Critical Analysis of Competent Nurses: Graduate to Registered Nurse

This essay provides a critical analysis of the transition process from a graduate nurse to a registered nurse, emphasizing the required competencies and the development of professionalism within the nursing field. The essay explores the significance of nursing standards, educational requirements, and the transition from student to professional roles, highlighting the importance of responsibility, accountability, and delegation of care. It analyzes the interrelationship between competency and professionalism, examining the expectations of competent professional nurses and the challenges faced during the transition. The essay delves into the critical analysis of nursing competencies, standards of practice, and abilities, discussing the impact of national accreditation processes and the factors influencing graduate nurse competencies. The essay also discusses the application of Benner's Five Stages Transitional Model, Dreyfus’s Skill Acquisition and Duchscher’s Professional Role Transition to understand the transition process, and the development of skills and competencies in the field of nursing. The essay concludes by emphasizing the necessity of competency among graduate nurses to become professionals, highlighting the importance of standardized codes and the need for ongoing development and support during the transition.

Critical analysis of interrelationship
between competent and professional
nurses
Case study of Graduate Nurses transition to Registered Nurse

Introduction
The transition from being a graduate nurse to a registered nurse requires certain skills
and competencies, based on dynamic nursing standards and protocols, thereby making
them professionals within the nursing field. The competency levels of nursing in
Australia are based on certain National Board Codes and Standards, educational
requirements, legislation and registration in the relevance of care. For interdependent
and independent practice, graduate nurses must transition from being students to
complete professionals through responsibility, accountability and delegation of care
(Phillips, Esterman & Kenny 2015). Ability of becoming a professional nurse enables
patients to trust on them, and treating patients and colleagues with dignity and respect
along with fine-tuning own competencies.
This essay helps in critically analysing competencies expected in graduate nurses and
interrelationship with being professional nurse through proper transition. Through a
proper critical analysis and discussion of the major concepts of nursing competencies,
standards of practice and abilities, transition of graduate nurses into professionals has
been analysed.
Critical analysis
In the healthcare sector, the competencies of nurses both new graduates and registered
nurses is vital requirement in safety and quality. Nursing competency based on
behaviourism, holism and trait theory is vital for improving professional nursing
standards. Core skills, individual traits and competency elements are complexly
interrelated to generate professional values, skills, judgement and attitude. The initial
skills, competencies of the graduate nurse are improved through transition programs for

their ongoing development to enrich their competencies for being a professional
addition to care-giving workforce. Australia prior to 2010 had less homogeneity in
standards and procedures of measuring competence level of graduate nurses due to
absence of a national level accreditation process (Cashin et al., 2015). Some factors
according to Halcomb, Stephens, Bryce, Foley, & Ashley (2017), like geographical size
of Australia, location of universities according to states, variability of nursing programs
and differing application of NMBA standards have led to inconsistency among
competencies of graduate registered nurses. As a result, this lack of homogeneity has
posed as a challenge for inducting graduate nurses with differing competencies as
registered nurses offering best-quality care to the patients.
For practical application of theoretical skills in nursing the vital areas consists of
improving professional capability throughout the length of nursing services, along with
interplay of competencies learnt and skills developed (Walker, Costa, Foster & de
Bruin, 2017). There are ranges of difference among the different graduate nurses during
initiation, however this difference slowly starts to minimise once the training and
transition kicks in and they are able to improve and enhance their theoretical skills into
practice. Competent professional nurses have certain expectations from the graduate
nurses upon entry into hospital-environment. The competency standards according to
NMBA for registered nurses includes professional practices, critical analysis, providing
care, therapeutic practice through collaboration, conducting assessments
comprehensively, creating nursing practice plans, adhering to safe nursing practices,
and evaluating outcomes ("Nursing and Midwifery Board of Australia - Professional
standards", 2019). The standards are provided to generate a fundamental
interrelationship with consumers and caregivers for improved patient safety and health

outcomes ("The NSQHS Standards | Australia Commission on Safety and Quality in
Healthcare", 2019).
According to Brown & Crookes (2016), some of the expected skills and competency in
the nurses upon graduation, are as follows: communication, abiding to legalities;
maintaining dignity, privacy; professional collaborative behaviour; teamwork; planning
nurse-care model; application of medical procedures; clinical interventions; using
assessment-tools for monitoring; reflective thinking capacities; dealing with patients;
learning-based environment; coordination skills; knowing procedures and instruments;
information technology. Having these professional skills and competencies are vital to
enable nursing students apply these skills in practical environment within patient-based
consumer approach. As Ankers, Barton & Parry (2018) opines, professionalism in
nursing conjures to standards to be met by professionals through discretion and
reliability. However, competences are the skills and level of skills required for
complying for nursing standards.
New nursing graduates are expected to display their proficiency in skills and
competence level upon registering themselves as nurses in the professional hospital
setting, in order to enable nursing coordinators and managers aware of their competency
level (Edmonds, Cashin & Heartfield, 2016). During the first week of transition
program in hospital-setting the new nurses undergoes supernumerary, enabling them to
cope with new work-environment and gain knowledge from proficient nurses in teams
(Innes & Calleja, 2018). Missen, McKenna, Beauchamp & Larkins (2016) puts forth the
arguments that inconsistency in the standards of competency among nurse graduates
poses the first barrier during transition phase, as the differing competency levels
generates difficulties in the specialist environment.

