Transition Experiences Of New Graduate Nurses In Clinical Practice

Challenges Faced By New Graduate Nurses

In Australia, the complexity of healthcare settings is constantly on the rise due to continuous evolution in the medical field. For registered nurses who have just graduated and are in transition from nursing schools to clinical practice, their experience is emotionally exhausting, stressful, and challenging (Hussein, Everett, Ramjan, Hu, & Salamonson, 2017). This is due to the struggle that they always have to undergo in an attempt to deliver safe patient care, handle huge workloads, as well as be accountable and responsible for all their actions. Subsequently, support programs for transition have been developed after various parties have raised concerns about the ability of nurses to cope and deliver safe care immediately after graduating from nursing schools.

It is of great significance that the workplace conditions, as well as the clinical environments of new graduate nurses, be well understood in order to gain full comprehension of their transition experiences (Duchscher, 2012). The work environment that graduate nurses are currently entering is characterized by increased patient acuity and a shortage of nursing staff among other challenges. Various researches and studies have linked early retention of newly graduated nurses to uncivilized behaviors, burnout, and work-related stress. It is from these reports that various bodies and health institutions have tried to develop techniques to aid better the experiences of newly graduated nurses.  Transition Experiences Of New Graduate Nurses In Clinical Practice Discussion Paper

There are endless benefits that new graduate Registered Nurses will derive from the experiences of previous new graduate nurses transitioning into clinical practice. They will be able to learn on what to expect upon entry into clinical practice (McKimm, Forrest, & Thistlethwaite, 2017). They will be able to learn how to utilize the confidence installed in them by the skills and knowledge they have learned in nursing schools for the sake of delivering safe care to patients. They will also be able to learn the various sources of fear when in actual clinical practice and how to evade them. There is also a huge pool of health professionals that new graduate nurses encounter when they enter into clinical practice. Subsequently, digging deeper into this issue will enable nurses with prospects of entering into clinical practice develop communication skills early enough to avoid coercion (Edwards, 2014). They will also research on various complex and high acuity units and learn on how to manage their operations when assigned in such units. Professional isolation being an issue affecting new graduate nurses, prospective nurses will be able to develop techniques on how to handle the issue effectively. Upon achieving all the aforementioned, new graduate nurses will have a smooth transition into clinical practice.

Importance Of Understanding Workplace Conditions And Clinical Environments

New graduate nurses entering into clinical practice have varied experiences depending on the work environment and the staff that they meet in the workplace. There are however some experiences that are similar and commonly occur to a great number of nurses entering into clinical practice. Several reports indicate that new nurses experience both feelings of fear and confidence (Chang & Daly, 2012). Fear is experienced due to the fact that new nurses have to be responsible for all the action that they do irrespective of the consequences (Walker, Costa, Foster , & De-Bruin, 2016). Confidence is reported by nurses who believe in the skills they have acquired throughout their learning and by the strong belief that they can offer the best care to their patients.

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Horizontal violence is also a common issue that face new graduate nurses who have just entered into clinical practice. Horizontal violence relates to aggressive acts portrayed by a colleague and could include verbal, physical or emotional threats, criticism or innuendo (Dellasega & Volpe, 2013). In previous studies, a significantly huge number of graduate nurses have confessed to being in a situation where older nurses were unsupportive and unkind to them. Some have even reported that they feared to ask questions to older nurses on how to get something done because the responses were always rude and harsh thus unhelpful. They also reported that this behavior is supported by nurse leaders, the people who should be helping terminate it.

Upon entry into clinical practice, new graduate nurses usually find themselves assigned to high acuity units. While working here, they are always required to make critical decision decisions, a process that they are not accustomed to (Hansen, 2011). On a typical working day in high specialty units, new nurses are presented to multiple patients with demanding health conditions that require critical judgment on clinical matters. Mistakes made on these units could be fatal and irreversible. In many of these situations, new graduate nurses are required to quickly make crucial decisions with no time to think over the decisions.

Further on, new nurses have always experienced less than ideal communication upon entering into clinical practice. This type of communication normally emanates from physicians as well as from members from other interdisciplinary teams (Riley, 2015). Some new nurses have reported of occasions when they call the doctor in charge to explain about a patient in a critical condition but are dismissed rudely before they can even finish their narration. In many scenarios, when older professionals express disgust or use gruff tones when responding to new graduate nurses, their confidence and self-esteem are lowered greatly.

Benefits Of Learning From Previous New Graduate Nurse Experiences

Due to the extreme chaos sighted in today’s health care settings, graduate nurses may experience the feeling of professional isolation (Cherry & Jacob, 2016). There are multiple occasions when new nurses reported that they felt completely alone while playing the nurse-role due to lack of cooperation from their counterparts. When working in busy units, they feel that their presence is unrecognized. New nurses, especially on night shift, also constantly find themselves facing certain patient situations where they don’t know what to do and there is no one to guide them or other nurses are too busy to help.

