Introduction
The transition from being a student to a professional practice comes with its fair share of challenges, and like most professions, transitioning from being a student to a practicing registered nurse also has its challenges because in transitioning change is experienced and change is uncomfortable until one gets accustomed to it. The schedule of a student and that of a professional in practice are different. The different occupational position comes with different demands, work being more demanding because one has to apply themselves in real-life situations. A lot hangs on the balance, maintaining the professional code of conduct, meeting the demands of the job, work pressure, and keeping the job.
A professional in practice needs to be able to manage professional role requirements, organizational technologies, and team dynamics while on the shift (Borbasi & Jackson, 2015). The transition from a student to a practicing professional is often accompanied by change personal circumstances for example a graduate has to balance their shift at work, working full time, and spare time to spend with friends and family.
The pressure of a student is whether they will complete and submit their assignment on time and whether they will pass or fail. In professional practice, there is pressure to perform well at work or otherwise get into trouble with the human resource department or lose your job. In a setting such as a hospital, the pressure is a lot more as one is dealing with people’s lives and health (Gilbert, Patel, Roberts, Williams, Crofton, Morris & Gilbert, 2017). A slight slack at the workplace could be a matter of life and death.
It is no wonder transitioning in any field or a new work station can be challenging. Many people are often not prepared for the transition ahead and as a result, work becomes overwhelming when they try to maintain a balance between their old lives and schedules with the new demanding schedule (Guinea, et al., 2019).
Some of the challenges registered nurses face during transition is not getting proper orientation into the new work environment. Each work environment has its policies and guidelines to be met that work as a system to enable the organization function to the optimum level. It takes time for new registered nurses to get used to the schedule and routines of the new work environment (Borbasi & Jackson 2015).
Sometimes during the transition, people are forced to work with new colleagues and it takes time to develop a good working relationship with a colleague and in other instances people find themselves paired with people they are unable to work with.
This paper will be analyzing the case study of a newly registered nurse, Alex who has been 8 weeks into the practice. It looks at the challenges the registered nurse faces during his transition phase (Guinea, et al., 2019).). It determines whether the graduate registered nurse met or did not meet the roles and responsibilities a registered nurse is supposed to meet.
It also makes recommendations of the measures that should be put in place to help newly registered nurses’ transition smoothly into the practice. This is to ensure they are not frustrated and overwhelmed right from the moment they get into active practice.
According to the case study, during his shift, Alex realized that it would be working with a new nurse and he got nervous, a normal reaction when you are apprehensive about working with someone new. He also got informed that his patients’ allocation had changed and in his new allocation he would be handling a patient with end – end-stage- liver failure a case he had never handled before, what this meant is he was unsure of how to go about handling the patient, being unsure meant he wasn’t confident while doing his work and this could have potentially led to blunders at work (McPhail, Avery, Fisher, Fitzgerald & Fulop, 2015).
During his shift, Alex was already feeling overwhelmed, apart from already missing out on his sister’s birthday he also had the admission, discharge, and post-operative patients to deal with. He was working in duress unsure of whether he would cope the rest of his shift another factor that would impede the quality and level of his work (Guinea, et al., 2019).
By the time it was time for him to handover at the end of his shift, he realized that after he had given one of his patients, Ms. O’Sullivan an antiemetic, he set the observation machine to take automatic observations. He however forgot to go in and check on this patient for the last 3 hours (Guinea, et al., 2019). He had not yet completed the admission documentation for yet another patient, Mr. Maple. Additionally, he had not also completed his patient notes on the computer on wheels (COWS) machine and had to stay behind 30 minutes after the end of his to complete the pending work.
Since he was overwhelmed at work, he ate into his time yet again falling into the cycle of feeling overwhelmed at work and home.
According to the case study, the registered nurse was unable to meet the roles and responsibility that was expected of him during the shift. The simple justification for this statement Is based on the fact that the registered nurse was feeling stressed on his way home and he wasn’t sure whether not Ms. O’Sullivan one of the patients under his care had experienced any post-op complications (McPhail, Avery, Fisher, Fitzgerald & Fulop, 2015). He felt frustrated that he may have missed other things during that shift and that he also had to stay late to finish his patient notes. The fact that he was quite unsure and satisfied with the work he had done was a clear indication that the registered nurse did not meet his roles and responsibility as expected of him and even he knew it.
The other reason that indicates he failed to meet his responsibility during the shift is evident in the way the nurse he is supposed to hand over to rolls his eyes when he hands over incomplete forms (McPhail, Avery, Fisher, Fitzgerald & Fulop, 2015). The rolling of the eyes is an indication of the dissatisfaction by the nurse taking over it is also reflective of the relationship they are having with his new colleague. His new colleague seemingly accustomed to the operations of the facility is impatient with Alex and not accommodative of his blunders.
Following the registered nurses’ standard practice, the nurse in question failed on several issues about engaging in therapeutic and professional relations (Guinea, et al., 2019). He should have, communicated effectively to gain assistance with one the patient with the end-stage- liver failure a condition he had never handled in a patient instead of taking the gamble that the patient would have been fine. He should not have been afraid to consult and ask for help.
The registered nurse standard practice stipulates that one uses delegation, supervision, coordination, consultation, and referrals in professional relationships to achieve improved health outcomes that were not put into consideration in this case.
