The global healthcare environment is ever changing. However, Hoffler and Thomas (2016) reveal that the need for qualified nurses remains unchanged due to the increasing shortage in the supply of these critical stakeholders in the medical system. According to Waddell Spalding, Navarro, Jancar, and Canizares (2015), new graduate nurses entering into clinical practice are faced with the immense pressure of operating in an environment that calls for inclusion of lean processes with higher levels of efficiencies. On the other hand, Reem, Kitsantas and Maddox (2014) demystify that new graduate registered nurses (RNs) transitioning into clinical practice are faced with critical organizational issues such as diminishing fiscal compensation, a tighter regulatory regime, and an upsurge in demand for medical services. Comparatively, Sheppard-Law, Curtis, Bancroft, Smith and Fernandez, (2018) explain that the demand for new graduate RNs continues to increase as a result of exponential population growths, an aging workforce, an upsurge in the number of patients with chronic ailments and inclusion of medical insurance covers targeting the populations that were previously classified as uninsured and underinsured. However, RNs transitioning from the world of academia into practice are faced with multiple challenges in their efforts of adapting to the conditions availed by their environments of practice. The current study seeks to undertake a critical analysis of the experiences presented to new graduate RNs as they transit into clinical practice in the ever changing healthcare environment.
The current study plays a significant role in reviewing the challenges faced by new graduate RNs when transitioning to practice in the healthcare environment that is ever-changing. According to Schroyer, Zellers and Abraham (2016), new nursing graduates reveal some levels of inadequacy in their levels of preparedness; an aspect that accounts for the stressful and problematic procedures experienced by these practitioners as they convert from student to novice stakeholders in the healthcare industry. Mooring (2016) identifies this as a global challenge that results into an increase in the rates of shortage and attrition. The demand for graduate RNs in the Australian healthcare system is attributed to the country’s rapid population growth, a rapid growth in the aging population and an increase in the number of people diagnosed with chronic sicknesses.
Further, the study acts as an informative blueprint aimed at guiding new graduate RNs on the most effective mechanisms of fostering effective transfer of skills acquired by these practitioners from the world of academia into clinical practice with the aim of attaining the desired outcomes. Missen, McKenna and Beuchamp (2016) explain that the ever-changing operational environment, dynamisms in the Australian healthcare system and fiscal issues have imposed multiple challenges among nurses transitioning from student to novice practitioners. By reviewing these challenges, the study will not only be of great essence in advising new graduate RNs on the most effective ways of fostering readiness but also act as a reference material for stakeholders in the field of nursing education such as nurse program coordinators on the most appropriate ways of preparing their students for the demands presented in the field.
Challenges faced by new graduate RNs transitioning from student to novice practice
New graduate RNs are faced with multiple challenges when they transition to clinical practice. Such encounters include workplace bullying, stress and fatigue, increasing number of patients with chronic conditions and an increase in workload. According to Ellis et al. (2017), the transition problem is heightened by the fact that most of these challenges occur in a simultaneous way.
New graduate RNs are exposed to multiple episodes of stress and fatigue when transitioning from academia to their fields of practice. According to Romano (2018), the practitioners face the obligations of managing their clients, professional and social relationships and offering leadership to their inter-professional groups. According to Allen (2016), novice RNs dealing with patients depicting complex conditions tend to develop a sense of exhaustion due to the stresses they are constantly exposed to. Further, Gordon, Carmany, Baker and Goliat (2018) explain that lack of supportive relationships could heighten anxieties; an aspect that leads to immense attrition.
The Australian healthcare industry has experienced a rapid increase in the rates at which experienced nurses are exiting their fields of practice as a result of retirement, workload upsurges, and decline in the supply of fiscal resources, lack of upward mobility, and an increase in the number of ambulatory opportunities. As a consequence, McNamara, LaVigne and Martin (2016) demystify that institutions are faced with the challenge of retaining experienced staff that are meant to play the role of mentoring new graduates. According to Graetz (2016), the current regime embraces millions of millennials who require adequate coaching for successful transitioning. Monrouxe et al. (2018) reveal that the inability of these organizations to offer their novices with effective mentorship opportunities leads to an increase in turnover.
Novice RNs experience fatigue when transitioning to clinical practice. According to Levine and Johnson (2014), role ambiguity contributes to significant levels of burnout among practicing nurses. On the other hand, Waddell et al. (2015) reveal that professionals are disconnected from their work and teams in instances where they are faced with workplace burnout. Further, Fetherstone, Browne, Andrus, and Batt (2017) explain that immense burnout imposes detached operations among novices. Levine and Johnson (2014) demystify that nurses depicting stress and detachment from their environments of work yield poor performances which may affect their patients in an adverse way.
Hoffler and Thomas (2016) describe workplace bullying among new nurses as a dominant challenge in the global healthcare environment. According to Gordon et al. (2018), the issue of workplace bullying limits a new graduate nurse’s ability to foster effective socialization. On the other hand, Allen (2016) reveals that long serving practitioners tend to bully their new counterparts in order to maintain control. Consequently, Ellis et al. (2017) demystify that leaders in the health care system are faced with the obligation of providing their employees with an environment that contributes to their wellbeing; an aspect that calls for inclusion of proper strategies of minimizing bullying.
