May June 2018 Vol 27no 3 199sonya Blevins Dnp Rn Cmsrn Cne I ✓ Solved

May-June 2018 • Vol. 27/No. 3 199 Sonya Blevins, DNP, RN, CMSRN, CNE, is a Member of the MEDSURG Nursing Manuscript Review Panel, Simpsonville, SC. From Nursing Student to Registered Nurse: The Challenge of Transition M aking the transition from nursing student to registered nurse (RN) is an exciting yet over- whelming time for new graduates. The new role includes increased responsibilities and socialization to the profession.

Making the transition comes with var- ious highs and lows, impacting the nurse’s confidence, retention, and tenure in the profession (Maria, Mei, & Stanley, 2017). Literature often reviews what healthcare facilities need from new graduate nurses; however, it is important to analyze what new graduate nurses need to be successful in transitioning to their new role. Why Should We Listen? The nursing shortage is not improving. The need for more nurses is growing, expected to persist through 2025 due to increased retirement of experienced nurses and the number of aging patients requiring more com- plex care (Kacik, 2018).

The U.S. Bureau of Labor Statistics (2017) projected 1.09 million nurses will be needed by 2024 due to nursing replacement and health- care growth. Training of nurses is expensive, ranging from ,700 to ,400 per nurse. In some states, the range can be higher (The University of New Mexico, 2016). According to The University of New Mexico, 17.5% of newly licensed nurses only work for 1 year while 43% of newly licensed nurses leave the hospital within 3 years of starting.

Financially, this has a negative impact on hospitals. Each year, the loss of these nurses costs hospi- tals .2-.1 million. This attrition of newly licensed RNs is not limited to the United States. Australia, Canada, and the United Kingdom face the same issue (Murray-Parahi, DiGiacomo, Jackson, & Davidson, 2016). Promoting Success Issues with successful transition to professional prac- tice were identified in the 1970s.

Kramer (1974) defined the issue as reality shock, referring to the difference between preparation in academia and integration into practice (Ankers, Barton, & Parry, in press; Mellor & Gregoric, 2016). More recently, the term as been rede- fined as transition shock. While academia can prepare students for some realities of practice, it cannot prepare for all of them. Increased communication and partner- ships between academia and hospitals can identify gaps and develop plans to address them (Murray-Parahi et al., 2016). The transition from nursing student to RN is a grad- ual process.

Expertise in nursing comes over time. Upon graduation, these nurses cannot simply hit the road running. A transition period has to be allowed to pro- mote success and retention in nursing (Mellor & Gregoric, 2016). The transition process is facilitated by two main concepts: structure and socialization (Ankers et al., in press). Continuous support is needed as a part of both concepts.

Structure Throughout the United States, nurse residency pro- grams have provided a structured approach to integrate new RNs into the hospital as well as the nursing profes- sion. In other countries such as Australia, they are called transition programs (Ankers et al., in press). These pro- grams enhance nurses’ critical thinking skills and pro- mote a comradery among them as they go through the same stress and emotions. Just as with simulation, resi- dency programs provide a safe environment in which nurses can share experiences and debrief (Mellor & Gregoric, 2016). Nurses share experiences and ask for guidance on how to handle unfamiliar situations.

Mellor and Gregoric suggested nurse residency educa- tors role play situations and offer assistance in how to best address them. By working with the nurses, educa- tors also can increase their confidence in dealing with unfamiliar situations. Socialization Working as an RN occurs in a much different envi- ronment than college. New nurses thus need to be socialized not only to the profession but also to their clinical units. They are the most vulnerable during this transition time.

Without effective socialization, new nurses may get discouraged, impacting their productiv- ity and engagement in patient care. This discourage- ment can cause them to leave the profession (Murray- Parahi et al., 2016). A support system is important. The unit nurse educa- tor, preceptor, and fellow staff should be engaged in the development of new nurses to promote their success. New nurses feel comfortable in seeking advice from individuals who demonstrate a level of caring and approachability.

When they have questions, new nurses appreciate interaction and explanation of processes so they can learn further. When these actions are done, Nurses as Educators Sonya Blevins May-June 2018 • Vol. 27/No. 3200 new nurses believe they can become an effective part of the team. In turn, their anxiety is reduced and their engagement on the clinical unit increased (Ankers et al., in press).

One of the most difficult situations new nurses expe- rience is lateral violence in the workplace. The notion that some nurses eat their young may increase the anx- iety of new nurses while making them feel isolated. New nurses need to feel encouraged even if they make a minor error. In handling these situations, the new nurse critically needs the support of the unit nurse educator and preceptor. If a positive relationship has been devel- oped between new nurse and preceptor, the nurse will feel comfortable in mentioning any situations where lateral violence is occurring.

