The First Year of Practice for Newly Graduated Registered Nurses - Literature review Example

Title: Literature Review Surrounding the First Year of Practice for Newly Graduated Registered Nurses Student Name: Instructor’s Name: University: Course Name and Code: Date of Submission: Literature Review Surrounding the First Year of Practice for Newly Graduated Registered Nurses Introduction The first year for a newly graduated registered nurse is typified by unremitting obscurity; besides the complexities of adapting to new challenges, responsibilities and the apprehension of individual accountability. It is a period that is characterised by pulsating learning experiences as well as the encounter of new and complex patient conditions. During this transition, graduates are expected to blend into the hospital systems and to exercise the knowledge they have acquired to solve real life problems. Unfortunately however, the period of transition is quite challenging for the new graduates; such that a considerable percentage end up leaving their jobs within the first few months. As a matter of fact, the turnover rate of nurse graduates represents more than half of the total turnover in various medical centres and hospitals. The challenges of newly graduated registered nurses have been attributed to a mixture of emotional pressure and anxiety that builds up as they try to adjust to their new roles. This is to a large extent influenced by the kind of reception and assistance accorded by other members of staff as well as the ability to put theoretical knowledge into practice. Further, the process of developing competence and confidence to handle new patient conditions plays a vital role in the ability of a nurse to hold on to the noble profession. This paper seeks to explore the predicament of newly registered nurses in their first year of practice and also encompasses the various issues relevant to the smooth transition from an enrolled nurse to a registered nurse. Literature Review Subsequent studies by individual medical researches and institutions have concluded that a registered nurse’s first year of practice is marked by difficult challenges, psychological instability and overwhelming learning experiences. In their completed studies, Duchscher (2008) and Etheridge (2007) describes the transition to a registered nurse as a period of learning and stress. It is a period in which escalating workplace expectations exude a mixture of anxiety, instability, insecurity and inadequacy among the newly graduated registered nurses as they attempt to adjust to the profession (Callara, 2008; CONO, 2009; Etheridge, 2007). Newly registered nurses are subjected to new patient problems everyday and they are expected to learn how to deal with the various challenges they encounter. In certain circumstances, newly registered nurses are often overwhelmed by the learning experiences to an extent that they are unable to handle the pressure. This often leads to a mixture of psychological imbalances which are likely to affect the newly registered nurses negatively. Newly registered nurses contribute to a high percentage of staff turnover rate in most medical institutions. This is attributed to the failure to adjust to their new role and inability to handle daily challenges which in turn leads newly registered nurses into giving up their profession (Duchscher, 2008). Various researches attest that a significant number of newly graduated nurses are likely to leave the profession during their first year. In reference to a study by Johns Hopkins University School of Nursing researchers, published in the year 2007 for example, it was established that more than fifty percent of graduates are more likely to leave their job within the first year of employment (Benner, Tanner & Chesla, 2009). Notably, it is during this time that a nurse is expected to undertake the responsibility of handling patients without working under the supervision of a registered nurse as in during their role as an enrolled nurse. This insinuates that a nurse is solely accountable for their own actions and should be in a position to make the right decisions in order to avoid mistakes (Duchscher, 2008; Dyess & Sherman, 2009). Most importantly, a nurse must be able to identify situations that require urgent medical intervention and take necessary precautionary measures to preserve the lives of patients. Newly graduated nurses who find the job very demanding, emotionally draining or very risky may end up leaving their jobs. Research indicates that less than half of newly graduated registered nurses are well prepared to work when they join health institutions. According to Hole (2009), newly graduated nurses suddenly feel incapable of serving as staff nurses despite the fact that they were well prepared for the role while in training, New nurses often find their new roles overwhelming due to the fact that they are required to learn a great deal of clinical aspects and practical procedures; which may not have been possible in the classroom setting (Pellico, Brewer & Kovner, 2009). The nurses must get used to handling unique situations on a daily basis, which may take a considerable time to achieve. It is during this time that clinical mistakes tend to be common. Depending on a newly graduated nurse’s willingness to learn, this could reduce significantly with time. However, it is common to find that most newly graduated nurses take a considerable time to catch up with the more experienced nurses such that they are more likely to make mistakes. It is noteworthy that newly graduated nurses require a lot of social, emotional and clinical support once they start practicing (Pine & Tart, 2007; CONO, 2009). This enables them to adjust more easily and to learn the important rules and practices. During this transition period therefore, a newly registered nurse is likely to adjust more easily if he or she interacts with understanding and helpful members of staff who are ready to offer guidance and share their experiences. Winfield et al (2009) notes that most nurses who undergo a smooth transition do so because of the cooperation accorded to them by more experienced members of staff within their workplaces. On the other hand, hostile colleagues often pose a challenge to newly registered nurses since they are not free to make inquiries, consult regarding various issues affecting their patients and to express their own ideas (Pine & Tart, 2007). This