Introduction
The nursing profession is highly dynamic in nature because the service that is offered by the service providers directly affects the health and well being of the patients and other service users (Abram, 2018). The review section fundamentally highlights the main challenges that the nursing students face while transitioning from the “student nurse” phase to the “graduate nurse” phase. A wide range of peer-reviewed journals have been used in order to explore the subject and identify the main solutions that solutions can be used for the purpose of overcoming these challenges.
The research journals that have been used in this work have been thoroughly assessed and analyzed to understand how various internal and external factors come into play and influence the overall transition process of an individual when he or she intends to shift from the student setting to the registered nurse setting. The fundamental objective of the review is to facilitate a better transition process in the nursing context so that both the service provider and service user can benefit in the process.
Search Strategy
One of the most critical aspects of carrying out the assessment of the transition process was to identify the suitable journal papers that could throw light on the relevant aspects that exist in the nursing setting. In order to have access to the best possible journals that are available, a systematic search process was carried out in a number of electronic databases including the CINAHL, PUBMED, ERIC, Proquestand Cochrane (Kaihlanen et al., 2017). These specific databases were considered to locate relevant journal papers so that the nursing topic could be thoroughly investigated and analyzed with ease and accuracy.
These authentic and reliable sources have been used to capture the latest studies that have been carried out in the area relating to the transition process that takes place from a nursing student to a registered nurse. While identifying the journals, special attention was given to the language that was used by the respective researchers. The research journals that were written in the English language were only considered for inclusion (Kaihlanen et al., 2017). Similarly, the journals that were published between the years 2008 to 2018 were only considered for the literature review. Such an approach was selected so that the most updated journals could be assessed and studied to identify the key challenges that are currently faced by nursing students when they transition to the graduate nurse phase.
The keywords that were used to identify and locate the most suitable and vital research papers and journals include the “nursing student” “transition in nursing” “registered nurses”, “transition from nursing student to registered nurses” and “challenges relating to the transition process in nursing”. All these keywords were selected so that the most suitable journals could be filtered and selected in the process. The key words were carefully decided so that the fundamental nursing subject could be thoroughly and carefully assessed (Amornyotin, 2015).
The key challenges that the students face
The nursing setting is highly complex in nature as the service that is offered to the patients can make a major impact on their lives. In this demanding scenario, the change process that every student of the nursing subject undergoes to be a competent “Registered nurse” is highly crucial. As per the study that was conducted by L Salminen, a number of students feel a high degree of stress when they see the changes in their roles and responsibilities in the nursing context(Kaihlanen et al., 2017). In the nursing context, these challenges have been identified by the authorities and they play a key role to smooth the overall transition process for the students so that they can feel comfortable in the demanding professional setting and perform in a diligent manner. Salminen has clearly stated that the very first year of the employment in the nursing environment as a Registered nurse can be highly overwhelming and intimidating for an inexperienced individual (Kaihlanen et al., 2017).
Some of the main challenges that arise before an individual while transitioning from a student nurse to a graduate nurse include the weak communication model, the lack of proper knowledge about the hospital’s policies, procedures and protocols, the lack of familiarity with the facility resources, and the inability to manage time (Smolowitz et al., 2015). These are some of the most common challenges that almost all the nursing students face when they transition into the Registered nurse. The lack of familiarity with the exact roles and responsibilities can be highly stressful which can further have an adverse impact on the overall performance and productivity of the concerned individual(Barnes, 2015).
The transition term is a very common term that is used in the healthcare and hospital setting. It naturally highlights that change is a constant in this work context that needs to be effectively managed to make sure that all the participants in the professional context can understand how they need to adapt to the new and challenging scenario. The changes that a nursing student experiences in the nursing setting can be exciting, stressful and challenging which can lead to an additional level of insecurity. As per the study that was carried out by Anu Marja Kaihlanen, one of the major challenges relates to the new and unknown clinical learning process (Kaihlanen et al., 2017). The next major challenge that the nursing students face in the new nursing context relates to their professional growth. Thestudy shows that the transition phase is an extremely natural process for all the nursing students and they strongly believe that their mentors can play a crucial role to empower them to adapt to the new and demanding professional setting (Buerhaus et al.,, 2017).
