same time camouflaging some of the effects of the challenging factors, and can even affect their performance leading to errors and affecting the patient safety and lowering the nursing staff ratio by the extremely affected nurses quitting halfway into their transition.

However, there are certain strategies that have been recommended by the years of research and the most notable as discussed by Hussein, Everett, Ramjan, Hu and Salamonson (2017), transition support programs with mentoring helps the nurses that are transitioning cope with the stress of practice better. In support Hofler and Thomas has mentioned nursing mentoring programs have helped increase the intent to stay in the profession for the new nurses and has in turn been reported to increase retention rates. Along with that, proper orientation with clear job role description has also been very beneficial for the nurses to have a clear mental preparation regarding what to expect in the care scenario.

On the other hand, for the acute care nurses that have to transition directly into clinical specialty practice area, Hussein et al. (2014) have discussed not assigning the newly graduating nurses to complex care patients for first rotation has been found to be extremely helpful in enhancing retention rates and positive experience of the transitioning nurses. However, as per Bull, Shearer, Phillips and Fallon (2015), the impact of the gap between theory and practice needs to be addressed in order to smoothen the experience o transition for the nurses. Hence, the authors suggest integration of the educational Bachelor degree for nursing to have a clinical honors or transition to practice program to help nurses learn the practical applicability while acquiring the degree. As discussed by Ebrahimi. Hassankhani, Negarandesh, Gillespie and Azizi (2015), the strategies must also include emotional support for the confused and terrified nurses with the aid of Assurance, creating a sense of relaxation and security, lifting spirits, and emotional belonging and involvement. Considering the Australian demographics especially, the article by Lea and Cruickshank, (2015) states that while transitioning and getting accustomed with the new and complicated responsibilities, the aid of learning support from seniors or supervisors in each step along the course of initial few months is extremely helpful. Coyne, Rands, Gurung and Kellett (2016) also has stated that the international and culturally diverse nurses that transition to residential aged care setting for nursing practice have been benefitted by support and education from the facility and the clients as well.

Conclusion:

Nursing is a profession more oriented with practice than theory and yet the educational course associated with the nursing profession is more focused on the theoretical knowledge and understanding. Along with the gap between theory and practical knowledge, there are other external and internal variables that impact the issues and challenges faced by these new nurses. Hence, the troubles and challenges faced by the nurses while going through the mentioned transition is as huge detrimental impact on their psyche and in turn their performance standards as well. The retention rates affected by the tumultuous transition experience is one of the main contributors to low staffing ratio for nurses in the present scenario. This journal article has attempted to explore and identify the exact challenging factors and protective factors which can be metamorphosed into strategies to counteract the impact of the challenges and help the nurses graduating and transitioning into practice be able to establish themselves successfully in practice. The strategies recommended can be hoped to ease the impact of the challenges predominant in nursing practice scenario to some extent, although there is need for more research to develop more targeted strategies and recommendations in the future.

References:

Bull, R., Shearer, T., Phillips, M., & Fallon, A. (2015). Supporting graduate nurse transition: collaboration between practice and university. The Journal of Continuing Education in Nursing, 46(9), 409-415. Doi: 10.3928/00220124-20150821-03

Coyne, E., Rands, H., Gurung, S., & Kellett, U. (2016). I-Kiribati nursing graduates experience of transition from university to residential aged care facilities in Australia. Nurse education today, 36, 463-467. Doi: 10.1016/j.nedt.2015.10.020

Ebrahimi, H., Hassankhani, H., Negarandeh, R., Gillespie, M., & Azizi, A. (2016). Emotional support for new graduated nurses in clinical setting: A qualitative study. Journal of caring sciences, 5(1), 11. Doi:  10.15171/jcs.2016.002

El Haddad, M., Moxham, L., & Broadbent, M. (2017). Graduate nurse practice readiness: A conceptual understanding of an age old debate. Collegian, 24(4), 391-396. Doi: 10.1016/j.colegn.2016.08.004

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. doi:  10.5539/gjhs.v6n1p215

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

Hussein, R., Everett, B., Hu, W., Smith, A., Thornton, A., Chang, S., & Salamonson, Y. (2016). Predictors of new graduate nurses’ satisfaction with their transitional support programme. Journal of nursing management, 24(3), 319-326. Doi: 10.1111/jonm.12321

Hussein, R., Everett, B., Ramjan, L. M., Hu, W., & Salamonson, Y. (2017). New graduate nurses’ experiences in a clinical specialty: a follow up study of newcomer perceptions of transitional support. BMC nursing, 16(1), 42. Doi: 10.1186/s12912-017-0236-0

James, B., Beattie, M., Shepherd, A., Armstrong, L., & Wilkinson, J. (2016). Time, fear and transformation: Student nurses’ experiences of doing a practicum (quality improvement project) in practice. Nurse education in practice, 19, 70-78. Doi: 10.1016/j.nepr.2016.05.004

Kuokkanen, L., Leino-Kilpi, H., Numminen, O., Isoaho, H., Flinkman, M., & Meretoja, R. (2016). Newly graduated nurses’ empowerment regarding professional competence and other work-related factors. BMC nursing, 15(1), 22. Doi: 10.1186/s12912-016-0143-9

Lea, J., & Cruickshank, M. (2015). The support needs of new graduate nurses making the transition to rural nursing practice in A ustralia. Journal of clinical nursing, 24(7-8), 948-960. Doi: 10.1111/jocn.12720

Penconek, T. (2015). Perpectives on Bullying. A quaIitative study into academic incivility among nursing students. Alberta RN, 71(1), 28-29. Retrived from https://www.safetylit.org/citations/index.php?fuseaction=citations.viewdetails&citationIds[]=citjournalarticle_493961_20

Tuckett, A. (2015). Speaking with one voice: A study of the values of new nursing graduates and the implications for educators. Nurse education in practice, 15(4), 258-264. Doi: 10.1016/j.nepr.2015.02.004

Walker, A., Costa, B. M., Foster, A. M., & de Bruin, R. L. (2017). Transition and integration experiences of Australian graduate nurses: A qualitative systematic review. Collegian, 24(5), 505-512. Doi: 10.1016/j.colegn.2016.10.004

Walker, A., Costa, B. M., Foster, A. M., & de Bruin, R. L. (2017). Transition and integration experiences of Australian graduate nurses: A qualitative systematic review. Collegian, 24(5), 505-512. Doi: 10.1016/j.colegn.2016.10.004

Wang, F. S., Jin, O., Feng, H., Wang, F. H., & Ren, C. H. (2015). Survey and coping strategies for job stress of new nurses in pharmacy intravenous admixture service: a pilot study. International journal of clinical and experimental medicine, 8(10), 19406. Retrived fromn https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694483/