Challenges Faced by Student Nurses Transitioning to Graduate Nursing

This report delves into the multifaceted challenges encountered by student nurses during their transition to graduate nurse roles. The research synthesizes findings from various databases and literature reviews, including MEDLINE and CINAHL, to identify key barriers. These challenges encompass high levels of stress and anxiety due to increased responsibilities, lack of support, bullying, and the complexities of real-world clinical practice. The report highlights the importance of strategies such as mentorship programs, peer support, and new graduate nurse programs to address these issues. The analysis examines the impact of these challenges on nurse turnover, patient care, and organizational culture, emphasizing the need for interventions to minimize stress and improve competency. Various studies mentioned in the report focuses on effective coping mechanisms, the need for support, and the importance of structured transition programs to facilitate a smoother transition and enhance the professional growth of new graduate nurses. The report also references studies that emphasize the importance of mentorship and preceptor-ship to help new nurses navigate the complexities of the profession and develop confidence in their abilities.

What are the challenges facing the
student transitioning from a student
nurse to a graduate nurse?

Table of Contents
INTRODUCTION...........................................................................................................................1
Search Words...................................................................................................................................1
Database search................................................................................................................................1
Literature Review.............................................................................................................................2
CONCLUSION................................................................................................................................8
REFERENCES..............................................................................................................................10

INTRODUCTION
The journey from a client nurse to a registered nurse has a huge amount of challenges
which a nurse has to face for successfully transitioning into a clinical practitioner so that they can
be able to practice the facts that they have studied, on the real world. Although the process is
challenging and has many barriers but these can be sought with the help of various strategies.
The research is about the various challenges a nurse faces while the transition process and the
techniques and methods that can be used for resolving the problems, thus focusing on work and
different operations.
Search Words
Transitioning
Preceptor-ship
MEDLINE
CINAHL
Barriers
Database search
Database Results
MEDLINE MEDLINE is considered as a database for
information and data regarding the biomedical
and life sciences. Information from various
sources are included in this database.
CINAHL Cumulative Index for nursing and allied health
literature (CINAHL) is termed as a database
that helps in getting the indexing of the allied
research available.
Database Results
MEDLINE 52
CINAHL 34
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Literature Review
In contradiction with Rush and et.al, (2013) which included databases like MEDLINE
and CINAHL for a better evaluation, Hilary (2016) says that a huge amount of students were
provided training for nursing practices and before that the information was collected. As per a
survey, two thousand pre graduated individuals took part in it, whether a specific amount of
people were affected by some external factors which acted as barriers in their journey of
transitioning from a client nurse to a graduate nurse. The nurses have to go through a great
number of challenges for the successful transitioning to be a registered nurse. Although the
nurses are in a great demand and the demand is even more critical than before.
In contrast to Hilary (2016), Linda (2016) says despite of the demand for nurses, there are
a huge number of challenges as well from which they have to go through whereas Hilary (2016)
said it is because of the external factors only that the nurses have to face difficulties in the
transitioning process. The reason behind this pressure is for the production of standard and
qualified nurses. In the year 2014, it has been observed a minimization in the number of
registered nurses. The reasons behind that was analysed as increasing growth in population, the
ageing workforce that is already existing. Also, it included a huge number of patients having
complex conditions. The nurses were less than compared to the patients. Various strategies have
also been implemented for successfully transitioning new nurses from the studies to the real
world practising. The involved challenges observed were a huge number of patients having very
complicated situations. Bullying can also be considered as a challenge which happens in this
industry even after various laws have been proposed for it. During the transition process, the
nurses also feel higher levels of anxiety and stress because their responsibilities increases and
they have to practice and operate in the real world, the things they have studied before.
In comparison to Jason (2013), Jalil, Reza and Ali (2014) says a very common reason for
turnover of nurses can be termed as ineffective coping with the transition process. Both of these
articles considers the turnover that may be because of the stress and other factors while the
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transitioning from client to a graduate nurse. The research consisted the data of sixteen nurses
from four hospitals. The information was collected qualitatively. While the transition from a
nurse to a registered nurse, there are various significant changes in roles as well as
responsibilities. Various issues like anxiety, stress etc. also acts as a reason for staff turnover
sometimes and it affects the whole culture of the organisation. This forces the organisation to
appoint less or unqualified nurses because some are there to be in the health care centre for
managing and taking care of the patients. If attention is not been paid to these factors, it leads to
further problems such as de motivational levels in nurses, fear or feeling less capable of
completing the responsibilities.
