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Introduction
The examination of the perceptions of transition from student to qualified nurse has made salient issues at pre-registration education with regard to efficiently preparing a student for a qualified nursing role. There remains concern as to whether education reforms do adequalty meet the needs of the transitioning nurse, to be able to function effectively within health care settings. This paper will review reality shock transition for nurses, their changing role and the implications for nurses.
Nursing and Reality Shock
The professional image of nursing is recognized for its high standard of health and welfare care, due largely to its reliance on the scientific method to guide policy making, is not the nursing image that many undergraduates have in mind. Twenty-first century nursing requires an empirical and ethical approach to human services, with an emphasis on the details, data recoding, critical reflection and ethical debate (Catalano, 2002). The nurse of the future is business-and-patient orientated, able to manage administration tasks and engage with software and hardware to record accurate reports of practices, as well as delegate responsibility, follow chains of command, work within an integrated team, communicate information and insights coherently and succinctly across an array of multi-medias and maintain an empathetic therapeutic relationship with the patient.
Attempts to deliver better “reality-orientation” to new graduates is hoped to ease the transition form an academic to work world in nursing. This approach draws on Kramer ‘s (1974) writings about the lack of coherence and continuity from studies to employment for graduate nurses. Socializing themselves into a multi-skilled nurse role is quite the challenge in modern nursing education and application in a professional setting.
Role of the RN as Related to Reality Shock
The changing role of nursing is that it has become more dynamic, and nurses are taking on more responsibility and accessing ongoing training. Importantly leadership and management issues are of critical importance to the discipline of nursing. Some of the areas that leadership and management incorporate are finances, business focus, information management, and marketing (Baker, 2000). It is expected that the RN be able to work in a multi-disciplinary field, network with other professionals, and maintain a patient-centered focus which emphasizes supportive and enabling practices.
Another key feature of current nursing practices is to work within a team environment. The nurse may find themselves working in a team environment comprised of other nurses, doctors, volunteers, chaplains, social workers and other health and human service workers (Martin, 2000). Team-work has been a traditional practice that is supported by nursing philosophy and is demonstrated in a variety of its practices, though current practices emphasize the inclusion of professionals from other industries and not just those within a department or healthcare itself.
Implications for Nursing Practice
Overall nursing is becoming a business-patient dichotomy. Information management seeks to ensure that the nurse has available sets of empirically supported protocols and procedures that maintain all stakeholders’ safety and enable health delivery goals to be met. Nurses must realize that they are in a key position to influence hospital care policies, as well as state and national legislation (Sullivan, 2001). It is contended that student nurses need to be encouraged to develop their leadership and managerial skills, as well as their clinical skills to transition effectively to the reality of work. The hospital working environment should be one that facilitates the nurse to carry out good practice by the effective integration of educational and real-world knowledge, skills and competencies. This requires support from more senior nurses to ensure that student nurses have been briefed and assessed on their understanding and practical demonstration of knowledge of procedures, policies and problem-solving methods.
However, nursing management that is over-controlling does not contribute to the nurse developing self-directed learning and concrete understanding of why protocols are undertaken as they are. Efficient and effective patient care and administration practices require flexible clinical leadership that recognizes and encourages good practices, inclusive debate and monitoring of service delivery. This would include acknowledgement that it has been shown that cross-functional teams are much more flexible and that when team members are able to ‘cover’ each other in general patient care duties, the patient is afforded more comprehensive and careful care. Perhaps this is due to a sense of responsibility instilled in each team member, as they are aware that they can rely on others to recognize their strengths and to provide support for their weaknesses.
Communication and critical thinking ability is vital to the teaching/facilitating process of student nurses. The practice of teaching by way of coaching and mentoring has been shown to ease transition for undergraduate nurses, which in turn benefits the working environment and delivery of care services. The practice of nursing necessitates scientific and technical knowledge of clinical practice, but it is also essential that the nurse be aware of, and to be motivated to, practice ethical codes of conduct. As such, abiding with ethics enables the nurse to be guided through value-based judgments whilst being socialized into the role of modern day nurse.
Conclusion
Much more attention needs to be focused on the provision of clinical, organizational and management skills during pre-registration. Additionally a bridging period may be needed during transition, the latter part of being an undergraduate and into the first 6 months as a qualified nurse. Finally, to enable and empower the nurse to socialize into an accountable health care provider policy must focus on gradual phasing in of responsibility.
References
Baker, C. M. (2000) Problem-based learning for nursing: Integrating lessons from other disciplines with nursing experiences. Journal of Professional Nursing, 16(5): 258- 266.
Catalano, J. (2002) Nursing Now! Today’s issues, tomorrow’s trends. New York: F.A.Davis and Company.
Kramer, M. (1974), Reality Shock – Why Nurses Leave Nursing, St. Louis: Mosby.
Martin, V. (2000) Developing team effectiveness. Nursing Management, 7(2): 26-29.
Marquis, B.L. & Jorgensen, C. (2002) Leadership Roles and Management Functions in Nursing: Theory and application. Huston: Wolters Kleuw.
Sullivan, D. J. (2001) Effective Leadership and Management in Nursing, 5th ed. Prentice Hall.
Thompson, I., Melia, K. & Boyd, K. (2000) Nursing Ethics 4th ed. Churchill.
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