With the changing environment of nursing practice, these are challenging and hard times for new nursing graduates who make their initial transitions into professional practice. It has been established that less than 50% of the individuals that are actually practicing nursing would not recommend the profession as an advisable alternative to anyone as a career option (Duchscher, 2008). It is therefore not surprising that about 33-61% of people leaving school to join the profession want to change their placements or quit nursing altogether in their first year of practice. For this reason, it is essential to explore the process of nursing graduate adaptation to practice, and establish the ongoing challenges in the healthcare facilities as well as schools of higher learning and the issue of policies to comprehend and thus respond to the concerns that could be driving motivated and highly energetic nurses out of nursing practice or acute care. One of the most acute, dramatic and almost immediate stage experienced by many graduate nurses is transition shock (National Advisory Council on Nurse Education and Practice, 2010). The design of the stage contains the elements of reality shock, transition theory, acculturation shock as well as cultural shock. This journal article will provide facts for the adaptation, growth, and development of graduate nurses by analyzing the experiences of working in the field.
As new nurses transition into the dynamic working environment, they realize that there are many challenges that are associated with working in the profession. For some of these individuals, the work environment is not quite as they expected it to be. Some leave nursing school with high hopes, determinations, and energy to apply their skills in the field only to be faced with transition shock that cut short their determinations with some preferring to change their practice while other abandoning the profession entirely. For this reason, discussing the transition elements with the registered nurses as they enter the new environment is essential to them as they get to understand some of the setbacks that they might face and how to quickly adapt to ensure that a smooth transition as they get to experience different aspects of the profession (Hussein, Everett, Ramjan, Hu & Salamonson, 2017). Having an idea of some of these aspects is significant for transitioning nurses as they get to understand pre-hand what they might face and be prepared to face any issue during the transitioning process.
Key findings in the literature suggest that for ease in transitioning, three themes have been identified for adaptation for new nursing graduates and include: Conceptual understanding of transition, role losses, and gains, as well as barriers and enablers.
Moving from one kind of practice setting to another is an aspect that is experienced by any person joining the nursing profession at various stages during their careers. However, one area that is likely to influence professional identity is moving from an institutional scenery into a community-based role (Hofler, 2014). For this reason, getting an idea of the working practice pre-hand is essential in helping the new graduate nurses to be in a position to adapt to the various activities inside a healthcare facility. With the changing dynamics, some people might find themselves in certain situations where they feel that they do not know how to handle a particular case. However, conceptualizing and comprehending the transition process would help individual nurses, as well as employers, benefit from understanding the appropriate initiatives, the role of transition, and thus supporting graduate nurses in the process. Four integrated ideas and concepts could be used for conceptual understanding of the change.
First is centering identities which relates to the changes linked to old and new roles of nursing practice, individual social behavior and characteristics, as well as personal factors like attitudes, values and cultural identities which influence the manner in which a person interact with others when he or she is part of a new group (Shipman, 2014). The second concept is established as ‘focusing’ roles which relate to the active process of establishing a plan of current as well as anticipated activities in order to achieve the needs of the new role. When the graduate nurse plans ahead of time and understands the current and the anticipated activities, they are able to perform their work with ease as opposed to handling tasks as they arise. The third concept is ‘enacting roles’ which relates to practical elements of the role assigned as well as the capacity of the graduate transitioning nurse to fulfill the task. The final concept is the ‘Shaping roles’ which relates to the ability of the new student to define their role in the new environment that they have been placed (Walker, Costa, Foster & Bruin, 2016). Defining the functions that are anticipated and having an idea of what is required of them would help nursing graduate transition faster into the working environment.
During nursing practice, the new nursing graduates will come to find out that there are various losses and gains associated with the roles that they perform in the healthcare environment. Nurses should be individuals that are open to learning, and thus with time, a more comprehensive understanding of the roles would be captured by these people when they join professional practice (Dyess & Sherman, 2009). For that reason, these gains would prove significant to the adaptation of an individual to the practice. However, working in this field comes with its own range of challenges such as working long hours, dealing with ever-changing, highly dynamic as well as the intense health-care environment and handling new roles that are assigned to them on a daily basis. During the process, various role losses might come up. The ability of a graduate nurse to be able to accept this as part of a challenge and adapt is essential for the transitioning process.
Some of the barriers or enables that determine how a graduate nurse transitions into the ever-changing healthcare environment is formal and appropriate educational preparation, availability of specific support systems like organizational orientation, mentoring, skill development, as well as team support in the working environment (Zinsmeister & Schafer, 2009). With formal education preparation and having a supportive team, as well as mentors, would be an excellent way for the new nurse to adapt to the workplace. Without these factors, then the barriers always occur.
As established from the discussion, some of the concepts that have been identified for adaptation for new nursing graduates include a Conceptual understanding of transition, role losses, and gains, as well as barriers and enablers. Out of these, significant strategies for the transition process and adaptation arise. The first strategy is to understand the transitioning process and what it entails first hand before joining the work filed. This could be achieved by having a formal education and involvement in the health care facilities as well as having mentors who can aid in their smooth transition (Healy, 2015). This step is quite critical as it ensures that a graduate nurse is well prepared both emotionally and mentally for the task ahead. The second strategy that could be established in this regard is that understanding the various role gains and losses is quite significant for the transition process since it enables the individual to embrace whatever challenge that comes their way with a positive attitude. The third strategy that could be established is understanding the barriers and enablers of the practice. This is one of the essential strategies that could be helpful to an entry-level nurse.