In adherence to the guideline of the registered nurse standard practice, he would also have actively fostered a culture of learning that included engaging other health professionals and colleagues by seeking knowledge through consultation and practice to supports person-centered care (McPhail, Avery, Fisher, Fitzgerald & Fulop, 2015). He did not seek guidance when he felt overwhelmed or even when he knew he had never handled a patient with such a condition, he instead decided to go through with the work despite being unsure of his capabilities potentially putting the life of a patient in danger.
Recommendations
The nurse in question could have done several things differently during the shift to ensure that he performed his work well and to the required standard. The following are recommendations on how the registered nurse would have conducted the shift differently (McPhail, Avery, Fisher, Fitzgerald & Fulop, 2015).
Having arrived 15 minutes early for his shift and discovering that he had not worked with the nurse on duty, the logical thing to do would have been to introduce himself, explain he was new and get over his apprehension about working with a new colleague (McPhail, Avery, Fisher, Fitzgerald & Fulop, 2015). The nurse was apprehensive about working with someone new because the work environment requires that one is comfortable at the working station with his colleagues and the general staff.
Considering the knowledge, skills, and attitudes that are inherent in the RN role, which includes: communication skills for nurses require that they listen and attend to patients. It involves information giving and support in the context of nurse-patient relationships. Communication between colleagues is also fundamental in giving healthcare (Guinea, et al., 2019). Patient information is shared between the different staff that handles the patients. It is important to ensure that the information shared is correct and timely to avoid rooky mistakes such as administering treatment that had already been administered by another. In the case study in question, the nurse failed to communicate effectively. He was unsure about treating a patient with a condition he had never handled before and left the shift unsure of the state they were in, in this case, he would have put his communication skills to use by consulting the team leader.
After encountering a new situation that was a patient with a condition he had never handled, the registered nurse practice requires that when nurses face new situations, they should be able to adjust their knowledge and skills accordingly. The adjustment the nurse would have made in this instance was consulting and communicating for clarification (Guinea, et al., 2019). He had never prepared a discharge sheet before yet he was assigned to patients that would be discharged on that day. He prioritized these activities while preparing his shift planner and even after his shift he still had pending work that required him to stay behind to complete. This indicates that the RN was overwhelmed considering he had finished his night shift the previous day and was required for the day shift in the afternoon. The RN was frustrated and tired. He had missed the alarm to attend his sister’s birthday and was already worried about how his shift would go with the new dynamics at work like working under a new nurse and handling new patients including one with a condition he had never handled before.
To promote resilience, build capacity, and maintain work/life balance during the graduate RN’s transition period some strategies can be put in place to ensure that they smoothly transit and adjust to their new work environment (Edvardsson, Watt, & Pearce, 2017).
One such strategy would be assigning nurses responsibility based on their skills and experience of work. While assigning shifts on the roaster, it is also important to pair new stuff with the old ones for proper orientation building work rapport, and encouraging constant consultation until they get accustomed to the new environment.
The schedule should create flexible and less rigorous shifts that allow the staff time to rest before changing from a night shift to morning shift (Edvardsson, Watt, & Pearce, 2017). Alex, the nurse in question had for the first four weeks worked alongside his nurse preceptor rostered on morning shifts. He had just completed his first five (5) night shifts the previous day and, in the morning, he was back on an afternoon shift on the day in question. This shows that the registered nurse was not well-rested and this could have been an impediment to his and the reason the nurse was feeling overwhelmed.
References
Laverty, M., McDermott, D. R., & Calma, T. (2017). Embedding cultural safety in Australia’s main health care standards. The Medical Journal of Australia, 207(1), 15-16.
Gilbert, A. V., Patel, B. K., Roberts, M. S., Williams, D. B., Crofton, J. H., Morris, N. M., … & Gilbert, A. L. (2017). An audit of medicines information quality in electronically generated discharge summaries–evidence to meet the Australian National Safety and Quality Health Service Standards. Journal of Pharmacy Practice and Research, 47(5), 355-364.
Edvardsson, D., Watt, E., & Pearce, F. (2017). Patient experiences of caring and person‐centredness are associated with perceived nursing care quality. Journal of Advanced Nursing, 73(1), 217-227.
Hamilton, S. (2019). The new NSQHS standards: One-day surgery unit’s accreditation experience. Day Surgery Australia, 18(2), 16.
McPhail, R., Avery, M., Fisher, R., Fitzgerald, A., & Fulop, L. (2015). The changing face of healthcare accreditation in Australia. Asia Pacific Journal of Health Management, 10(2), 58.
Guinea, S., Andersen, P., Reid-Searl, K., Levett-Jones, T., Dwyer, T., Heaton, L., … & Bickell, P. (2019). Simulation-based learning for patient safety: The development of the Tag Team Patient Safety Simulation methodology for nursing education. Collegian, 26(3), 392-398.
Guinea, S., Andersen, P., Reid-Searl, K., Levett-Jones, T., Dwyer, T., Heaton, L., … & Bickell, P. (2019). Simulation-based learning for patient safety: The development of the Tag Team Patient Safety Simulation m Borbasi, S., & Jackson, D. (2015). Navigating the maze of research: Enhancing nursing and midwifery practice. Elsevier Health Sciences. methodology for nursing education. Collegian, 26(3), 392-398.