Supporting New Graduates Through Their Transition By Amber Niles RN, BSN, CEN ● NGR 6725 Fall 2017 ● Florida Atlantic University

How Long is a New Graduate Transition? The transition from Graduate Nurse to Competent Provider, generally occurs after the first year of employment This Photo by Unknown Author is licensed under CC BY-NC

What Happens in the First Year? Five Weeks of In Class Training and Simulation Labs 7 weeks of Preceptorship (with skills checks/competencies every 2 weeks) 90 Day Probation-Takes full assignment in Non Critical Areas of Department with resource nurse in same area, parallel assignment as well as the Charge Nurse. 6 months as a Novice Nurse-taking more critical assignments with a resource nurse in same area. Utilizing less and less assistance from Resource and Charge Nurses, Annual competency completed by Charge RN. Nurse able to work independently in any assignment within the department. Charge nurse continues to act as resource if necessary Source: HCA Nurse Specialty Program (NSP) Progression Timeline

The Good vs. The Bad Successful Nurse Graduate Transition… Unfavorable Nurse Graduate Transition… Positive Work Environment Stressful work environment Constructive Working Relationships Burnout Support for Professional Practice Job/Career Dissatisfaction Support and understanding of learning needs Turnover/Retention Issues (Cubit & Ryan, 2010)

A Day in the Life of a Newly Graduated Nurse Lack of Sleep due to overthinking throughout the night Decreased appetite due to “nervous stomach” Feeling of Uncertainty upon arrival for shift Being nervous about not being able to perform well or as expected by peers Sense of accomplishment when day complete and feeling of euphoria if successful day (Edwards et al, 2015) This Photo by Unknown Author is licensed under CC BY-NC-ND

Hire for Success The Following are Traits listed by the ENA (Emergency Nurses Association) that demonstrate good qualities of a nurse, especially into their first job, that will increase level of longevity: • Ability to shift gears and accelerate pace as needed • Good observational, assessment, and prioritization skills • Multi-tasking skills • Good interpersonal and customer service skills • Stamina • Good personal coping skills • Assertive patient advocate • Ability to maintain calm amidst chaos • Good sense of humor • Ability to think fast on one’s feet (Winslow et al, 2009)

How Can We Help with the Transition? Pre Nursing School Graduation Post Nursing School Graduation Residency Programs that account for minimum of last Semester of nursing school Nursing Fellowships in Specialty Departments Mandatory volunteer hours in hospital setting, in specialty of choice Specialty Courses Preceptorship (at least 12 weeks) Mentorship Program (for lifetime of career, not just for probationary period) Required skills and knowledge evaluations Workshops Rush et al, 2013

Mentoring…Guidance that Lasts a Lifetime Mentor: One that can help light the way to career goals, instill professionalism, provide encouragement and open opportunities for networking and leadership (Marquis & Huston, 2017) Having a good mentor while entering the nursing field for the first time, can assist new nurses in not only learning necessary skills but also knowing the expectations of them from their peers. Guiding them during this transitional period can decrease the stress felt by new nurses and the staff members they encounter (Miller, 2011).

Required Skills Workshops Requiring that new nursing staff, and established staff alike, attend skills workshops like Skills Fairs and Simulation labs will ensure the efficiency and continuity in their clinical practice. Moving from the school setting to the work setting can be difficult for some, this will assist in the transition. (Valdez, 2008)

Sometimes you just need an ear to listen Employee Rounding can be extremely effective when helping a new nurse transition into their role. Addressing concerns, providing constructive feedback and providing praise, when necessary, can increase employee engagement and can lead to increased staff satisfaction and retention. Check on your new staff often. Simply listening can decrease their level of anxiety. (Scott, Engekle & Swanson, 2006)

Just Remember…You were there once Be calm, be patient Provide Real-time Feedback If they are not meeting expectations: be honest Be consistent: make your expectations clear Document their progress, share with managers and educators to aide in strengthening weaknesses No Bullying or discouraging words or actions

References Cubit, K. Ryan, (2010). Tailoring a Graduate Nurse Program to meet the needs of our next generation nurses. Nurse Education Today. 31 (2011) 65-71 Edwards, D. Howker, J. Carrier, J. Colin, R. (2015). A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse. International Journal of Nursing Studies. Marquis, B. Huston, C. (2017). Leadership Roles and Management Functions in Nursing: Theory and Application. Philadelphia, PA: Wolters Kluwer Miller, P. (2011). Successful Graduate Nurse Transition: Meeting the Challenge. Nurse Leader. August 2011. 32-40 Rush, K. Adamack, M. Gordon, J. Lilly, M. Janke, R. (2013). Best practices of formal new graduate nurse transition programs: An integrative review. International Journal of Nursing Studies Scott, E. Engelke, M. Swanson, M. (2006). New graduate nurse transitioning? Necessary or Nice? Applied Nursing Research. 21 (2006) 75-83. Valdez, A. (2008). Transitioning from Novice to Competent: What can we learn from the literature about graduate nurses in the emergency setting? Journal of Emergency Nursing. 34 (5) 435-440 Winslow,S. Almarode, M. Cotingham, S. Lowry, K. Walker, K. (2009). New graduates in the Emergency Department: Could you, Would you, Should You:? Journal of Emergency Nursing. 35(6). 521-524