401021: Critical Analysis of Graduate Nurse Transition and Reflection

This essay provides a critical analysis of the transition from university to professional practice for new graduate nurses (GNs), examining the challenges and opportunities they encounter. It explores the importance of reflective practice in enhancing patient care performance and achieving competence and confidence. The essay delves into the professional context, highlighting the need for support, coping strategies, and trust within the healthcare system. It discusses the application of Gibbs' reflective cycle, Benner's clinical competence stages, Duchscher's professional role transition stages, and Dreyfus' skill acquisition model to improve clinical practice and patient management. The study emphasizes the value of peer mentoring and clinical communication, advocating for a blend of interventions to optimize the new GNs’ experience and improve patient outcomes.

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Introduction
The transition of a student from the university level to a new graduate nurse (GN)
practice is instilled with numerous challenges and opportunities. The new GN is a newly
registered nurse (RN) who attains an initial exposure to the clinical practice environment
after accomplishing the formal nursing study. The new GNs require substantial emotional,
social, and clinical support in the context of accomplishing their patient care liabilities and
accountabilities in the hospital setting (Hussein, Everett, Ramjan, Hu, & Salamonson, 2017).
The acquisition of competence and confidence by the new GN requires considerable time,
effort, and dedication during the initial phase of patient care management. The reflective
practice proves highly conducive to the enhancement of new GN’s patient care performance.
Accordingly, the essay critically analyses the relationship between the professional context
and reflective practice of the new GNs.
Critical Analysis
The case study emphasises the state of confusion experienced by the unprepared new
GNs during their initial deployment across the clinical practice environment. Hezaveh, Rafii,
and Seyedfatemi (2014) argue that the absence of comprehensive support measures and
transition-work interventions inside the hospital settings predominantly impact the learning
experiences of the new GNs. Contrarily, Zheng, Lee, and Bloomer, (2016) emphasise several
other attributes that potentially influence the work practice and learning experience of the
newly RNs across the clinical practice environment. These attributes include coping
strategies, professional growth perception, and family support level that determine the new
GNs’ emotional stress level inside the hospital setting (NMBA Standard-1) (Nursing and
Midwifery Board of Australia, 2016). For example, emotionally weak nurses experience
psychological stress while witnessing the death experience of terminally ill patients. These

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outcomes reveal that the newly RN requires consistent support from their senior health care
members in the context of improving their coping skills, work action plan, and overall
learning experience.
The case study emphasises the need for improving the newly RNs’ trust in the overall
health care process to effectively enhance the level of their preparedness in the hospital
setting. However, Ebrahimi, Azizi, Gillespie, Negarandeh, and Hassankhani (2016) argue that
this requirement is based on the development of a sense of security and comfort among the
new GNs. The constructive professional relationship between the new GNs with their peers
and mentors also improves their self-confidence and critical thinking ability while
minimising the intensity of anxiety and stress under complex health care circumstances
(Standard-2) (Nursing and Midwifery Board of Australia, 2016). Accordingly, they must
develop a robust interpersonal relationship with their peers and senior nurses to accomplish
the entire learning needs and training gaps.
The newly RNs must effectively comply with reflective practice to improve their
procedural knowledge and clinical skills. Koshy, Limb, Jafree, Whitehurst, and Gundogan
(2017) argue that reflective-practice assists the new graduate to nurses to comprehensively
understand and deal with various postoperative complications, missed diagnosis, dissatisfied
patient, and failed medical interventions. Reflective practice also assists the newly RNs to
revisit their successes and failures after encountering each patient care situation. For example,
reflective practice helps them to identify the successful handling of a difficult medical
procedure (based on clinical governance) or evaluate the occurrence of a safety event that
could have occurred under the impact of medical error or negligence (Australian Commission
on Safety and Quality in Health Care, 2019). Reflective practice in this manner consistently

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motivates the new GNs to improve their learning experience and quality of health care
services.
The case study emphasises the initiation of supernumerary shifts to facilitate the
acclimatisation of the new GNs inside the health care setting. The initial deployment of the
new GNs inside the hospital setting proves to be their critical career enhancement phase
(Walton, Lindsay, Hales, & Rook, 2018). They need to learn from each clinical practice
experience while understanding medical errors and their associated risks in terms of safety
events, medicolegal issues, and patient dissatisfaction. Sibiya, Ngxongo, and Beepat, (2018)
argue that the integration of peer mentoring and reflective practice substantially improve the
learning outcomes of the new GNs inside the clinical setting. Contrarily, Adams and Gillman,
(2016) emphasise the configuration of an evidence-based transition intervention to effectively
improve the facilitated learning opportunities, socialisation level, psychosocial support, and
reflective practice of the new GNs. The evidence-based recommendations in this manner
emphasise the requirement of undertaking focussed, planned, and comprehensive measures to
improve the reflective practice skills of the newly registered nurses inside the clinical setting.
The case study emphasises the development of confidence, autonomy, and feedback
management skills of the new GNs through the administration of mentor-based support
measures. The case study also motivates the new GNs to seek emotional and psychosocial
support from their mentors for improving their clinical/reflective practice skills. Accordingly,
Lutz, Roling, Berger, Edelhäuser, and Scheffer, (2016) emphasise the need for improving the
clinical communication skills of the new GNs in the context of enhancing their creative
responses against a range of clinical practice situations. Contrarily, Larsen, London, and
Emke (2016) correlate the new GNs’ experience with their reflective practice skills. This
indicates that the new GNs should invest substantial time with patient management services

