Strategies for Making the Transition From a Student Nurse to Staff Nurse

Introduction

• The critical need of the hour today- Professional nurses with sound knowledge & work experience, as they provide 80% of direct care to patients.
• Practical applications for student nurses- Valuable strategies to switch from student nurse to the role of professional nursing. Have vital knowledge of care of patients.
• Vital tips to pass the grade- In depth studies to assist the most serious student to make the transition.
• Relationship with Mentor – Importance of working under the guidance of a proficient and experienced nursing professional.
• Handling patients and colleagues- Understand working as a team and yet have independent thinking.
• Conclusion- Future is bright for those aspiring students willing to make a smooth transition to a staff nurse. There is a ray of hope for the future Florence Nightingales in the making. Nursing isn’t a dying profession.

Critical Need of the Hour

A silent crisis engulfs American hospitals and many nursing care centers. Nurses-the most vital staff have become ineffective support systems due to shortages of experienced personal. They struggle to remain the barometer of a good hospital staff. With patients and their families constantly looking at nurses to help in the process of recovery, experienced professional nurses are few and rare.

Why?

The answer to this is the difficulty in student nurses finding it difficult to make a smooth transition to staff nurses. The main reasons where the difficulties arise are quite stark, as some of the findings have shown from time to time. Delving into some of the most critical problems, addressing them and solving them can help the young impressionable nurses much early in their careers if they have to turn from amateurs to professionals.

1. a) Shortage of funds in many hospitals has reduced the orientation programs for new graduates, resulting in poor performances in the first three critical months. Nervous, new and inexperienced grads have shown little inclination for responding to patient care and handling family and relatives in times of crisis.

1. b) The inexperience of student nurses is affecting the health care quality to patients, general ignorance on public health care policies, miscommunication with fellow staff, time constraints to learn valuable skills on the job in short terms, clinical & practical difficulties treating patients and stressful working hours.

1. c) Difficulty in judgments and decision making independently in absence of seniors.

1. d) Anonymous surveys reveal that stress, violence and jealousy are also contributing factors in new grads facing trouble in first time jobs. Quite a few of the complaints go unreported; thereby keeping some contentious factors still under wraps and sensitive issues still burning.

1. e) Turbulent transitional influences have affected the nurses and patients adversely. Loss of confidence, low self esteem, and unsatisfactory job satisfaction has marred the carefully learnt clinical lessons by the student community. Theory is far different from the practical environment which they eventually face. And that’s where the challenge lies.

Practical applications for Student Nurses

Every problem has a solution and with a little conviction and useful applications, new nurses have much hope with a little prayer on the lip! Some of the transition solutions, as studies show are bridging the gap to infuse more confidence to become professionals. Success of Capstone courses, orientation programs, mentor-grad working, self-motivation and practical tips have worked excellently for some students who are now on staff and confidently working. Some methods have innovative approaches and solve difficulties. 

‘A shortage of nurses prepared at the baccalaureate level may be affecting health care quality and patient outcomes. In a study published in the September 24, 2003 issue of the Journal of the American Medical Association (JAMA), Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and buffer patient outcomes This extensive study found that surgical patients have a “substantial survival advantage’ if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level. In hospitals, a 10 percent increase in the proportion of nurses holding BSN degrees decreased the risk of patient death and failure to rescue by 5 percent.’

‘A number of studies have indicated that the transition from student to graduate nurse is extremely stressful and challenging (Chamley, 1999; IDearmun, 1998; Delaney, 2003; Maben & Clark, 1998; Oernann & Moffitt-Wolf, 1997). These studies address the aggregate of nurses from different nursing education routes, for example, associate and baccalaureate.’

Capstone Courses 

Considering that the student nurses will have an assured level of competency, the Capstone course alleviates the amateur to work and think like a competent staffer. A student gets acclimatize and is virtually guided, to perform with practiced skills to make the transition smooth for a professional life. The faculty is largely responsible to train the students, give tips, as circumstances change and if need be become ‘a sounding board’. As the student learns the quality skills of the professionals, they work with; they maintain a balance between care for the patients, relationship with staffers and seniors and tackle red tapism of administration in the hospital. The Capstone course is vital in the sense that it allows the student to apply practical knowledge in real clinical environment. As they say practice makes one perfect—as the student becomes perfect and applies in everyday work.Faculty knowledge in own practice it means the transition has been successful and smooth. 

