Transitioning to professional clinical practice from graduate training comes with opportunities and challenges especially in an increasingly dynamic and ever-changing healthcare environment (Walker, Costa, Foster, & de Bruin, 2017). At the transitioning time, graduating nursing students possess with them a mixture of feelings and are often confused yet anticipative of their new life in active clinical practice. Opportunities present platforms for learning and development in the nursing career while challenges present obstacles for successful transitioning. Most importantly young nursing students are caught in the dilemma of figuring out how to merge the gap between applying classroom theory to active professional practice with its complex and multifaceted perspectives.
However, with adequate transitioning strategies in place, healthcare institutions can help young nursing graduate successfully transition into active professional nursing practice. In an increasingly dynamic and ever-changing healthcare environment in Australia, the demand for nurses is the only factor that remains unchanged. This is because of the ballooning Australian population and the fast retirement of older registered nurses from active nursing practice (Ostini & Bonner, 2012). To this end, coming up with formidable transitioning mechanisms that can assist fresh graduates to transition rather fast in the nursing profession can go a long way in filling these gap. The focus of this paper is to extrapolate the experiences of the new graduate registered nurses as they transition to clinical practice in an ever-changing healthcare environment.
Like has been mentioned, transitioning from graduate training in colleges and universities to clinical practice will always advance fresh graduates with challenges and opportunities that if well exploited can help novice nurses get accustomed in the profession. Challenges include facing high workload due to an increasing number of patients with complex healthcare conditions, generational diversity of the healthcare workforce, lack of adequate support systems, performance anxiety, intimidation and bullying from experienced practitioners, social isolation, applying theory into practice, ethical dilemmas, and concerns of professional misconduct (Hofler, & Thomas, 2016). More shockingly, these challenges present simultaneously. To this end, these challenges can be overwhelming besides having the potential of leading nurses into extreme fatigue and feeling of stress and anxiety can set in during the transition period leading to attrition. However, with adequate transitioning strategies in place, registered nurses can be in a position to build enduring resilience to easily overcome these transitioning challenges (Laschinger, (2008).
On the other hand, the transitioning period presents young graduates with an opportunity to learn and develop in the nursing career (Hussein, et al., 2017). It is basically a period in which nurses can utilize to merge their classroom learning experience with actual workplace experience by endeavoring to employ nursing theory to real workplace practice. Moreover, the transitioning period is a time when registered nurses can build relevant resilience in tackling various workplace adversities, challenges, and trauma (Murray?Parahi, DiGiacomo, Jackson, & Davidson, 2016). Furthermore, transitioning nurses can utilize the experiences during transitioning to get accustomed with the nursing profession requirements such as issues concerning professional misconduct; workplace health, safety and wellbeing; nursing professional standards, codes, ethics and other legal concerns; conflict management; nursing leadership; and nurses’ role in providing compassionate care through various clinical approaches. To this end, comprehensively understanding the opportunities and challenges of transitioning in becoming registered nurses in an ever-changing Australian healthcare environment can go a long way in assisting nurses to settle in the profession with a lot of ease and with vigor (Fedoruk, & Hofmeyer, 2012).
Thomas, Bertram, and Allen, (2012) observe that Australian healthcare system’s policymakers, educators and healthcare administrators ought to continuously find viable solutions to promote and ease the transitioning experience of undergraduate nurses to become registered nurses. Indeed, Bennett, Barlow, Brown, and Jones, (2012) assert that with the increasing dynamism in the Australian healthcare industry in which case there is an increasing shortage of nurses which is mismatched with the increasing demand for health care services; and there being an alarming aging nursing workforce, transitioning of undergraduate nurse students to become registered nurses is very fundamental to merge the gap. These factors are responsible for causing pressures to healthcare organizations and therefore successful strategies of staff recruitment, transitioning and retention are critical in solving the shortcoming the Australian healthcare system faces.
However, McDonald, Willis, Fourie, & Hedgecock, (2009); Missen et al., (2015) contend that transitioning from undergraduate student nurse to become registered nurses is quite stressing and challenging to most novice nurses. For instance, in a study conducted by Hegney, Tuckett, Parker, & Eley, (2010), transitioning nurses experienced workplace bullying, intimidation and abusive behaviors from their senior healthcare practitioners in their first six months into their nursing profession. Moreover, Skancke Bjerknes and Torunn Bjork (2012) contend that most graduate registered nurses experience an unsupportive workplace environment that leads them to feel isolated, unwanted and more so doubtful of their healthcare delivery performance. Bogossian, Winters-Chang, and Tuckett, (2014) assert that nurses are very primary healthcare practitioners though they experience a high rate of workplace trauma, stress, and burnout. Bennett, Barlow, Brown, & Jones, (2012); Duchscher (2009) contend that nurses earliest experiences can be described as a “reality shock” and “transition shock”.
