The Experience of Transition of an RN into an Organisation

Continuing lifelong learning to enhance the individual scope of practice and clinical knowledge following the transition to the role of a registered nurse.

Abstract

Newly graduated and registered nurses often face a lot of challenges that have an impact in the way they successfully transition from academics to practice. Most of the health care organisations around Australia need to understand how the changes in the health care landscape impact newly registered nurses, and how they transition to the working environment.

This article examines the perceptions of newly registered nurses during their transition from graduation as students to working as staff members in health institutions around Australia. There has been  increasing need to find the right strategies that will assist to make this transition healthy, enjoyable as well as productive in the developmental career of the freshly registered nurses. A comprehensive investigation of secondary sources of data will be examined with various databases searched. Several themes will be discussed in this article and some of which include developing a sense of belonging, independence and mentoring programs.  Fortunately, the literature also offers strategies which eventually position the new registered nurses for success. Nurse mentoring programs, Exploration of future career development alongside having a supportive clinical environment for a newly registered nurse will act as the main basis for this discussion (Zarata, Bailey & Jessica, 2010). The need for new graduates in the nursing field to achieve competency, autonomy, and confidence. To do this, the organisations have the responsibility to design well-structured strategies to develop the right kind of mentors who will play a vital part in the transitioning.  

Keywords

Nursing, newly registered nurse, transition 

Introduction

The transition of a student nurse to being a registered nurse is an aspect that can be fraught with different kinds of emotions.  Not only about happiness and excitement, but also anxiety, indecision, anxiety and fear. It can be a time where the graduates keep questioning their abilities, to whether the choices they have made are correct. The new student nurses may not be sure if they will effectively work as the experienced nurses in their new ward. This is a type of transition that is referred to as reality shock (Turner, 2018). With the thought that as a new nurse, there is a chance that they may hurt or kill a patient with wrong nursing interventions, a majority of student nurses find it hard to accept the reality within the work environment. 

However, it is common for new nurses to feel insecure as well as not very sure about their ability to be registered nurses in Australia. After shifts of excitement that have been accompanied by feelings of incompetence, insecurity and exhaustion, a student nurse may begin to question their ability to make informed decisions. Consequently, this could lead the nurse being overwhelmed by the demands of the new role given (Numminen et al., 2015) The nursing educators are perfectly positioned to support graduate nurses and make sure their ability to transition to the professional practice is ultimately a success.  

The significance of the issue

This topic is of importance to the registered nurse transitioning from being a student nurse as it examines their perceptions as registered nurses working in Australia. The nurses have been trained to work in different clinical settings within the country, and therefore, the topic prepares them to fully understand ways to make this transition healthy, enjoyable and productive (Ostini & Bonner, 2012). A review of the past literature within the Australian nursing setting highlights various issues during the transition period, out of which several themes emerged. These themes included, a sense of belonging for the nurse, preceptorship and mentoring program, allocation of a student, workplace bullying and independence. These are the main concerns that cause issues during the transition from a student nurse to a registered nurse in the Australian setting.  It is of utmost importance that other registered nurses become conscious of this transition and support whenever it is required (Turner, 2018).

Little attention has been given by the Nursing and Midwifery Board of Australia during the transition phase from the student nurse to a newly qualified registered nurse. Hence, this topic offers further investigations into the transition phase to make an evaluation of the on-going developments of the registered nurse within their workplace (Chang & Daly, 2015). Since most of the newly qualified nurses view the transition phase with mixed emotions of anxiety and excitement, the topic plays a leading role in providing guidance to what should be done during the transition.

 Discussion

According to Bennett et al., (2017) even qualified nurses are not expected to be fully aware of everything within the nursing profession. Key findings from the pieces of literature have established that to become a team member in the nursing field and adapt to the new environment, and it will take time considering the working shifts that will make a new nurse not meet all the staff right away.  On the hand, a qualitative study that was conducted by Natasha, (2013) explored how the student nurses develop their knowledge and skills within their eighteen months of practice as registered nurses. From the literature, there are factors that promote or to some extent affect newly registered nurses in their professional development. From the studies, it was found that the newly registered nurses could still be working their way to developing a sense of belonging to the new environment (Temple, 2012). They could also be dealing with issues of independence after being taken care of by their parents and guardians while at the universities. Exploration of future career development is also another possible challenge that was found to affect newly registered nurses. Therefore, the need to conduct more studies in order to ensure the transitional period is well explored to develop the professional ability of the newly registered nurses into full-time employment. It has also been found that the newly registered nurses have the need to feel that their voice is being heard. It is alright for the nurse to communicate and air out their concerns while in their new workstations, especially to their colleagues and other members of the health care team without the feeling of incompetence or expectations (Chang & Daly, 2015).

