Transition to Practice: Challenges and Strategies for Newly Graduated Nurses

The transition from being a nursing student to a practicing registered nurse is a challenging process. This article discusses the challenges faced by newly graduated nurses during this transition and the impact on patient safety. It also highlights the importance of mental health awareness in the nursing profession. Strategies to overcome these challenges are explored.

Transition to practice 1
TRANSITION TO PRACTICE
STUDENTS NAME
INSTITUTIONAL AFFILIATION.

Transition to practice 2
The Transition.
The transition from being a nursing student to being a practicing registered nurse is
usually a very challenging moment in the nursing profession. It is a process of change. Just like
any other process of change, resistance is a normal occurrence (Burnes, 2015). Managing change
requires skills and should be implemented in a systematic way. In terms of the responsibilities
and the expectations the two cadres of the nursing profession are different. A registered nurse
can be held accountable for their action independently. They can make decisions concerning
patient care in accordance to their clinical judgement. A student on the other hand cannot act
independently. They receive instructions from the registered nurse. They are still learning and
will always have to be under the supervision of a more experienced nurse. The change in
responsibilities and duties causes a shift from the normal equilibrium (Spector et al, 2015).
Finding a new equilibrium for the system takes time. It might also put the patients care at risk if
not managed properly.
Challenges during transition and the effect on patient safety.
Becoming a registered nurse ushers a nursing student into a healthcare team. They are
now considered competent to carry out their duties diligently. They are required to provide input
from their professional training. The team is constituted by professionals from different field in
the medical profession. It becomes necessary for them to understand and have the skills to work
as a team. Most students do not have such an experience or background. They mostly work with
other students. Becoming a registered nurse integrates them to the team by virtue of being
professionals in the nursing field. Most students will shy away from giving their opinions. They
lack professional confidence (Ortiz, 2016). Their contributions may be limited. If this transition
is not handled well, the patient may not receive care from all the professions. The nurse being the

Transition to practice 3
closest to the patient may fail to include other members of the team. This may be due to
ignorance or inability to relate with other professionals.
Communication is an integral component in healthcare. Communication with patients and
colleagues catalyzes the process of healthcare provision. The student nurse may have had some
knowledge on the importance of communication especially to the patient. This is mostly in
theory and also in some instances during the rotations. The student can always get help from the
Registered Nurse (RN) if they are unable to communicate effectively. Being the RN, one is
expected to master the skills to retrieve information from the patient. Any intervention on the
patient is dependent on the way they communicate (Law & Chan, 2015). Giving consent,
explaining how they feel or seeking clarification will depend on the communication.
Communicating with other professional and colleagues is also a challenge. There are some words
and abbreviations that are used in nursing practice. It takes time to understand them and
ultimately use them in conversations.
In healthcare provision, time is an important factor to consider. Delays in performing a
particular procedure may lead to loss of life. Being a student nurse, the time factor does not
properly manifest in patient care. The number of patients assigned to them is small and easily
manageable. A registered nurse is incharge of a larger group of patients (Goode, Ponte &
Havens, 2016). They have to attend to all of them within a speculated time. The responsibilities
increase while the time allocated remain the same. Managing time becomes a very challenging
issue. It takes time and experience to come to speed with the way things should be handled.
Occasionally, the newly graduated student nurse will find themselves behind schedule in their
duties. In the emergency room for instance, nurses are expected to attend to a patient within the
shortest time possible to avoid for instance further loss of blood. For an RN who is not fully

