Becoming a Registered Nurse

  1. The researcher stated that the real shock was experienced as professional nursing was difficult to practice due to which the nursing professionals were leaving jobs. The framework named transition to professional practice was designed to understand and respond to the changing behavior of nursing professionals. Despite giving patient-centered and value-basedcare to patients, the nursing environment was facing lots of contradictions. The newly professional nursing members face the job more challenging because they have a move from academia to practice setting (Beuchat, Seropian and Jeffries 2016). Nursing professional development is responsible to overlook the transitions, stages, and factors that are responsible to retain newly professional nurses in the organizations.

There are three stages of transition to professional practice:

  • Stage 1 (Doing)
  • Stage 2 (Being)
  • Stage 3 (Knowing)

Every nursing professional goes through all the stages and these are constantly changing due to the evolutions, strict progressions, and ultimate transformations.

Stage 1: (Doing)

This is the post orientation period for a new professional nurse which is approximately three to four months. The initial movement towards theory into practice in the context of putting theoretical knowledge into practice for expectations, anticipations, and responsibilities of professionals at work. Initially the new professional just keeps on looking for someone to guide them, instead of experiencing the challenges by putting theoretical knowledge into practice and debriefing accordingly. This practice provides them with vulnerable emotions due to the complicated behavior of nursing professionals. By the passage of time, on the third or fourth day, the nursing professionals feel that they have been given full patient load which is equal to senior from them (Blegen, Spector and Ulrich et al 2015). This is the most critical time that the capabilities of nursing professionals are not judged,and they are given the responsibilities the same as their senior colleagues. This is the point where the nursing professional's stage of transition is steep, and they feel self-doubt and anxiety about their professional performance.

Stage 2: (Being)

This is the period when nursing professionals have passed three to four months in an organization. The professionals are characterized by rapid advancement in thinking, skill competency, and knowledge level (Zoffmann, Hörnsten and Storbækken et al 2016). Comfort level is gained by the nursing professionals ta this stage and they confront their inadequacies and inconsistencies that are there in the healthcare system. In the initial times of this stage, the professionals start becoming comfortable and start implementing medical and nursing interventions to the healthcare delivery system. At this stage, professionals do not need constant guidance.

Stage 3: (knowing)

This is the stage when the new professional nurses look at the day they started and transition amongst them professionally. They start feeling professionals on their own and desire for work-life balance.

Though this is the fifth month of the professional practice of Mark, in this case, he is at the second stage of transition to professional practice. But here he is on rotation in the Acute Assessment Unit (AAU) in the healthcare organization. He wants to pursue his nursing career in the emergency department by following the transition to professional practice. Although he received positive feedback from senior nursing staff, still he is lacking confidence and doubting his knowledge and skills of nursing. He at this point is stuck with complicated emotions as he is not getting any support from his seniors for the performance in nursing practice (Mroz, Pitonyak and Fogelberg et al. 2015). These are the signs of first stage Doing, that is he must put his practical knowledge into practice by debriefing the concepts. He must understand that this is the point where the nursing professional's stage of transition is steep, and they feel self-doubt and anxiety about their professional performance.

  1. There would be a negative impact on the healthcare delivery system and patient-centered care depending upon Mark's current situation. Patient-centered care is very important by professionals to recognize patient's opinions, preferences, and desires in the active role-playing of individuals. The patient-centered care is associated with both the healthcare service provider as well as patient satisfaction to reduce healthcare cost of delivery, and improved health outcomes. However, in this case, Mark is feeling demotivated and getting distracted from serving in the healthcare organization. This hampers the care provision with best practices as it could lead to the occurrence of adverse events and risk to patients who are assigned to him. This will result him in not giving proper time to patients though which is very important to provide patient-centered care. Mark is quiet and not interacting with anyone although he must understand the point that communication is very important to provide patient-centered care and if not provided so will lead to poor quality patient care. It is because patient-centered care includes an understanding of the patient’s perspectives, reaching a shared understanding of the patient's problem, understanding the patient within unique cultural and psychological contexts to respect patient values. Although, the professional here Mark must understand that it is the role of the healthcare provider to ensure a participatory role for being informed about patient care and eliminating barriers inpatient care context. According to the professional code of conduct, the nursing professionals are required to perform their duty by adhering to some standards such as patient dignity, the primacy of patient interests,promotion of patient safety, accountability and responsibility, self-integrity, and influence on the environment (Regan, Wong and Laschinger et al. 2017). The attitude of Mark is violating the Nursing code of Professional Conduct that results in poor quality patient care. The reason is that interaction with the staff and patient allows them to maintain and administer the patient's needs according to requirements. He must treat the patient by understanding the illness of patients. This will help in boosting independence, encouragement, sincerity, motivation, and self-determination. Mark was here in the stage of demotivation, but he should realize the difference between student life and professional life (Smolowitz, Speakman and Wojnar et al. 2015). The person has to handle all the responsibilities based on the profession. He must use his theoretical knowledge by debriefing into practical sense so that he can provide the best patient care according to the need of the patient. This will automatically result in the delivery of quality services by being accountable and responsible for actions taken in the profession (Kirkevold 2016). The nursing profession is a lifelong learning process and the professionals must not feel demotivated and quit. They should show a strong desire to learn more and more and serve for the betterment of healthcare status.
  2. Mark is here the point of attention, and the evidence-based strategies will be developed for his successful transition to practice.