The journal publication titled “New nurse transitions: A qualitative study of perceived difficulties” by Carter also highlights the fact the transition phase for the new nursing students and new nurses in the nursing backdrop can be highly intimidating which can ha vena adverse influence on the nursing facility or the healthcare facility (Brewington, 2013). Various healthcare and nursing facilities have understood the significance of this challenge and have introduced relevant changes in the overall structure and process so that the best possible support can be offered to the new nurses in the new and dynamic context.
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The major themes that have been highlighted in the journal publication show that the application of acquired knowledge in the real-life nursing setting can pose new and unique challenges for the graduate students and the new nurses (Brewington, 2013). Similarly, the building of professional relationships in the dynamic nursing context can get highly stressful for them and thus act as a major challenge in the process.
The study by Debra Shipman titled “The lived experience of transitioning to a new graduate nurse following a prelicensure hospital-based externship experience” highlights the various challenges that are faced by new graduate nurses (Shipman, 2014). A crucial challenge that has been highlighted by the researcher relates to the decision-making process. Since the new graduate nurses have to function in the broad and dynamic nursing context, the decision-making process becomes difficult due to the lack of experience. The various journal publications that have been used in this literature review section show that the transition process of the nursing students into the graduate nurses can be highly complex and challenging in nature if they do not get the necessary guidance and mentoring from their seniors or mentors (Shipman, 2014). Some of the core challenges that are faced by the new graduate nurses relate to the ineffective communication model, the ineffective knowledge about the hospital’s policies, procedures and protocols, the lack of familiarity with the resources of facility, the lack of ability to manage time, the new learning process, the application of the acquired knowledge and the complex decision-making process.
Solutions offered in literature to resolve these challenges
The various journals that have been used have helped to identify the relevant and effective intervention techniques that can be used in the nursing context in order to enhance their transition process so that they can be empowered as the nursing professionals. According to the journal paper titled “Experiences during The First Year of Practice among New Graduate Nurses”, in the initial stage when the nursing students start to function as graduate nurses, they have a number of insecurities in their minds that need to be effectively and efficiently addressed by the facility (Thanomlikhit & Kheawwan, 2017). The role of the nursing facility in which they function plays a critical role to make sure that their transition phase of these individuals takes place in a smooth and effective manner.
The study that was carried out revealed that the facility or the institution where the new graduate nurses function need to introduce and develop suitable “benefit packages” that can help these inexperienced nurses to overcome the key challenges relating to the organizing function, prioritizing function and the communicating function (Thanomlikhit & Kheawwan, 2017). Similarly, the nursing institutions can also focus on offering high-quality nursing residency programs so that the new nurses can get the constant support to transition into efficient and productive nurses that can handle and manage the dynamic nursing professional context.As per the journal, the effectiveness of the nursing residential program is high as it helps to strengthen the overall retention rate of the nurses, boosts their confidence, increases their productivity, enhances their competence level and overall job satisfaction.
According to the journal article titled “The Lived Experience of Female Nurse Graduates of Inter-professional Education Transitioning to Clinical Practice” by Michelle Romano, in the highly-demanding nursing environment, a collaborative approach needs to be adopted so that the new graduate nurses can feel comfortable and confident in the nursing context(Romano, 2018). The researcher has made a serious and sincere attempt to understand how the “inter-professional education” comes into the picture and helps the new nurses to adjust in the nursing scenario (Smith & Boschma, 2016). S pet the findings of the study, the inter-professional educational model helps the nurses to get acquainted with the team dynamics. It also helps these individuals to identify the core competency areas that they need to work upon and the responsive communicators that can be used in the nursing scenario. This approach can add value for the new graduate nurses as it would help them to gain a better insight into the team dynamics that are needed in the nursing setting. This education model can act as a vital solution that can simplify the transition process of the nurses in the nursing professional context (Conner, 2015).
