The Transition from Student Nurse to Clinical Nurse

The Transition from Student Nurse to Clinical Nurse Nicole Mc. Donald NURS 450 Ferris State University

Objectives • Discuss the difficulties of the transition into nursing • Look at the implications of a difficult transition on nursing retention • Examine theories related to the transition • Assessment of the healthcare environment related to the transition • Implications and consequences of this problem on patients and new nurses • Examine policies related to the transition • Perform a root cause analysis on the issue • Recommendations for quality and safety improvement • Examine QSEN competencies and ANA standards related to the transition

The Problem • Up to half of new RNs consider leaving within the first year (Mac. Kusick & Minick, 2010). • 30 -50% of new RNs change jobs or leave nursing in the first 3 years (Mac. Kusick & Minick, 2010). • Less than 50% of practicing nurses would recommend it as a career (Duscher, 2009) • 25% of practicing nurses would actively discourage someone from going into nursing (Duscher, 2009)

Why is this an issue? • • Transition Shock/Reality Shock Bullying High patient to nurse ratios Orientation & Preceptors Lack of support Exhaustion Staffing The Nursing Shortage

Transition Shock Theory Dr. Judy Boychuk Duchscher Nursing the Future Initiative

Schlossberg’s Transition Theory 4 S’s • Situation • Self • Support • Strategies Dr. Nancy Schlossberg Professor of Counseling Psychology

Assessment of the Health Care Environment • • • Transition Shock/Reality Shock Expectations vs. Reality Unfriendly environment Emotional distress Fatigue and exhaustion Lack of comfort in challenging situations

Implications, Inferences & Consequences For patients: • Decreased quality of care • Decreased safety • Delayed care, increased time in hospital • Negative outcomes • Decreased confidence in nursing staff

Implications, Inferences & Consequences For new nurses: • Increased risk for errors • Decreased job satisfaction • Helplessness • Staffing • High turnover rates • High costs

Spectrum Health Policies • Code of Excellence – Non-retaliation policy, p. 6 – Disclosure of potential conflicts, p. 11 – Building relationships with colleagues, p. 14 – Maintaining respectful treatment, p. 15 – Preventing workplace violence, p. 16

Spectrum Health Initiatives • • Leadership training Relationship-based Care Model Shared Governance Model EXCEL Nursing Professional Development Model

Root Cause Analysis Lack of Support Bullying Staffing Peers Call-ins Isolation ↑Pt load Supervisors Low Retention of New Nurses Physical Lack of experience Cut short Emotional Fatigue Judgment ↑ acuity Preceptor Confidence Orientation High Stress

Recommendations for Quality & Safety Improvements • Program emphasis on leadership, communication, conflict management, collaboration in final semester (Casey et al. , 2011) • Simulation experiences (Casey et al. , 2011) • Intensive preceptor-guided clinical (Casey et al. , 2011) • Novice Nurse Leadership Initiative (Dyess & Sherman, 2011) • Nurse Residency Programs (Bratt, 2013) • New nurse networking programs • Education on new nurse support - peer and supervisor • Performance evaluations

Nurse Residency Programs in Michigan • Children’s Hospital of Michigan – Detroit Medical Center • St. Joseph Mercy Health System • Beaumont Health Systems • Sparrow Health System • Munson Medical Center – Critical Care Internship

QSEN Competencies • Teamwork & Collaboration • Quality Improvement

ANA Standards • Communication • Leadership • Professional Practice Evaluation

References American Nurses Association. (2010). Nursing: Scope and standards of practice (2 nd ed. ). Silver Springs, MD: Nursebooks. org Anderson, M. L. , Goodman, J. , & Schlossberg, N. K. (2012). Counseling adults in transition: Linking Schlossberg’s Theory with practice in a diverse world (4 th ed. ). New York, NY: Springer Publishing Company LLC. Boychuk Duchscher, J. E. (2009). Transition shock: The initial stage of role adaptation for newly graduated registered nurses. Journal of Advanced Nursing, 1103 -1113 Bratt, M. M. (2013). Nurse residency programs: Best practices for optimizing organizational success. Journal for Nurses in Professional Development, 29(3), 102 -110. Casey, K. , Fink, R. , Jaynes, C. , Campbell, L. , Cook, P. , & Wilson, V. (2011). Readiness for practice: The senior practicum experience. Journal of Nursing Education, 50(11), 646 -652. Dyess, S. & Sherman, R. (2011). Developing the leadership skills of new graduates to influence practice environments: A novice nurse leadership program. Nursing Administration Quarterly, 35(4), 313 -322. Mac. Kusick, C. I. & Minick, P. (2010). Why are nurses leaving? Findings from an initial qualitative study on nursing attrition. Medsurg Nursing, 19(6), 335 -340 Pellico, L. H. , Brewer, C. S. , & Kovner, C. T. (2009). What newly licensed registered nurses have to say about their first experiences. Nursing Outlook, 57(4), 194 -294 Quality and Safety Education for Nurses (2014). Competencies. Retrieved from http: //qsen. org/competencies/pre-licensureksas/ Spectrum Health (2014). For nurses: Nursing excellence providing world class care. Retrieved from http: //www. spectrumhealth. org/nursing