This is because most novice nurses’ undergraduate transitioning expectations are not met by the realities in real practice. Bennett, Barlow, Brown, & Jones, (2012) assert that the transitioning constitute complex and multifaceted changes, expansive differences between expectations and responsibilities and complexities that only well-structured transitioning methodologies can solve. Walker, Costa, Foster, & de Bruin, (2013) contend that even though undergraduate nurse student is well aware of the nursing professional misgivings along its steep learning curve, they also expect the healthcare organizations’ administration to advance a favorable transitioning environment that not only nurtures skills and experience they possess but also that that allows them to settle smoothly in the profession. Globally, registered nurse programs and formal preceptorship programs of about one year have been labeled as instrumental in effective transitioning and retention strategies for undergraduate nurse students (Whitehead et al., 2013).
The Australian nurses complete three years of undergraduate training in order to start off as registered nurses in employment. Upon graduation and effectively moving ahead to transition to active nursing practice, novice nurses are supposed to be subjected to these programs to secure their successful transition even though they are not mandatory. Australia’s transitioning support systems for graduate nurses are by and large variable with regard to different healthcare settings and actually range from informal to formalized programs. Missen, McKenna, & Beauchamp, (2016) assert that little has been done to institute consistent support systems for transitioning and integration of graduate nurses into the nursing profession. In a qualitative literature review that involved registered nurses transitioning experiences in an international context, Teoh, Pua, and Chan (2013) deduced that graduate nurses always yarn for support systems that are premised on three themes; structured graduate and orientation programs; matching graduate students’ expectations with realities of clinical nursing practice; and the significance of positive health facility administration support.
The ability to adapt to workplace resilience is very critical in the nursing profession following the trauma, adversities, and challenges that come with the nursing profession. This is especially the case for transitioning nurses to allow them to get accustomed to the professions’ realities from rather an early onset (Chang, & Daly, 2016). To this end, healthcare institutions must put in place adequate transitioning mechanisms for the same to allow novice nurses to transition smoothly. Shipman (2014) observe that healthcare institutions can adopt transitioning strategies such as providing graduate nurses orientation periods, availing positive and welcoming environments, and coming up with support mechanisms such as the assigning of mentors and couches to novice nurses.
Moreover, taping from the opportunities presented by interdisciplinary and multidisciplinary teams, novice nurses can have an opportunity to not only learn how various nursing procedures are done but also exploit chances of further integrating, and socializing with existing healthcare practitioners. Healthcare institutions can also devise and institute novice friendly performance appraisals to measure and evaluate the performance of graduate nurses and by extension using the findings to guide and further orient them in the nursing profession. Tuckett, Eley, and Ng, (2017) observe that such strategies are instrumental in creating a positive transitioning experience for novice nurses which by extension assist them to grow professionally instilling them competence and confidence.
Skancke Bjerknes and TorunnBjork, (2012); Halfer, Graf, & Sullivan, (2008) contend that graduate nursing programs such as “internship” and mentorship policies are critical in helping to graduate nursing students to adopt in a healthcare environment that is not only ever-changing and dynamic but also that is full of workplace health and safety concerns. Through such programs, nurses are in a position to develop resilience mechanisms against various nursing adversities, trauma, and challenges and by extension exploiting opportunities for future professional career development. Moreover, clinical focus programs and transition to specialty practice programs can go a long way in assisting novice nurses to settle in their respective specialization in a rather fast way than when generalized training are offered (Morphet, Considine, & McKenna, 2011)
Some of the novice’s transitioning challenges and concerns include merging theory to practice, time management, patient assessment, patient care, effective clinical decision making, ethical dilemmas, performance anxiety, effective planning and formulation of care plans, effective medication prescription, accountability and many more. According to Haggerty, McEldowney, Wilson, & Holloway, (2010) engaging novice nurses in an on job training programs such as a yearlong Career Development Program or a Nurse Entry to Practice (NETP) program can go a long way in assisting them transit and effectively settle in the roles as registered nurses. Apart from this formalized support systems, healthcare organizations can also encourage novice nurses to exploit personal strategies that can assist them to transition with ease into the nursing profession. Transiting nurses are supposed to exploit their own internal strengths such emotional intelligence; intrapersonal and interpersonal intelligence, problem-solving skills; effective communication; and nursing leadership skills to help themselves accustomed into an ever-changing healthcare system (Dyess, & Sherman, 2009).
Conclusion
Indeed, transitioning into active clinical practice by new registered graduate nurses can be a daunting task that if unchecked can jeopardize the efforts and objectives of nursing students to become registered nurses. Even as such, if the opportunities and challenges the transitioning period presents are fully exploited from a positive light, then novice nurses can have an enjoyable time during this time. New registered graduate nurses are supposed to exploit their transitioning period to learn the dynamics of an ever-changing Australian healthcare industry and align their capabilities with the impending opportunities and challenges in order to live by the promise of the nursing profession. At the transitioning time, graduating nursing students possess with them a mixture of feelings and are often confused yet anticipative of their new life in active clinical practice. As such health care organizations ought to come up with adequate but relevant transitioning strategies and policies to assist graduate nurses to settle in their respective career paths under a resilience footing.
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