Transition from Student Nurse to Staff Nurse

The author has chosen to examine the perceptions of newly qualified staff nurses during their transition from being student nurses to registered nurses working as staff nurse in various clinical settings to fully understand the issues involved and find ways to make this transition a healthy, enjoyable and productive phase in career development of new nurses. A review of the literature highlights many issues during the transition period. A comprehensive investigation of relevant studies and other available research dating back to 2001 were examined. Various databases were searched. The two main themes that emerged throughout the review of related studies were support system and stress. From these two main themes emerged five subthemes, which included ‘sense of belonging’, ‘preceptorship/mentoring programmes’, ‘allocation of student’, ‘bullying’, and ‘independence’. These are the concerns during the transition from student nurse to staff nurse. It is of utmost importance that nursing staff are conscious of this transition and the support that is available to them.

Little attention is given to the experiences of new nurses during the transition phase from student nurse to newly qualified registered nurse. McKenna and Newton (2008) suggest that further investigation must be conducted during the transition phase to evaluate the on-going development of registered nurses in the workplace. Newly qualified nurses generally view the transition phase with mix emotions of anxiety and excitement.

The transition process from a student nurse to staff nurse is not only stressful and challenging but can be a productive experience that shapes the nurse to become a safe practitioner. For many new nurses, the transition is an exciting period but also scary. Douchester (2008) states that newly registered nurses often experience feelings of fear, apprehension, self-doubt as well as excitement, feelings of responsibility and lack of confidence in their abilities (Pearson 2009) as they embark on their new career. Pearson (2009) shared her personal reflection on her experience with transition from nursing student to staff nurse as uncomfortable and stressful in her Double Blind Peer Reviewed and Editorial Board Reviewed journal article. She was haunted with the following questions that altered her sleep pattern: “How will other staff and patients see me? Am I expected to know everything? What if I make a mistake? Will I be liked? Can I do justice to the profession?” These questions may be part of the anxiety commonly felt during the transition phase.

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According to Pearson (2009) even as qualified nurse, new nurses are not expected to know everything. Establishing oneself to become a team member and adapting to the new environment takes time considering that working shifts mean you will not meet all the other staff right away. A qualitative study conducted by McKenna and Newton (2008) explored how new nurses develop their knowledge and skill over the first 18 months following graduation, as well as factors that promote or affected their professional development. It was found in this study that new nurses may still be working their way to develop a sense of belonging, independence in their practice and exploration of future career development. The authors recommend that more studies shall be conducted in order to explore the transition period in the development of professional and registered nurses.

New registered nurses need to feel that it is alright for them to voice out their concerns and communicate their worries to the other members of the health care team, without feeling incompetent or without expectations from older nurses that they need to know everything all at once (Pearson 209). It is therefore a need for new nurses to have support systems as they journey towards professional growth. A support network can be identified as a number of people who offer emotional and/or practical help to an individual (Evans et al. 2008). Cleary et al. (2009) in Australia and Zinsmeister and Schfar (2009) in the United Kingdom found that a direct effect on the expectation of the transition for newly qualified nurses was the level of support experienced. Furthermore, Nugent (2008) found out that the presence of a supportive clinical environment for newly qualified nurses enhanced their transition experiences considerably. However, a qualitative design study carried out by Evans et al. (2008) incorporating face to face interviews found that due to the constant rotating nature of the transition support programme, it led to support networks demonstrated neither among experienced nurses nor newly qualified nurses on any ward. This further led to participants in this study not feeling accepted as part of the team and lacking a certain sense of belonging.

The sense of belonging was acknowledged however by a new nurse who felt the transition support programme offered positive outcomes. When support was provided to newly qualified nurses, the benefit and strength of the programme became noteworthy. They proved beneficial and enabled the new nurses to feel accepted and able to work as a valued member of the team. Recognised limitations of this particular study included the interview style used. It was suggested by Parahoo (2006) that while studies incorporated the interview method, the increasing likelihood of hawthorne effect is apparent as a result of the personal interaction that took place between the researcher and the interviewee.

New nurses gain a sense of belonging and are able to complete their socialization into the clinical workplace only after they complete their graduate year (McKenna and Newton 2008). These researchers found that new nurses were grappling with realities of nursing practice and their own survival within their first six months of clinical practice. Understanding the hospital process and procedures and finding their niche in the clinical setting was a challenge. It takes time for a new nurse to know where things are kept. “I used to walk around in circles when what is needed is just right in front of me,” claimed Pearson (2009). The sense of belonging may be demonstrated by participants in various ways. However generally, after rotating around different departments, they voiced out contentment at being able to settle and belong in one ward. Finding a niche in the workplace fosters confidence and in the case of the new nurses, a growing independence as practitioners (McKenna and Newton 2008).