Creative elements could be incorporated into the learning program and it would make sure that the knowledge of the new nursing graduates gets enriched. Such an approach could focus on creative and innovative communication techniques and collaborative ability and thus it could strengthen the overall quality and scope of the educational experience of the new graduate nurses. Such an approach can be used to make sure that the new nurses are ready for the real-life experiences (Romano, 2018).
According to the study titled “Nursing Role Transition Preceptorship” by Susan M Batory, one of the most crucial factors that come into play and influences the ultimate transition process of the nursing students and the new graduate nurses is their perception about the clinical setting (Batory, 2014). The study highlights a unique solution that can be used in the dynamic clinical setting in order to support and assist the nursing students in the overall transition from the student to a Registered nurse. The solution that has been highlighted by Susan is the “Preceptorship Clinical model”. This model can play a key role to assist the new and inexperienced nursing students to understand the various aspects relating to the nursing profession (Batory, 2014).
The responses of the respondents is highly favorable towards this solution because they believe that this real-life experience would provide them with the relevant amount of exposure that would ultimately help them to identify the vital components relating to the nursing experience. Such a model would fundamentally make sure that the new nursing graduates are able to function in a superior quality learning setting where they would be able to get the hands-on experience on various nursing activities and functions. The positive impact that could be observed in the process includes the increase in the overall competency level of the new graduate nurses, better safety of the patient care and overall reduction in the number of the patient mistakes or errors.
According to the journal titled “The transition from nursing student to registered nurse: The mentor’s possibilities to act as a supporter”, the role of the mentor in the nursing context is extremely crucial to make sure that the new graduate nurses are able to effectively transition from the student phase to the registered nurse phase (Kaihlanen et al., 2013). These individuals can act as a major support system for the nursing graduates and help them by sharing their experience. They can also play a vital role to familiarize the new Registered nurses with the facilities’ processes, protocols and overall systems.
The various journal publications that have been used in the literature review show that in order to strengthen the overall transformation of the nursing students from the student nurse to the graduate nurse, a number of solutions can be used in order to overcome these challenges such as developing a robust learning environment, direct involvement of the mentors and facility leaders and the introduction of the nursing residential program. All these solutions can act as essential intervention techniques that can help the nursing students to effectively and confidently transform into productive Registered nurses (Czirakie et al., 2014).
Personal Plan to overcome the identified challenges
The nursing setting is full of complexity and one of the main participants who are at the receiving end is the nurses that offer their services to the users and patients. Keeping the recommendations that have been arrived at after analyzing and evaluating the various journal publications, the personal plan has been designed to overcome the known challenges so that the most effective nursing practices can be adopted while entering as a novice nurse (Plohal et al., 2017). Both the short-term plans and the long-term plans have been incorporated into this plan so that the most feasible and effective transition phase can be possible and the best possible value can be created for in the service setting.
As per the article,“Understanding Transitions to Promote Student Success: A Concept Analysis”, there is need to take into consideration the core elements that exist in the transition process such as the personal psychological factors, the professional setting and the demand of the service users (Hart & Swenty, 2016). Thus in the initial stage, the main focus would be on understanding the main nursing setting so that relevant strategies could be introduced at the individual level to adapt to the changes. Such an approach would help to make the best use of the clinical or nursing experience and learn in the process. This approach would be useful in the long run as well as in the short run in the nursing context (Griffiths et al., 2016).
