Academia to Bedside is a four-part series that focuses on the transition of nursing students from education to their professional role. Part 1 focuses on “What we know now” about our new graduates.
By: Sabrina Beroz and Beth Hallmark
Nearly 90 percent of nurse faculty but only 10 percent of nurse executives feel that students are prepared to provide safe care upon transition to practice (Berkow, Virksitis, Stewart, & Conway, 2009). Nationally and internationally, new graduate nurses (NGNs) transition into practice as novices or advanced beginners. At the time of the Berkow et al. study, NGNs constituted more than 10 percent of hospital staff, a percentage expected to increase with the retirement of greater numbers of experienced nurses. More recently, the Health Care Advisory Board projected that 42 percent of the nurses hired into the acute care setting will be new graduates (Theisen & Sandau, 2013). As hospitals hire inexperienced nurses, academic and hospital nurse leaders seek out ways to augment their readiness.
What is known
The novice is a beginner, a person with little experience, who relies on rules to guide performance (Benner, 2001). But rule-directed decision-making is limited and inflexible. The advanced beginner can demonstrate marginal but acceptable levels of performance but is only beginning to see meaningful patterns in practice and continues to need help with setting priorities.
For the NGN, transition to practice is stressful. The gap between education and practice creates a reality shock that affects confidence in managing the complexities of care, working with technology, and engaging in interprofessional communication (Jung, Lee, Kang, & Kim, 2017). Hence, the transitioning NGN requires support, but that is often insufficient, leading to high turnover rates of 35 to 60 percent (Theisen & Sandau, 2013).
Complicating the academic-practice gap are nurse educators with divergent perceptions on NGN readiness for practice. To identify the educational needs of NGNs, the Nurse Executive Center surveyed practice leaders about 36 competencies deemed essential for safe and effective care (Berkow et al., 2009). While all competencies were found to require improvement, the greatest needs for development included tracking multiple responsibilities, the ability to prioritize, delegation, and the anticipation of risk. Symptoms of these limitations are evident, with nearly 85 percent of NGNs making a medication error within the first year of practice (Saintsing, Gibson, & Pennington, 2011). In addition, the number of falls and incidents of failure to rescue are higher with NGNs. These results provide clear evidence for opportunities to adapt curricula and orientation processes to lessen the academic-practice gap.
What is being done
Many initiatives are already under way, spurred by the Institute of Medicine’s report on the Future of Nursing (2011), which advocates for “transition to practice” nurse residency programs to enhance the development of the skills necessary for the delivery of safe, quality care. Taking this IOM recommendation to heart, the University HealthSystem Consortium (UHC) and the American Association of Colleges of Nursing (AACN) developed residency curricula to broaden the typical orientation experience through the harnessing of essentials such as mentoring and providing content for clinical competency and professional transition (Kowalski & Cross, 2010). The core curriculum focuses on leadership, patient outcomes, and professional roles. NGNs participating in residency programs transition to practice with the knowledge and skills necessary for safe care.
Recognizing the need for a blended learning solution, with a systems-based orientation program, the National League for Nursing (NLN) Center for Academic and Clinical Transition has developed a signature program in partnership with Laerdal Medical and Wolters Kluwer Health. Accelerating to Practice (A2P) addresses the challenges presented by the NGN transition to the workplace through the use of simulation, coaching, and personalized education plans.
The struggles experienced by NGNs serve as a call for collaboration among nurse educators in academia and practice to ease the transition into practice and thereby enhance the quality of patient care. Transitioning the NGN from an internal focus (getting through the day) to an external focus (the integration of a new self-concept) takes time and mentoring (Kowalski & Cross, 2010). “Stay tuned” as this series, “Academia to Bedside,” will explore how technology, and simulation, can be used to bridge the academic-practice gap.
References
Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice, (Commemorative edition). Upper Saddle River, NJ: Prentice-Hall Health.
Berkow, S., Virksitis, K., Stewart, J., & Conway, L. (2009). Assessing new graduate nurse performance. Nurse Educator, 34, 17-22.
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
Jung, D., Lee, S., Kang, S., & Kim, J. (2017). Development and evaluation of a clinical simulation for new graduate nurses: A multi-site pilot study. Nurse Education Today, 49, 84-89.
Kowalski, S., & Cross, C. (2010). Preliminary outcomes of a local residency programme for new graduate registered nurses. Journal of Nursing Management, 18, 96-104.
National League for Nursing. (2017). NLN Center for Academic and Clinical Transitions. Retrieved from http://www.nln.org/centers-for-nursing-education/nln-center-for-academic-and-clinical-transitions
Saintsing, D., Gibson, L., & Pennington, A. (2011). The novice nurse and clinical decision-making: How to avoid errors. Journal of Nursing Management, 19, 354-359.
Theisen, J. L., & Sandau, K. E. (2013). Competency of new graduate nurses: A review of their weaknesses and strategies for success. Journal of Continuing Education in Nursing, 44, 406-414.
I have been a nursing administrator in a small community hospital. The points made in this article only serves to confirm my suspicion about how well we were doing orienting new graduates. Several of the points made i this article will assist me in my new role as the instructor.