Nursing Education in the Present Day - Essay Example

Nursing: Issues Likely to Affect the Graduate Nurse in Their First Year of Practice Introduction: It has been recommended that the first post-degree year of clinical nursing practice should receive a structured and planned support to achieve an effective transition from student to professional, where the new practitioners will have improved skill levels, confidence, recruitment, and retention (Ministry of Health, 2004). The first year of practice in the life of a freshly graduate nurse is both significant and important, because at this time, their experiences enable them to practice confidently as registered nurses. This challenging task is accomplished by ensuring that the fresh graduates are provided with formal preceptoring and hence professional development in the first year of their clinical practice. The journey from theoretical lectures to implementation of that knowledge in evidence-based practice is difficult, stressful, and not exactly filled with the animal enthusiasm necessary for this, and there are many issues, which a graduate nurse faces and fights along the pathway of a seemingly long journey of metamorphosis of a just-a-few-days-back student into a full-blown registered nurse practitioner. In this short work, an in-depth analysis will be made of two important issues, making a transition to registered nurse and issues that a fresh nurse practitioner encounters when she faces the cultural shock of working in a multidisciplinary team. Making the Transition to a Registered Nurse: Nursing education in the present- day world has changed to academically based degree programs. With the increase of medical and nursing technologies, it was felt increasingly that there should be improvement in the standards of practice in the case of practicing registered nurses, and mere academic preparation of a student nurse is not enough for adequate patient care, and the work environment on the first phase of the practice appeared to be more advanced than the academic environment. This gap between theory and practice would compromise the quality of service, and the shock that is experienced by the just-a-few-days-back students in the clinical setting can overwhelm their self-esteem. The key to this problem is difference between expectations and reality. The university-workplace transition is, therefore, marked by the students' expectations of the graduate year and the hard reality that they encounter in the workforce setting (Heslop, L. et al., 2001). In response to this perceived gap and in response to the understanding that this will affect the employee satisfaction and employee retention, most of the hospitals developed transition programmes, such as, nurse externship that offered the fresh graduates scope to develop clinical skills enough to enter the formal work force. The conditions that promoted such a plan still exist, and now the authorities having seen the benefits of such transition programmes and having sensed the stresses commonly faced by new registered nurses are stressing on the successful transition of the new graduates to the registered nurse role (Starr, K., and Conley, V.M. 2006). The three factors inherent in special attention to the transition phase of a registered nurse are changes in nursing condition, changing nursing education and healthcare trends, and the reality shock that the new nurses experience. The other agenda was to ease the transition from a student to registered nurse by creating opportunities for the new nurses to acquire basic nursing skill competence and to develop confidence in practice (Allison et al., 1984). The benefits would be immense. If the registered nurses continue to work in the same environment in the second year of practice, the falls and falters of the first year in the phase of transition would enrich the nurses' experience and would allow them to develop a customized strategy for the same environment, if not by experience, at least by trial and error. This would enhance the self- confidence with cumulative little successes in delivering care, build insight into the staff duties, teach time management, and in this way, will ease the transition to the professional role (Jairath, N., Costello, J., Wallace, P., & Rudy, L. 1991). Reality: While this is true that the authorities have a very good intent of converting the initial nursing experiences of new graduate nurses in the context of clinical setting of a health service organization into an exciting and inspiring one, and the new nursing graduates weigh the workplace environment and clinical training as very significant to their future life and career, actually within the clinical setting, the new graduate nurses are socialized into the health service organization's informal rules, formal protocols and procedures, norms, and expectations (Heslop, L., Mcintyre, M. & Ives, G. 2001). In reality, the nurses find that their experience is reverse. They suffer stress instead of zeal, disillusionment in place of expected events, and despair in lieu of encouragement on the face of very inappropriate organizational support and assistance to each obstacles faced in every step (Buckenham J.E., 1994). Feelings: The feelings of these new entrants to the professional field as it applies to their confidence and competence usually ramify in three directions, the nature and extent of workload, knowledge of ward routine and layout, and the nature and more importantly the manner of the feedback they receive on their performance. Rather than holding the hand, most of the time, the hand raises a accusing finger, and the whole period of encouragement and learning becomes a race of obstacles, and most graduates stay to prove that "they can do it!" (Kelly, B. 1996, p.1068). Trauma: The experience that was expected to be preceptored and mentored turns out to be extremely traumatic due to rigid environment; unrealistic expectations