Transitioning into Clinical Practice: New Graduate RN Experiences

This report, structured as a journal article, delves into the experiences of new graduate Registered Nurses (RNs) as they transition into clinical practice within a dynamic healthcare environment. The article begins with an abstract summarizing key challenges such as horizontal violence, communication issues, fear of practice, and the need for consistent guidance. The introduction sets the stage by highlighting the difficulties RNs face when adapting from academia to the workplace, including unfamiliar responsibilities and organizational policies. The significance of the issue is explored, emphasizing the importance of preparedness, confidence-building, and strategies for addressing challenges like poor communication and horizontal violence. The discussion section examines the feelings of fear and confidence, less-than-ideal communication, horizontal violence, professional isolation, and the complexities of working in high-acuity units. The evaluation section proposes transition programs incorporating debriefing, skill enhancement, and the development of clinical judgment. Strategies such as role-playing, leadership links, and specialized education are suggested to support new RNs. The article concludes by emphasizing the importance of tailored support, consistent preceptor guidance, and access to organizational resources to facilitate a smoother transition for new graduate RNs.

Running head: TRANSITIONING INTO CLINICAL PRACTICE 1
Experiences of New Graduate Registered Nurses Transitioning to Clinical Practice in an
Ever Changing Healthcare Environment.
Name
Institutional Affiliation

TRANSITIONING INTO CLINICAL PRACTICE 2
1. Abstract
This article is an inscription describing the most common experiences that new graduate RNs
face during their transition into the clinical practice in an ever-changing healthcare environment.
Majority of these experiences are quite challenging and new graduate nurses are therefore
expected to develop relevant skills to overcome the challenges. Horizontal violence is one such
challenge that nurses face in the workplace (Bartholomew, 2014). Transition programs for new
nurses should entail scripted responses that new RNs should utilize when faced by such
challenges. During their interaction with other professionals, new graduate RNs are bound to
encounter lesser than ideal communication (Arnold & Boggs, 2015). As such, they should
develop the interdisciplinary skills of communicating with other staffs.
A significant number of nurses are usually confident of the skills and abilities they possess
when entering into clinical practice. However, the larger population of new nurses are always
filled with fear of actual practice. To eradicate this, facility leaders should avail support to new
nurses throughout the first year (Dyess & Sherman, 2009). While seeking guidance from various
professionals on certain issues, new graduate RNs will be fed with lots of contradictory
information. They should, therefore, identify and secure for themselves one preceptor who will
feed them with consistent information. New nurses could also find themselves assigned to high
acuity units calling for advanced decision-making skills which the nurse should develop to
ensure survival in such units (Koutoukidis, Stainton, & Hughson, 2012). New nurses who
perceive themselves as professionally isolated could solve this by developing formal links with
leaders within the healthcare setting.
2. Introduction

TRANSITIONING INTO CLINICAL PRACTICE 3
For any occupation, the transition from the school environment and subsequent adaptation
into the workplace prove hard for many people. This is usually the case as people have to
develop competence and confidence to undertake their new responsibilities. Additionally,
individuals find it shocking upon discovering that there lacks consistency between ideologies
learned in school and the situations presenting at the work pace (Stabler-Haas, 2012). Nursing
students are of no exemption to the aforementioned. Upon graduating as registered nurses, their
entry into clinical practice presents to them the endless challenges of having to learn unfamiliar
responsibilities and tasks as well as a changed environment and a new set of people.
Upon selecting their area of practice, new graduate registered nurses try their best to fit
themselves into the healthcare setting that they are based. Simultaneously, they are to familiarize
themselves with the policies of the particular organisation in addition to developing new and
required clinical skills. However, due to limited exposure to clinical settings while in nursing
schools, the entire process tends to be overwhelming. Undergoing externship programs is,
however, a known way of increasing preparedness of graduate nurses entering the workplace
(Cardillo, 2010). This is because nurses are able to develop self-confidence and advanced
nursing skills.
3. Significance of the issue
For a new graduate RN entering into clinical practice, this topic will play a significant role in
increasing their preparedness for their jobs. To begin with, gaining vivid awareness of the
experiences that many new graduate nurses encounter upon entering into clinical practice will
enlighten them on what to expect in the field. They will be able to boost confidence in their
abilities and skills. Additionally, they will be able to learn how to cope with fear associated with
entering into a new environment with new characters. New nurses will learn how lesser than

