Introduction
Despite completing a degree and studying for three-plus years, graduate nurses often find it difficult to transition into registered nurse. Having so much support throughout their degree, it can sometimes be a shock to the system for a graduate registered nurse when finally taking full responsibility for patients, as well as completing tasks and delegating. Even though, the graduate may feel that they have learned tasks whilst at university, these tasks may be a lot more difficult to complete than the graduate thought, because of this the graduate nurse may develop feelings of insecurity and hopelessness as they feel like they may not “have enough knowledge”. It is often that graduate registered nurses describe feelings of being unprepared for their new profession. The feelings that a graduate registered nurse can feel when faced with these transitional challenges range from somewhat uncomfortable to highly shocking. Having these feelings can not only affect the individual but it can have an impact on staff retention in the workplace. This essay will be based on a case study of a graduate who begins her new job within a busy medical ward and will consider the transition challenges and the coping strategies required by the graduate to overcome these. As well as this, the essay will critique conflict and change management strategies within organization cultures and how this can impact all members of the multidisciplinary team, and define the scope of practice and the delegation roles of the registered nurse and how to use them within the nursing profession.
Transitioning from a nursing student to a registered nurse has proven to be a difficult transition. Studies show that new graduate nurses were not adequately prepared to assume the role of a nurse (Saifan, AbuRuz & Masa'deh, 2015, p.20). As the new graduate nurse Karen Is faced with transitional challenges whilst entering the workforce. One of these challenges is the theory-practice gap. The theory-practice gap is known as the gap between “what is taught” and “what is practiced” (Saifan, AbuRuz & Masa'deh, 2015, p.21). There is clear evidence of difficulty with what a student learns by theory and what they practice when faced with a real-life scenario (Saifan, AbuRuz & Masa'deh, 2015, p.27). What is taught in a classroom can never truly resemble what happens in real life (Falk, Falk & Jakobsson Ung, 2016, p.14). It can never give a fully comprehensive explanation in nursing application to practice, nor can it give a real picture of the patient’s current status (Monaghan, 2015, p.2). When in nursing clinical practice, the student is given scenarios that resemble real-life scenarios, and although this is helpful for the student it can never truly resemble what is going to happen at that point in time when in the clinical field (Jamshidi, Molazem, Sharif, Torabizadeh & Najafi Kalyani, 2016, p.1)
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As the new registered nurse Karen was faced with a patient that needed to be hoisted, as Karen had performed this before in clinical nursing practice she felt like she would be able to complete this task alone. Although, this patient was complex as they have had recent major abdominal surgery as well as, intravenous therapy, an indwelling catheter, a wound drain, and a large incision at the operation site. As Karen was getting Mr. B in the hoist she accidentally got all his attachments caught in a tangle causing the patient quite a bit of pain. It is evident that in this scenario Karen is currently struggling with a theory-practice gap, due to the fact that although this has been completed plenty of times before in a clinical setting, when faced with a real-life scenario with more complexity it becomes difficult to perform the same task. Linking theoretical information with practice is found to be one of the challenges for many nursing students in their current study period. Many new graduate nurses explained that they are not sure how to exactly link their information to clinical scenarios and that theoretical education is in one world whilst practice was in another (Reference).
Reality shock
Another challenge that most students face when transitioning from a student nurse to a registered nurse is reality shock. Transitioning from a newly graduated nurse to a registered nurse Is considerably challenging, to say the least. As healthcare is always advancing and undergoing complex change, it can become a significant burden to a new graduate nurse (p.106). Reality shock is found to be experienced by the majority of new graduate nurses and is described as a reaction to different emotions (p.107). Some emotions that a graduate nurse may feel when experiencing reality shock are doubt, confusion, disorientation, and constant feeling of loss (p.111). As graduate nurses they feel as reality shock is highly avoidable, as it is never truly understood due to the inconsistency between what was expected of them before and what is expected of them now they are in the workforce (Reference). Graduate nurses fear being ‘exposed’ as incompetent and portrayed as they cannot providing safe care, and fear not being able to cope with their responsibilities, ultimately they fear rejection from the multi-disciplinary team (Reference). Studies show that new graduates discussed that when commencing on their wards they found the increase in responsibility and the upskill needed to complete certain tasks which the new reality surprised and overwhelmed them (Reference). Some new graduate nurses even described that it got to the point where they were not listening to their patients and were too focused on completing tasks (Reference). In the scenario provided it was evident that Karen was aware of the task on hand, and what needed to be done but was not aware of how to complete the task for that particular patient. Karen felt reality shock and began to fear what the team might think of her if she was to ask for help with what she thought was a ‘simple’ task. These types of transitions occur due to a lack of professional and emotional support for the new graduate nurse, it also occurs due to a lack of confidence, the uncertainty of a new environment, and unrealistic performance and expectations. (Reference). A solution for Karen in this particular scenario would be to put aside her lack of confidence and ask for help, or go home and continue learning about the expectation and safety of manual handling of patients. It would also come as a benefit for the hospital to provide education programs to prepare nursing students with the knowledge and skill base needed before starting their new role (Reference).
OHS
When new graduate nurses prepare to start their new roles, they undergo training in regard to occupational health for nurses and patients. Occupational health and safety provide employees with guidelines to protect the safety, health, and welfare of themselves and their patients (Reference). Occupational health and safety also provide nurses with guidelines to protect their mental well-being whilst at work. It is just as important as ensuring that nurses protect their mental well-being, as well as their physical health (Reference). Looking after the mental well-being of employees provides for a positive workplace and decreases the likelihood of mistakes being made (Reference).