In comparison to Rush and et.al, (2013) which included databases like MEDLINE and
CINAHL for a better evaluation, Kumaran and Carney(2014) says the nurses who come from
this transition from a student nurse to the specific nurse, all they need is support as incorporating
the actual knowledge in clinical practice is considered as a quite hard process. Although there
are various approaches, but in this study, Heideggerian Hermeneutic approach has been used.
The interview was taken from ten nurses, on the basis of which the study conducted further. Van
Manen's thematic analysis was also used in the whole process. At the starting of the work, they
all were excited to a huge extent but after a few times, during the transition period, they all were
frustrated with the roles. The reasons for frustration were evaluated as the lack of support from
the authorities.
In contrast, with Kaihlanen, Lakanmaa and Salminen (2013) where the importance of an
authority or a mentor has been explained as very essential, Jason (2013) says that an online
survey was done for the analysis of the data. It was done with the help of an open source
software package that involved 21 questions on an average basis. The qualitative information
was collected from the focused groups. It was observed that the stress factors are the main
reasons for the turnover of the staff in health care centres and hospitals. Also, the industry is
being affected as the number of retirements and excessive workload in some situations. Bullying
has also been a reason for the nurses who are transitioned from the student nurses to clinical
practitioners. It was also observed in the research that the stressed nurses resulted in poor results.
In comparison to Banister and et.al. (2014) which included the importance of guidance
from the leaders or mentors, Rush and et.al, (2013) says, the search regarding this study will
include PubMed (MEDLINE) and the cumulative index to the nursing and allied health literature
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(CINAHL). Cooper's five stage approach has been used for the integration of the process and the
whole data collection. The examination included some major themes such as Support,
Competency, Education and the critical thinking process. There were various programs included
in the process such as transition programs, mentorship, internships, peer to peer support
functions. A mentorship model was also included in which efficient communication skills were
involved within the employees of the organisation. It was developed in order to describe the fact
that the nurses and the employees can help each other in case of complicated situations and also
can suggest any advice etc., if required. After this program, it was evaluated that the level of
competency between the nurses also increased to a higher level. Everyone was trying to have a
step further from the others. However, it helped the nurses to focus on the work, rather than
having any stress factors or any related issue. Many centres have developed a new graduates
nurse programs for the new nurses that have been transitioned from the client nurse to the
graduate nurse. These programs helps the nurses in completing their educational needs and then
provide a platform for practising the studies in the real world.
In comparison to Suresh, Matthews and Coyne (2013), Kaihlanen, Lakanmaa and
Salminen (2013) says whether the transition process is quite exciting, it also has a huge number
of stresses and challenges. Both the authors consider the factors that act as barriers and
challenges. In this research, the importance of mentor in this process of transitioning from a
nursing student to a registered nurse has been evaluated. Data from 16 nurses have been taken.
They informed about the changes they have been gone through after coming under the guidance
of a mentor. They told the support and guidance helped them in coping with all the issues came
such as the stress factors etc. They also observed the increase in the professional growth which
helped them to a huge extent in the transition process from a client to a graduate nurse. There
came some bitter moments also but all that guidance and strictness lead them to a successful
graduated nurse and they became enough capable to cope with various types of situations such as
they have observed minimized level of fear while operating and dealing with patients having
serious and complicated conditions. On an overall basis, they experienced huge level of increase
in their confidence status. The process helped them in gaining an understanding of being a
mentor and guide the clients about different ways to deal with the patients and such situations.
In contradiction with Liaw and et.al (2014) which included the sub division of the
process in two parts, Suresh, Matthews and Coyne (2013) says about the stress factors nurses
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have whiled the process of the transition, it directly or indirectly affects the person itself, the
clinical environment and the patients as well. To the person itself, it makes the person lacking in
confidence levels, thus a decreasing level of attention towards the actual roles and
responsibilities. In this study, the research was made from the questionnaires. The comparison
was done between the newly qualified nurses and the ones who are going to be appointed as the
graduate nurses. An instrument has also been used in this process, the nursing stress scale. It was
analysed that the level of stress was found very high in both the groups. The reasons evaluated
was excess level of workload, not better interactions and various complicated situations.