from the seniors and management; and conflict in attitudes, career aspirations, and values between the old and the young, between the experienced and the novice, between the stable and the wandering. The conflict is not only in the process of socialization, the conflict is also in the implementation of care; the ward routine almost forces them to conform to old- fashioned, ritualistic, ineffective, and destructive practices as opposed to their theoretical education for the changing world of medicine and healthcare (Kelly, B.,1996, p.1067). Constraint: They consider this as a constraint to their endeavour and development, and they find the, otherwise, well-planned transition programme is never well executed, and they blame this on the organizational design of the hospital, its vertical hierarchy, its professional structure, and above all, the hospital bureaucratic practices. Although some of these complaints are not entirely baseless, things are changing rapidly in the new world, and there is a change in the attitude of the health service organization management, and rigid, bureaucratic organizational structures are changing in a direction to allow lateral communication and allow increasing participation of the new nurses in decision making (O'May, F.& Buchan, J., 1999). Social Process: The whole social process of becoming a nurse from just earning a degree involves fulfillment of learning by doing and being with an expert in the actual practice setting where the new nurses undertake their occupational role. This professional socialization process happens through observation of the nurses rendering patient care and through participation in nursing functions, and this makes the new nurses more confident in performing nursing tasks, creates a better understanding of their future roles, inspires them to pursue an interest in expanding their roles, makes them more and more independent as practitioners (Nursing and Midwifery Council 2002). Organization: The organizational context of the hospital becomes more relevant and critical here since it affects the transition process, rather than enriching the transition process, in some situations, it may diminish it. The more the health service organization is bureaucratic and traditional, the more it will attempt to frame and regulate the behavioural patterns of the first year nurses ( actually, it tries to shape up all, the veteran ones from experience knows to bypass it or they have learnt to succumb to it) and will constitute initial nursing practice in pre-formed patterns (instead of innovating a new strategy) that will constrain practicing nurses' autonomy, independence, creative potential, and innovative acumen (Kelly, D., Simpson, S., Brown, P. 2002). Necessary Evil: It has been argued that this kind of obstacle is necessary because the first year nursing is essentially a period of trial, almost an initiation ritual to test who is fit to bear the title 'nurse', and this test of endurance is a must for preparing the nurses of the new era, of the changing world. Change: However, things are on the verge of rapid change now. Increasingly, the health care providers and authorities are leaning toward clinical rotations in different discipline in the first year transition phase, and the intent of the authorities is to create a supportive learning environment through the use of trained preceptors, who will provide positive reinforcement and will guide the learning process through a well-planned orientation and ensure a hands-on experience (Oermann, M.and Moffitt-Wolf, A. 1997). Preceptor: The preceptors would not be bosses, but they will behave as a role model in the unit. They will create environments for self-motivation of the transiting graduates and create opportunities to practice skills and procedures more than once. With this approach, there would be a significant difference on the personal accomplishment scales, with greater feelings of competence and successful achievements for the graduate nurse in the first year of practice (Hardy, R. and Smith, R. 2001). Working in a Multidisciplinary Team: Nothing makes a graduate nurse more excited and happier when the nurse gets a chance to work in a multidisciplinary team. It has action, hard work, enthusiasm, and in-built sense of importance. It needs a little motivation, but as long as the graduate nurse remains a graduate nurse in transition looking at experiences in the ward as the pages of text books embodied, they never lack the spark of interest necessary to get charged to be involved in a multidisciplinary care team. In reality, most of the cases the decision makers, the people in authority get together and make decisions and announce them to the new people, so that the pathways in a multidisciplinary team, such as, how to handle disputes between different members, how to make beds differently, what time to offer treatments and how swiftly are decided separately away from the graduate nurses, and orders appear to descend from the hierarchy, harsh enough to allow the first year graduates to feel sighted and uninvolved. They will carry out the orders, but their hearts would never be in it. They would never feel that they have contributed, and letting the nurses contribute would motivate them most, since feeling needed is one of the very basic human needs. Working in a multidisciplinary team needs involved people, where feeling of importance, a chance to learn, a chance to bear the responsibility for the results, and necessity of commendations for a job well done (Allen, R. 1975). In most of the key health services in the world, multidisciplinary teamwork is the key process through which healthcare is managed. It is a necessity but a problem in itself, since working in a multidisciplinary team requires many skills including understanding of one's own skills and role along with the roles of other professionals in that team. As mentioned, a good teamwork is essential