Lastly, there are many situations when new nurses find themselves receiving contradictory information regarding a certain issue. Upon entering into practice, graduate nurses have numerous questions for which they must seek answers from the experienced nurses. Various professional, however, gives contradicting information on the same issue and the new nurse is left in a dilemma on which set of information to implement (Huston, 2013). The most stressing bit for them is the fact that implementing the wrong idea could give fatal results and the consequences on their side could be dire. Further, they are required to make a choice from the viewpoints of various colleagues quite fast without sufficient time to think over them.

To fight fear and boost confidence, new graduate nurses should be supported during the entire first year of practice. Transition programs should be designed and implemented to be undertaken within the first 3-6 months of entry into clinical practice. Enhancement of skill set, debriefing opportunities and development of clinical judgment are some of the support exercises that should be offered in the long term (Chang & Daly, 2012). During the first twelve months of practice, new nurses should be taken through three stages; knowing, doing and being while being supported throughout all the stages.

New graduate nurses may lack appropriate preparedness on how to react and respond to acts of horizontal violence. Strategies of how to respond to it should, therefore, be among the specific information shared about horizontal information. Scripted responses should be included in transition programs’ guidelines to offer guidance on how to respond to acts of horizontal violence that may be encountered (Dellasega & Volpe, 2013). Proper channels should also be provided through which new graduate nurses can report older nurses who are horizontally violent to them. Stiff actions should be taken against such nurses to discourage the behavior.

Common Experiences Faced By New Graduate Nurses

Whenever new nurses are assigned to high specialty units, the management of the health facility should make sure that extended transition support is availed. Organizations should avail extensive high acuity education and orientation training relating to disease management and technology (Hansen, 2011). Further on, due to the intense patient situations that new graduates face in these units, they should be given the opportunity to emotionally process any resultant feelings until they get used to such situations. They should also be helped in making critical decisions to avoid the occurrence of any errors.

In order to adjust themselves to the issue of less than ideal communication, it is recommended that new graduate nurses develop some interdisciplinary communication skills. They can only achieve this by the management offering interpersonal communication skills training (Riley, 2015). They should also be taught how to effectively resolve conflicts within the workplace. The management of a healthcare facility could offer simulations illustrating and giving new nurses how to engage in professional and collegial communication with minimum or no coercion.

New graduates should develop a link with the existing leadership in order to avoid feeling professionally isolated. Research has shown that graduate nurses feel less alone when they are in direct contact and making conversations with various leaders and more so nurse leaders in the units they have been assigned (Cherry & Jacob, 2016). It is through formal nursing leadership links that new graduate nurses are able to promote a two-way professional dialogue that facilitates constructive feedbacks. Seasoned, successful and open-handed nurse leaders should be assigned the task to handle new graduate nurses.

Conclusion

Conclusively, it has been brought into the limelight that new graduate nurses transitioning into clinical practice encounter more challenges than positive experiences. Developing the preparedness of prospective new graduate nurses has been identified as the core reason for exploring into the issue. As it has been discussed, new graduate nurses who are aware of the challenges they are likely to encounter during the transition into clinical practice more likely to counter the challenges more effectively. Such nurses, therefore, have a higher likelihood of delivering high-quality care to patients from their first day in practice.

Various experiences that are common to new graduate nurses transitioning into clinical practice have also been discussed in depth. It has been told that new nurses are most likely to experience fear, confidence or a combination of both. Horizontal violence, which means aggressive acts from colleagues, have also been identified as a major experience of nurses in transition. Such nurses are also likely to find themselves assigned in complex units where they are required to make fast and complex decisions. New graduate nurses also experience less than ideal communication, professional isolation, and contradictory information relating to issues that they may seek help. This article has concluded by giving viable and effective solutions to all identified challenges.

References

Aggar, C., Bloomfield, J., Thomas, T. H., & Gordon, C. J. (2017, March 23). Australia’s first transition to professional practice in primary care program for graduate registered nurses: a pilot study. BMC Nursing, 16(14). Retrieved October 10, 2018, from https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-017-0207-5

Chang, E., & Daly, J. (2012). Transitions in Nursing – E-Book: Preparing for Professional Practice (3 ed.). Elsevier Health Sciences.

Cherry, B., & Jacob, S. R. (2016). Contemporary Nursing: Issues, Trends, & Management (illustrated ed.). Elsevier Health Sciences.

Dellasega, C., & Volpe, R. L. (2013). Toxic Nursing: Managing Bullying, Bad Attitudes, and Total Turmoil. Sigma Theta Tau.

Duchscher, J. B. (2012). From Surviving to Thriving: Navigating the First Year of Professional Nursing Practice (2 ed.). Nursing The Future.

Edwards, M. (2014). Communication Skills for Nurses: A Practical Guide on How to Achieve Successful Consultations (reprint ed.). Andrews UK Limited.

Hansen, J. (2011). Nurse Residency Program Builder: Tools for a Successful New Graduate Program. Hcpro Incorporated.  Transition Experiences Of New Graduate Nurses In Clinical Practice Discussion Paper