Lecture 9: Making the Transition from Student to Professional Nurse - PDF

Making the Transition from Student to Professional Nurse Coordinator: Dr. Eman KH. Ebrahim LEARNING OUTCOMES: After completing this chapter, you should be able to: 1. Identify the concepts of transition and reality shock. 2. Explain the four phases of reality shock. 3. Discuss Benner (19...

Making the Transition from Student to Professional Nurse Coordinator: Dr. Eman KH. Ebrahim LEARNING OUTCOMES: After completing this chapter, you should be able to: 1. Identify the concepts of transition and reality shock. 2. Explain the four phases of reality shock. 3. Discuss Benner (1984) model which describes the five stages through which novice nurses proceed to become clinically competent. 4. Special Needs for Novice Nurses  An Overview Transition is defined as “change” or the “passage from one state, place, stage, or subject to another.” As nurses prepare to enter the profession and make the transition from student to registered nurse (RN), they move not only from one role to another, but also from the school or university setting to the workplace. Transition is a complicated process during which many changes may be happening at once.  An Overview The first impression the novice nurse has of his or her chosen profession is valuable and sets the stage for entry into nursing. This first impression occurs during the transition phase from student to professional.  Reality Shock Novice nurses are described as feeling as though they have changed from the most intelligent students in nursing school to the most incompetent nurses in the professional practice environment. This time marks the end of one era as a student and the beginning of a new era in a nursing career. Novice nurses often suffer from reality shock, which is the result of inconsistencies between the academic world and the world of work.  Reality shock occurs in novice nurses when they become aware of the inconsistency between the actual world of nursing and that of nursing school. Reality shock leads to stress, which can threaten the well- being of new nurses and result in physical illness and mental exhaustion, leading to disappointment with their career and ultimately absenteeism and turnover. There are four phases of reality shock: honeymoon, shock or rejection, recovery, and resolution. I) Honeymoon Phase During the honeymoon phase, everything is just as the new graduate imagined. The new nurse is in orientation with former school friends or other new graduates who often share similarities. Many novice nurses in this phase are heard making the following comments: “Just think; now I’ll get paid for making all those beds” and “I’m so glad I chose nursing; I will be a part of changing the future of health care.” II) Shock (Rejection) Phase Then orientation is over, and the novice nurse begins work on his or her assigned unit. This nurse receives daily assignments and begins the tasks. “But wait. I’ve only observed other nurses hanging blood. Where is my instructor?” Now the shock or rejection phase comes into play. The nurse comes into contact with conflicting viewpoints and different ways of performing skills, but lacks the security of having an expert available to explain uncertain or gray areas.  As Registered Nurses, they found they have to ‘think on their feet’ without the ‘comfort blanket’ of student status”. The security of saying, “I am just the student nurse,” is no longer valid. Vague feelings of discomfort are experienced. After going home from a shift, the new nurse may experience feelings of rejection and a sense of lack of accomplishment.  The novice nurse may reject the new environment and have a preoccupation with the past when he or she was in school. A need to contact former instructors, call schoolmates, or visit the nursing school may occur. Others may reject their school values and adopt the values of the organization. In this way, they may experience less conflict, however, there are drawbacks to this approach as well.  Dealing with the shock phase can be approached in many different ways including: ❖ Natives: Many nurses choose to go “native”. That is, they decide they cannot fight the experienced nurses or the administration, thus they adopt the ways of least resistance. These nurses may mimic other nurses on the unit and take shortcuts, such as administering medications without knowing their action and side effects and the associated nursing responsibilities. ❖ Runaways: Others choose to “run away.” They find the real world too difficult. These new nurses may choose another occupation or return to graduate school to prepare for a career in nursing education to teach others their “values in nursing.” ❖ Rutters: Some adopt the attitude that “I’m just working until I can buy some new furniture.” These nurses are called rutters. They consider nursing just a job. ❖ Burned Out: These nurses bottle up conflict until they become burned out. Inexperienced nurses may become burned out because they assume full patient loads and varied responsibilities in a short period of time. The more intelligent, hard-working nurses are the most prone to burnout. ❖ Compassion Fatigue: Compassion fatigue is the gradual decline of compassion over time as a result of caregivers being exposed to events that have traumatized their patients. Nurses who work in emotionally