NEW GRADUATE NURSE TRANSITION INTO PRACTICE

  In 1982 Benner outlined a framework of how nurses progress through various stages from that of a novice to an expert. The novice stage, completed through the course of the nurse’s education, is a time of new experiences and the performance of tasks. The new nurse merging into professional practice is an advanced beginner (Benner, 1984). The advanced beginner uses “aspects,” which are characteristics of the current situation that are recognized as a result of a previous similar experience. However, the advanced beginner is unable to determine which aspects are most important and treats all aspects as having equal importance (Benner, 1984). Benner’s implications for this stage include the need for support in the clinical setting by setting priorities and ensuring patient needs do not go unattended as the new nurse is unable to discriminate what is most important in providing care (Benner, 1984). Current research supported Benner’s findings and shed light onto how the new nurse graduate transitioned into practice. Research demonstrated this is a time of learning and stress (Duchscher, 2008; Etheridge, 2007; Hodges, Keeley, & Troyan, 2008; Lavoie-Tremblay, et al., 2008). Challenges faced during the first year of practice as a new nurse include: lack of clinical knowledge and confidence in nursing skills, forming relationships with peers, workload demands, prioritization and organization related to care delivery, and interaction with physicians (Duchscher, 2008; Etheridge, 2007). New graduate nurses in their first few months of practice cited the most difficult aspect of the transition as developing competence and confidence in new situations within the realm of patient care (Hodges, et al., 2008). During this time the new nurse relied heavily on their preceptor to answer questions and serve as a resource (Hodges, et al., 2008). This point is reinforced in the literature finding that new nurse graduates feared they would not know everything that was occurring with each patient and thought it was important to be able to synthesize information and know its meaning. They encountered more responsibility and accountability for patient care than they anticipated, as this level of responsibility was not experienced as students (Etheridge, 2007; Duchscher, 2008). After several months on a unit, new graduate nurses developed the ability to align themselves with knowledgeable and accepting nurses who could serve as a resource and offer support (Etheridge, 2007; Hodges, et al., 2008). Towards the end of their first year in practice, new nurse graduates developed more self-confidence, trusted their own judgment, and were more comfortable with what information they knew, as well as what they did not know (Duchscher , 2008; Etheridge, 2007; Hodges, et al., 2008). Benner’s model has several stages after the nurse completes the advance beginner stage, which require continued support by experienced nurses and nursing leaders.

  STRATEGIES IMPLEMENTED BY HEALTHCARE ORGANIZATIONS

  ORGANIZATIONAL REQUIREMENTS

  In order to have successful outcomes, organizations must provide new graduate nurses the tools necessary to succeed in their career. Successful programs found that buy-in from all levels within the organization and adequate funding allowed for full implementation of the orientation plan (Pine & Tart, 2007). The culture on the unit can also have an impact on new graduate nurse transition. Identified as key in transition by new graduate nurses was a work environment that was supportive and accepting of new nurses and offered personal direction and guidance (Hodges, et al. 2008). However, new graduate nurses often were required to develop street smarts in order to survive within the unit culture which required perseverance and resource identification (Hodges, et al., 2008). Nurse managers and informal leaders on each unit can have a significant impact in creating a culture that is more supportive of new graduate nurses, including creating a welcoming environment and emphasizing the need of the whole unit to contribute to the education of the new graduate. After orientation it is important that the nurse manager, preceptor, and teammates on the unit, continue to support the new nurse encouraging the progression through Benner’s stages with the goal of becoming an expert nurse.

  ORIENTATION

  Each orientation strategy implemented by the organizations examined outlined goals for their new graduate nurse orientation programs. Overreaching goals of all programs were to support the development of both competency and role transition with narrower focus on areas such as: partnership, coaching and collaboration, communication, professional role development, critical thinking, improving patient outcomes, leadership, and sense of belonging (Shermont & Krepcio, 2006, Halfer, 2007, Pine & Tart, 2007).

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