Transition from Enrolled Nurse to Registered Nurse - Case Study Example

Transition from Enrolled Nurse to Registered Nurse Introduction In Australia, every year among university graduates who become registered nurses for the first time, some of them are nurses who earlier had trained and practiced as enrolled nurses. Newly graduated nurses who previously practiced as enrolled nurses go through a transitional phase and face various challenges as well as stress levels (Nayda & Cheri, 2008). Enrolled nurses re-enter the workforce in their new role as registered nurses with anticipations that they will not have any problems due to their previous acquaintance with nursing practice as enrolled nurses. These expectations from this group as well as from their colleagues result to lack of the required support that other newly graduated graduates without prior experience get (Nayda & Cheri, 2008). This essay argues that graduate registered nurses who previously practiced as enrolled nurses have unique needs and face various challenges during their transition from enrolled nurses to registered nurses and hence require support for a smooth transition. Australian Nursing and Midwifery Council (2010) states that enrolled nurses are supposed to work under the guidance and supervision of registered nurses. On the other hand, it is the responsibility of a registered nurse to make appropriate delegations to the enrolled nurses within the framework of the experience, skills and knowledge of the enrolled nurses. Enrolled nurses are always accountable for their own actions and are responsible to the delegating nurse for all delegated nursing activities (Australian Nursing and Midwifery Council, 2010). This shows that the role of a registered nurse is much broader and diverse when compared to the role of an enrolled nurse. Therefore, transitioning from an enrolled nurse to a registered nurse is a journey that is compounded with various challenges due to the increased responsibilities and adaptation the new role. Basically, enrolled nurses already have some level of socialization to the work environment due to their familiarity with aspects such as medication administration, patient care, communication with patients and other healthcare providers as well as familiarity with care prioritizing (Gallagher, 2010). Nonetheless, just like new graduates without previous experience in nursing practice, this group also faces stressors such as intense increase in responsibilities that coincide with increased decision-making and higher accountability. Gallagher (2010) further adds that the transition of enrolled nurses to registered nurses is mostly shadowed by self, peer as well as administrative expectations of having the ability to cope well with the transition. Generally, these expectations counter any supposed experience that enrolled nurses might have due to their previous training and practice. Gallagher (2010) explains that transition experience for enrolled nurses to registered nurses is equally stressful as for newly graduated registered nurses without any clinical experience. Johnstone et al (2008) identified values dissonance as one challenge that enrolled nurses face during their transition as registered nurses. The study found out that once previously enrolled nurses are employed as registered nurses they suddenly realize that the value system running within the workplace is different from their own. The value system includes completion of routine tasks in a specific timeframe as well as management of busy workload. This normally prevents them from providing individualized patient care like they used to do as enrolled nurses. Even though enrolled nurses are often busy, since they do not have many responsibilities as registered nurses they are able to have more time with their patients. According to El Haddad et al (2013) inability to spend adequate time with their patients or provide the level of care they feel their patients need is a major source of frustration, dissatisfaction as well as distress for enrolled nurses on their transition to registered nurses. More importantly, a class of values in the long run occurs and this leads to these nurses feeling they do not achieve their individual ideals of what a registered nurse ought to be or match up to the expectation of their peers (Evans et al, 2008). This means that during transition enrolled nurses often feel dissatisfied with themselves and also their colleagues are equally dissatisfied with them. In addition, this group is normally confused regarding what they are supposed to be doing and they just suffer like new graduates without any clinical experience when it comes to stress allied to role ambiguity (El Haddad et al, 2013). This group also faces the challenge of role adjustment during their transition as registered nurses. A study conducted by Johnstone et al (2008) indicates that previously enrolled nurses basically have a superficial understanding of the role of a registered nurse especially during their first year of practice as RNs. Generally, they view their new role as RNs as just adding skills to their former role of being enrolled nurses instead of perceiving their new role as a role change. These perceptions contribute to a more complicated transition especially in regard to provision of diverse prioritized nursing activities required of the registered nurses (Australian Nursing Council, 2010). As new registered nurses, performing routine activities of an RN stresses, stretches and also leaves this group stressed. In most cases, most of these graduates are assigned numerous patients and this makes gives them a very heavy responsibility to them as registered nurses without experience (Fero et al, 2009). Basically, during their practice as enrolled nurses they never had many responsibilities as their new role and hence adapting to the new role as an RN with increased responsibilities, is not an easy task for them. Even with their prior nursing background as enrolled nurses, most of them experience stress as well as role conflict during their adaptation to the role of a registered nurse during transition. This is supported by Gallagher (2010) who argues that even though previously enrolled nurse might be having broad experience in providing nursing care to several patients, the differentiating factors include increased responsibility and added dependence on advanced clinical decision making skills. The reality of accountability in regard to decision making is particularly very hard for all newly registered nurses (Gallagher, 2010). Nayda & Cheri (2008) demonstrates that enrolled nurses transitioning to registered nurses often lack peer support, administrative support as well as medical personnel support. This makes previously enrolled nurses feel insecure and frustrated because of inadequate managerial and peer support who perceive their transition as smooth owing to their prior experience as enrolled nurses. Ahern (2008) explains that proper and adequate support for all nursing graduates including former enrolled nurses is paramount for their smooth transitioning as registered nurses. Such lack of support for the new registered nurses leaves them very anxious. In addition, this group rarely gets supervision by senior personnel and this is perceived as systematic malpractice. Burns & Poster (2008) emphasizes the significance of new nursing graduates being provided with prompt open