charged environments, such as hospice, emergency departments, and mental health settings, are likely to experience this reaction. ❖ Loners: These nurses create their own reality. They adopt the attitude of “just do the job and keep quiet.” These nurses may prefer night shifts, during which they often are “left alone.” ❖ New Nurse on the Block: These nurses change jobs frequently. They go from the hospital setting to community health to the physician’s office. They are always new in their setting and therefore adopt the attitude of “teach me what you want; I’m new here.” ❖ Change Agents: These nurses care enough to work within the system to elicit change. They frequently visit the nurse manager or head nurse to suggest change or a better way. They keep the welfare of the patient at the forefront. III) Recovery Phase The return of humor usually is the first sign of the recovery phase. The novice nurse begins to understand the new culture to a certain degree. There is less tension and anxiety, and healing begins. The nurse in this phase may comment, “I’ll hang that blood, and I’ll bet I can infuse it before 8 hours this time.” IV) Resolution Phase The resolution phase is the result of the shock phase combined with the novice nurse’s ability to adjust to the new environment. If the nurse is able to positively work through the rejection phase, he or she grows more fully as a person and a professional nurse during the resolution phase.  From Novice to Expert Benner (1984) described the following five stages through which novice nurses proceed to become clinically competent: Stage 1: The nurse has few experiences with clinical expectations, this stage usually occurs while completing the nursing educational requirements. Stage 2: Exemplifies advanced beginners who are able to perform adequately and make some judgment calls based on experience; most novice nurses enter the workforce during this stage.  Stage 3: Includes competent nurses who are able to foresee long-range goals and are mastering skills. Stage 4: Includes proficient nurses who view whole situations rather than parts and are able to develop a solution. Stage 5: Includes expert nurses for whom intuition and decision making are instantaneous.  During these five stages of transition from novice to expert, nurses are most likely to experience stress. Stressors common to novice nurses include the following: Unrealistic expectations: Novice nurses are expected to care for a standard patient workload as soon as orientation is completed. Stressful work environments: Patient ratios are unrealistic. Powerlessness: Novice nurses are not heard when suggesting changes to improve workflow, but often are blamed when things go wrong.  Special Needs for Novice Nurses I) Interpersonal and communication skills II) Clinical skills III) Organizational skills IV) Dealing with violence I) Interpersonal and communication skills: Most physicians, administrators, and nurse managers expect the novice nurse to immediately develop interpersonal skills that they take for granted. It is difficult for many people, including novice nurses, to be comfortable with interpersonal skills at work when they feel incompetent and inadequate as a member of the interprofessional health care team.  They are often uncomfortable making rounds, clarifying orders, and participating in interprofessional team conferences. However, effective communication is critical. Novice nurses need to develop interpersonal communication skills, which can be learned through role-play and simulation. II) Clinical skills Practice increases the effectiveness, efficiency, and correctness of performing skills. However, until the nurse has experience, there are actions the novice nurse can take. For example, it is wise to be familiar with the procedure manual on the unit. Also during the orientation phase, the novice nurse should ask for a mentor to observe or assist with procedures to improve the clinical skills. III) Organizational skills The novice nurse may lack organizational skills. Typically, student nurses are responsible for a limited number of patients; typically they are not responsible for as many patients as they will be assigned as new nurses. Someone is usually with students to offer suggestions on how to organize their time. Planning and prioritization skills were seen as areas of concern of newly graduated nurses. IV) Dealing with violence Workplace violence aimed at nursing is increasing at an alarming rate across the world, with abusive acts committed by patients increasing. Student nurses are also leading recipients of horizontal or nurse-to-nurse violence.  Horizontal or lateral violence, to include such acts as “antagonism, criticism, scapegoating, passive aggression, withholding information, bullying, and verbal and physical aggression. This type of violence leads to decreased job satisfaction and even turnover.  The first step to preventing horizontal violence is to educate yourself about how to recognize it and how to intervene. The Joint Commission (2008) has established a standard that all hospitals must define horizontal violence or “inappropriate behavior” and then provide a process that addresses the behavior. The Center for American Nurses (2009) states that there is no place for bullying among nurses or health care providers and issued a “Zero Tolerance for Abuse.”