Introduction
Transitioning from being a student nurse to becoming a staff nurse is a stressful period every graduate registered nurse (GRN) goes through. According to Flinkman and Salanterä (2014), during the first year of practice, many GRNs choose to abandon the profession for a variety of reasons, including poor practice environment, lack of support, and choosing nursing as a second-best profession. Parker, Giles, Lantry, and McMillan (2014) also mention that new graduates are unable to adhere to all the expectations of person-centered practice. The present paper describes GRN’s ability to work within their scope of practice and the implications of the matter.
Identifying the Issue
Working within one’s scope of practice is a central competence of all the care providers, including nurses. However, despite the nursing profession being one of Australia’s largest regulated workforces, its limits are poorly understood (Birks, Davis, Smithson, & Cant, 2016). While nurse practitioners’ (NPs’) standards of practice are described by the Nursing and Midwifery Board of Australia (NMBA, 2014), they are elusive and make it difficult to distinguish where the competence of an RN starts and ends. According to Birks et al. (2016), both NMBA and the international community fail to recognize an RN’s definite scope of practice. The boundaries are often context-driven and differ from one facility to another (Birks et al., 2014). The matter poses considerable difficulties for nurses to act within their scope of practice.
Inability to act within one’s scope of practice is a significant issue of GRNs. Unclear standards, lack of experience, low self-esteem, and insufficient guidance make them unable to limit their actions to meet the standards set by NMBA (Lima, Newall, Kinney, Jordan, & Hamilton, 2014). Such incompetence often leads to significant patient safety issues (Lubbe & Roets, 2014). Therefore, the problem is of extreme importance for person-centered care.
Associated Difficulties
Among all the difficulties GRNs face during their transition period, working within one’s scope of practice may be one of the most challenging tasks. As stated above, one of the reasons for the matter is the obscure nature of the scope of practice. While the general principles and expectations of RN’s work are clear, they may be confusing when it comes to situational decision-making. For instance, a beginner RN may be unsure if he or she should reinsert a nasogastric tube if it falls out. According to Jacob, McKenna, and D’Amore (2017), expectations may differ among universities and healthcare institutions. Such uncertainty may lead to hesitancy and delay in care delivery, which may cause patient safety issues (Lubbe & Roets, 2014). Therefore, GRNs need careful guidance during the transition period from learning to practice.
The assistance from senior RNs, however, may be unavailable for a variety of reasons. First, the global nurse shortage makes hospital units understaffed, which means that senior nurses have an intense workload (Albsoul, FitzGerald, Finucane, & Borkoles, 2019). Second, GRNs may have inadequately high expectations concerning guidance during their transition period (Mellor & Greenhill, 2014). Third, senior nurses often believe that GRNs should be competent in the matter despite the lack of relevant experience (Freeling & Parker, 2015; Jacob, McKenna, & D’Amore, 2014). As a result, beginner RNs may make inappropriate decisions, which can negatively influence their experience during the transition to practice. Acting within one’s scope of practice may be difficult for GRNs since they are often unable to get adequate assistance in hospital settings.
Inability to get adequate support from peers to understand one’s scope of practice leads to low self-esteem among GRNs associated with feeling underqualified and overwhelmed. Mellor and Greenhill (2014) state that insufficient clinical support may lead to low job satisfaction among new RNs. At the same, senior RNs may consider GRNs underprepared and incompetent, which may lead to workplace bullying (Hartin, Birks, & Lindsay, 2018). Flinkman and Salanterä (2014) state that a lack of guidance and dysfunctional workplace relationships may lead to increased turnover rates and a further shortage of nurses.
All of the information presented above may be put into three categories of difficulties GRNs face associated with the inability to work within one’s scope of practice. First, GNPs experience difficulties with defining an NP’s role since it is between a nurse and a physician. Second, the matter is associated with colleague negativity and deterioration of professional and interpersonal relationships. Third, failure to act within one’s scope of practice may cause low self-esteem during the transition period, which can cause self-doubt, disillusionment, confusion, and feelings of isolation and guilt (Faraz, 2016). In summary, the ability to act within one’s scope of practice is of extreme importance.
Implications for Safe Person-Centred Care
The provision of safe person-centered care is a major concern of the Australian healthcare system. Person-centered care can be identified as the provision of health care recognizing and respecting all the needs of patients and providing them with the opportunity to make informed decisions concerning the process of care (Ross, Tod, & Clarke, 2014). In person-centered care, safety is a significant concern since adverse events are associated with poor choices of healthcare professionals (Murray, Sundin, & Cope, 2017). Inability to work within one’s scope of practice may lead to various short- and long-term implications.
Short-term consequences are understood as implications of the matter during one month after the event. As a result of working outside the scope of practice, the patient may experience complications, which can lead to the increased cost of care and decreased trust in the GNP from the patient (Murray et al., 2017). As a result, the GNP may suffer from self-doubt and disapproval of his or her colleagues. The emotional state of the care provider may lead to decreased consecration and poor decision-making while treating other patients (Faraz, 2016). As for long-term implication, which applies to the period from a month to five years, the GNP may feel discouraged to continue the practice. Poor retention among GNPs may lead to an increased shortage of nurses, which is closely associated with an increased number of adverse patient outcomes (Ross et al., 2014). Additionally, acting outside one’s scope of practice may cause patients’ distrust in the role of an RN, which will cause severe complications with the provision of person-centered care (Faraz, 2016). In brief, the long-term implications of the problem are the result of poorly addressed short-term consequences.
Conclusion
Acting with one’s scope of practice is crucial for GRNs to provide safe, person-centered care. However, for the majority of novice RNs, it may be difficult to act within their scope of practice due to role ambiguity, insufficient support from peers, and lack of self-confidence. A lack of adherence to standards of practice identified by NMBA and healthcare institutions may lead to an increased number of complications and adverse patient outcomes. As a result, the issue may cause NPs’ burnout and distrust of the profession.
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