NUR3504 - Transitioning to the Role of Registered Nurse Assessment

Introduction

The transition from a nursing student to a graduate registered nurse is a significant milestone marked by newfound responsibilities and challenges ‌ (Graf et al., 2020). This crucial juncture in a nurse's career is accompanied by a series of hurdles that necessitate careful consideration and effective coping strategies. Among the challenges newly graduated nurses (NGNs) face, three particularly noteworthy ones emerge prominently among the six peer-reviewed articles: a lack of confidence, feelings of stress and anxiety, and workplace bullying. Lack of confidence is caused by abrupt shifts from a controlled learning environment to a dynamic and often unpredictable clinical setting, which can induce feelings of inadequacy and uncertainty (Joseph et al., 2022). The demanding nature of healthcare, coupled with the weight of responsibility, can lead to heightened levels of stress and anxiety, which can have detrimental effects on the nurse's well-being and the quality of patient care (Kim & Yeo, 2019). Workplace bullying is a form of mistreatment encompassing verbal abuse, intimidation, exclusion, and belittling, often perpetuated by colleagues or superiors within the healthcare environment ‌(Alshawush et al., 2021). This essay will delve deeper into the challenge of feelings of stress and anxiety, exploring both evidence-based strategies from the literature and personal coping mechanisms that newly graduated nurses can employ to navigate this transitional phase successfully and ensure the delivery of high-quality care to their patients.

Challenges

Occupational Stress

The most formidable challenge is experiencing a sense of being overwhelmed, accompanied by heightened stress and anxiety due to the transition from the role of a student to an NGN, resulting in 'transition shock' (Kim & Yeo, 2019). This term refers to the emotional reaction experienced by NGNs due to the inconsistency between their expectations before graduation and the realities they face in the workforce. In terms of the Nursing and Midwifery Board of Australia (NMBA) standards, the heightened stress and anxiety experienced during the transition can affect the nurse's ability to meet the professional competence and performance standards set by the board. NGNs often experience a sense of inadequacy and a belief that they should know more than they do (NMBA, 2018). In addition to facing the emotional aftermath of patient deaths, they might fear making mistakes and communicating difficulties with doctors, patients, and senior staff (Kim & Shin, 2020). Conditions involving numerous admissions, critically ill patients, and scarce resources aggravate this feeling. Furthermore, it can be especially difficult to transition from being a student to assuming all of the duties of a registered nurse. These circumstances can be extremely stressful and anxiety-inducing for new nurses, hindering their ability to give the best care possible (Wildermuth et al., 2019). They may feel unsure about their clinical judgment and require additional support and supervision to build confidence in their clinical decision-making skills. (Opoku et al., 2020).

Job Satisfaction, Burnout and High Turnover Rates

Persistent stress and anxiety in newly graduated nurses during their transition to professional practice can have other significant repercussions, too. It can lead to diminished job satisfaction. When nurses constantly grapple with overwhelming stress and anxiety, job satisfaction plummets (Wildermuth et al., 2019). This is because they find it increasingly difficult to derive a sense of fulfilment and accomplishment from their work, which is crucial for professional contentment.

Moreover, prolonged stress and anxiety can contribute to burnout, contradicting the National Safety and Quality Health Service (NSQHS) standards of ensuring a safe and supportive work environment (ACSQHC, 2023). Feelings of cynicism, detachment, and a diminished sense of personal achievement can indicate this emotional, mental, and physical exhaustion (Hampton et al., 2021). In addition to negatively affect the nurse's health, burnout makes it more difficult for them to give patients the best care possible. This is a serious issue since the mental health and general well-being of medical staff directly impact patient outcomes. Moreover, the high turnover rates among recently graduated nurses can largely be attributed to this ongoing stress and anxiety. The psychological burden of the work, in addition to inadequate assistance during the shift, may cause nurses to look for work elsewhere or even consider quitting the field completely (Gautam et al., 2023). The stability and efficacy of healthcare teams, as well as the continuity and quality of care given to patients, are all impacted by this turnover. Thus, addressing and reducing these stress and anxiety levels is critical to protecting nurses' well-being and the standard of patient care.