‘A capstone course can socialize students into “thinking like a professional nurse or as Schon (1987) argues in his classic work, the core of professional competency which is artistry unique to that profession. Unlike specific course8 that establish mastery in specific areas, for example, physical assessment and medication administration, Schein (1972) suggests that the capstone approach prepares nurse professionals through a program component along with an actual service component that includes unique skills as well as attitudes.’ 

Once the student nurse steps into professional life with responsibilities of quality care, it brings confidence in the patient and family too. Any creative or responsive program elicits negative and/or positive results. If found lacking, they can be upgraded to suit the faculty and students. As there is a shortage of nurses on a national level, a student might be required to indulge and practice some specific area of health care before taking up independent charges. Sure, the work pressures keep the young ones on their toes but eventually it prepares them for bigger roles. Resident nurses need the exposure to actual patient environment, deal with emergencies looking up at the seniors in constant action.

Ideally, some questions put to student nurses to remove apprehensions and fear are important. On their part, the students need to figure out what they wish to specialize in eventually. Students should interview with various different faculty before making decision to apprentice. The crucial first three months can help students make proper goals in their ultimate professional goals.

Mentoring and Passing Vital Tips to Succeed

Mentoring is obviously one of the classic ways to groom a student nurse. Keeping in mind the requirements of the organization (hospital, nursing care unit, elderly care, criticare or emergencies etc) a mentor takes into fold the raw inexperienced model. What would emerge finally would be a self image or a brand new independent product. The risk of finding a good mentor lies with the student. Word of mouth, a little research might lead the student into the right hands. Guidance by the mentor in most practical environment and for a considerable time for the student to assess and absorb is important. The crucial learning process involves nearly a hard time in stressful moments but a total faith in the mentor at all times.

 ‘The Academy of Medical— Surgical Nurses (AMSN), the only professional nursing organization that represents medical-surgical nurses, has a program called, “Nurses Nurturing Nurses,’ or “N3,’ used today at multiple hospitals across the country. The program emphasizes that mentors communicate clearly and professionally, and that they listen well. The mentor should have a positive attitude, serve as a role model and resource person, and provide mental support and guidance- The potential mentor should be able to perform well under stress and be even-tempered- The mentor is successful in building caring relationships while fostering independence. 

The mentor-mentee… relationship is a win-win situation. A successful mentor helps the student to recognize strengths and weaknesses; encourages the mentee to establish goals for further performance, improvement; monitors and reviews progress in achieving identified goals; identifies problems that may be affecting progress; and assists the mentee in realizing his/her full potential The mentee not only receives the satisfaction of helping you become a professional, but also gains leadership and teaching skills, as well as enhancing professional growth The experienced nurse can have a tremendous impact on the professional life of the new graduate.’ 

‘Hale (2004) used the Hale Mentorship Assessment tool for nurses and found that the presence of a mentoring relationship improved retention, confidence, competence, and personal and professional growth in new graduate nurses (NCN).’ 

Signs of a good mentor clearly mention the importance of the mentor’s role in grooming a novice into a professional nurse. When the mentor and mentee work together for longer periods it works definitely in the favor of the latter’s learning abilities. Each study conducted in the last few years are evident with ample proof that students respond positively to a good mentor. An overall satisfaction of 93 % suggests that it is a good role model to diffuse the shortage of nurses in crucial work stations. When the mentor satisfies the student, it becomes easier for the transition to handle independently in absence of the senior after a time.

‘Angelini (1995) studied the relationship between the provision of mentorship strategies for staff nurses and their career development. Thirty-seven female staff nurses and eight female nurse managers from four acute care hospitals in two northeastern states participated in the interview. Study participants recognized that mentorship is critical to their career development and 95% identified their peers and nurse managers as most influential in the mentorship relationship. Two mentorship models emerged, which were classified as structural mentorship and process oriented mentor- ship. The structural mentorship model identified three mentoring influences, i.e., environment, people, and events. The environment was defined as the workplace. People were defined as those workers and family members with whom nurses came into contact, and events were defined as occurrences perceived by staff nurses to be critical to their career development.’ 

Positive career development helped narrowing the shortage of nursing staff with the mentor-mentee relationship. With its success, more organizations are being encouraged to have this as a role model to experiment. With ample proof, funds can be set aside for proper roles of experienced staff to function as mentors. Some funds can be set aside for practical applications as it can work wonders. Attrition and retention of nurses can be controlled. If certain benefits are given nurses would definitely find confidence in the program to make long term goals.

