• Internal Code :
  • Subject Code : NCS3202
  • University : Edith Cowan University
  • Subject Name : Nursing

Introduction

Nursing as a course usually takes up to four years for one to be fully acquainted with the required nursing skills. Hussein, Everett, Ramjan, Hu, & Salamonson (2017) notes that individuals who have been in the job field for two years and less are also considered as graduate registered nurses. Previously, nursing education in Australia was mostly conducted in a hospital-based environment. However, the studies have been moved from the hospital-based set up to a university-based setup. This has created a gap in terms of the application of the theoretical knowledge gained in class to the workplace set up. This is what is referred to as a theoretical practice gap (Feltrin, Newton, & Willets, 2019). In the early stages of practice, the graduate nurse usually faces anxiety and stress due to the ambiguity of the role bestowed to them. The actual workload experienced in the first year of assignment also contributes to the stress experienced.

The reality of the healthcare environment is that graduate nurses usually undergo a lack of support and pressure due to patients 'accountability demands. It is also characterized by a lack of enough staff workers and cooperation between the already working nurses and the graduate nurses who are new in the practice set up. According to Hossein et al. (2017), this period is when the graduate nurses undergo total burn out and highly attritional rates of working in Australia. It is referred to as the reality shock period. Generally, nursing entails a wide range of tasks right from conflict resolution and organizational attributes which categorically classify nursing as a profession with a wide load of work to be accomplished (Hossein et al., 2017). This literature review will explore the ultimate factors which affect graduate nurses as they transition into the actual practical conjecture.

Background

Graduate nurses 'transition entails understanding and adapting to the healthcare sector by graduate nursing individuals. Due to the difference between the education set up and the actual healthcare work environment, someone moving from the graduate status to a fully functional nurse in Australia is subject to certain factors. In most cases, graduate nurses are usually younger as compared to the already practising nurses in the field. This brand's age as a possible factor that influences the transition of graduate nurses to a practical healthcare environment. As such, the relationship between age and nursing service delivery builds confidence. Also, the rate at which one is required to conduct his/her tasks is also a point of concern. It all builds up to the amount of experience that one possesses.

Also, the quality of education that one underwent affects the way he/she transitions to the practice field. This includes the rigorous assessments, knowledge quotient, clinical placement period, and the confidence level towards reality. The healthcare set up is also attributed to some factors which one has to face directly as he/she transitions. They include The ration between the available nurses and the number of patients, workplace civilization, support from the management, acuity by patients, and ward culture. A major source of stress is the integration in talks between the nurse and the friends and families to the patients. This usually happens regardless of whether one has attended to the patients or not.

This does not only apply to Australia alone but is also felt in other countries. The transition experience is termed as stress, and its effects are evident in the NGRN's lives. Their lives are significantly impacted based on the nature of the issues faced during the transition period. Additionally, performance for new nurses is significantly affected in a way that puts patients 'safety at risk. As such, the whole situation is distressing, and the outcome is total burnout and attrition. All in all, the global shortage of nurses should not be relied upon as the reason for the mass turnover of nurses since this will tamper with the quality of healthcare being delivered.

Frögéli, Rudman & Gustavsson (2019) advocates for professional clinical support to ensure that the actual transition discourse is smooth. Furthermore, the program should implement initiatives such as mentorship programs, preceptor-ship, and nurse residency programs (NRP). Such programs were designed in a way that supports graduate nurses right from the novice level to beginner and even to a professional nurse in their first year of work. To develop their nursing skills, graduate nurses are usually exposed to preceptor-ship in which they structured nursing pieces of training under the supervision of a senior nurse. On the same note, mentorship is set in place in which the support given by experienced nurses is prolonged. Anyhow, this support accorded to graduate nurses ensures they become professionals but cannot guarantee continuity.

Laschinger et al. (2016) alluded that despite the varied kinds of support accorded to the graduate nurses, little to no achievement has been achieved in terms of reduction of stress, anxiety, and burnout. Research by Krozek (2017) showed that the strategies in place had been deficiently created and due to that, they cannot adequately address the social and psychological issues which are the key causes of stress and anxiety to graduate nurses during the transition. The programs have also failed not only due to their deficiency but also due to other factors. Such factors include Time limitation, strenuous work environment, inadequate peer support, and over expectations by the management in terms of work output by the graduate nurses. It makes them lack belief in their work as well as the organization at large.

In most cases, this leads to a change in profession. For a nurse to deliver quality care to patients, social well-being, as well as individual tenacity, are vital. Besides, they also contribute to job satisfaction, stress management, and boldness while conducting their duties. Therefore, improving strategies associated with self-care, social configuration, and resilience are inevitable to transform graduate nurses to competent professionals perfectly.

