Transition of Nurses: Challenges and Importance of Increased Understanding

This essay discusses the challenges faced by new graduate nurses during their transition to the role of a professional nurse. It elaborates on the importance of an increased understanding in new graduate practice for a smooth transition. The essay also reflects on the Dreyfus model and Benner’s 5 stages to becoming a professional nurse. The skills required for a successful transition are also discussed.

Running head: TRANSITION OF NURSES
401021 Being a Professional Nurse or Midwife
Name of the Student
Name of the University
Author Note

1TRANSITION OF NURSES
Introduction- The transition period of a graduate nursing student to a registered nurse
is often fraught with several emotions such as, happiness, anxiety, excitement, uncertainty,
and fear. It encompasses a situation where the new graduates question everything from their
skill, to whether they have made an appropriate career choice, or if they will be able to adorn
the role of a registered nurse successfully. In an ever altering health related environment, one
feature that remains unaffected is the request for nursing professionals, and the necessity is
graver now, than ever before (Thrysoe et al., 2011). Some of the common issues that are
faced by the nurses during their transition encompass gaps in theory to practice, time
management. Documentation skills, accountability, limited proficiency in execution and
management of technical skills, decision making, and medicine administration. The essay
will elaborate on the importance of an increased understanding in new graduate practice for
a smooth transition to the role of a professional nurse.
Critical analysis- There is mounting evidence for the fact that clinical practices have
been found to be under huge pressure to function in an efficient and lean manner, owing to
the upsurge in regulatory oversight, shrinkage of reimbursements, and augmented
consumerism (Ortiz, 2016). This pressure stresses that education programs should be able to
produce nurses who demonstrate a readiness for their work, from the very moment they enter
their practice domains. Hospitals usually find more number of patients suffering from
multifaceted chronic conditions. Global statistics have demonstrated a disproportionately
increased rates of cancer, cardiovascular disease, diabetes, obesity, end-stage renal disease,
and mental illnesses (Mills et al., 2016). Most of these conditions can be accredited to the
absence of adequate access to primary care services, restricted access to preventive services,
boundaries in subsidy for care, and deep-seated social and cultural issues. Some of the
clinical skills that a nurse must possess include acute care, treatment planning, life
support, telemetry, case management, advanced cardiac life support, and patient or

2TRANSITION OF NURSES
family education. The skill of treatment planning acts in the form of a blueprint and guides
the care services that the nurses deliver to their clients (Ackley et al., 2016). Hence, the new
graduate nurses are subjected to circumstances where they have to collaborate with other
professionals, for the best interest of their patients. Similarly, the skill of acute care makes the
nurses provide care to patients for a short period of time, following an illness or injury
episode (Kramer, Brewer & Maguire, 2013). The nurses are also subjected to conditions
where they have to focus on automated communication process for collecting measurement
of patients at inaccessible or remote locations. Therefore, these situations make the nurses
feel stressed and fatigued during their transition to practice (Leong & Crossman, 2015).
Nurses are entitled with the competence of handling patients, relations with the providers and
families, and leading the interprofessional team. Caka, Van Rooyen and Jordan (2015) stated
that under circumstances that do not provide nurses with supportive relationships, new
registered nurses who have the responsibility of caring for complex patients often feel
overawed and fatigued, and they might suffer from momentous anxiety, all of which can
result in attrition.
Clinical currency comprises of a range of domains, beginning from simple
provisions of providing direct care to the patients, till the expert knowledge on the particular
area of nursing practice (Candela, Gutierrez & Keating, 2015). There is mounting evidence
for the great benefits that are associated with provisions of direct care for patients, along with
the up keeping of clinical ability, in clinical environment (Rush et al., 2013). Adorning the
skills of clinical currency assists the nursing professionals to become credible. Furthermore,
the fact that new nurses are also expected to display a commitment to lifelong learning urges
them to demonstrate skills for enhancing their competence, relevant to nursing practice
(Phillips et al., 2014). Hence, clinical currency and continuing formal education is imperative
for nurses for maintaining clinical competency.

