Transition of Novice Nurse to Registered Nurse Persuasive Essay

Extant nursing scholarship demonstrates that the transition from being a novice nurse to becoming a registered nurse can be stressful and challenging for new entrants, as many experience fear of failure, fear of assuming total responsibility in clinical settings, as well as fear of making mistakes (Banks et al., 2011; Dyess & Parker, 2012; Jamieson, Harris, & Hall, 2012; Morrow, 2009; Newton & McKenna, 2009).

Because early experiences in the workplace have been shown as strong predictors of future work satisfaction and career development (Jamieson et al., 2009), the transition literature has continued to attract widespread attention as scholars and practitioners attempt to understand the movement of professionals from novice nurses to registered nursing practitioners, the associated experiences and consequential development (Cubit & Lopez, 2012). Consequently, it is important to explore the experiences of novice nurses in transitioning to clinical settings within the first two years after absorption into gainful employment.

The experiences and challenges of newly qualified nurses in their attempt to transition to registered practitioners have been well documented in the literature, with several scholars arguing that these experiences and challenges are embedded within a framework that causes nurses to be enmeshed between the socializing forces of academia and the day-to-day reality of nursing (Ross & Clifford, 2002).

Indeed, the transition is particularly difficult as novice nurses are required to adapt to new responsibilities and expectations irrespective of the fact that developments in nursing curricula in many countries across the world continue to provide a broader and deeper theoretical base for practice, but with little regard to the level of practical skills attained (Cleary, Matheson, & Happell, 2009). Consequently, new nurses find it challenging to get socialized into the context of clinical nursing practice due to their own real or perceived inadequacies in the practice environment (Newton & McKenna, 2009).

Ross and Clifford (2002) note that “in 1974, Kramer highlighted the reality shock experienced by newly qualified nurses in the USA when they found themselves in work situations for which they felt inadequately prepared” (p. 546). The concept of ‘reality shock’ therefore denotes how novice nurses experience feelings of bewilderment, inadequacy, stress, and lack of confidence in their own professional identity as they transition to registered nurses.

These feelings, which have been directly associated with high nurse turnover and low job satisfaction levels in practice settings (Ashcraft, 2004, Candela & Bowles, 2008; Okerby, Newton, Cross, & Jolly, 2009), are reinforced by the ‘colliding expectations’ between what novice nurses are taught in institutions of nurse education and what they normally experience in clinical settings (Jamieson et al., 2012).

Drawing from the earlier works of Kramer, Duchscher (2009), extensively cited in Dyess and Parker (2012), conceptualized the ‘transition shock’ to imply “multifaceted, inclusive of misunderstood perceptions of practice and adjustment, and difficulty in appreciating differences among generational cohorts and mixed emotions” (p. 616).

This description, through fragmented in scope, demonstrates how “the contemporary new graduate engaging in a professional practice role for the first time is confronted with a broad range and scope of physical, intellectual, emotional, developmental and socio-cultural changes that are expressions of, and mitigating factors within the experience of transition” (Duchscher, 2009, p. 1103).

Using the Transition Shock Theory, several scholars have demonstrated how novice nurses experience feelings of anxiety, insecurity, stress, inadequacy, and instability as they attempt to adjust to their expected roles and responsibilities in clinical settings (Banks et al., 2011; Bennett, Barlow, Brown, & Jones, 2012; Dyess & Parker, 2012; Standing, 2007). All these experiences, according to Christiansen and Bell (2010), contribute to nursing retention challenges, further exacerbating the nurse shortage problem being experienced in many developed countries across the world.

The experiences highlighted here are attributed to a multiplicity of reasons, including lack of support during the initial post-qualification period (Jamieson et al., 2012), frenetic pace, high patient acuity, and high expectations for quality and safety in clinical settings (Dyess & Parker, 2012), lack of holistic undergraduate education and poor working conditions (Ashcroft, 2004; Cleary et al., 2009), as well as role stress, role ambiguity, unrealistic expectations by clinical staff, values conflict, lack of confidence in autonomous decision making, lack of organizational skills, large patient loads, horizontal violence, and tensions within the social climate of the workplace (Candela & Bowles, 2008; Morrow, 2009; Phillips, Esterman, Smith, & Kenny, 2013).

Available nurse transition scholarship demonstrates that the factors leading to these adverse experiences can be successfully dealt with through implementing transition programs aimed at facilitating learning and skill acquisition in a flexible, supportive, and mutually-respectful professional environment (Cleary et al., 2009), facilitating the capacity for novice nurses to learn, adjust, and socialize with other nursing professionals in the new workplace (Jamieson et al., 2012), bridging undergraduate educational curricula with escalating workplace expectations (Bennett et al., 2012), as well as developing and initiating interventions to enhance job satisfaction (Morrow, 2009).

Overall, it is evident from this exploration that novice nurses experience myriad challenges in transitioning to clinical settings, particularly within the first two years of employment. These experiences have been reviewed using the ‘reality shock’ and ‘transition shock’ paradigms and found to compound the nursing shortage problem due to their adverse effects on nurse retention. Consequently, it should be the role of nurse managers to implement initiatives that provide a proper framework for the effective transition of those nurses who are newest to the profession.

References

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Banks, P., Roxburgh, M., Kane, H., Lauder, W., Jones, M., Kydd, A., & Atkinson, J. (2011). Flying Start NHS ^TM: Easing the transition from student to registered health professional. Journal of Clinical Nursing, 20(23/24), 3567-3576.

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Standing, M. (2007). Clinical decision-making skills on the developmental journey from student to registered nurse: A longitudinal inquiry. Journal of Advanced Nursing, 60(3), 257-269.