The issue thus can be addressed instead of being a constant problem in the workplace (Leong & Crossman, 2015). The Preceptor An effective preceptor makes a tremendous difference. When hiring a new graduate, the manager should select as preceptor a nurse who has the desire as well as training in effective methods of precepting. Consistency of pre- ceptors is important because the new RN may train on multiple shifts. When multiple preceptors are used, new nurses may perceive they are being passed around with no structure or consistency of guidance.

Having assigned preceptors allows the development of a relationship in which the preceptor can assess the growth of the new nurse over time and provide constructive feedback on areas of strength and opportunity. The feedback should be consistent, with areas of need identified early so cor- rective training can occur (Mellor & Gregoric, 2016). In this relationship, the preceptor builds the level of confi- dence of the new nurse (Maria et al., 2017). Knowing the areas of strength and opportunity allows the preceptor to build the new nurse’s patient assignment gradually. The acuity and number of assigned patients can be increased as the new nurse achieves specific orientation milestones (Ankers et al., in press).

Conclusion As a new RN enters practice, a great deal of transition occurs during acclimation to the profession. Hospital leaders must understand the needs of these nurses so the orientation provides a positive environment of growth and development. Benefitting from structure and an effective support system, new nurses have the resources to be successful (Phillips, Kenny, & Esterman, 2017). Not only does this further their growth, but it enhances the function of the clinical unit. REFERENCES Ankers, M.D., Barton, C.A., & Parry, Y.K. (in press).

A phenomenological explo- ration of graduate nurse transition to professional practice within a transition to practice program. Collegian, 1-7. doi:10.1016/j.colegn.2017.09.002 Kacik, A. (2018). Nursing shortage will continue to pinch hospital margins. Retrieved from / NEWS/ Nurses as Educators Kramer, M. (1974). Reality shock: Why nurses leave nursing.

Philadel phia, PA: Mosby. Leong, Y.M.J., & Crossman, J. (2015). New nurse transition: Success through aligning multiple identities. Journal of Healthcare Organi zation and Management, 29(7), . Maria, H.S.Y., Mei, W.L., & Stanley, L.K.K. (2017).

The first year of professional nursing experience: The transition challenges faced by new graduate nurs- es. Paper presented at Global Healthcare Conference, New York, NY. Mellor, P., & Gregoric, C. (2016). Ways of being: Preparing nursing students for transition to professional practice. Journal of Continuing Nursing Education, 47(7), .

Murray-Parahi, P., DiGiacomo, M., Jackson, D., & Davidson, P.M. (2016). New graduate registered nurse transition into primary health care roles: An inte- grative review. Journal of Clinical Nursing, ), . Phillips, C., Kenny, A., & Esterman, A. (2017). Supporting graduate nurse transition to practice through a quality assurance feedback loop.

Nurse Education in Practice, 27, . University of New Mexico. (2016). The high cost of nurse turnover. Retrieved from U.S. Bureau of Labor Statistics. (2017).

Employment projections . Retrieved from holder's express written permission. However, users may print, download, or email articles for individual use.

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From Nursing Student to Registered Nurse: The Challenge of Transition

Transitioning from nursing student to registered nurse (RN) is a pivotal moment in a nurse's career, marked by both excitement and trepidation. The reality of increased responsibilities and expectations can overwhelm new graduates, leading to a sense of "transition shock" (Blevins, 2018). Understanding the challenges faced during this transition is essential for reducing turnover rates, enhancing job satisfaction, and ultimately improving patient care outcomes. This paper will explore the components of successful nurse transition and the significance of structure and socialization in fostering new nurses' development.

The Context of Nursing Transition

The modern healthcare landscape increasingly faces a nursing shortage, projected to worsen with an estimated requirement for 1.09 million nurses by 2024 (U.S. Bureau of Labor Statistics, 2017). The high turnover rate among newly licensed nurses, which can reach 43% within the first three years, exacerbates this challenge (The University of New Mexico, 2016). Financially, this turnover is costly, with estimates suggesting losses of between .2 to .1 million annually per hospital (Blevins, 2018).
To address these pressing issues, attention must shift from merely evaluating the operational needs of healthcare institutions to understanding the developmental requirements of new graduate nurses (Maria, Mei, & Stanley, 2017). Strategies for supporting nursing graduates during their transition can contribute to greater job satisfaction and retention.

Reality Shock Versus Transition Shock

Historically, the concept of "reality shock" was introduced by Kramer in the 1970s to highlight the dissonance between nursing education and actual practice (Kramer, 1974). More recent literature has adapted this term to "transition shock," which accounts for the gradual nature of acclimatization to the nursing profession (Mellor & Gregoric, 2016). Nursing education adequately prepares students in many technical and theoretical domains; however, it often inadequately prepares them for the emotional, social, and organizational dynamics encountered in clinical settings. New graduates require structured support to navigate this gap successfully.