TRANSITIONING INTO CLINICAL PRACTICE 4
ideal communication impacts the quality of their work. Subsequently, they will learn various
techniques to deal with the issue should it present itself to them.
This topic will also highlight the various forms of horizontal violence that new nurses should
expect upon entering into clinical practice. They will also know on which authorities to report
should they be violated horizontally. Various ways of addressing professional isolation will also
be brought into the limelight for the benefit of the New RN transitioning into clinical practice. It
is also through digging deeper into this issue that new RNs will learn on how to survive in
complex high acuity specialty units. Finally, new graduate RNs will learn how to handle and/or
avoid contradictory information.
4. Discussion
It is common for many graduates registered nurses entering the workplace to experience
feelings of both fear and confidence. Nurses who are driven into the field by the passion for
nursing work usually feel good and excited for being in the healthcare setting and for being with
patients. Other nurses could experience a fusion, mix of fear for being held responsible for
patients, and the challenge of utilizing the knowledge acquired in learning institutions to tackle
all prevailing situations (Ebrahimi, Hassankhani, Negarandeh, Gillespie, & Azizi, 2016).
Confidence is experienced when nurses believe in their abilities and skills as well as hoping that
their emotional growth will be supported by existing organizational systems.
Graduate RNs transitioning into clinical practice are also bound to experience less than ideal
communication with other nurses and physicians amongst other interdisciplinary crew affiliates
(Dyess & Sherman, 2009). A nurse could, for example, try to report a lab value that is abnormal
to the doctor in charge via a phone call. The doctor could, however, rudely dismiss the nurse and

TRANSITIONING INTO CLINICAL PRACTICE 5
hang up claiming to be in his/her rounds and pressing on that the issue could wait until he/she is
done. Expressions of disgust or use of gruff tones by other professionals could greatly heighten
the lack of professional confidence felt by graduate RNs.
Frequent experiences of horizontal violence while in the workplace have also been reported
by new graduates. These are any aggressive acts that a colleague could portray and includes
criticism, innuendo as well as verbal, emotional and physical threats (Russell, 2016). It is also
common for graduate nurses to encounter unkind and unsupportive nurses while in their settings
of practice. In many healthcare facilities, leaders emphasize to new graduates that horizontal
violence should be tolerated at zero level. New graduates, however, observe that such behaviors
exist and nurse leaders at the unit level tolerate it, thus making it hard for them to report such
behaviors.
In the current world, extreme chaos is experienced in healthcare environments. Graduate
nurses could, therefore, feel overwhelmed in addition to being professionally isolated while
working in these environments (Koutoukidis, Stainton, & Hughson, 2012). Previous researches
have reported multiple occasions where nurses have perceived themselves as being alone while
undertaking their nursing roles. Such perceptions and experiences have had negative impacts on
their work quality. There are also many situations when a new graduate could get stranded
without knowing the appropriate course of action to take in certain patient situations (Cardillo,
2010). Subsequently, lack of a more experienced nurse willing to guide them in such situations
worsens the issue.
New graduate nurses usually find themselves working in specialty locales where some
patients require care calling for decision-making skills of the highest level (Martin & Badeaux,
2018). For most graduate nurses, a typical working day involves handling multiple patients with

TRANSITIONING INTO CLINICAL PRACTICE 6
demanding health conditions that require intensive and critical judgement (Kritek & Hickey,
2011). It is not an unusual ordeal for new graduate nurses to find themselves faced with the
responsibility of caring for three dying patients. As a result, the nurse in question is always in a
dilemma on which patient to attend to. New nurses could also find themselves in situations
where they are required to make quick important decisions without sufficient time to think over
them.
Upon entering into clinical practice, new graduate nurses have plenty of questions and
usually seek advice from other practitioners within the facility. It is whoever a common
phenomenon for the nurses to receive contradicting information from various professional
regarding the same issue (Chang & Daly, 2015). In many clinical settings, the pace of operation
is always high. New nurses are therefore required to make quick decisions relating to specific
issues at hand. It is however hard for them to arrive at such decisions when viewpoints from
colleagues are conflicting. Additionally, organizational procedures and policies that new nurses
rely on for guidance are not always quickly accessible.
5. Evaluation
Typically, transition programs for new graduate nurses are designed to be undertaken in 3-6
months. To curb fear and boost confidence in new graduate RNs, suggestions are that
opportunities for debriefing, skill set enhancement, and development of clinical judgement
amongst other longer-term supports would suit the purpose (Stabler-Haas, 2012). As Duchscher
(2008) proposed in his conceptual framework for graduate nurses transitioning, new graduate
nurses should move through three different stages namely; knowing, doing and being. They are
to accomplish the aforementioned during the first twelve months of clinical practice but with
relevant support.

TRANSITIONING INTO CLINICAL PRACTICE 7
During orientation, new graduate nurses receive basic skills in interpersonal and
interdisciplinary skills of communication (Arnold & Boggs, 2015). Such nurses also require
training to enhance their communication skills such as conflict resolution and interdisciplinary
role-play conversations. Additionally, the use of simulations for illustration as well as according
new graduates’ opportunities for practicing professional and collegial communication would be
helpful. It would also be of great significance if new graduate nurses are debriefed as well as
given chances to convey feedbacks. Lastly, new graduate nurses should prepare themselves
sufficiently for crucial conversations with other people in the workplace.
Upon entry into the workplace, graduate nurses expect maximum support and cooperation
from colleagues. On the contrary, they are faced with untold horizontal violence which they are
subsequently not ready to handle. It is therefore of great significance for leaders in healthcare
facilities to share specific information related to horizontal violence as well as specific strategies
for responding to it (Bartholomew, 2014). Additionally, scripted responses that graduate nurses
could use when faced with such situations should be included in transition programs.
Opportunities for role play and practice would also be of great help.
In a bid to curb the perception of being isolated professionally, developing a link to
leadership for new graduate nurses would be a strong intervention. Developing and maintaining
direct conversations and contact with nurse leaders have been proven to eradicate feelings of
isolation. Similar to other affiliates in their millennial age cohort, new graduate RNs want
transparency, visibility, and accountability from leaders within their facilities. It is through
formal leadership links that graduate RNs are able to receive feedbacks of a constructive nature
while simultaneously promoting mutual dialogues in a professional manner.

