Transition from student to Professional Nurse Prepared by: . Asma'a S. Ayyash . Ala'a J. Break . Shima'a Abd El Aal Under supervision: . Dr. Hamza Abd Al jawad

By the end of this lecture we will be able to : Define the Transition . Define the Reality shock & Phases of reality shock. Know the Causes of reality shock. Realize strategies to ease Transition.

Definition Transition Is the passage from one state, place, stage, or subject to another change. As nurses prepare to enter the profession from student to registered nurse (RN) . They move not only from one role to another, but also from the school or university setting to the workplace. Transition is a complicated process during which many changes may happening at once.

Reality shock Is the result of inconsistencies between the academic world of work. Reality shock occur in novice nurses when they become aware of inconsistency between in the actual world of nursing and that of nursing school. As the novice nurse enter the new profession, reality shock begins.

Phases of reality shock There are four phases of reality shock : Honeymoon phase. Shock or Rejection phase. Recovery phase. Resolution phase.

Phases of reality shock (con) Honeymoon Phase During the honeymoon phase, everything is just as the new graduate imagined. The new nurse is in orientation with former school friends or other new graduates who often share similarities.

Phases of reality shock (con) Shock (Rejection) Phase During this phase the nurse receives daily assignments and begins the tasks. The novice nurse may be frightened or react by forming a hard cold shell around himself or herself. The nurse comes into contact with conflicting viewpoints and different ways of performing skills, and lacks the security of having an expert available to explain uncertain or gray areas. Vague feelings of discomfort are experienced.

Shock Phase(con) The novice nurse may reject the new environment and have a preoccupation with the past when he or she was in school. But others may reject their school values and adopt the values of the organization. Dealing with the shock phase is approached in many different way :

They decide they can't fight the experienced nurses or the administration; thus they adopt the ways of least resistance. Native These new nurses may choose another occupation or return to graduate school to prepare for a career in nursing education to teach others their "values of nursing'' Runaways They consider nursing just a job to get money only. Ratters These nurses bottle up conflict until they burned out. Burned Out These nurses create their own reality. These nurses may prefer night shifts Loners These nurses change jobs frequently. New Nurse on the Block They are the nurse who care enough to work within the system to elicit change. They frequently visit the nurse manager or head nurse to suggest change or a better way. Change Agent

Phases of reality shock (con) Recovery Phase The novice nurse begins to understand the new culture to a certain degree. There is less tension and anxiety, and healing begins. Resolution Phase The resolution phase is the result of the shock phase and the novice nurse's ability to adjust to the new environment. If the nurse is able to positively work through the rejection phase, he or she grows more fully as a person and a professional nurse phase.

Causes of reality shock Fear, lack of confidence, total responsibility Unrealistic expectations of self and co-workers. Fatigue. Role conflict and undefined expectations. Lack of resources and lack of support. Dealing with physicians and other health care workers. Lack of organizational skills/new situation. Heavy workload, frequent interruptions.

FROM NOVICE TO EXPERT There are five stages which novice nurse proceed to be more clinically competent: Stage 1: the nurse has few experience with clinical expectation and skills are learned by rote. This stage usually occur while completing the nursing educational requirement. Stage2: Exemplifies advanced beginners who are able to perform adequately and make some judgment calls based on experience most novice nurse enter the work force during this stage .

FROM NOVICE TO EXPERT(con) Stage3: includes competent nurse who are able to foresee long range goal and are mastering skills. Stage4: includes proficient nurse who view whole situation rather than part and are able to develop solution. Stage5: includes expert nurse with whom intuition and decision making are instantaneous .

Reality shock (con) FOUR REASONS LEAD TO STRESS 1- Realty of practice. 2- Unfamiliar with the structure of the organization. 3- Lack of professional relationships. 4- Lack of clinical judgment. SPECIAL NEED OF NOVICE NURSE 1- Interpersonal skill. 2- Clinical skills . 3- Organizational skills. 4- Delegation skills . 5- Priority setting skills.

Interpersonal skill Most physician administrators and the head nurse expect the novice nurse to immediately develop interpersonal skills that they take for granted. They had time to get to know the members of the health care team and felt comfortable interacting with them. They are often uncomfortable making rounds. clarifying orders and participating in trans disciplinary team conferences. However effective communication is critical. Novice nurse must listen. Ask the appropriate person and avoid distraction when communicating.

Clinical skills The novice nurse has basic knowledge of how to perform nursing skills. practice increases effectiveness, Efficiency and correctness of performing skills. During orientation phase the novice nurse should ask to observe or assist an experienced nurse with procedures for which there is a lower comfort level or lesser degree of experience .