Search Strategy

The framework stipulated by Gerrish and Lathlean (2015) was utilized in searching for six peers reviewed articles that are vital to this paper. The search was across databases such as CINHAL, PubMed and Medline were fully explored. The term used in the search includes new graduate nurses, transition in nursing, self-care, and support strategies. Transition support and as well as coping mechanisms were also searched. The general search resulted in 55 articles and abstracts. When several inclusion criteria were applied, and the top criteria were to settle down with recent articles. That is ranging from 2016-2020. The articles were also supposed to peer-reviewed and form Australia of any other developed country. They were to directly cover factors faced by graduate nurses and other vital findings such as the support initiatives. When these aspects were used in the search, it brought about peer-reviewed articles in which six were selected. They were thoroughly perused to retrieve vital information that conferred this literature review.

Results

This part handles all the vital information retrieved from the six articles. The factors affecting graduate nurses 'transition were classified into three categories as stipulated by the assignment template. They include preceptor-ship, reflective practice, and positive workplace environment, and peer support.

Reflective Practice

Many pieces of research have alluded that reflective practice is a vital tool for professional development to novice nurses. The articles such as Saunders et al. (2018); Walton et al. (2018) and Stephens et at. (2017), have displayed the written reflections by graduate nurses on the stressful situations that they encountered during the first year of transition. Everything presented was based on what they specifically experienced. According to Walton et al. (2018), the reflections helped them to gain a deeper understanding of both the short term and long-term impacts of the stressful experience they are undergoing. It also helps them to create a plan on how to deal with future uncertain situations.

On the same note, Stephens et al. (2017) also arrived at the same conclusions. In their paper, they found out that the reflections helped graduate nurses to focus on the positive aspects during their work. Such factors include; positivity, faith, humour, self-awareness, flexibility in terms of duties, and hope. The essence of this is to ensure that they easily adapt to the changing environment and cope with possible adverse situations for their well-being. Sounders et al. (2018) concurred with the above results in that they found out that self-reflections helped graduate nurses to move out from being stressed and overwhelmed to a condition of easy with bold energy to remain resilient to future adverse events. All of the above articles all agree that self-reflection should be perceived as private documents. However, it is deemed vital for the graduate nurses to share them out with their mentors so that they get advised accordingly.

Positive Workforce Environment and Peer Support

Lalonde and McGillis (2017) note peer support refers to a strategic form of support whose aim is to enhance personal well-being to curb attrition and stress. This kind of support entails co-workers stretching support in terms of un-ending mentorship to the graduate nurses. This involves frequent positive feedback as well as creating an all-round conducive environment that does not condole any form of conflict and violence. Gardiner & Sheen (2017) in their investigation on the experience of graduate nurses during the graduate nurses' program, noted that about 54 per cent of graduate nurses lacked sufficient support and feedback complements from their seniors when they most needed them.

More so, they found out that over 51 per cent of the graduate burses suffered from distress which is directly attributed to the bullying behaviour from their seniors as well as the unsupportive nature of their seniors. The personality disparity between the graduate nurses and the experienced peers brought about judgmental feedback from them as well as total unsupportiveness. Gardiner & Sheen's (2017) findings complied with the studies conducted by Tommieto et al. (2015) and Lalonde and McGillis (2017). In contrast, 156 nurses who participated in the study by Tommieto et al. (2015) reported that their seniors accorded them consistent support and this helped them a lot in improving the turnover rate and also the contemplation concern change in profession.

Preceptorship

The studies by Saunders et al. (2018); Walton et al. (2018); Stephens et al. (2017); Lalonde and McGillis (2017); Tommieto et al. (2015) and Gardiner & Sheen (2017) noted that preceptor-ship helps graduate nurses to know the best direction to head to. Also, they are found out the preceptor-ship helps graduate nurses in developing resilience in their move to cope with their new practical environment. Through the help of their seniors, studies have shown that they properly identified the best coping mechanism for their new environment.

Discussion

This literature review examined the factors which directly or indirectly influence the transition of graduate nurses to their places of practice. The ultimate goal as to why there is a need to consider the positive sections of these factors is that they help fortify self-care while creating resilience to future adverse events. There are more than enough studies that have been conducted concerning the actual factors that affect the transition of graduate nurses to practice. Still, it remains pivotal to consider the factors in a way that promotes social, phycological, and mental health for graduate nurses. When the articles were critically reviewed, factors such as self-reflection, peer support, and positive work environment as well as preceptor-ship can be viewed from two perspectives. When well-considered, they foster social, phycological, and self-completeness. The outcome is that less professional change will be expected. On the same note, judgmental feedback, violent workplace environment, lack of peer support, and inadequate preceptor-ship can negatively impact on the well-being of graduate nurses. As such, they can lead to a massive career change.

Despite having two perspectives, peer support has shown a positive impact in terms of positive transition. Based on the findings in the retrieved sources, positive peer support makes graduate nurses feel much valued and accepted in the healthcare organization. Through communication and networking, positive peer support is achieved. Such skills can as well be developed while one is still undertaking his/her studies in school as well as during the graduate nursing programs. Some studies vouched for innovative peer support which entailed pairing up of graduate nurses and the senior nurses for continuous mentorship. Also, they suggested the creation of a sustainable online platform with the availing personal and professional support to the graduate nurses whenever they wanted.