TRANSITIONING INTO CLINICAL PRACTICE 8
Due to endless changes in the healthcare environment, new graduate RNs previously
assigned to general surgical-medical units are now being assigned to high acuity specialty units.
It is therefore upon healthcare organizations to offer support, specialized education on disease
management, and technology during the first year of practice (Kritek & Hickey, 2011). In
addition to the aforementioned, new nurses should also be accorded opportunities to emotionally
process some intense patient conditions that they encounter in high acuity units. It is through
periodic professional evaluations that new graduates will be able to acclimate to the clinical
practice environment.
For new graduate RNs, being assigned to one individual increases the consistency of
information and experience from the preceptor. Working with one preceptor also reduces the
disappointment of having to sift through loads of contradicting information in the search for the
most appropriate course of action to take (Chang & Daly, 2015). By having one preceptor, new
graduates are able to share positive comments, accomplishment stories, as well as professional
validation emanating from the preceptors. Lastly, new graduates should be given copies of
organizational policies, procedures, and guidelines that they can refer to in times of need until
they are accustomed to the same.
6. Conclusion
It has been identified that transitioning from the school environment into clinical practice is a
quite challenging experience for new graduate RNs. New nurses could feel confident in their
abilities and skills but in many circumstances, fear of actual practice dominates their minds. To
curb the aforementioned, leaders in any healthcare facility should avail support to new graduate
RNs during the first year of practice. It will also be common for new nurses to find themselves

TRANSITIONING INTO CLINICAL PRACTICE 9
entangled in communication situations that are less than ideal. Subsequently, they are called
upon to develop relevant interdisciplinary skills of communicating.
Horizontal violence has also been identified as another issue that new nurses encounter. They
are therefore to learn and acquit themselves with responding techniques when faced with such
situations. Professional isolation being another challenge, new nurses are called upon to develop
and maintain strong formal links with leaders in the organisation. Graduate RNs will also find
themselves in complex units where they will be required to make critical decisions. Transition
support should, therefore, be accorded to such nurses. Lastly, new nurses are bound to receive
contradicting viewpoints when consulting on certain issues. They should, therefore, find
themselves consistent preceptors who will ready and willing to help.

TRANSITIONING INTO CLINICAL PRACTICE 10
7. References
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Skills for Nurses (7, illustrated ed.). Elsevier.
Bartholomew, K. (2014). Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and
Each Other (2 ed.). Hcpro Incorporated.
Cardillo, D. (2010). Your First Year As a Nurse, Second Edition: Making the Transition from
Total Novice to Successful Professional (revised ed.). Crown Publishing Group.
Chang, E., & Daly, J. (2015). Transitions in Nursing - E-Book: Preparing for Professional
Practice (4 ed.). Elsevier Health Sciences.
Duchscher, J. B. (2008). A process of becoming: The stages of new
nursing graduate professional role transition. The Journal of Continuing Education in
Nursing, 39(10), 441-450.
Dyess, S., & Sherman, R. O. (2009, September). The First Year of Practice: New Graduate
Nurses’ Transition and Learning. The Journal of Continuing Education in Nursing ·
September 2009. doi:10.3928/00220124-20090824-03
Ebrahimi, H., Hassankhani, H., Negarandeh, R., Gillespie, M., & Azizi, A. (2016, March 1).
Emotional Support for New Graduated Nurses in Clinical Setting: a Qualitative Study.
Journal of Caring Sciences, 5(1). doi:10.15171/jcs.2016.002
Koutoukidis, G., Stainton, K., & Hughson, J. (2012). Tabbner's Nursing Care - E-Book: Theory
and Practice (6 ed.). Elsevier Health Sciences.
Kritek, P. B., & Hickey, M. (2011). Elsevier Health Sciences. Springer Publishing Company.

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Martin, J. L., & Badeaux, J. (2018). Sepsis, An Issue of Critical Care Nursing Clinics of North
America E-Book. Elsevier Health Sciences.
Russell, M. N. (2016). Lateral Violence Among New Graduate Nurses. Gardner-Webb
University.
Stabler-Haas, S. (2012). Fast Facts for the Student Nurse: Nursing Student Success in a
Nutshell. Springer Publishing Company.