As we find success can be achieved it is necessary to evaluate what pitfalls can be avoided to turn potential dreams from turning into nightmares. As the current situation shows that misunderstandings, incompetence work, and other negative aspects are ruining lives. Some startling figures spell bad news. Sometimes wrong mentors assigned to new grads that eventually leave with bad impressions. This should be avoided, at all costs, to stop shortages of nursing staff.

Even if a new nurse is assigned, a mentor is there a guarantee that it would work for both. It is crucial to understand that a mentor should be someone every new grad would want to be like. A mentor is a perfect role model to emulate and has the necessary valuable experience to offer the students.

How does one check out some of the important qualities of a good and responsible mentor?

1. A commitment to teach new grads and help in their growth.
2. Most of the mentees reach out to mentors in the hope of learning the ropes. It is important the two connect to each other on a professional level. Sometimes, it is crucial for them to meet in an environment other than work place to understand each other.
3. Not all seniors can become mentors. Leadership qualities are required to handle each new grad and problems that may arise.
4. A willingness to nurture the novice is essential. Handling errors of a new grad deftly will earn respect and more responsibility too for a long term relationship.
5. A good mentor recognizes the fears of a new nervous grad and helps to become more patient, tolerant and accommodating. Frustrations can lead to tensions and poor health care.
6. A mentor cannot to keep secrets. A sense of mutual respect connect the two to work harmoniously.
7. Nursing for long hours can be tedious. A mentor ought to help relieve the environment of drudgery.
8. The relationship between the mentor-mentee is an on going process. At any given time, a mentor should be able to help the mentee.
9. A good mentor is knowledgeable and allows a new grad to learn more by practical observation.
10. A good mentor also sets an example for hard work, as most nursing requires most of the times. Such sacrifices help in building better quality of nurses.

‘Approximately 58 of new graduates change jobs during the first year of work (Mathews & Nunley 1992 Turnover rates have been reported to be as high as 55% in a public teach hospital (Hamilton Murray, Lind Holm, & Myers, 1989) and 36% in a children’s hospital (B Kunzman, & Qt. 2001) The turnover rates like these are costly and have a negative effect on nurses and the hospitals. To reduce turnover and improve retention it is imperative to develop a transition framework for graduate nurses that facilitates their growth and achievement of their potential (Delaney, 2003) Theoretical Framework 

Benner’s (1984) model of novice to expert was based on her research from 1979 to 1981 involving over 1,200 nurses, and includes the difficulties graduate nurses experienced adjusting to professional nursing roles (Chinn & Kramer 1999). Benner proposed that changes in the performance of nurses occur as the level of skill acquisition develop and she proposed five levels of skill acquisition and development: novice, advanced beginner, competent, proficient, and expert (Benner, 1984). in addition, she described an advanced beginner as one who has had enough experience to grasp aspects-but not attributes-and recurrent meaning of parts of a given situation, as well as demonstrate marginally acceptable competence.’ 

Most of the transitional issues can be addresses during the crucial first three months. As knowledge keeps, changing and improving the clinical and theoretical studies are of less help. As the student keeps asking, the correct practical applications there are fewer pressures on the process of learning. Many a new student nurse faces the challenge of the first day at work is thrust with complex issues of patient, administration and hostile colleagues—all at the same time. Not a very memorable way to begin with, but if the student looks at it positively she/he can use it as an excellent model to overcome pressures. If not, there lies the danger of being caught in a whirlpool of a hostile environment and no care! Health care is now more specialized with the result specific area focus helps the student nurse. Most of the nurses eventually wish to be maxi nurses and not mini doctors! Therefore, it makes sense for the student to develop support skills which are handy to become part of the workforce in hospitals.

Handling Patients and Colleagues and Abuses at Workstations.

Ask any senior who has survived the most important years of her nursing career some secrets. One is undoubtedly is handling with ‘care’ patients and staff alike, the other probably is her sweet smile and gentle demeanor. A new grad may find it difficult to understand inter-personal relationships but this is one key area which should not be overlooked. As the transition from an intern, asking questions to a silent professional nurse who functions efficiently any seasoned staffer will say it is essential to understand the working styles of the administrations and staff around.  Not many young new grads will complain about the ‘work pressure’, ‘hostile attitude’, and ‘abuse’. The fear of ostracization and unfavorable reports at the end of the term make students hide ugly facts of difficulties of transition. A diplomatic turn around help registered nurses to continue work without tension. Running away is no solution. This is where a mentor can be useful for the student. Certain amount of protection helps build confidence and cover up unhealthy incidents.