communication as well as constructive feedback regarding their performance as new RNs and this can only be achieved through effective supervision. Such actions increase their confidence and hence enable them to learn and adapt into their new role as RNs successfully. On the contrary, new RNs who previously were enrolled nurses do not get the required constructive communication and feedback from senior nurses, physicians and administrators as well. A study conducted by Ahern (2008) shows that this has negative effects of their ability to adapt and acclimatize to their new role as registered nurses and this thus hinders their professional development. Worse still, other personnel have a likelihood of continuing to view the new registered nurse in their enrolled nurse role and therefore neglect support for their development. This study further shows that these new RNs become more anxious and frustrated when they are not supported in events and situation that are beyond their abilities due to the assumption that they can cope owing to their earlier experience as enrolled nurses. A study carried out by Cubit & Lopez (2012) showed that registered nurses who had previous training as enrolled nurses prefer not to be identified as having prior nursing experience because they fear being treated by their nurse managers as nurses who already have the ability of practicing as registered nurses while in reality they required support just like any new nursing graduate. Therefore, enrolled nurses transitioning into registered nurses require mentoring and constructive feedback from their peers, senior nurses as well as the management for their smooth transitioning (Lopez, 2011). Evidence confirms that support is important for each and every nursing graduate making his/her transition when there is retraining in the profession (Cubit & Lopez, 2012). However, the available evidence shows that support for new registered nurses with prior enrolled nursing experience is not adequate. As well, this group of new nursing graduates is normally not prepared to cope with broad knowledge and skills necessary for the “generalist” role of a registered nurse. Basically, novice registered nurses are fragile and when they find themselves in situations and conditions that preventive their effective operation their confidence is negatively impacted (Cubit & Lopez, 2012). This is further complicated by the fact that registered nurses are expected to play diverse roles of giving nursing care to different patients with diverse health needs. Such diversity implies that the novice RNs are unable to get constant exposure to nursing events and situations that have the likelihood of increasing their skills, knowledge as well as their confidence if their new role as registered nurses. This is line with Burns & Poster (2008) who explain that the diversity of RN’s roles results to delay in the novice registered nurses understanding RN practice, decreased confidence levels in their role as RNs and a delayed onset of professional autonomy. Nursing literature demonstrates that supporting transition of enrolled nurses to registered nurses is vital in retaining as well as a strategy in maintaining enough nursing workforce in Australia. Socialization in the nursing practice is a crucial aspect of successful transition (Fero et al, 2009). This necessitates the new graduates to obtain enough skills, familiarization with the workforce and work environment as well as confidence to nursing practice. In addition, there is a need for strong supportive and steady relationship of these new registered nurses with other experienced registered nurses and the acknowledgement of the exclusive aspects of a registered nurse (Kelly et al, 2008). Support needs that enrolled nurses require during their transition include clinical support allied to nursing practice; more time with increased time in regard delivery of nursing care to enable them familiarize and adapt to their new role much easily and avoid workload; opportunities to timely debriefings and regular reviews and feedbacks about their progress; communication skills and strategies for promoting efficient engagement with other RNs, support to enable them manage prospects and confidence levels during their adjustment to their new role as novice nurses; providing them with support for them to adapt into the new work setting which may consist of diverse levels of access to senior personnel; supporting them to adapt to regularly changing teams; in addition to giving them opportunity to ask questions without making them feel like they are inefficient and without being judged by other clinical support staff (Kelly et al, 2008). Conclusion As the essay shows, various factors influence transition of enrolled nurses to registered nurses and these factors include the effect of workforce and workplace reality, the expected knowledge and skills for new registered nurses, the available support as well as adapting to the RN’s role of responsibility and accountability. Evidence shows that transition of enrolled nurses to registered nurses is not that smooth. The benefits and experience that this group had obtained during their practice as enrolled nurses is counteracted by a shallow and inadequate understanding of the scope of their new role as registered nurses. Similarly, this group also faces stress of adapting to their role just like new graduates without any prior experience. The stresses are compounded by the fact that peers expect nurses who previously worked as enrolled nurses to adopt to the role of registered nurse successfully due to their previous experience and hence they are offered little or no support. In conclusion, nursing expectations for new RNs who previously trained as enrolled nurses should be in line with their views, capabilities as well as recognizing the needs unique to their transition. Enrolled nurses require same level of guidance, support as well as understanding given to other new nursing graduates entering nursing practice as new registered nurses. References Ahern, K. (2008). Preparing nurses for practice: a phenomenological study of the new nursing graduate in Australia. Journal of Clinical Nursing. 18, 910-918. Australian Nursing and Midwifery Council (2010). National competency standards for the registered nurse. Australian Nursing and Midwifery Council. Burns, P. & Poster, E. C. (2008). Competency development in new registered nurse graduates: closing the gap between education and practice. The Journal of Continuing Education in Nursing. 39(2) 67-74. Cubit K & Lopez V. (2012). Qualitative study of enrolled nurses transition to registered nurses. J Adv Nurs. 68(1):206-11. El Haddad, M., Moxham, L. J. and Broadbent, M. (2013). Graduate registered nurse practice readiness in the Australian context: an issue worthy of discussion. Collegian. 20 (4), 233- 238. Evans J, Boxer E & Sanber, S. (2008). The strengths and weaknesses of transitional support programs for newly registered nurses. Australian Journal of Advanced Nursing. 25(4). Fero, L. J., Witsberger, C. M., Wesmiller, S. W., Zullo, T. G. & Hoffman, L. A. (2009). Critical thinking ability of new graduate and experienced nurses. Journal of Advanced Nursing. 65, 1103-1113. Gallagher, L. (2010). The Transitional Journey of Enrolled Nurse to Registered Nurse: A Review of the Literature. Tamworth Rural Referral Hospital. 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