2 paragraph article summary

May-June 2018 • Vol. 27/No. 3 199

Sonya Blevins, DNP, RN, CMSRN, CNE, is a Member of the MEDSURG Nursing Manuscript Review Panel, Simpsonville, SC.

From Nursing Student to Registered Nurse: The Challenge of Transition

M aking the transition from nursing student to registered nurse (RN) is an exciting yet over- whelming time for new graduates. The new

role includes increased responsibilities and socialization to the profession. Making the transition comes with var- ious highs and lows, impacting the nurse’s confidence, retention, and tenure in the profession (Maria, Mei, & Stanley, 2017). Literature often reviews what healthcare facilities need from new graduate nurses; however, it is important to analyze what new graduate nurses need to be successful in transitioning to their new role.

Why Should We Listen? The nursing shortage is not improving. The need for

more nurses is growing, expected to persist through 2025 due to increased retirement of experienced nurses and the number of aging patients requiring more com- plex care (Kacik, 2018). The U.S. Bureau of Labor Statistics (2017) projected 1.09 million nurses will be needed by 2024 due to nursing replacement and health- care growth.

Training of nurses is expensive, ranging from $37,700 to $58,400 per nurse. In some states, the range can be higher (The University of New Mexico, 2016). According to The University of New Mexico, 17.5% of newly licensed nurses only work for 1 year while 43% of newly licensed nurses leave the hospital within 3 years of starting. Financially, this has a negative impact on hospitals. Each year, the loss of these nurses costs hospi- tals $5.2-$8.1 million. This attrition of newly licensed RNs is not limited to the United States. Australia, Canada, and the United Kingdom face the same issue (Murray-Parahi, DiGiacomo, Jackson, & Davidson, 2016).

Promoting Success Issues with successful transition to professional prac-

tice were identified in the 1970s. Kramer (1974) defined the issue as reality shock, referring to the difference between preparation in academia and integration into practice (Ankers, Barton, & Parry, in press; Mellor & Gregoric, 2016). More recently, the term as been rede- fined as transition shock. While academia can prepare students for some realities of practice, it cannot prepare for all of them. Increased communication and partner- ships between academia and hospitals can identify gaps

and develop plans to address them (Murray-Parahi et al., 2016).

The transition from nursing student to RN is a grad- ual process. Expertise in nursing comes over time. Upon graduation, these nurses cannot simply hit the road running. A transition period has to be allowed to pro- mote success and retention in nursing (Mellor & Gregoric, 2016). The transition process is facilitated by two main concepts: structure and socialization (Ankers et al., in press). Continuous support is needed as a part of both concepts.

Structure Throughout the United States, nurse residency pro-

grams have provided a structured approach to integrate new RNs into the hospital as well as the nursing profes- sion. In other countries such as Australia, they are called transition programs (Ankers et al., in press). These pro- grams enhance nurses’ critical thinking skills and pro- mote a comradery among them as they go through the same stress and emotions. Just as with simulation, resi- dency programs provide a safe environment in which nurses can share experiences and debrief (Mellor & Gregoric, 2016). Nurses share experiences and ask for guidance on how to handle unfamiliar situations. Mellor and Gregoric suggested nurse residency educa- tors role play situations and offer assistance in how to best address them. By working with the nurses, educa- tors also can increase their confidence in dealing with unfamiliar situations.

Socialization Working as an RN occurs in a much different envi-

ronment than college. New nurses thus need to be socialized not only to the profession but also to their clinical units. They are the most vulnerable during this transition time. Without effective socialization, new nurses may get discouraged, impacting their productiv- ity and engagement in patient care. This discourage- ment can cause them to leave the profession (Murray- Parahi et al., 2016).

A support system is important. The unit nurse educa- tor, preceptor, and fellow staff should be engaged in the development of new nurses to promote their success. New nurses feel comfortable in seeking advice from individuals who demonstrate a level of caring and approachability. When they have questions, new nurses appreciate interaction and explanation of processes so they can learn further. When these actions are done,

Nurses as Educators Sonya Blevins

May-June 2018 • Vol. 27/No. 3200

new nurses believe they can become an effective part of the team. In turn, their anxiety is reduced and their engagement on the clinical unit increased (Ankers et al., in press).