Aggar et al., (2017) found out that the presence of an understanding and supportive clinical environment for a newly registered nurse will play a vital role in enhancing their transition experiences in a considerable way. Nevertheless, a qualitative design study that was carried out by Ostini & Bonner, (2012) incorporated face to face interviews with the newly registered nurses found out that, due to constant rotation nature of the transition support programs, the newly registered nurses lack a sense of belonging.   Additionally, preceptorship and mentoring programs should be able to aid the new nurses adjust well to their environment.

Most hospitals are seeing more patients streaming in with complex chronic conditions. In major cities such as Melbourne, Sydney, Perth and Brisbane, statistics have shown disproportionately increased rates of heart disorders, diabetes, cancer, obesity and mental health-related conditions (ACT Government, 2018). All these conditions can be attributed to the lack of the right access to primary care, inadequate access to preventive care alongside other socioeconomic issues. Most of the health care institutions in the country also recognise the fact that experienced nurses depart due to increased workloads, retirements, lack of mobility and increased ambulatory requirements (Chang & Daly, 2015). This makes it hard for most of the organisations responsible for leveraging new graduate staff to get the right mentors. For a long time, coaches have been essential to any possible transition. Therefore, the right mentoring relationship has to be established to ensure that the newly graduated nurses stand a chance to withstand the existing pressure within the workplace and gain the required experience to pass onto the subsequent generations to come (Darvill, Melanie & Leigh, 2018).   

Each of these challenges which amount to the main key findings of the literature individually can be quite problematic for the new graduates. Coming together without the right kind of strategies to mitigate, then new registered nurses face a situation in which it will be quite difficult to successfully transition from the schooling environment to a professional workplace environment.

Evaluation

Nursing professional bodies such as the Australian Nursing and Midwifery Federation, the Australian Primary Health Care Nurses Association, Nursing and Midwifery Board of Australia and the Australian Government Department of Health need to work hand in hand to formulate strategies that will be put in place to ensure new registered nurses feel they are in the right place (Zarata, Bailey & Jessica, 2010). 

For this to take place, the nursing professional bodies need to look at the stressful transition phases that are attributed to lack of enough experience at the workplace, development of new skills an innovations. The same extends to lack of organizational skills, various situations that involve interdisciplinary teams, reliance and lack of an effective support system. With this stressful transition phase aspects, it becomes difficult for the nurses to transition from being a novice to well experienced and vast in the field (Hodge & Varndell, 2018). It has been a common norm that most new graduate registered nurses are allocated students at the time when they themselves are getting to acquaint themselves with the new work environment. For this reason, the right strategies need to be formulated to allocate the new graduates with experienced nurses to enable them to grip their new roles (Darvill, Melanie & Leigh, 2018).

Notably, bullying and violence have for a long time been a factor of stress in most Australian health care facilities. Most of the new nurses feel undervalued and neglected, and some even face unjust criticism. Developing and understanding a newly registered nurse’s goals and planning will enable educators and professional bodies in Australia to provide a more clear structure through their transition period. Once the goals have been established and communicated, educators can then collaborate with the newly registered nurses to plan and implement the strategies with a view that they have achieved their professional goals. 

Another strategy is understanding learning styles of the graduate nurses. These will positively contribute to a much smoother transition to practice (Temple, 2012). With the right learning styles while in practice, the nurse will be better supported in the commencement of a lifelong learning as well as continued professional development while working.