Interventions would have taken at that time and they could have also helped in reduced levels of
stress for both of the groups. But due to various internal reasons, they have not been identified.
Although there was no as such difference in both of the groups, but they both have same level of
stress factors. These measures have been identified essentially because these can help in
minimizing the stress levels, thus focusing on the work properly and competing with the
situation, no matter how hard it is.
In contradiction with Ebrahimi and et.al., (2016) in which the transition from a client
nurse to a graduate nurse has been termed as a traumatic process, Liaw and et.al., (2014) says, it
is a crucial process to provide the appropriate training to the ones who are going to be graduate
nurses from client nurses. Various consolidated clinical practices are being provided to students
so that they can be able to cope with the situations and thus results in better outcomes. A
framework have been developed for the successful implementation of the simulation program.
On an overall, analysis of 94 students were taken, in which they all participated in a 15 hour
SIMPLE program which included various cases that are actually based on the real world
practices. The tests were sub divided into pre and post parts so that the nurses that are going to be
transitioned to the graduate nurses can be prepared well for the upcoming situations. It will
overall help them in completing their duties well which will further help the clinical or
organisational status.
In contradiction with Phillips and et.al, (2014) which involved help from the interpretive
description process, Ebrahimi and et.al., (2016) says, often new nurses feels the transition as a
traumatic procedure. In this research, semi structured and unstructured interviews have been
taken in which 18 nurses that were already licensed were selected through the sampling process.
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In this research as well, the barriers were evaluated as less support and motivation from the
mangers and team embers, weak interaction levels with them, cultural barriers etc. The findings
of this research were that a proper understanding of the issue can help in solving it with the help
of appropriate strategies and techniques. These issues may occur due to various reasons such as it
does not mean that it may be happening because of the nurse's fear etc., but because of the
weakness of the organisation. There must be some loop holes in the clinical or organisational
process which further leads to these issues for the nurses and the process of them transitioning
from client to the registered nurses.
In comparison to Banister and et.al. (2014) which represented the importance of the
guidance and support from the authorities or mentors, Phillip and et.al., (2014) says the research
analysed the views and ideas of various nurses that have been become graduated nurses. They
experienced that although the process was challenging and quite stressful, but it made possible
with the hard work, patience and the support of the managers. They also explained that they
faced various difficulties such as in adjusting in the role etc. The qualitative information and data
has been collected having some sets involved such as the global theme, value practices etc. With
the help of support from the authorities, they faced no problems in becoming graduates in
nursing and also they became capable of competing with such situations. These factors helped
them in getting proper satisfaction from their job, thus coping with all the difficulties.
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In contradiction with Phillips and et.al (2014), in which the qualitative data has been
collected from focused groups and it also included the interpretive descriptive approach which can
help in managing the stress and other factors while the transitioning process, Pfaff and et.al,
(2014) says in this study, five male and seven female were considered from whom the data has to
be collected. Interview questions have been asked from the both parties in which half of the
people said that the stress is the only factor that interferes in the transitioning process whereas the
other half analysed that new challenges and processes are the factors that actually leads to stress
factors and various other issues. The data has been collected till the saturation of all the
individuals. It was further analysed that all these measures such as less support from the
organisation, minimized level of interaction within the co workers and the staff can be considered
as the factors that actually de motivates an individual, thus further leads to various de
motivational factors and less encouragement levels. It was found at the end that specific
preparation should be provided to the client nurses so that they can make their mind for these
situations and it will help them in a way that if they have already made their mind, these issues
will not any more bother them or their work.
In contradiction with Hilary (2016) which says the barriers come in the transition process
because of the external factors, Phillips and et.al, (2014) says, with the help of interpretive
descriptive approach, two qualitative data sets have been analysed from the focused groups. The
nurses observed that pre paid employment services can be considered as a better option. This also
made a fact that the pre paid employees will be given different sort of treatment by the mentors
and the authorities. It also included a criterion that for early transitioning of a client nurse to a
graduate nurse, the senior staff have to provide an efficient treatment to the newly ones. Just not
because the sake of pre paid services, but for the sake of becoming a graduate nurse, so that the
nurse can be able to practice the things in the real world, that she has studied before.
In comparison to Jason (2013) which included the limitations such as any sort of
discrimination or bullying or ragging, Rush And et.al, (2014) also says that often new nurses
appointed are become a victim of bullying or ragging from the previous students or nurses.