3TRANSITION OF NURSES
A range of non-clinical skills that are essential for new registered nurses to display
following their transition include effective communication, critical thinking, flexibility, and
attention to details. The duty of a nurse requires the professional to stay on the front lines of
care. Research evidences also focus on the need of nurses to foster an open dialogue with
patients and their families, so they fully understand their diagnosis, medication and any other
medical concerns (Kensington et al., 2016).
Effective communication amongst fellow doctors, nurses, and other healthcare
professionals is also crucial since the nurse has the responsibility of sharing the tasks of
caring for all service users. Additionally, in the words of Walton et al. (2018) these new
nurses are often subjected to conditions where they find themselves in charge of facilitating
dialogue with the uncooperative and/or worried patients, their concerned family members,
doctors and other allied health professionals. Owing to the fact that graduate nursing courses
do not often comprise of situations where the nurses are expected to demonstrate strong
communication skills, their sudden transition to professional practice results in challenging
situation for the nurses.
Furthermore, although the baccalaureate courses have a definite time period, as a
nurse, the professionals are never aware of the events that they might encounter on a
particular day. Some of the last-minute changes regularly pose challenges, while the
registered nurses juggle their multiple treatment plans, requests from physicians, interaction
with patient families, and paperwork (Gaundan & Mohammadnezhad, 2018). Most nurses
also agree on the fact that adaptability to the work pressure is one of their most significant
non-clinical nursing skills. However, some of the strengths that are commonly recognised by
new graduate nurses include a sense of self-understanding, empathy, communication skills,
and professional and personal values. The nurses also have the role of being accountable for
one’s judgments related to nursing, its omissions and actions. Hence, following immediate

4TRANSITION OF NURSES
transition from the role of a nursing student to an RN, thy have to maintain their competency,
while safeguarding the quality of patient care outcomes. The nurses are also entitled with the
duty of adhering to the standards of the profession, besides being answerable to the patients
who are affected by the nursing practice.
Discussion- According to the Dreyfus model of skill acquisition learners are able to
acquire their skills via practice and formal instructions. The four binary qualities that are
elaborated by the model are namely, recollection, recognition, awareness, and decision.
Hence, the abilities that are expected of new graduate nurses, in relation to development of
clinical and non-clinical skills are associated with enhancement of expertise and change, with
the nursing practitioner becoming more skilful (Lyon, 2015). Nurses having difficulty in
understanding the ends of their practice often face difficult in understanding skills that are
related to problem and interpersonal engagement. Hence, Dreyfus is able to provide a model
related to knowledge and talent acquisition, relevant to the training of nurses in practical
sense. The Benner’s 5 stages to becoming a professional nurse focuses on, novice,
advanced beginner, competent, proficient, and the expert. While the novice encompasses a
nursing student in the initial years of clinical education, the advanced beginner refers to new
graduates in their first job. The nurses lacking proficient flexibility, but having mastery on
organizational and advanced planning skills form the third stage (Pasila, Elo & Kääriäinen,
2017). The proficient nurses learn from experiences, while the expert recognizes the
resources and demands that helps them attain their goals. Hence, the two nursing theories are
able to explain the steps that must be followed for a smooth transition to nursing practice.
Reflection- Preparation for nursing transition promotes competency. While reflecting
on the challenges that are encountered during transition, I realized that all stages of
professional role transition reflects in the form of a non-linear process that transfers the
novice practitioner through professional, developmental, emotive, and intellectual skills.

5TRANSITION OF NURSES
Furthermore, realised that transition shock will often emerge in the form of movement from
the actual role of a nursing graduate to the moderately less acquainted role of a professional
nurse (Hoare, 2016). My clinical placement helped me gain a sound understanding of what to
expect in the practice setting. During my placement I have shown adherence to the standard
1 and 3 of nursing practice (Nursingmidwiferyboard.gov.au, 2014). I have shown
competence in developing my practice through reflection, respecting all cultures, accurately
documenting patient information, adopting a lifelong approach and holding accountability for
my actions. Hence, I am at the threshold phase of transition to nursing and intend to develop
my clinical and non-clinical skills for a smooth transition to practice.
Conclusion- To conclude, the transition shock experienced by the nurses are generally
embedded within the initial stages of transition of professional roles. Nurses are expected to
display a range of clinical skills in their workplace. As a nurse, it does not come as a surprise
that there are a plethora of practical nursing skills that are indispensable for executing the
duties that are expected of a nursing staff. Most treatment plans help in typically highlighting
the essential assessment information, defines the domains of concern related to the patient
and also facilitate establishment of goals for the treatment of the patients. The new RNs are
often found to act as the middleman, communicating critical material from the physicians to
the patient. Thus it can be concluded that enhancement of skills and lifelong learning are
imperative for averting the problematic experiences that can occur during transition from a
student to an RN.