Abuse at Workstation

Not having a positive attitude at work can spell bad news for an organization. Not many findings will be made public and well known in nursing circles about abuse at work. It affects the morale of the new grad and deters one to pursue the profession further. Working amicably under stressful conditions can be a challenge for both new nurses and seasoned staff. Both mentors and registered nurses can keep a few points in mind before things get worse.

1. Aggression on anyone’s part can be detrimental—especially handling suspicious family members. Sometimes they need more careful handling than the patient does!
2. Both the mentor and mentee need to understand each other’s background before setting to work together. Working styles should not come as a shock to each other. A shy newcomer might take time to adjust and the mentor should not tick off for slow work.
3. Every institution has different expectation from their staff. Recognizing appropriate grads is necessary. Once a training program begins, one invests a lot more than just time. It should not back fire.
4. Unsafe surroundings can demoralize a new student. Protection ensures good results.
5. A mentor should not hit back the new grad with responsibility which cannot be handled. An unfriendly environment is likely to create hostility and spark further abuse.
6. Most new grads will be careful and fearful about complaining of violence. A good mentor should check signs if new grads are being a victim by fellow staffers.
7. Most new grads are sensitive and will understand if they are accepted or rejected. A mentor needs to check out for any irregular behavior. References and knowledge of every staff helps, acquaintance with the work culture prior to the experience is essential. This is one of the reasons orientation programs are necessary.
8. Mistrust and problem areas should be discussed weekly and more privately if need be. This will al least stop victimizing of new grads.
9. Most new grads today are aware it is difficult to make a transition to make to as a professional. If they have still taken up the challenge, they should be encouraged and not shunted out.
10. Violence should be penalized in form of suspension and made a deterrent to nip the problem in the bud. Each other’s weaknesses cannot not be exploited at any level.

The patient-nurse relationship counts in the end. A grad must understand the perspective of the patient and learn to handle families and relatives asking awkward questions. An experienced nervous nurse may add to the fears of a family reeling under a health crisis of a family member. However, under the mentor the student can definitely become a symbol of hope and courage. Training in-house is crucial for the registered nurse to gain experience. Working as a team member and thinking independently when required makes a student nurse more confident of her/his abilities. Firm decisions allow lateral thinking and obviously come with a lot of responsibility. Under good guidance, this comes naturally for a new nurse. Another important tip is the specialization area. It works well for the patient who has immense confidence in the nursing ability. Patients prefer to cut waiting times for specialized treatments due to rising costs. Where ever criticare is required, survival rates of patients’ increases with qualified and specialized nurses. A qualified and effective nurse eventually has the following qualities;

1. Will think critically and act with maturity and responsibility. Will adhere to strict work ethics.
2. Will coordinate efficiently with other allied healthcare professionals like physicians and patients.
3. Will better communication skills by listening, observing and applying procedures responsibly.
4. Will become apt at problem solving skills (especially with fellow works and peers).
5. Will naturally become caring and empathetic.
6. Will be eventually able to sacrifice weekends, evenings and holidays and do double shifts without complaining or making mistakes!
7. Will have the ability to handle manuals, have visible dexterity, physical strength and endurance.
8. Most importantly will have a polished, groomed and professional look of a qualified nurse.
9. Humor relieves tensions in serious situations and a good nurse is likely to smile confidently and focus on the patient or situation good- naturedly.

As new nurses adapt to their work environments they will learn to handle different problems effectively.

Conclusion

A smooth transition ensures that a student nurse will not eventually regret her/his decision. There is hope as quite a few researches are continuously making room for improvement in bettering the standards of nursing and addressing crucial problems of student nurses. Much has been reported and more findings will continue to emerge. This at least gives a ray of hope to the current crop that faith in the system will not fail them. Strategies that are more effective will emerge with better role models as systems go into place. Since it is an inter-personal and inter-dependent situation for both faculty and students in their own interests they can improve situations. Why would anyone want to risk of blacklisting? New nurses are eager to be accepted and are willing to work. Institutions can help to develop a bond to ensure that the shortages of nurses be reduced. Helping new nurses to adapt and become professional helps eventually in health care and keeps patients happy and instills faith in the system.

As for the faculty, a responsible dean ensures that seniors assist juniors to make a smooth transition to professionalism. It is as much responsibility of the seniors to encourage new nurses and develop a new generation of professional staff. To succeed and graduate to a level of a professional nurse is the ultimate ambition no nurse can deny. Why deny a chance? Why wipe out a blossoming career. The future is bright for aspiring new nurses as long as they continue their quest to become better than their predecessors do.