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for reflective practice outcomes. These outcomes reveal that no measure can single-handedly
improve the clinical practice experience of new GNs. Accordingly, they require a blend of
interventions including peer support, clinical communication, and health care exposure for
effectively improving their patient management outcomes.
Discussion
The case study emphases the self-assessment of limitations by the new GNs in the
context of improving their clinical practice skills and experience. Accordingly, Gibbs’ model
of reflection substantially assists new GNs to effectively improve their clinical practice skills
and patient management ability (Oxford Brookes University, 2019). The description-phase of
Gibbs’ reflective cycle helps the new GNs to elaborate on their patient care situations. The
feeling-phase helps the new GNs to introspect their emotions, thinking, and feelings about the
clinical encounter. The evaluation-phase helps the new GNs to identify the pros and cons of
their health care experience. The analysis-phase helps them to understand the outcomes of the
clinical practice situation based on the causative factors and interventions. However, the new
GNs require utilizing the conclusion-phase of Gibbs’ reflective model to identify the gaps
that could have resulted in adverse patient outcomes or the areas of improvement that could
have improved the clinical practice situation. Finally, the action plan phase helps the new
GNs to apply their critical thinking skills in the context of configuring proactive strategies to
handle similar situations in the future. Undoubtedly, the new GNs require consistent support
from their peers and mentors to effectively utilise Gibbs’ reflective cycle while addressing a
range of complex and comprehensive patient care requirements.
The case study advocates the need for enhancing multidisciplinary skills and clinical
knowledge of the new GNs to effectively improve their professional, analytical, reflective,
and critical assessment aptitude during graduate practice transition. Accordingly, the new

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GNs need to utilise Benner’s clinical competence stages for transformation themselves to
expert registered nurses across the clinical practice environment (Manoochehri, Imani,
Atashzadeh-Shoorideh, & Alavi-Majd, 2015). The new GN requires utilising Benner’s
clinical competence stage-1 to understand and evaluate physical and verbal cues related to
safe clinical practice requirements. Furthermore, they require taking assistance from their
mentors in the context of exhibiting marginally acceptable outcomes while undergoing
Benner’s stage-2. However, the stage-3 demands the investment of considerable time and
efforts by the new GNs in the hospital setting for improving their overall confidence and
coordinated patient care outcomes. The proficiency stage (or stage-4) is based on the
meaningful accomplishment of the health care goals by the highly proficient and transformed
graduate nurses. However, the expert stage (or stage-5) warrants the development of critical
analysis skills in the aspiring new GNs over time across the clinical practice environment.
Accordingly, the implementation of a robust clinical practice transition program is highly
necessary for the successful accomplishment of the novice-to-expert journey of the new
GNs.
The case study emphasises the need for mitigating the clinical practice limitations of
the new GNs for effectively improving their meaningful participation in comprehensive
medical procedures. Accordingly, the new GNs require experiencing Duchscher’s
professional role transition stages and utilising Dreyfus’s skill acquisition model in the
hospital setting (Duchscher, 2008). The new graduates require overcoming Duchscher’s
shock and crisis stages through the practice of learning, performing, accommodating,
searching, concealing, examining, questioning, doubting, and revealing attributes. They
eventually gain clinical knowledge and proficiency while improving the accepting, critiquing,
exploring, recovering, and separating attributes. Similarly, the new GNs require experiencing
novice, competent, proficient, expert, and master stages of the Dreyfus model to

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systematically improve their patient management skills and knowledge of medical procedures
(Field, 2014). The systematic integration of various professional development theories is,
therefore, highly needed not only to enhance the patient management proficiency of the new
GN but also to improve their overall patient care experience.
Conclusion
The essay emphasises the need for improving professional development, coping skills,
and clinical practice experience of new GNs inside the hospital setting. Peer support and
effective mentoring are highly needed to improve the trust and confidence of new GNs in the
entire health care system. Reflective practice proves to be a robust tool to introspect the
health care knowledge gaps of the new GNs across the clinical practice environment. The
systematic integration of Gibbs’ reflection model, Benner’s 5-stages approach, Duchscher’s
role transition stages, and Dreyfus’ skill acquisition model through a robust clinical practice
transition program is highly needed to enhance the clinical practice adaptation of new GNs.
This integration is based on the need for improving the reflective practice skills of new GNs
for the systematic enhancement of their patient care performance. In conclusion, the new
GNs require evaluating and re-evaluating their clinical practice outcomes and performance
improvement areas in the context of enhancing their integration with the patient care
environment.

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