Professional bodies have the duty of providing the right frameworks within which they have the ability to design a supportive development program as well as a transition towards the new practice toolkit for the student registered nurse. Creating a supportive professional; the environment is a strategy that is effective for a smooth transition (ACT Government, 2018). The relevant bodies can facilitate these by providing reassurance to the new nurses and scheduling time for follow-up support throughout their duration as newly registered nurses. Ensuring initial communication with the graduate nurses remains well inviting, approachable and welcoming is a good strategy that can be developed to act as a promoter to transition. The same goes for being available to answer any questions that the newly registered nurses may be having in a face to face fashion (Natasha, 2013).

Another significant strategy that arises from the discussion is the provision of constructive and timely feedback that will ensure the newly graduated nurses understand the position in which they are from the time they got registered. The feedback must be delivered in a constructive manner and should be timely to avoid anxiety. In any case, the right person is not present to observe how a nurse is performing, the boards should encourage and recognise feedback from the peers (Darvill, Melanie & Leigh, 2018).   

Conclusion

From the discussion and evaluation of this journal, it can be concluded that most of the newly registered nurses needed specific support systems, independence and helped to develop a sense of belonging to enhance and improve their transition from being student nurses to staff nurses. However, it has been noted that certain weaknesses that are associated with support networks within Australia led by lack of belongingness and dissatisfaction at the place of work affect the transition period of most newly registered nurses. Preceptorship and other mentoring programs need to be used to support and aid the newly graduated nurses to transition. This are aspects that are highly valued by the nurses especially when the right strategies are used in their implementation.

The Australian health care environment possesses a lot of challenges in assuring that the general nursing workplace is able to meet the demands of the delivery systems. The need to have a well skilled new generation of nursing professionals is unprecedented. With the strategic implementation of specific programs that largely focus on building new nursing graduates’ confidence as well as their competence goes a long way into helping make the transition from academic to practice successfully. The various bodies within Australia charged with the responsibility of ensuring the country continues to have a sufficient number of well qualified nurses to meet the growing need of the Australian citizens.

References

• ACT Government. (2018). Transition to Practice Program for Registered Nurses. Retrieved January 04, 2019, from https://health.act.gov.au/health-professionals/nursing-and-midwifery-office/transition-practice-programs/transition-practice
• Aggar, C, Bloomfield, J Tamsin H. T & Gordon, C. (2017). Australia’s first transition to professional practice in primary care program for graduate registered nurses: a pilot study. Retrieved January 05, 2019, from https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-017-0207-5
• Bennett, L, Leanne G, Grimsley, A & Rodd, J. (2017). The Gap between Nursing Education and Clinical Skills. ABNF Journal 28(4), 196 – 234.
• Chang, E & Daly, J. (2015). Transitions in Nursing: Preparing for Professional Practice. Amsterdam, Netherlands: Elsevier Health Sciences.
• Darvill, A, Melanie, S & Leigh, J. (2018). Transition to Nursing Practice: From Student to Registered Nurse. Melbourne: SAGE Publications.
• Hodge, A. &. (2018). Professional Transitions in Nursing: A guide to practice in the Australian healthcare system. Crows Nest, NSW: Allen & Unwin.
• Natasha, F. (2013). Clinical Supervision in Undergraduate Nursing Students: A Review of the Literature. e-Journal of Business Education and Scholarship Teaching, 7(1), 85-94.
• Numminen, O, Leino-Kilpi, H, Isoaho, H & Meretoja, R. (2015). Newly Graduated Nurses’ Competence and Individual and Organizational Factors: A Multivariate Analysis. Journal of Nursing Scholarship, 47 (5), 569-588.
• Ostini, F & Bonner, A. (2012). Australian new graduate experiences during their transition program in a rural/regional acute care setting. Retrieved January 4, 2019, from http://www.contemporarynurse.com/archives/vol/41/issue/2/article/4551/australian-new-graduate-experiences-during-their/
• Temple, J. (2012). Becoming a Registered Nurse: Making the transition to practice : Transforming Nursing Practice Series. Melbourne: SAGE Publication .
• Turner, D. (2018). Transition to Practice: Assisting Graduate Nurses. Retrieved January 04, 2019, from https://www.ausmedcorporate.com/transition-to-practice/
• Zarata, B, Bailey, M & Jessica H.(2010). Career Motivation in Newly Licensed Registered Nurses: What Makes Them Remain. The Qualitative Report 15(6), 123-162