Strategies to Alleviate the Stress of Transition

Self-care and Emotional Well-being

Self-care techniques like journaling, mindfulness, and gratitude expression are essential for handling transition among NGNs, especially when confronted with extreme stress and anxiety. This strategy, backed by Fitzgerald and Konrad (2021), includes a number of methods meant to improve emotional and mental toughness. Through journaling and expressive writing, nurses can introspect and recognise their emotions, feelings, difficulties, and successes (Tonarelli et al., 2018). Through this process, people can freely express themselves and learn more about their emotions. Nurses can improve their ability to handle stress and maintain composure under pressure by engaging in mindfulness practises, which centre on developing present-moment awareness and inner calm (Penque, 2019). NGNs can also employ gratitude exercises by intentionally recognizing moments of accomplishment, support, and growth, which can counterbalance the challenges and uncertainties associated with the transition, fostering a sense of fulfillment and motivation (Sekaja et al., 2022). Phased and Continuous Transition Programs

Implementing a phased and continuous transition program is instrumental in easing the adjustment process for NGNs, as advocated by the findings of Kim and Shin (2020). This approach recognizes that the level of support needed may vary depending on the duration of work experience. NGNs may benefit from a more structured and intensive program, gradually tapering off as they gain confidence and competence which helps them deal with their stress. This phased approach ensures that support aligns with the nurse's evolving capabilities (Kim & Shin, 2020). Providing ongoing education and extending the orientation period allows for continued skill development, exposure to diverse clinical scenarios, and reinforcement of clinical decision-making, which helps nurses handle stressful situations better, thus reducing the incidence of burnout and turnover (Flaubert et al., 2021). It also fosters a supportive learning environment, enabling nurses to seek guidance and clarification as they encounter new challenges.

Time Management and Organisation

Effective time management and organization are paramount for a smooth transition when contending with overwhelming stress and anxiety (Goldsby et al., 2020). NGNs often face many responsibilities, from patient care to documentation and collaboration with healthcare teams. Without effective time management, these responsibilities can easily become too much (Goldsby et al., 2020). Nurses who practise time management can ensure that no task is missed or rushed by allocating enough time for each. This entails establishing time-bound objectives that are reasonable and allow for the precise and comprehensive completion of tasks (Dierckx de Casterlé et al., 2020). Moreover, it is imperative to execute organisational strategies. This includes keeping their workspace organised, making sure they have simple access to the supplies NGNs need, and using digital applications or checklists to help NGNs remember tasks and appointments (Warshawsky et al., 2020). Setting priorities is also essential because it helps avoid having too many unfinished business. Furthermore, creating a routine can give one a sense of structure, lessen uncertainty—which frequently fuels stress and anxiety—and build confidence in one's capacity to handle the rigours of the new role (Warshawsky et al., 2020).

Conclusion

The shift from being a nursing student to a graduate registered nurse is a critical stage that is characterised by significant obstacles like low self-esteem, stress and anxiety, and bullying at work. Among these, "transition shock," or the extreme stress and anxiety that accompany this change, stands out as a significant barrier. The conflict between pre-graduation expectations and the realities of clinical practise is the cause of this emotional reaction. Persistent stress and anxiety have far-reaching effects on people's lives. They lower job satisfaction, raise the risk of burnout, and increase turnover rates. There are various evidence-based strategies that have been identified to successfully navigate this transition. These include the application of gradual and ongoing transition programmes, as well as self-care techniques like journaling, mindfulness, and expressing gratitude. Furthermore, the ability to manage time well and be organised is essential for reducing stress and anxiety. By adopting these techniques, recently graduated nurses can improve patient care while simultaneously strengthening their own resilience and well-being. Through recognition and proactive resolution of the obstacles presented by this shift, nurses can confidently and competently commence their professional journey with a dedication to providing quality care.

References

‌ Alshawush, K., Hallett, N., & Bradbury?Jones, C. (2021). The impact of transition programmes on workplace bullying, violence, stress and resilience for students and new graduate nurses: A scoping review. Journal of Clinical Nursing , 31 (17-18), 2398–2417. https://doi.org/10.1111/jocn.16124

Australian Commission on Safety and Quality in Health Care (ACSQHC). (2023). The NSQHS standards. https://www.safetyandquality.gov.au/standards/nsqhs-standards

 Dierckx de Casterlé, B., Mertens, E., Steenacker, J., & Denier, Y. (2020). Nurses’ experiences of working under time pressure in care for older persons. Nursing Ethics , 27 (4), 096973301989579. https://doi.org/10.1177/0969733019895797