Transition to practice 4
accustomed to this kind of procedures, they might feel as if they are under intense pressure.
Sometimes, so much time is spent consulting with other nurses since they may have never done
some of the procedures.
Quality improvement activity
In view of all the challenges facing a newly graduated nurse, an organized orientation
program for them will do so much good in helping them get settled and ready to perform their
new roles. Many have difficulties trying for figure out what they are expected to do. They are
posted in a completely different environment that that which they are used to. A properly
organized orientation program will not only be of help get integrated into the nursing profession
but also improve their level of patient care. According to research into the transition program, it
has been found out that the newly registered nurses experience the most intense stressors within
their first three to six months in practice (Cherry & Jacob, 2016). The changes may bring a lot of
mixed feelings and emotions which will affect the way they provide care to the patients.
Most of the employers take their time to introduce the new graduates to the system
through a kind of orientation program where they are informed of the expectations. Experienced
nurses are also instructed to offer assistance to the newly integrated nurses and help them to
come to speed. In my practice, the mentorship is not just enough. It mostly targets equipping the
newly graduated RN with the necessary skills to carry out their duties. An important aspect of
this program is ignored. One that will focus on the mental and emotional well-being of the
nurses. Stressors in the line of duty are immense (Liang, Lin & Wu, 2018). Emotional fatigue
and disappointments cannot be ignored. Health care providers have been identified as one of the

Transition to practice 5
groups of people who are affected by stress but fail to seek professional help. According to
Laschinger et al (2016), mental well-being will not only enable them acquire the right attitudes
towards the job but will also encourage resilience in the face of pressure.
Integrating mental health awareness program into the orientation program will be an
activity that will improve the performance of new RNs and thus improve the quality of patient
care. The definition of health includes the aspect of mental well-being. However, this has been
neglected in so many situations by healthcare providers. They are unwell although they can be
viewed as the agents of wellness. Psychiatrists should be incorporated into the program.
Experienced nurses may also be taught on how to evaluate the level of stress in the newly
graduated nurses in order to help them cope. A weekly visit to the psychiatrist will be a step
towards making them aware of their feelings and emotions. They will get attention depending on
the severity of their conditions. Stress and mood disorders are a common phenomenon. If they
are not addressed early enough, they become they may progress to serious mental health
illnesses. These illnesses will reduce their performance and efficiency at work (Wing, Regan &
Spence Laschinger, 2015). Such a nurse will be danger to the patient. The principles of medicine
demand that no harm should be done to the patient. Having mentally unstable nurses taking care
of the patients is a contravention of this principle.
My role in the team.
The role of the team is to carry out a quality improvement activity. As the team leader I
am supposed to oversee all the activities. Before any steps can be made, we need to identify a
problem within the system that need to be addressed. Facts and statistics to support the existence
of the problem should be identified. We should sensitize the staff about the problem and also
seek their opinions concerning it. An implementation plan is then formulated after considering

Transition to practice 6
all the opinions and suggestions of all the affected parties. For instance, having identified a
loophole in the orientation program, we should provide the evidence of its existence and give our
recommendations on how this should be solved. Being the team leader, I should see through the
whole process and delegate the duties to the team members (Sharma & Bhatnagar, 2017).
My role will be spearheading the coordination and collaboration with other departments
(Cartwright, R. (2017). It will involve more than one department, thus the need to follow the
right channels to ensure cooperation.
Challenges in leading the team.
Working in a new environment will be quite a challenge for a team leader (Ekström &
Idvall, 2015). It may be hard to navigate around the departments. This activity will include other
departments other than the nursing profession. For instance, accessing the head of psychiatry
department in the hospital may be a challenge especially is I am not aware of their schedule. The
team member may not be fully aware of their expectations. There may be a lot of confusion
especially in a new environment.
Communication is very essential in making such a consultative activity occur (Arnold &
Boggs, 2015). My team and I should be well equipped with the necessary skills to engage the
other parties in the middle of their day to day activities. To be able to convince them to spare
their time in the middle of their busy schedules. We would expect some resistance from those
opposed to the idea. It may not be possible to convince every person that we might need the
program. Member of the time might disagree on the activity that we should carry out. We may be
forced to carry out the project that will be supported by most of the team members. Some will
have to do what they do not consider as a priority because it has been chosen by the majority.