Being in a capacity to understand the different factors that could be a barrier to the nursing practice is significant to overcome them. For instance, if a person understands that the environment is ever changing and new challenges might arise, then they could be in a position to adapt quickly to the working environment. However, if they are not aware of such barriers, then they would have a hard time adjusting (New Zealand Government, 2017). In addition to this, knowing the enablers is also essential as in establishing what factors are in the nurse’s favor while undertaking various tasks in the healthcare environment. The final strategy that could be adopted from the discussion is that during the transition process, nurses should seek opportunities that enlighten them about the various tasks that are expected of them in the profession and this could be information that can be obtained from nurses that are professionals in the field. Understanding how they got to adapt to the career could be a great way of boosting the confidence of a graduate nurse.
Conclusion
As many graduating nurses would come to find out, the process of transitioning from school into nursing practice could be challenging due to the ever-changing dynamic environment in which they are required to join and adapt. The process of adaptation is not as easy, as it has been established that many challenges could be faced by these individuals. To their advantage, however, there are various approaches, measure, and strategies that could be used in ensuring proper transitioning and adaptation. Some of the concepts that have been identified for adaptation for new nursing graduates include a Conceptual understanding of transition, role losses, and gains, as well as barriers and enablers. With these strategies such as establishing a formal and relevant educational preparation, availability of specific support systems like organizational orientation, mentoring, skill development, as well as team support is vital for a positive transition in the working environment.
References
Ashley, C., Halcomb, E. J., & Brown, A. M. (2016). Transitioning from Acute to Primary Health Care Nursing: An Integrative Review of the Literature. University of Wollongong, 1-40. Retrieved from https://ro.uow.edu.au/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=5056&context=smhpapers
Duchscher, J. B. (2008, October 17). Transition Shock: The initial Stage of Role Adaptation for Newly Graduated Registered Nurses. Journal of Advanced Nursing, 1-11. Retrieved from https://nursingthefuture.ca/assets/Documents/TransitionShock2009.pdf
Dyess, S. M., & Sherman, R. O. (2009, September). The First Year of Practice: New Graduate Nurses’ Transition and Learning Needs. The Journal of Continuing Education in Nursing, 1-25. Retrieved from https://www.researchgate.net/publication/26811977_The_First_Year_of_Practice_New_Graduate_Nurses%27_Transition_and_Learning_Needs
Healy, M. (2015, March). Report on the Transition to Practice Needs of Newly Graduated Enrolled Nurses and Postgraduate (entry to practice) Midwives. Transition to Practice, 1-113. Retrieved from https://www.health.vic.gov.au/__data/assets/pdf_file/0003/911748/Transition-to-Practice_Final-report_March_2015.pdf
Hofler, L. (2014). Transition of New Graduate Nurses to the Workforce: Challenges and Solutions in the Changing Health Care Environment. North Carolina Medical Journal, 1-23. Retrieved from https://www.ncmedicaljournal.com/content/77/2/133.full
Hussein, R., Everett, B., Ramjan, L. M., Hu, W., & Salamonson, Y. (2017, July 13). New Graduate Nurses’ Experiences in a Clinical Specialty: A Follow up Study of Newcomer Perceptions of Transitional Support. BMC Nursing, 1-28. Retrieved from https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-017-0236-0
McKenna, L., & Newton, J. M. (2018). After the graduate year: a phenomenological exploration of how new nurses develop their knowledge and skill over the first 18 months following graduation. Research Paper, 25, 1-7. Retrieved from https://www.ajan.com.au/vol25/vol_25-4_mckenna.pdf
National Advisory Council on Nurse Education and Practice. (2010, March). Addressing New Challenges Facing Nursing Education. Solutions for a Transforming Healthcare Environment, 1-45. Retrieved from https://www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Reports/eighthreport.pdf
Newzealand Government. (2017, May 16). Recruitment of New Graduate Registered Nurses. Retrieved September 25, 2018, from www.health.govt.nz: https://www.health.govt.nz/our-work/nursing/developments-nursing/recruitment-new-graduate-registered-nurses
Shipman, D. (2014, January 1). Lived Experience of Transitioning to a New Graduate Nurse Following a Prelicensure Hospital-Based Externship Experience. Nova Southeastern University, 1-103. Retrieved from https://nsuworks.nova.edu/cgi/viewcontent.cgi?article=1001&context=hpd_con_stuetd
Walker, A., Costa, B. M., Foster, A. M., & Bruin, R. (2016, October 3). Transition and Integration Experiences of Australian Graduate Nurses: A Qualitative Systematic Review. Elsevier, 1-8. Retrieved from https://www.collegianjournal.com/article/S1322-7696(16)30122-6/pdf
Zinsmeister, L. B., & Schafer, D. (2009). The Exploration of the Lived Experience of the Graduate Nurse Making the Transition to Registered Nurse During the First Year of Practice. Journal for Nurses in Staff Development, 1-7. Retrieved September 25, 2018, from https://www.ccdhb.org.nz/working-with-us/nursing-and-midwifery-workforce-development/preceptorship-and-supervision/the-lived-experience-of-a-graduate-nurse.pdf
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