kind of treatment is likely to derail a newly registered nurse’s adjustment to the new role thus affecting their performance and willingness to continue with the nursing profession. Specific issues affecting newly graduated registered nurses Difficulty of the nursing discipline It is generally agreeable that the nursing practice is remarkably intricate right from the classroom level to the practical level. Nurses are expected to fully assimilate the medical knowledge and to face new challenges everyday. In this respect, developing competence and confidence to handle new complexities in patient care have been cited as the most common challenges among newly registered nurses (Duchsher, 2008; Winfield et al, 2009; Etheridge, 2007). This is particularly enhanced by the fact that these nurses previously worked under instruction from experienced nurses. Furthermore, the experienced nurses serve as valuable resources to enrolled nurses during their practice (Pellico, Brewer & Kovner, 2009). It therefore becomes difficult when one is required to make important and life changing decisions due to the fear of making a mistake. More importantly, the new nurses are aware of the increased level of responsibility and accountability towards the patients’ health such that the worry of making the wrong judgment is often overwhelming. Clinical mistakes Newly registered nurses are prone to clinical mistakes due to inexperience and lack of confidence when executing various roles (Kay, 2005). This is a great threat to their careers; more so because in the modern world, medical practitioners are expected to take responsibility for their actions during service delivery. More often than not, new nurses could find themselves in situations where they did not follow the right procedures; either due to ignorance of what is required or due to inexperience. Consequently, they are more likely to end up in court to answer medical malpractice suits. These in turn could lead to severe emotional imbalance thus affecting their willingness to work. Further, the fear of such predicaments could stress a newly registered nurse and may even curtail his or her ability to learn (Hole, 2009). Newly registered nurses may also tend to avoid procedures that they consider risky hence limiting their ability to gain valuable experience. Practical application of learned knowledge Newly graduated registered nurses find the process of applying learned knowledge practically rather challenging. Notably, there is a great separation between theoretical knowledge and practical knowledge. Most newly graduated nurses however go with the mentality that they are well prepared to work due to their educational background; until they discover that the practical part is more challenging (Callara, 2008). As a result, mistakes are likely to occur during the first year of practice which may in turn lead to panic and emotional distress. This may be further magnified by exaggerated expectations from the management and the presence of hostile colleagues (Benner, Tanner & Chesla, 2009). A new graduate in his or her first year of practice may therefore develop the fear of undertaking difficult assignments and making important decisions thus hindering their potential growth. Emotional Turbulence The emotions of a newly registered nurse are likely to be unstable due to a combination of various work factors. There are pressures associated with the process of blending in with the health care team members, coping with uncooperative colleagues, solving new problems, suggesting new ideas and handling difficult clinical assignments single-handedly (Pine & Tart, 2007). Lack of confidence and competence limits newly graduated nurses in such a way that they may shy away from crucial clinical procedures and even feel like they are not contributing enough towards the success of their organizations. Beginners may also find it humiliating to keep on referring to others even in addressing simple patient problems (Pine & Tart, 2007). As a result, they end up failing to acquire the required knowledge and experience which may further jeopardise their careers due to clinical mistakes. It is notable that most of the newly graduated nurses have not been well prepared to cope with negative clinical occurrences such as patient pain and death (Kay, 2005). As a result, they may tend to suffer psychologically due to the guilt of losing a patient or not being able to reduce the pain they are going through (Benner, Tanner & Chesla, 2009). They may also feel incompetent thus blaming themselves for the fate of patients under their care. Such emotional turbulence is highly detrimental to the career growth of newly registered nurses and may consequently affect their performance even in later years. Further, a considerable number of graduate nurses leave their professions because they cannot keep up with their colleagues’ expertise; a factor that makes them new nurses to feel unappreciated. Prioritising duties The challenge of prioritising jobs stems out from inexperience; such that newly registered nurses face difficulty in differentiating urgent situations from the ones which can wait. This is particularly common where work load is overwhelming yet there are few members of staff. Dyess & Sherman (2009) noted that this challenge is easily triumphed over if a newly registered nurse works under the guidance of a more experienced nurse during the first year of practice. Lack of such guidance is likely to lead to clinical mistakes which in turn affect the new nurses negatively. Unfortunately, it is common for newly registered nurses to lack a mentor where they work either due to busy schedules that more experienced nurses have or general reluctance of these nurses to help the new ones (Callara, 2008). Furthermore, guiding a new nurse through the medical practices is quite demanding; such that other members of staff will tend to avoid the role. Job stability and motivation Finding a stable and well paying job at graduate-entry level often proves exigent for most newly graduated nurses. Consequently, it is difficult for newly graduated nurses to attain job satisfaction; more so because they have high expectations following their graduation. These anticipations are soon frustrated once they realise that the job market is much tougher than they had imagined. Experienced nurses are preferred by most health institutions because they are expected to deliver better quality service (Ellis & Hartley, 2001). Graduate nurses are therefore disadvantaged in the job market since potential employers may look at them as liabilities to their organisations; given that they need further training which could prove expensive and the fact that they may not deliver high quality healthcare due to their inexperience (Ellis & Hartley, 2001). Accordingly, newly graduated nurses customarily land low paying jobs and part-time jobs which do not provide adequate motivation (Ellis & Hartley, 2001). It also becomes difficult for the new nurses to meet their daily expenses such that stress levels resulting from failure to actualise personal financial goals are likely to increase. This is very discouraging and could actually drive nurses into changing their careers. Lack of motivation also hinders positive development among new nurses such that they do not give in their best. Working Environment Besides matters related to nursing knowledge, it is important to note that graduate nurses face numerous challenges in the process while adjusting to their new environments. This may be related to the physical location of their places of work or the general staff reception once they are posted to their duty stations. The physical location of an individual’s workplace plays a significant role in determining their productivity. Accordingly, an individual’s optimal performance can only be achieved if he or she is comfortable with the environment. This is often pegged to family connections; social networks; climate; culture and the fear of change (Kay, 2005). Newly graduated registered nurses tend to take more time to adjust if they find jobs in places that are far away from their homes. Further, factors such as climate change and culture shock are likely to affect a person’s comfort. As noted earlier, the kind of reception that newly graduated nurses are accorded in their places of work is likely to affect them significantly. It is quite challenging for nurses who encounter unhelpful colleagues and demanding managers to adjust to their new roles. The result would be poor productivity and a negative attitude towards one’s job. Transition from an enrolled nurse to a registered nurse It is clearly evident that the first year as a nursing graduate carries a significant mount of challenges which an individual must be ready to encounter. A smooth transition from an enrolled nurse to a registered nurse not only requires patience on the side of the new nurse but also places new responsibility on host organizations to ensure that new graduates are able to adjust comfortably (Benner, Tanner & Chesla, 2009). There are various issues which would prove relevant in this transition including the passion to learn, proper assimilation of theoretical knowledge, support from other staff members and the ability to face new challenges positively (Callara, 2008; Ellis & Hartley, 2001). Newly registered nurses must critically review their notes since the theoretical aspect of nursing plays a great role in guiding practical application in real life settings (Jeffreys, 2006). Notably, nursing is incredibly intricate and there is need to properly understand the various concepts and practices before practicing. Furthermore, theoretical knowledge serves as a good source of reference whenever newly registered nurses are faced by complex patient conditions. In order for a newly graduated nurse to adapt easily to their new roles, it is important for them to continually interact with experienced nurses in order to learn important nursing practices (Hole, 2009). This also insinuates that health institutions should make it a responsibility to continually orient newly registered nurses to the profession (Jeffreys, 2006). Individual attitude is vital towards effective transition from an enrolled nurse to a registered nurse (Hole, 2009). Newly graduated nurses must therefore anticipate the various challenges that they are likely to encounter once they start working. Information on such challenges may be obtained from nurse guides, textbooks, magazines and interaction with experienced nurses. They should then devise ways of coping with them and have a positive attitude towards their future role. This way, it is will be much easier for them to cope as registered nurses. Conclusion The findings of this study exemplify that transition into the role of a registered nurse is definitely a challenging endeavour. This is explained by the kind of difficulties that newly registered nurses encounter during their first year of service. Some of the most common challenges include the difficulty of applying learned knowledge, acquiring confidence and competence to practice as a nurse and the emotional distress that comes with everyday frustrations as they offer health care to patients. The newly graduated nurses often succumb to emotional pressure whenever the life of a patient under their care is threatened or when they are not able to deliver to their managers’ expectations. The same applies where there are uncooperative colleagues yet the new graduates require extensive guidance during their first year. It is important for newly registered graduates to be adequately prepared before undertaking their new roles. This can be done by having a proper understanding of theoretical concepts, interaction with experienced nurses and being emotionally prepared for the job through reading nursing guides and talking to experienced nurses. As indicated by the rate of turnover, it is evident that only the strong willed newly graduated registered nurses are likely to survive in the profession References Benner, P, Tanner, C.A & Chesla CA, 2009, Expertise in nursing practice: caring, clinical judgment & ethics, Springer Publishing Company, New York, NY. Callara, L.R. 2008, Nursing Education Challenges in the 21st Century, Nova Publishers, Hauppauge, NY. College of Nurses of Ontario (CONO), 2009, National competencies in the context of entry-level registered nurse practice, College of Nurses of Ontario, Toronto, Ontario, Canada. Duchscher, J.E.B, 2008, Transition shock: The initial stage of the role adaptation for newly graduated Registered Nurses, Journal of Advanced Nursing, vol 65, no 5, pp. 1103 – 1113. Dyess, S.M, & Sherman, R.O, 2009, The first year of practice: New graduate nurses’ transition and learning needs, The Journal of Continuing Education in Nursing, vol 40, no 9, pp. 403 – 410. 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