The Transition from Student Nurse to Clinical Nurse

Nicole McDonaldNURS 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 (MacKusick & Minick, 2010).

• 30-50% of new RNs change jobs or leave nursing in the first 3 years (MacKusick & 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 SchlossbergProfessor 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

Low Retention of New Nurses

BullyingStaffingLack of Support

Fatigue Confidence Orientation High Stress

Peers

Supervisors

Call-ins

↑Pt load

Isolation

Physical

Emotional

Lack of experience

Cut short

Preceptor

Judgment

↑ acuity

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

ReferencesAmerican Nurses Association. (2010). Nursing: Scope and standards of practice (2nd 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 (4th 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.

MacKusick, 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-licensure-ksas/

Spectrum Health (2014). For nurses: Nursing excellence providing world class care. Retrieved from http://www.spectrumhealth.org/nursing