Most of the registered graduate RNs transitioning into clinical practice are not well prepared to face the obligations presented by their workplaces (Romano, 2018). As a consequence, Reem, Kitsantas and Maddox (2014) reveal that such novices depict professional gaps in offering their clients with crucial clinical services such as monitoring patients and identifying vital signs. According to McNamara et al. (2016), graduate RNs are overly reliant on technologies such as the internet when making vital observations rather than advancing the necessary competencies in this field. Ellisn Wilkinson, Kesten, Anderson, Lyons, and Bondmass (2017) reveal that such inadequacies limit the ability of these novices to foster professional adjustments from a student to an independent RN; an aspect that emanates into “transition shocks”.
Hoffler and Thomas (2016) identify the transiting graduate RNs’ inability to foster effective communication as a practical social issue experienced by novices. According to Waddell et al. (2015), graduate RNs are faced with the obligation of interacting with a wider range of people such as patients, team members and colleagues. Further, Schroyer, et al. (2016) demystify that graduate novices tend to struggle in their communications with nurse managers and other healthcare stakeholders due to their inefficient social skills. Such social limitations expose new graduate RNs to crucial operational vulnerabilities that may compromise with the safety of their clients.
While novice registered RNs are faced with multiple challenges when they transition to clinical practice, the current study avails the strategies that need to be applied to position these new graduates for operational efficiencies in their areas of engagement. The ensuing paragraphs present the strategies to be adopted by stakeholders in the Australian healthcare system in order to enhance the novice RNs experiences.
There is need for healthcare organizations to include nurse mentorship dockets aimed at enhancing graduate novice RNs’ retention rates and intent to stay in their institutions. According to Missen et al. (2016), incorporation of structured approaches in organizational settings play a significant role in fostering a new nurse’s ability to inculcate competence, autonomy and confidence in their engagements. According to Gordon et al. (2018), professional advancement among novices is enhanced through inclusion of a working environment that fosters collaboration between new entrants and long serving members of the system. Sheppard-Law et al. (2018) reveal that the competency of graduate RNs increase after they are engaged in a mentorship program.
The Australian healthcare system is faced with challenges such as an increase in the complexities depicted by different patient populations and tight regulatory regimes. As a consequence, new graduate RNs transitioning to clinical practice are faced with the obligation of ensuring that they are effective in synthesizing evidence-based data by cultivating their critical thinking skills (Allen, 2016). Further, Monrouxe et al. (2018) reveal that workplace environments need to be designed in such a way that they enhance the novices’ ability to practice translational research, enhance their leadership skills, comprehend the changes depicted by the medical landscape, understand the significance of adopting quality care and develop their leadership abilities. On the other hand, Hofler and Thomas (2016) reveal that leaders in these systems must be considerate when setting the processes, goals, and expectations needed to guide novices.
Healthcare institutions need to engage new RNs in their decision making processes as a way of building an environment that fosters inclusivity. Graetz (2016) demystifies that proper engagement of new practitioners in making decisions concerning the issues that affect them in a direct way plays a crucial role in inculcating their abilities to cope up with workplace stressors. On the other hand, Fetherston et al. (2017) advocate for inclusion of strategies aimed at promoting shared governance as a way of bringing forth the platforms needed to foster discussions on the issues that affect the RNs’ practice. According to Waddell et al. (2015), nurses feel empowered when they are actively involved in the decision making endeavors of their institutions. On the other hand, Allen (2016) advocates for inclusion of inter-professional decision making strategies as a way of promoting an atmosphere that enhances confidence and respect among institutional stakeholders.
Effective communication among new graduate RNs needs to be strengthened through incorporation multi-disciplinary interactions in their scholarly curricular. Reem et al. (2014) explain that such a strategy plays a significant role in establishing friendly interactions among professionals drawn from different areas of practice. Consequently, the graduate RNs will have the chance of communicating with other members in team settings and transpose the experiences acquired in clinical settings. On the other hand, Ellis et al. (2017) advocate for inclusion of systematic communication instruments in transition programs aimed at developing graduate RNs into effective correspondents when entering into practice.
Conclusion
The study undertakes a critical analysis of the experiences presented to new graduate RNs as they transit into clinical practice in the ever changing healthcare environment. Based on the research established, graduate novices experience workplace bullying, stress and fatigue, increasing number of patients with chronic conditions and an increase in workload as the major professional challenges. In particular, the research identifies lack of supportive relationships in healthcare stings as an issue that heightens anxieties and therefore, immense attrition. On the other hand, the scholarly material identifies knowledge deficit among new RNs as an aspect that limits their ability to foster healthy interactions.
Despite the challenging experiences, the study identifies multiple strategies of ensuring that new graduate RNs enjoy their workplace environments. For instance, the study recommends that organizations must include nurse mentorship dockets aimed at enhancing graduate novice RNs’ retention rates and intent to stay in their institutions. Further, medical institutions are faced with the obligation of engaging new RNs in their decision making processes as a way of building an environment that fosters inclusivity. Lastly, the research reveals that effective communication among new graduate RNs needs to be strengthened through incorporation multi-disciplinary interactions in their scholarly curricular as a way of fostering healthy interactions.
References
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Fetherston, C. M., Browne, C., Andrus, P., & Batt, S. (2017). Renewal of an entry to practice baccalaureate nursing curriculum: Adapting to complexity. Journal of Nursing Education and Practice, 8(2), 104.
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