to make multidisciplinary care a successful one. The common barriers to a good teamwork are differing perceptions of team work in a multidisciplinary team, different levels of skill acquisitions to function as a team member, and the dominance of medical power that influences interactions in a team (Atwal. A, and Caldwell. K., 2006). To accommodate the changing needs of modernized health care provision, there is increased need of teamwork as an essential component in practice, but in actuality, multidisciplinary, interprofessional, or multiprofessional organizational skills are desired but absent from the field of practice (Greener-Temkin, H.,1983). Applied to the graduate nurse in the first year, multidisciplinary working refers to a group of professionals who come from different disciplines for rendering care but who do not necessarily interact. There may be numerous problems with multidisciplinary interprofessinal working, and as a result, the patients might experience considerable difficulties when all the team members are not unanimous about the common goal or when individual members have not completed specific tasks. The lack in interprofessional collaboration in a multidisciplinary team might create severe constraints to the new registered nurse in the making and these may precipitate a new hindrance to the desired teamwork. One thing is to be made explicit that a multidisciplinary team care has proven advantages when it really works as a team. There are advantages of improved planning, services that are more effective clinically, services that are more sensitive to the patient's needs, the chances of avoiding duplication and fragmentation, and provision for more satisfying role of the involved health care professionals (Royal Pharmaceutical Society of Great Britain and British Medical Association, 2000). The interdisciplinary team would share resources, skills, and responsibility, and rather than working independently, they would better work interdependently, and hence, ideally, the multidisciplinary team despite having different professional backgrounds would make complementary contribution in the care of the patient. The graduate nurse if required to work in a multidisciplinary team would have unique experiences which have both positive and negative effects in her first year clinical practice (Leathard, A.1994). The success of a graduate nurse in such a team actually depends minimally on the attitude of the nurse, but pivotal role is ideally to be borne by the health and social care professionals in the team by overcoming numerous obstacles toward a harmonious teamwork, for there is ample evidence that health-care multidisciplinary teams do hardly implement the management principles of teamworking, and the graduate nurse being the youngest member inducted into such a team will just lose the direction because there is no team. During ward rounds, which are one of the most important opportunities for the graduate nurse to learn and participate, the absence of the concept of teamwork may create many obstacles that might prevent the nurse from participating (Atwal, A. 2001). If it is to be a successful multidisciplinary team approach, it has to be instrumental in establishing goals by active participation of all the team members. The doctor in the team is to sanction the decision made by the team, not to disseminate decision. The team conference should carry a serious weightage, where everyone should not only feel important, every member including the new graduate nurse should have a say on the patient care. The absence of this is reflected in the clinical meetings or ward rounds where the doctors in the team instructs, and the nurses listen, and they then order the graduate nurses to carry out their orders. In this scenario, the ego, hope, self-esteem of the graduate nurse will reach the nadir, and the opportunities of learning gets wasted (Manias, E., and Street, A. 2001). The graduate nurse hence views the concept of multidisciplinary team approach with a lot of skepticism once she gets to know what it is. Just the fact that a group of people who knows each other's name does not constitute a teamwork. They should rather aim jointly for the same goal of better care of the patient. Other than deficiency in knowledge of team work, there has been an issue of deficiencies of assertiveness and confidence on the part of the graduate nurse in participating in a team, but newcomers will always be newcomers, and it is the duty of senior members of the team to express support to the graduate nurses to turn them into assertive and confident individuals. The consultants would always lead a multidisciplinary team, and they would always speak convincingly and assertively on any issue, and just due to the fear of being scapegoated by the fellow professionals most graduate nurses are afraid to express an alternative opinion (Atwal. A, and Caldwell. K., 2006). Conclusion: To conclude, a graduate nurse in the first year clinical practice is the future in the making, and health service providers, doctors, senior nurses, mentors, and preceptors, all should make provisions for their on-the-job training and learning, and the graduate nurses should feel confident and assertive in their approach to the new emerging world of medicine and should never feel at loss and rather take up the leadership in the larger domain of the clinical ward because larger challenges are just a few blocks away. Reference List Allen, R. (1975). Changing a Staff into a Team, Nursing, pp. 91-92. Allison, S. E., Anderson, B., Balmat, C. S., Hinton, P. A., Keheley, P. C., King, F. E., et al. (1984). Externship programs: The Mississippi model. Nursing Outlook, 32, 207-209. Atwal, A.( 2001). Structure, aim, and constraints of interprofessional working. British Journal of Therapy and ehabilitation; 8: 366-370. Atwal. A, and Caldwell. K., (2006). 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