Transition to practice 7
I would also expect a shortage of resources in the process. Many organizations, are faced
by the problem of shortage of resources. The hospital will not be an exception. We will have to
work with the available ones. It may not be regarded as a major project, thus some may disregard
it and not really accord it the attention it deserves.
Dealing with the challenges.
To avoid the confusion, the objective of the activity should be well stated. All the
members should understand what they are expected to do. Encouraging cooperation by rallying
them towards a common goal. A sense of purpose will give them determination and encourage
them to work together (Zhu, 2016). Making them aware of the environment before starting the
process will make it easy for them to navigate around the hospital. Consulting with the
concerned departments earlier in advance will be quite instrumental in avoiding disappointments
of being turned down if they appear without a prior notice.
Disagreements within the team should be solved amicably to bring in a win-win situation
(Wang, & Zhang, 2015). Members should be convinced on the way to go based on facts. They
should also be encouraged to accept the outcome of decision making process. Acknowledging
their ideas and concerns will make them feel recognized. Disagreeing with them respectfully will
influence them to working with the team despite having a contrary opinion.
Shortage of resources can be addressed by making a physical budget for the whole
process and indicating the entire breakdown. A detailed budget will be more convincing and
more likely to indicate proper planning which prevents wastage. Cutting down on unnecessary
expenditure will save resources to be used on the actual project.

Transition to practice 8
References.
Arnold, E. C., & Boggs, K. U. (2015). Interpersonal relationships: Professional communication
skills for nurses. Elsevier Health Sciences.
Burnes, B. (2015). Understanding resistance to change–building on Coch and French. Journal of
Change Management, 15(2), 92-116.
Cartwright, R. (2017). Mastering team leadership. Macmillan International Higher Education.
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management.
Elsevier Health Sciences.
Ekström, L., & Idvall, E. (2015). Being a team leader: newly registered nurses relate their
experiences. Journal of nursing management, 23(1), 75-86.
Goode, C. J., Ponte, P. R., & Havens, D. S. (2016). Residency for transition into practice: An
essential requirement for new graduates from basic RN programs. Journal of Nursing
Administration, 46(2), 82-86.
Laschinger, H. K. S., Cummings, G., Leiter, M., Wong, C., MacPhee, M., Ritchie, J., ... &
Young-Ritchie, C. (2016). Starting out: a time-lagged study of new graduate nurses’
transition to practice. International Journal of Nursing Studies, 57, 82-95.
Law, B. Y. S., & Chan, E. A. (2015). The experience of learning to speak up: a narrative inquiry
on newly graduated registered nurses. Journal of clinical nursing, 24(13-14), 1837-1848.
Liang, H. F., Lin, C. C., & Wu, K. M. (2018). Breaking through the dilemma of whether to
continue nursing: Newly graduated nurses' experiences of work challenges. Nurse
education today, 67, 72-76.

Transition to practice 9
Ortiz, J. (2016). New graduate nurses' experiences about lack of professional confidence. Nurse
education in practice, 19, 19-24.
Sharma, A., & Bhatnagar, J. (2017). Emergence of team engagement under time pressure: role of
team leader and team climate. Team Performance Management: An International
Journal, 23(3), 171-185.
Spector, N., Blegen, M. A., Silvestre, J., Barnsteiner, J., Lynn, M. R., Ulrich, B., ... & Alexander,
M. (2015). Transition to practice study in hospital settings. Journal of Nursing
Regulation, 5(4), 24-38.
Wang, J., & Zhang, J. (2015). A win–win team formation problem based on the
negotiation. Engineering Applications of Artificial Intelligence, 44, 137-152.
Wing, T., Regan, S., & Spence Laschinger, H. K. (2015). The influence of empowerment and
incivility on the mental health of new graduate nurses. Journal of nursing
management, 23(5), 632-643.
Zhu, H. (2016). Avoiding conflicts by group role assignment. IEEE Transactions on Systems,
Man, and Cybernetics: Systems, 46(4), 535-547.