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Despite of various laws and rules against it, it has been still implemented in various colleges and
clinical organisations. Initially, the graduate nurses are new to the practising and the related
operations, so they need support at this time. An online survey was conducted in which it was
analysed that the new graduates had the poor transition experience than the others. Various more
programs have been implemented for the same which helped in limiting the activity but still it has
its own little presence left. Ragging or bullying of these new candidates makes their confidence
level even lesser which further effects their focus and concentration towards work and the specific
operations.
In contrast to Phillips and et.al, (2014) which involved the interpretive descriptive
approach, Banister and et.al. (2014) says, in the following research the client students were paired
with an experienced clinical nurse of any partnering agency. The focus of this was to guide the
client nurses throughout the minor and major projects. The research also included a small survey
in which the mentors and mentees rated against each other in terms of help, support etc. The
evaluation was based on the interaction level between them and the level of encouragement they
both provide to each other. According to the client nurses, it was evaluated that the mentoring or
working under the guidance of an experienced leader can help in achieving the targets and also
makes one able to cope with any sort of situation as well.
CONCLUSION
It was concluded from the report that although the process of transitioning from a client
nurse to a registered nurse is quite exciting, but the process has along with it various challenges
and stress factors that may act as barriers in the whole journey of the transition. There are various
strategies that can help in easing the process and make the nurse even capable of coping with
different kind of situations. It was also analysed from the research that guidance and support from
the authorities play an important role, thus competing with the stress factors and maintaining a
balance over work.
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REFERENCES
Books and Journals
Rush, K. L. And et.al., 2014. New graduate nurse transition programs: Relationships with
bullying and access to support. Contemporary nurse, 48(2). pp.219-228.
Banister, G. and et.al., 2014. Using career nurse mentors to support minority nursing students and
facilitate their transition to practice. Journal of Professional Nursing. 30(4). pp.317-325.
Phillips, C. and et.al., 2014. Does the choice of pre-registration paid employment impact on
graduate nurse transition: An Australian study. Nurse education today. 34(4). pp.532-
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537.
Pfaff, K. and et.al., 2014. An integrative review of the factors influencing new graduate nurse
engagement in inter professional collaboration. Journal of advanced nursing. 70(1).
pp.4-20.
Phillips, C. and et.al., 2014. A secondary data analysis examining the needs of graduate nurses in
their transition to a new role. Nurse Education in Practice. 14(2). pp.106-111.
Ebrahimi, H. and et.al., 2016. Barriers to support for new graduated nurses in clinical settings: A
qualitative study. Nurse education today. 37. pp.184-188.
Liaw, S. Y. and et.al., 2014. Easing student transition to graduate nurse: a simulated professional
learning environment (SIMPLE) for final year student nurses. Nurse education
today. 34(3). pp.349-355.
Suresh, P., Matthews, A. and Coyne, I., 2013. Stress and stressors in the clinical environment: a
comparative study of fourth‐year student nurses and newly qualified general nurses in
Ireland. Journal of clinical nursing, 22(5-6), pp.770-779.
Kaihlanen, A. M., Lakanmaa, R. L. and Salminen, L., 2013. The transition from nursing student
to registered nurse: The mentor’s possibilities to act as a supporter. Nurse education in
practice, 13(5). pp.418-422.
Rush, K. L. And et.al., 2013. Best practices of formal new graduate nurse transition programs: an
integrative review. International journal of nursing studies, 50(3). pp.345-356.
Jason., G. 2013. [Online]. Available through:
<http://www.msfhr.org/sites/default/files/Expanding_the_Evidence_for_New_Graduate
_Nurse_Transition_Best_Practices.pdf >. [Accessed on 23rd October 2017].
Kumaran, S. and Carney, M., 2014. Role transition from student nurse to staff nurse: Facilitating
the transition period. Nurse education in practice. 14(6). pp.605-611.
Jalil., A, Reza., N. and Ali., F. 2014. [Online]. Available through: <
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825481/>. [Accessed on 23rd October
2017].
Linda., H. 2016. [Online]. Available through:
<http://www.ncmedicaljournal.com/content/77/2/133.full>. [Accessed on 23rd October
2017].
Hilary., B. 2016. Exploring the factors that influence nurse practitioner role transition. Available
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