‌Fitzgerald, A., & Konrad, S. (2021). Transition in learning during COVID?19: Student nurse anxiety, stress, and resource support. Nursing Forum , 56 (2). https://doi.org/10.1111/nuf.12547 Gautam, S., Anju Poudel, Kalpana Paudyal, & Mangal Maya Prajapati. (2023). Transition to professional practice: Perspectives of new nursing graduates of Nepal. BMC Nursing , 22 (1). https://doi.org/10.1186/s12912-023-01418-2

Flaubert, J. L., Menestrel, S. L., Williams, D. R., & Wakefield, M. K. (2021). Supporting the health and professional well-being of nurses. In www.ncbi.nlm.nih.gov . National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK573902/

Goldsby, E., Goldsby, M., Neck, C. B., & Neck, C. P. (2020). Under pressure: Time management, self-leadership, and the nurse manager. Administrative Sciences , 10 (3), 1–18. https://www.mdpi.com/2076-3387/10/3/38

Graf, A. C., Jacob, E., Twigg, D., & Nattabi, B. (2020). Contemporary nursing graduates’ transition to practice: A critical review of transition models. Journal of Clinical Nursing , 29 (15-16), 3097–3107. https://doi.org/10.1111/jocn.15234

‌Hampton, K. B., Smeltzer, S. C., & Ross, J. G. (2021). The transition from nursing student to practicing nurse: An integrative review of transition to practice programs. Nurse Education in Practice , 52 (52), 103031. https://doi.org/10.1016/j.nepr.2021.103031

Joseph, H. B., Issac, A., George, A. G., Gautam, G., Jiji, M., & Mondal, S. (2022). Transitional challenges and role of preceptor among new nursing graduates. Journal of Caring Sciences , 11 (2), 56–63. https://doi.org/10.34172/jcs.2022.16

Kim, E.-Y., & Yeo, J. H. (2019). Effects of pre-graduation characteristics and working environments on transition shock of newly graduated nurses: A longitudinal study. Nurse Education Today , 78 , 32–36. https://doi.org/10.1016/j.nedt.2019.04.002

Kim, J. H., & Shin, H. S. (2020). Exploring barriers and facilitators for successful transition in new graduate nurses: A mixed methods study. Journal of Professional Nursing , 36 (6), 560–568. https://doi.org/10.1016/j.profnurs.2020.08.006

Nursing and Midwifery Board of Australia ( NMBA). (2018). New codes of ethics in effect for nurses and midwives. https://www.nursingmidwiferyboard.gov.au/News/2018-03-01-new-codes-of-ethics-in-effect.aspx

Opoku, E. N., Van Niekerk, L., & Jacobs-Nzuzi Khuabi, L.-A. (2020). Exploring the factors that affect new graduates’ transition from students to health professionals: a systematic integrative review protocol. BMJ Open , 10 (8), e033734. https://doi.org/10.1136/bmjopen-2019-033734

‌Penque, S. (2019). Mindfulness to promote nurses? well-being. Nursing Management , 50 (5), 1. https://doi.org/10.1097/01.numa.0000557621.42684.c4

Sekaja, L., Tully, C. A., Mahlangu, S., de Freitas, K., Tyelbooi, L. N., Mjojeli, B. P. L., Mokhethi, M. E., & Mabitsela, T. (2022). Thankful employees: The manifestation of gratitude at work during a pandemic in South Africa. Frontiers in Psychology , 13 . https://doi.org/10.3389/fpsyg.2022.941787

Tonarelli, A., Cosentino, C., Tomasoni, C., Nelli, L., Damiani, I., Goisis, S., Sarli, L., & Artioli, G. (2018). Expressive writing. A tool to help health workers of palliative care. Acta Bio Medica : Atenei Parmensis , 89 (Suppl 6), 35–42. https://doi.org/10.23750/abm.v89i6-S.7452

Warshawsky, N. E., Caramanica, L., & Cramer, E. (2020). Organizational Support for Nurse Manager Role Transition and Onboarding. JONA: The Journal of Nursing Administration , 50 (5), 254–260. https://doi.org/10.1097/nna.0000000000000880

Wildermuth, M. M., Weltin, A., & Simmons, A. (2019). Transition experiences of nurses as students and new graduate nurses in a collaborative nurse residency program. Journal of Professional Nursing , 36 (1), 69–75. 

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