Preceptorship/mentoring programmes during the transition phase aid new nurses in adjusting to the new work environment. Preceptorship programmes are promoted by the Irish Nursing Board. Preceptorship incorporates development and support for new nurses and usually lasts around six months (Pearson 2009). The Nursing and Midwifery Council (2002) cited in Hollywood (2011) recommends that newly qualified nurses should be mentored for the first four months. It is not until six to nine months that new graduates experience a positive paradigm shift in their job and get to develop a system that works for them. Understanding the limitations of new nurses and being able to freely ask questions will foster a good working relationship between mentor and mentees. This in turn leads to a safe, effective nursing care delivery system. Thus, the clinical team must be supportive of the new staff’s learning needs and acknowledge that relationships with mentors/ supervisors, and other staff will affect the new nurses’ ability to fit in, to ask questions and to feel safe in the workplace (Pearson 2009).

In a study that was carried out by O’Shea and Kelly (2007) using a phenomenological research approach it was found that newly qualified nurses in the Republic of Ireland described their initial experiences of being on the ward as stressful. Furthermore, Walker (1986) cited in O’Shea and Kelly (2007) affirms that the transition period from student to staff nurse was highlighted as a stressful time. Respondents felt inefficiently prepared in terms of the skills required and the situations encountered. They reported that their student status denied them the experience and confidence they needed to face situations they would encounter when qualified. O’Shea and Kelly (2007) highlighted that some of the most stressful aspects for the new graduate nurses were organisational/managerial skills deficits, clinical skills deficit, the allocation of student nurses and dealing with new situations. The stressful transition phase can be attributed to factors such as lack of experience, lack of organizational skills, new situations involving the interdisciplinary team, large patient loads, interruptions, reliance on others and perceived lack of support, which can all make new nurses’ transition from novice to expert extremely stressful.

Douchscher (2008) acknowledges that issues frequently cited as worrying throughout the initial twelve months that may lead to stressful situations for new nurses at various stages include lack of clinical knowledge and confidence, relationships with fellow colleagues, workload demands, organization and prioritization related to decision making and direct care judgments and communication with physicians. A foremost stressor was the allocation of student nurses to newly qualified staff nurses (O’Shea and Kelly 2007). Participants in the study made it clear that they didn’t feel confident being allocated with student nurses. New graduates felt they were being allocated students at a time when they themselves were only getting to grips with their new role.

Bullying/Horizontal Violence is a factor to stress in the work place during the transition phase. McKenna et al. (2003) cited in Morrow (2008) studied the occurrence of horizontal violence frequently experienced by nurses in their first year of practice. It was found that many new nurses felt undervalued and neglected by some colleagues who were more experienced and faced unjust criticism, as well as rude and humiliating verbal statements. They also felt distraught and anxious due to the obvious conflict between members of the healthcare team. Yildirim and Yildirim (2007) determined that 86% of nurses have encountered bullying behaviours on one or more occasions within the last twelve months and that the source of a large percentage of these behaviours stemmed from their managers. Evans et al. (2008) also spoke about this issue and concluded that most nurses interviewed spoke of bullying or horizontal violence amongst their peers, whilst most participants knew of a ward in each of the hospitals where bullying was known to frequently occur. One new graduate nurse reported they were not the only nurses to experience bullying in the workplace but also the student nurses and agency staff encountered this stressful experience. With bullying as a stressful experience, new nurses view the transition phase as anxiety provoking.

The perception of inadequacy of university preparation drives new nurses to seek independence. New nurses demonstrate this independence through “knowing.” Levels of knowledge are achieved actively through experiential learning and with this knowledge, new nurses develop confidence. Additionally, with independence they develop increased sense of responsibility. Participants expressed a realization of their need to be more independent (McKenna and Newton 2008). As stated by one new staff nurse: “… we have to stand on our own two feet now; rather than saying, I’m a grad and acting dumb. You just have to stand on your own two feet so it makes you do it better.”

The transition phase from student to staff nurse role has many factors that contribute to a terrible experience among new nurses yet also offers a promising outcome for career development. These factors are support systems, stress, sense of belonging, preceptorship/mentoring programmes, allocation of students, bullying and independence in practice.

From perceptions and research findings it can be concluded that many new nurses felt specific support systems, sense of belonging, and independence, would enhance and improve their transition from student to staff nurse. However, certain weaknesses of the support networks led to lack of belongingness and dissatisfaction in their new role. Preceptorship/mentoring programmes supported and aided the transition from student to staff nurse, thus preceptorship was highly valued by new nurses when it was implemented in some areas.

Stress was directly linked to the lack of experience, organisational/managerial skills, allocation of students and the lack of support. Bullying in the workplace was also seen to cause stress among new graduates. Allocation of students is also seen as stressful to new nurses. Even if the transition phase is stressful, new nurses have to undergo them in order to start with their career development.