Review Limitations

Here are a few confinements related to the examinations that was conducted in this literature review regarding to graduate nurses’transition. In most of the examination articles picked to audit, subjective information has been utilized utilizing a self-report survey or meeting technique. Information assortment ought to have been rehashed to guarantee exactness as it very well may be helpless to reaction predisposition (Gerrish and Lathlean, 2015). Also, the testing populace was generally restricted in numbers and regularly needed decent variety as some overwhelmingly used just Caucasian female examples. These measures are fundamental for the outcomes to be material to locally various NGRN populace (Gerrish and Lathlean, 2015). Moreover, a few investigations have picked testing information from one or a couple of neighbourhood clinics which might be summed up broadly (Saunders et al., 2018).

Future investigations can investigate if they help methodologies to improve the prosperity and strength of NGRNs are the same or diverse to those required for other senior medical attendants. This would help with planning formative projects appropriate to all the nursing staff where comparative methodologies are valuable for both the gatherings. Also, it will help to distinguish issues explicit to NGRNs gathering to create an even-minded and compelling GNP. A blended strategy put together powerful examinations concerning an example populace bunch that matches with the genuine alumni nurture populace in Australia will offer doable help methodologies.

Recommendations

Suggestions for clinical practice and nursing training were increased through breaking down the subjects recognized in this examination, dependent on the outcomes and conversation segments. Nursing instruction should create intelligent composition among nursing understudies through assignments and during clinical practice situations and teaching concerning the criticality of self-care through solid conduct to effectively rise above the obstacles of change. As relational abilities are imperative for peer-support, understudies ought to be urged to close the gap by working together with the nursing staff just as the inter-professional group. Clinical practice proposals are encouraging a benevolent and strong work culture by giving chances to associations just as sort out training and strengthening on intelligent practice and remaining beneficial to give quality patient consideration.

Conclusion

Generally speaking, new graduate nurses make some troublesome memories through their change into the working environment, with vulnerability compounding this experience. This prompts poor results for the graduate nurses, bringing about medical issues, poor occupation fulfilment, and low standards for dependability. New graduate nurses should be set up with procedures to defeat working environment cynicism and positivist, just as further research to be led to focus on the issue. This will prompt a progressively steady workplace for graduate medical caretakers, and forestall the inevitable deficiency anticipated in this industry around the world.

References

Feltrin, C., Newton, J. M., & Willetts, G. (2019). How graduate nurses adapt to individual ward culture: A grounded theory study. Journal of advanced nursing, 75(3), 616-627.

Frögéli, E., Rudman, A., & Gustavsson, P. (2019). Preventing stress-related ill health among future nurses: Effects over three years. International Journal of Stress Management, 26(3), 272.

Gardiner, I., & Sheen, J. (2017). Graduate nurses' experience of feedback, support, and anxiety: a pilot study. Australian Journal of Advanced Nursing, The, 35(1), 6.

Gerrish, K., & Lacey, A. (2015). The research process in nursing. John Wiley & Sons.

Hussein, R., Everett, B., Ramjan, L. M., Hu, W., & Salamonson, Y. (2017). New graduate nurses' experiences in a clinical speciality: a follow-up study of newcomer perceptions of transitional support. BMC Nursing, 16, 1-9. DOI:10.1186/s12912-017-0236-0

Krozek, C. F. (2017). Psychodynamics of onboarding new graduate nurses. The Journal of Continuing Education in Nursing, 48(7), 299-301.

Lalonde, M., & McGillis Hall, L. (2017). The socialization of new graduate nurses during a preceptorship program: strategies for recruitment and support. Journal of clinical nursing, 26(5-6), 774-783.

Saunders, D. R., Arnold, E., Seaman, K., Green, A., & Gullick, K. (2018). Graduate registered nurses’ reflections on implementing safety and quality improvement projects. Reflective Practice, 19(5), 678-689.

Spence Laschinger, H. K., Wong, C., Read, E., Cummings, G., Leiter, M., Macphee, M., ... & Grinspun, D. (2019). Predictors of new graduate nurses' health over the first four years of practice. Nursing Open, 6(2), 245-259.

Stephens, T. M., Smith, P., & Cherry, C. (2017). Promoting resilience in new perioperative nurses. AORN Journal, 105(3), 276-284.

Tomietto, M., Rappagliosi, C. M., Sartori, R., & Battistelli, A. (2015). Newcomer nurses' organizational socialization and turnover intention during the first two years of employment. Journal of nursing management, 23(7), 851-858.

Walton, J. A., Lindsay, N., Hales, C., & Rook, H. (2018). Glimpses into the transition world: New graduate nurses' written reflections. Nurse Education Today, 60, 62-66.

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