The Role of Structure in Transition

Structured support systems such as nurse residency programs or transition programs—while prevalent in the United States—are modeled differently in other countries, such as Australia (Ankers, Barton, & Parry, in press). These structured programs not only facilitate knowledge and skill acquisition but also foster collaboration among new nurses who share similar experiences and challenges. This communal support can help mitigate feelings of isolation and anxiety faced by new graduates (Mellor & Gregoric, 2016).
Simulation and role-playing scenarios—integrated into these structured programs—allow new nurses to practice and refine their skills in a low-stakes environment. This experiential learning boosts their confidence in addressing clinical uncertainties and equips them to handle real-life situations more effectively (Mellor & Gregoric, 2016).

Socialization: The Critical Component

Socialization into the nursing profession is essential for new nurses as they establish their identities within clinical settings. The transition from academia to practice introduces new dynamics, and effective socialization strategies can prevent disenchantment and disengagement (Murray-Parahi et al., 2016). New nurse graduates must develop relationships with various members of their healthcare teams to cultivate a supportive environment conducive to growth.
Having approachable unit nurse educators, preceptors, and experienced staff can significantly affect new nurses' initial experiences (Ankers et al., in press). Relationship-building enhances trust and creates an atmosphere where new nurses feel comfortable asking questions or seeking assistance. When senior nurses actively engage with new graduates, it fosters a sense of belonging and productivity, ultimately reducing attrition rates (Leong & Crossman, 2015).

The Role of Preceptors

Selection and training of preceptors hold critical importance in the transition process. An ideal preceptor should not only possess strong clinical skills but also be invested in the educational growth of the new nurse (Mellor & Gregoric, 2016). Consistency in preceptorship is vital as rotating preceptors can disorient new nurses, potentially leading to feelings of being "passed around" without sufficient support.
The term "complexity of roles" describes the varying identities that new nurses must integrate, which may include those of a caregiver, a professional, and a student (Leong & Crossman, 2015). A dedicated preceptor can guide new nurses in balancing these roles, providing constructive feedback and gradually increasing their patient assignments to reflect their progress in mastering these identities (Ankers et al., in press).

Addressing Lateral Violence

One notable concern for new nurses during this critical transition is the phenomenon of lateral violence, which may create additional stress in the workplace (Leong & Crossman, 2015). New nurses, often feeling vulnerable, risk becoming discouraged in environments characterized by hostility or bullying from peers. The support from preceptors and educators is essential in addressing instances of lateral violence, as these mentors can empower new nurses to report inappropriate behaviors and seek resolution (Murray-Parahi et al., 2016).

Conclusion

The transition from nursing student to registered nurse is fraught with challenges but offers ample opportunity for growth and professional development. To mitigate the risks of turnover and enhance job satisfaction, healthcare institutions must invest in structured support programs and foster effective socialization practices for new nurses. A focus on these areas not only aids in the successful transition of new graduate nurses but also enhances overall patient care outcomes, with new nurses feeling supported and valued as they acclimatize to their roles. Supportive mentorship is an integral part of this journey and provides the foundation upon which successful nursing careers can be built.

References

1. Ankers, M.D., Barton, C.A., & Parry, Y.K. (in press). A phenomenological exploration of graduate nurse transition to professional practice within a transition to practice program. Collegian, 1-7. doi:10.1016/j.colegn.2017.09.002
2. Blevins, S. (2018). From Nursing Student to Registered Nurse: The Challenge of Transition. MEDSURG Nursing, 27(3), 199-205.
3. Kacik, A. (2018). Nursing shortage will continue to pinch hospital margins. Retrieved from [insert source].
4. Kramer, M. (1974). Reality shock: Why nurses leave nursing. Philadelphia, PA: Mosby.
5. Leong, Y.M.J., & Crossman, J. (2015). New nurse transition: Success through aligning multiple identities. Journal of Healthcare Organization and Management, 29(7).
6. Maria, H.S.Y., Mei, W.L., & Stanley, L.K.K. (2017). The first year of professional nursing experience: The transition challenges faced by new graduate nurses. Paper presented at Global Healthcare Conference, New York, NY.
7. Mellor, P., & Gregoric, C. (2016). Ways of being: Preparing nursing students for transition to professional practice. Journal of Continuing Nursing Education, 47(7).
8. Murray-Parahi, P., DiGiacomo, M., Jackson, D., & Davidson, P.M. (2016). New graduate registered nurse transition into primary health care roles: An integrative review. Journal of Clinical Nursing.
9. Phillips, C., Kenny, A., & Esterman, A. (2017). Supporting graduate nurse transition to practice through a quality assurance feedback loop. Nurse Education in Practice, 27.
10. U.S. Bureau of Labor Statistics. (2017). Employment projections. Retrieved from [insert source].