One of the most difficult situations new nurses expe- rience is lateral violence in the workplace. The notion that some nurses eat their young may increase the anx- iety of new nurses while making them feel isolated. New nurses need to feel encouraged even if they make a minor error. In handling these situations, the new nurse critically needs the support of the unit nurse educator and preceptor. If a positive relationship has been devel- oped between new nurse and preceptor, the nurse will feel comfortable in mentioning any situations where lateral violence is occurring. The issue thus can be addressed instead of being a constant problem in the workplace (Leong & Crossman, 2015).

The Preceptor An effective preceptor makes a tremendous difference.

When hiring a new graduate, the manager should select as preceptor a nurse who has the desire as well as training in effective methods of precepting. Consistency of pre- ceptors is important because the new RN may train on multiple shifts. When multiple preceptors are used, new nurses may perceive they are being passed around with no structure or consistency of guidance. Having assigned preceptors allows the development of a relationship in which the preceptor can assess the growth of the new nurse over time and provide constructive feedback on areas of strength and opportunity. The feedback should be consistent, with areas of need identified early so cor- rective training can occur (Mellor & Gregoric, 2016). In this relationship, the preceptor builds the level of confi- dence of the new nurse (Maria et al., 2017). Knowing the areas of strength and opportunity allows the preceptor to build the new nurse’s patient assignment gradually. The acuity and number of assigned patients can be increased as the new nurse achieves specific orientation milestones (Ankers et al., in press).

Conclusion As a new RN enters practice, a great deal of transition

occurs during acclimation to the profession. Hospital leaders must understand the needs of these nurses so the orientation provides a positive environment of growth and development. Benefitting from structure and an effective support system, new nurses have the resources to be successful (Phillips, Kenny, & Esterman, 2017). Not only does this further their growth, but it enhances the function of the clinical unit.

REFERENCES Ankers, M.D., Barton, C.A., & Parry, Y.K. (in press). A phenomenological explo-

ration of graduate nurse transition to professional practice within a transition to practice program. Collegian, 1-7. doi:10.1016/j.colegn.2017.09.002

Kacik, A. (2018). Nursing shortage will continue to pinch hospital margins. Retrieved from http://www.modernhealthcare.com/article/ 20180307/ NEWS/180309921

Nurses as Educators

Kramer, M. (1974). Reality shock: Why nurses leave nursing. Philadel phia, PA: Mosby.

Leong, Y.M.J., & Crossman, J. (2015). New nurse transition: Success through aligning multiple identities. Journal of Healthcare Organi zation and Management, 29(7), 1098-1114.

Maria, H.S.Y., Mei, W.L., & Stanley, L.K.K. (2017). The first year of professional nursing experience: The transition challenges faced by new graduate nurs- es. Paper presented at Global Healthcare Conference, New York, NY.

Mellor, P., & Gregoric, C. (2016). Ways of being: Preparing nursing students for transition to professional practice. Journal of Continuing Nursing Education, 47(7), 330-340.

Murray-Parahi, P., DiGiacomo, M., Jackson, D., & Davidson, P.M. (2016). New graduate registered nurse transition into primary health care roles: An inte- grative review. Journal of Clinical Nursing, 25(21-22), 3084-3101.

Phillips, C., Kenny, A., & Esterman, A. (2017). Supporting graduate nurse transition to practice through a quality assurance feedback loop. Nurse Education in Practice, 27, 121-127.

University of New Mexico. (2016). The high cost of nurse turnover. Retrieved from https://rnbsnonline.unm.edu/articles/high-cost-of-nurse-turnover.aspx

U.S. Bureau of Labor Statistics. (2017). Employment projections 2016-26. Retrieved from http://www.bls.gov/news.release/pdf/ecopro.pdf

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