Organizational skills The novice nurse may lack organizational skills. Someone is usually with student to offer suggestions on how to organize their time. Delegation skills Most student nurse have limited exposure to delegation uncertainty or feeling uncomfortable with delegation may be result of the personnel to whom one is delegation.

Priority setting skills Priority setting is a skills that all nursing student must demonstrate . the difference between nursing school and the real world is that serious consequence occur if prioritizing is not done effectively.

Strategies to ease transition 1-BICULTURALISM Biculturalism is the joining of two contradictory value system . Those of school values with these of the work places these designed to enhance appositive self-image and allow the new nurse to introduce idea or value brought from nursing school and integrate them into the work environment .

Strategies to ease transition 2-ROLE MODEL AND MENTORS A staff nurse can be a role model for a novice nurse but have no interaction with the novice . Mentors are experienced nurse who must be willing to commit to a 6 month relationship with novice nurse . Mentors help novice nurse set and reach realistic goal by reinforcing and recommending .

Strategies to ease transition 3-PRECEPTORSHIPS preceptors program have gained popularity as a means to socialize the novice nurse into the profession and to ease tension of transition from student to nurse . preceptor program often are Incorporated during the senior nursing student final practicum .

Strategies to ease transition 4-SELF MENTORING Novice nurse can also help by using self mentoring when preceptor or mentors are not available . Novice nurse must be willing to learn appropriate reference . Develop problem solving skills and ask question .

Strategies to ease transition 5-SELF-CONFEDENCE & SELF ESTEEM. Self esteem or belief in oneself comes as the novice nurse passes through the stages of reality shock and into career in nursing Self esteem= self confidence + self respect. Individuals with high self esteem can critically problem solve .tackle obstacles . Take sensible risk believe in themselves and take care of themselves . Nurse with self esteem are effective and respond to themselves and other in healthy way. They can accomplish more because they fell comfortable with themselves.

Keys to survival during transition Think before answering ,take a few minutes before you answer and decide what is best for you . Take vacations , what can seem like a crisis before the break may become mange . Get rid of minor things that drain your energy , bring your lunch and eat in a quite space rather than spending most of your break waiting in line , only to swallow your lunch whole or even worse , eat on the unit . support your co-workers , be a good listener .

Keys to survival during transition Wear comfortable uniforms and shoes, you cant think if your feet hurt and your pants are too right . Treat yourself , do something nice every week. Avoid people who irritate or hassle you, pessimistic people can bring you down . Keep in to touch with yourself , don’t take on everyone else s responsibilities . Say no and don’t feel guilty . Remember nursing is a noble profession .

Organizational Skills Lack of organizational is common when the novice nurses assignment becomes much heavier than that of a student nurse . The use of a report sheet can enable the novice nurse to note important information received during the shift report and from other members of the trans-disciplinary health care team as the day progresses . The report sheet can also be used to document occurrences during the shift . Another suggestion for the novice nurse is to contact a former nursing instructor .

Clinical skills Suggestions for developing skills needed in practice new will be addressed . Based on banners model the graduate nurse must be allowed to develop clinical skills based on experiences . The novice nurse can develop competence with clinical skills during the orientation phase by asking to observe an experienced nurse perform those skills with the novice nurse is less familiar the novice also can provide the nurse manager and mentor with a list of skills that need further practice.

Interpersonal skills Developing interpersonal skills may be achieved by attending unit meetings volunteering for committees on the unit or within the agency and taking an active interest in the nursing unit . These activities aid in socialization into the unit and professional . It is important for all nurses regardless of their experience to take part in professional organizations at the local regional state or national level .

Interpersonal skills Various methods that may be used to develop professional relationships should be emphasized during the orientation period . Nurses in staff development positions can be key players in assisting the novice nurse in development pro-fissional communication skills .

Delegation skills Body language is important when delegating . After communicating face to face give a list of tasks in writing or post it at the nurses station . Be willing to change the assignment if there are changes in a patients condition new patients are admitted or you realize that the time needed to perform a task was underestimated. If time allows it is always good to help those to whom you have delegated tasks .

Transition Palestinian student nurse to professional The difficulties facing the nursing student: A gap between theoretical and practical field in hospitals. Discrimination between nursing colleagues. Some work problems such as the lack of tools and resources needed to complete the work. A lot of pressure at work.

How we deal with new graduate in Palestine? Most of the health institution follow these steps: Orientation program for new nurses. Orientation about the hospital as general . How to calculate drug doses. Cardiac life support program for all new nurses and refreshment course for the old one. Hospital and unit policies and procedure. In-service education programs. Follow job description.