In order to overcome the identified challenges that exist in the nursing scenario, there would be the need to have access to robust support from the mentors, senior nurses and doctors. Their involvement would be highly crucial in the short term so they have been included in the short term plan. They could share their experience and make sure that the transition phase of the new nurses can be simplified to the best possible extent. They could offer proper guidance to the nurses and make sure that their contribution adds value for the facility as well as the service users in the process. As per the journal by Twine, the first year in the nursing context is extremely crucial for the new nursing graduates Twine, 2017). Since these individuals are fresh out of college, they have the potential to grab as much information as possible. So in this scenario, a robust learning setting must be established that can support them and guide them to make a positive and constructive change in the dynamic nursing environment (Twine, 2017).
In the long-term, one of the basic necessities would be to take part in a learning program so that the core elements of the nursing profession could be identified. Such an approach would be necessary to make sure that a strong learning is encouraged that would ultimately be valuable to the service users in the nursing context. Such an approach must be adopted in the initial phase and its results could be observed in the long run. Similarly, a collaborated approach could be adopted by establishing a strong communication network with the other participants of the facility (Purpora & Blegen, 2015).
It would make sure that the proper communication and information flow exists in the dynamic nursing environment. As identified in the literature review, some of the major challenges that arise before the new Registered Nurses relates to the prioritizing of different nursing activities and functions. The robust communication model would make sure that the senior and mentors are there to offer the relevant guidance in the nursing context that can smoothen the transition process from the student nurse to the Registered nurse. Such an approach would make sure that a valuable and useful learning is possible in the nursing context that can strengthen the overall value and productivity for the new nursing graduate as well as the service users in the process (Glasper, 2017).
The personal plan has been carefully designed and structured by taking into consideration the relevant short term goals and the long term goal. The fundamental purpose of the plan is to effectively handle and manage the identified challenges and issues relating to the core challenges that the nursing student face while transitioning from the ‘student nurse’ phase to the ‘graduate nurse’ phase. The various journal papers that have been referred here have played a vital role to design the personal plan in a constructive manner. The various strategic elements that have been included in the personal plan has been designed after taking into consideration the most feasible solutions that could simplify the overall transition process in the nursing context (Parry, Barriball & While, 2015). Such an approach would make sure that a robust learning is encouraged in the nursing professional setting.
References
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Brewington, D.M.C., 2013. New nurse transitions: A qualitative study of perceived difficulties. East Carolina University.
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Parry, A.M., Barriball, K.L. and While, A.E., 2015. Factors contributing to Registered Nurse medication administration error: A narrative review. International journal of nursing studies, 52(1), pp.403-420.
Plohal, A., Dumont, C., Perry, C., Biddix, V., Bird, D.B., Darst, T., Eisenhart, C.J. and Pugh, M., 2017. The Role of the Registered Nurse in the Insertion of Nontunneled Central Vascular Access Devices. Journal of Infusion Nursing, 40(6), pp.339-345.
Purpora, C. and Blegen, M.A., 2015. Job satisfaction and horizontal violence in hospital staff registered nurses: the mediating role of peer relationships. Journal of clinical nursing, 24(15-16), pp.2286-2294.
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Shipman, D., 2014. The lived experience of transitioning to a new graduate nurse following a prelicensure hospital-based externship experience. Nova Southeastern University.
Smith, K.M. And Boschma, G., 2016. Toward Community-Based Practice: The Changing Role of the Registered Nurse in Psychiatry and Mental Health. Nursing History for Contemporary Role Development, p.93.
Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E.M., Ulrich, S., Hayes, C. and Wood, L., 2015. Role of the registered nurse in primary health care: meeting health care needs in the 21st century. Nursing Outlook, 63(2), pp.130-136.
Twine, N., 2017. The first year as a nurse practitioner: An integrative literature review of the transition experience. Journal of Nursing Education and Practice, 8(5), p.54.
Thanomlikhit, C. and Kheawwan, P., 2017. Experiences during The First Year of Practice among New Graduate Nurses. Asian Journal of Nursing Education and Research, 7(4), pp.461-465.
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