6TRANSITION OF NURSES
References
Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2016). Nursing Diagnosis Handbook-E-
Book: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences.
Caka, E. M., Van Rooyen, R. M., & Jordan, P. (2015). Dual transitions in nursing: a military
perspective. Africa Journal of nursing and Midwifery, 17(Supplement 1), 191-208.
Candela, L., Gutierrez, A. P., & Keating, S. (2015). What predicts nurse faculty members'
intent to stay in the academic organization? A structural equation model of a national
survey of nursing faculty. Nurse education today, 35(4), 580-589.
Gaundan, D., & Mohammadnezhad, M. (2018). Reality Shock: A Transitional Challenge
Faced By Intern Nurses at Labasa Hospital, Fiji. International Journal of Healthcare
and Medical Sciences, 4(9), 158-164.
Hoare, K. J. (2016). Retaining new graduate nurses in practice; under-pinning the theory of
reciprocal role modelling with ‘routinisation’theory and transition shock. Social
Theory & Health, 14(2), 224-238.
Kensington, M., Campbell, N., Gray, E., Dixon, L., Tumilty, E., Pairman, S., ... & Lennox, S.
(2016). New Zealand’s midwifery profession: Embracing graduate midwives’
transition to practice. New Zealand College of Midwives Journal, (52).
Kramer, M., Brewer, B. B., & Maguire, P. (2013). Impact of healthy work environments on
new graduate nurses’ environmental reality shock. Western Journal of Nursing
Research, 35(3), 348-383.
Leong, Y. M. J., & Crossman, J. (2015). New nurse transition: success through aligning
multiple identities. Journal of health organization and management, 29(7), 1098-
1114.

7TRANSITION OF NURSES
Lyon, L. J. (2015). Development of teaching expertise viewed through the Dreyfus model of
skill acquisition. Journal of the Scholarship of Teaching and Learning, 88-105.
Mills, K. T., Bundy, J. D., Kelly, T. N., Reed, J. E., Kearney, P. M., Reynolds, K., ... & He, J.
(2016). Global Disparities of Hypertension Prevalence and ControlClinical
Perspective: A Systematic Analysis of Population-Based Studies From 90
Countries. Circulation, 134(6), 441-450.
Nursingmidwiferyboard.gov.au. (2014). Registered nurse standards for practice. Retrieved
from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/
professional-standards/registered-nurse-standards-for-practice.aspx.
Ortiz, J. (2016). New graduate nurses' experiences about lack of professional
confidence. Nurse education in practice, 19, 19-24.
Pasila, K., Elo, S., & Kääriäinen, M. (2017). Newly graduated nurses’ orientation
experiences: A systematic review of qualitative studies. International journal of
nursing studies, 71, 17-27.
Phillips, C., Kenny, A., Esterman, A., & Smith, C. (2014). A secondary data analysis
examining the needs of graduate nurses in their transition to a new role. Nurse
Education in Practice, 14(2), 106-111.
Rush, K. L., Adamack, M., Gordon, J., Lilly, M., & Janke, R. (2013). Best practices of formal
new graduate nurse transition programs: an integrative review. International journal
of nursing studies, 50(3), 345-356.
Thrysoe, L., Hounsgaard, L., Dohn, N. B., & Wagner, L. (2011). Expectations of becoming a
nurse and experiences on being a nurse. Vård i Norden, 31(3), 15-19.

8TRANSITION OF NURSES
Walton, J. A., Lindsay, N., Hales, C., & Rook, H. (2018). Glimpses into the transition world:
New graduate nurses' written reflections. Nurse education today, 60, 62-66.