Experiences of new graduate nurses during first year of transition can be characterised
as over-whelming and stressful, as they need to display their skills, provide essential
patient care and mould-in to new environment, catching up to expectations of seniors.
During onboarding it is essential that newcomers be socialised to the specialised
environment, gather knowledge, generate homogeneity in competence and address
challenges (Read & Laschinger, 2017). If nurses during onboarding do not achieve an
understanding of their own skills through competency assessment, then the
heterogeneity of skills persists, thereby generating a differing work-climate for
improving professional standards. Hence Halter et al., (2017) advises to introduce
mandatory transition programs for reducing attrition rate among nurses, and retain
talents through 12-month program based on ward orientation, ward rotations, planned
studies, clinical supervision and improve theoretical approach with practical orientation,
for becoming professional competent Registered Nurse.
Discussion
The critical analysis of requirements of competency levels in professional nursing is
reviewed through two theories, which integrates skills acquisition and stages of
transitioning to professional nurse from graduate’s level. This is done through
application of two theories, Benner’s Five Stages Transitional Model, Dreyfus’s Skill
Acquisition and Duchscher’s Professional Role Transition.
Benner’s Transitional Model through Clinical Competence: any graduate nurse
undergoes 5 levels of transition- Novice, Advanced-Beginner, Competent, Proficient
and Expert, through reliance on theories to practical application; learner’s ability to
perceive holistic demand; and being an involved performer (Murray, Sundin & Cope,
2019).

Novice: No experience, and complete rookie, wherein nurse graduates are taught rules
and base actions on the rule-paradigms, applying knowledge based on abstract rules,
with little or no past-experience.
Advanced-beginner: Upon gathering experience, these nurse graduates start to
demonstrate performance based on concepts after numerous trial-errors, and begin to
apply principles to real-life situations and experience.
Competent: After being in the field for some years, the graduate nurse starts to analyse
actions into goals and plans, and develop perspective on solving problems by
themselves through acquired knowledge. As Benner (2019) opines, through experience,
a situation is understood, analysed and direction is created towards solving the problem.
Proficient: The holistic approach of analysing the problem comes with high experience,
competency skills and flexible approach in dealing with problems, based on long-term
goals. A proficient nurse is able to perceive a situation through differing angles,
critically analyse situation and based on reflective analysis, draws out the solution.
Having a deep understanding of the problems enables them to take actions in a
particular direction.
Expert: Instead of relying on rules, guides and principles, an intuitive understanding
helps an experienced nurse analyse whole situation and tackle with the challenges. The
nurses have high skilled analytic capability, enabling them to solve problems.
Depending upon the critical analysis of the non-standard competency measures among
the nurses after graduation, Duchscher’s professional role transition model has been
discussed. The change to more standardisation in competency level for graduate nurses
has been catalysed through need for progress in skills, and demands of improving

professional nursing practices with other regulated scopes in health outcome. A need for
standardisation in competency level of registered nurses is hence necessary for
improving professional conduct, professional standards in nursing and related healthcare
practices.
For the newly graduate nurses, passing through Duchscher’s professional role transition
is both for professional and personal development based on Doing, Being and Knowing.
The processes within the stages include learning, performing, anticipation-ing,
revealing, questioning, separating, adjusting, exploring, engaging and re-discovery
(Murray, Sundin & Cope, 2019). For initial 3-4 months, every graduate nurse goes
through doing phase, from a structured predictable life-style to a challenging, expecting
and responsibility-seeking life-style. There is lack of skills, educational preparations,
wide discrepancy between idealistic life and realistic life, wherein nurses feel
incompetent, and struggles with the intensity of workload. There are huge fluctuations
of expectations, emotions and mental idealisms, which shape their primary concern that
is to do what is expected through feelings of uncertainty and inadequacy. New
experiences provide a steep learning curve, helping new graduates advance their skills,
confidence, knowledge, and familiarity to clinical problems.
In the being stage after 5 months, there is consistent advancement towards higher skill
and competency, testing the graduate notions and their inadequacies. This stage is
marked with promises of personal development, as new graduates try to generate an
increased awareness about them, and scrutinise their professional roles through
disengaging, questioning, revealing, recovering and reengaging into career. The
knowing stage as per Whitmore, Kaasalainen, Ploeg & Baxter (2019), is more with
coping with stress, roles, responsibilities, frustrations and growing amidst adversities,
after initial decline in momentum. The stage is followed with ability to answer

questions, instead of asking them suggesting changes, and providing a holistic view of
situation.
Conclusion
Overall, the essay critically discusses about the necessity for competency among
graduate nurses in becoming a professional. The whole life cycle of the nursing career
from graduating to registering as a professional nurse takes time, patience and offers
challenges, which must be solved. It has been analysed that certain skills and
competencies are expected from graduate nurses, while initiating the transition to
becoming a professional registered nurse. However, prior to 2010, absence of proper
standardised codes led to heterogeneous competency-levels, challenging development
of professional RNs. Nevertheless, the addition of standards like NMBA and NSQHS
standards after 2010 helped in standardising competency for developing professional
nurses.

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