In the scenario, Karen is faced with a difficult situation between herself and her patient, as a new graduate nurse Karen feels like she cannot ask for help as her team might look at her as incompetent, therefore goes ahead with moving the patient. As Karen moves Mr. B, she accidentally gets all of his attachments caught and causes the patient quite a lot of pain. It is evident that during this situation that Karen was faced with reality shock, and chooses not to ask for help, during this time of shock she proceeds with moving the patient and not only put herself in danger but the patient.
Nursing education has evolved over the years to provide an excellent education for student nurses and support them to have a better transition (Kim, Yeo, Park, Sin & Jones, 2018, p.206). Although, because of the theory-practice gap and reality shock, the initial experience of newly graduated nurses is not positive (Kim, Yeo, Park, Sin & Jones, 2018, p.107). Studies show that because of the real shock and the theory-practice gap around 13 percent of new graduate nurses changed their jobs within a year, and 26 percent of new nurses quit within 2 years (Kim, Yeo, Park, Sin & Jones, 2018, p.111). As for this, it is important as a new graduate nurse that positive coping strategies and skills of resilience are absorbed in order to keep good new graduate nurses in the profession. As a new graduate nurse, it is important to work on skills of resilience as well as development strategies. Resilience is a skill that provides the ability to overcome a stressful situation (Wahab, Mordiffi, Ang & Lopez, 2017, p.52). Using resilience enables the individual to emerge stronger, perform better, and become more confident and self-efficient (Wahab, Mordiffi, Ang & Lopez, 2017, p.52). Resilience will assist healthy, well-adjusted individuals and overall enhance their abilities and improve overall job satisfaction (Stephens, Smith & Cherry, 2017, p.278). It is evident that as a graduate nurse, these areas definitely lack. Therefore, the importance of advancing resilience and coping strategies is paramount to ensure the safety of the nurse and the patient (Barratt, 2018, p.43). Strategies to consider as a new graduate nurse to improve resilience within the workplace would be to establish a supportive workplace culture by treating colleagues with respect, ensuring the need to reflect together as a team, always working for change, and remaining hopeful when times get challenging (Barratt, 2018, p.47). Once the ability to identify, enhance and or/ develop certain factors and strategies is developed, new graduate nurses will be better equipped to effectively manage stress within the workplace (Yu & Lee, 2018, p.352).
As well as developing resilience, it is important to consider positive coping strategies to overcome the real shock and the burnout that new graduate nurses experience.
Conclusion
It is clear that the prevalence of reality shock for new graduate nurses is high. It is becoming more of a common situation for graduate nurses to feel overwhelmed during their first year. As a student nurse, it is evident that there is a strong feeling of hopelessness and the need for change when starting in a new nursing position. It is common for them to feel like they are in the wrong career and that they are not efficient enough for this position. Therefore, as students and teachers, it is recommended that resilience and coping strategies are used to overcome the fear and struggle of reality shock. If this is implemented throughout universities and hospitals that take a large number of graduate nurses, it could reduce the likelihood of new nurses quitting. This essay has outlined reality shock, the theory-practice gap, the occupational health and safety of reality shock, and the coping strategies that could be used as a graduate nurse to overcome certain situations.
References
- Saifan, A., AbuRuz, M., & Masa'deh, R. (2015). Theory Practice Gaps in Nursing Education: A Qualitative Perspective. Journal Of Social Sciences, 11(1), 20-29. doi: 10.3844/jssp.2015.20.29
- Monaghan, T. (2015). A critical analysis of the literature and theoretical perspectives on the theory-practice gap amongst newly qualified nurses within the United Kingdom. Nurse Education Today, 35(8), 1-7. doi 10.1016/j.nedt.2015.03.006
- Falk, K., Falk, H., & Jakobsson Ung, E. (2016). When practice precedes theory – A mixed methods evaluation of student's learning experiences in an undergraduate study program in nursing. Nurse Education In Practice, 16(1), 14-19. doi 10.1016/j.nepr.2015.05.010
- Jamshidi, N., Molazem, Z., Sharif, F., Torabizadeh, C., & Najafi Kalyani, M. (2016). The Challenges of Nursing Students in the Clinical Learning Environment: A Qualitative Study. The Scientific World Journal, (1), 1-7. doi: http://dx.doi.org/10.1155/2016/1846178
- Kim, E., Yeo, J., Park, H., Sin, K., & Jones, C. (2018). Psychometric evaluation of the Environmental Reality Shock-Related Issues and Concerns instrument for newly graduated nurses. Nurse Education Today, 61, 106-111. doi 10.1016/j.nedt.2017.11.003
- Wahab, S., Mordiffi, S., Ang, E., & Lopez, V. (2017). Light at the end of the tunnel: New graduate nurses' accounts of resilience: A qualitative study using Photovoice. Nurse Education Today, 52, 43-49. doi 10.1016/j.nedt.2017.02.007
- Stephens, T., Smith, P., & Cherry, C. (2017). Promoting Resilience in New Perioperative Nurses. AORN Journal, 105(3), 276-284. doi 10.1016/j.aorn.2016.12.019
- Barratt, C. (2018). Developing resilience: the role of nurses, healthcare teams and organizations. Nursing Standard, 33(7), 43-49. doi: 10.7748/ns.2018.e11231
- Yu, M., & Lee, H. (2018). Impact of resilience and job involvement on turnover intention of new graduate nurses using structural equation modeling. Japan Journal Of Nursing Science, 15(4), 351-362. doi: 10.1111/jjns.12210
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