In professional development, the professional should look after enhancing their skills by following strategies to advance career development. Quitting and staying quiet is not the solution to any problem. In the healthcare provision, all the professionals must follow new growth opportunities for both the patient as well as professional (Liberati, Gorli and Moja et al 2015). The four concepts that are followed in Mark’s professional development are

Belongingness

Resilience

Emotional intelligence

Communication

Strategies:

Belongingness –

  1. The professionals must be commented on the attitude of colleagues and lack of understanding and appreciation for the impact on future goals.
  2. Communicating the importance of solid orientation by welcoming them and showing their importance in the industry.
  3. Sharing own experiences
  4. Offering students greater commitment for the betterment and upliftment of health status.
  5. Welcoming the professionals and asking what they want to achieve
  6. Making them realize the importance of respecting their seniors and taking guidance from them.
  7. Making them realize that patient care is their responsibility and accountability.
  8. Encouraging confidence among professionals.
  9. Ensuring support for coping with routine procedures.
  10. Asking them to feel free for interaction.

Resilience –

  1. Building self-esteem by reminding them about their strengths and weakness
  2. Asking them to be flexible and face changes in the system.
  3. Working on a supportive culture for nursing professionals.
  4. Setting reasonable goals to deal with problems
  5. Developing optimism and positive thinking
  6. Asking them to remember that there are various problems that nursing professionals face at the time of practice in healthcare institutions
  7. Taking action to solve the problems that come in their way.
  8. Paying attention to own needs.

Emotional intelligence –

  1. Practicing strong listening skills
  2. Using stress-reduction techniques
  3. Learning to change the expectations to control feelings of rejection and anger.
  4. Cultivating more understanding of own emotions
  5. Working with a therapist to deal with stressful conditions (Spector, Blegen and Silvestre et al. 2015).

Communication -

  1. Setting realistic goals
  2. Asking the professionals how they want to get treated
  3. Focusing on critical thinking and clinical reasoning
  4. Reflecting on practice
  5. Providing them timely feedback.

References for Transition to Professional Practice

Beuchat, J.R., Seropian, M., and Jeffries, P.R., 2016. Communication and empathy in the patient-centered care model—why simulation-based training is not optional. Clinical Simulation in Nursing12(8), pp.356-359. https://doi.org/10.1016/j.ecns.2016.04.003

Blegen, M.A., Spector, N., Ulrich, B.T., Lynn, M.R., Barnsteiner, J., and Silvestre, J., 2015. Preceptor support in hospital transition to practice programs. JONA: The Journal of Nursing Administration45(12), pp.642-649. 10.1097/NNA.0000000000000278

Liberati, E.G., Gorli, M., Moja, L., Galuppo, L., Ripamonti, S., and Scarlatti, G., 2015. Exploring the practice of patient-centered care: The role of ethnography and reflexivity. Social Science & Medicine133, pp.45-52. https://doi.org/10.1016/j.socscimed.2015.03.050

Mroz, T.M., Pitonyak, J.S., Fogelberg, D., and Leland, N.E., 2015. Client centeredness and health reform: key issues for occupational therapy. American Journal of Occupational Therapy69(5), pp.6905090010p1-6905090010p8. https://doi.org/10.5014/ajot.2015.695001

Regan, S., Wong, C., Laschinger, H.K., Cummings, G., Leiter, M., MacPhee, M., Rhéaume, A., Ritchie, J.A., Wolff, A.C., Jeffs, L. and Young‐Ritchie, C., 2017. Starting: qualitative perspectives of new graduate nurses and nurse leaders on the transition to practice. Journal of Nursing Management25(4), pp.246-255. https://doi.org/10.1111/jonm.12456

Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E.M., Ulrich, S., Hayes, C., and Wood, L., 2015. Role of the registered nurse in primary health care: Meeting health care needs in the 21st century. NursingOutlook63(2), pp.130-136. https://doi.org/10.1016/j.outlook.2014.08.004

Spector, N., Blegen, M.A., Silvestre, J., Barnsteiner, J., Lynn, M.R., Ulrich, B., Fogg, L., and Alexander, M., 2015. Transition to practice study in hospital settings. Journal of Nursing Regulation5(4), pp.24-38. https://www.sciencedirect.com/science/article/abs/pii/S2155825615300314

Zoffmann, V., Hörnsten, Å., Storbækken, S., Graue, M., Rasmussen, B., Wahl, A., and Kirkevold, M., 2016. Translating person-centered care into practice: a comparative analysis of motivational interviewing, illness-integration support, and guided self-determination. Patient Education and Counseling99(3), pp.400-407. https://doi.org/10.1016/j.pec.2015.10.015

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