Transitions require support

Nurses who are new to the workforce or changing their area of practice need the right resources for success.

When newly registered nurses commence employment within the Australian healthcare system, they quickly learn what is truly required of them. Their education continues as they learn to practise as a nurse, reconciling their professional learning with the requirements of the organisation for which they work. Often the reality of employment does not match expectations. We know that the pressure placed upon newly registered nurses when they transition into the workforce has caused some to leave the profession early. I would argue that this is an unnecessary loss; the availability of further support frameworks would lead to greater confidence and job satisfaction, directly affecting nurse retention. However, there is still a space for each and every one of us to do what we can to ensure that the transition for these nurses is one that builds their confidence and capability so they stay to become the core of the future workforce.

It’s also important for us to remember that the concept of transition to practice is not limited to newly registered nurses. Any nurse who is new to an area of practice requires a period of transition; a necessary time of adjustment that will vary from individual to individual. An expectation that a newly registered nurse or a nurse transferring to a new area of practice will function to the same level as someone who has been in an area for a period of time is at best unrealistic and at worst unfair. The nature of nursing as a career is that it requires strong theoretical preparation combined with a high standard of clinical competence. The constant changes within the clinical environment pose difficulties within nursing education in Australia, with graduates’ and those nurses transitioning to a new area of practice often faced with a period of stress. Key to this transition period is one’s ability to analyse both your own and others’ practice, as well as learning to be accountable for your own actions (Chang & Daly 2012, 4).

When ACN member and newly registered practice nurse Natalie Sharp was asked about her recent experience transitioning from student to registered nurse, she said, “I have found it difficult living up to the expectations of being a registered nurse, having this weight on my shoulders that I should know everything and not put one foot wrong. However, this has enabled me to fully engage with tasks on hand and improved my ability to think critically and reflect on my ongoing practice, while always learning.”

It would be ideal if newly registered nurses and nurses embarking on a change in their area of practice could meet all the expectations required upon them. However, research has shown that development of clinical expertise requires years of immersion in clinical experience (Chang & Daly 2012, 4). Nursing is a profession that requires intelligence, adaptability and critical thinking that translates into the safe delivery of care. We work in high-demand settings, and it should be expected that it takes time and support to adjust to professional nursing practice.

Health services and senior nurses play an important role in assisting in the transition period. Paula Lambert, an ACN member engaged in a paediatrics program for newly registered nurses confirms this.

“Knowing each shift I was paired with another staff member to help alleviate the stress I felt allowed me to focus and learn the things I needed prior to being on my own,” Lambert says. “I know I have the full support of other staff and if I ever feel unhappy or overwhelmed further down the track, I know that I have support.”

Similarly, ACN member and newly registered nurse Renee Callender has experienced support and strong guidance in her aged-care role.

“The focus on holistic care and teamwork within this role has really shown me the great side of this area of nursing,” Callender says. “My workplace is excited to focus on my transition, by building up my knowledge of the aged-care sector without throwing me in the deep end. They have provided me ongoing orientation, education sessions and valuable mentors in my new colleagues.

“I have been really encouraged to keep a reflection diary as a way to deal with new challenges, and to measure and evaluate growth throughout my new role. So far this has been a great tool to guide future learning and reflect upon my current knowledge and actions in a new environment.”

We must also acknowledge that the intricacies of workplaces, navigating the health system and finding a work-life balance are important aspects of any nursing career – not just for newly registered nurses. External pressures also apply; Australia struggles with health sector reforms, the growing burden of chronic disease, an ageing population and seemingly diminishing human resources for health (Chang & Daly 2012, 2). These confirm a need to support health professionals as they change from one setting to another.

ACN has raised the need for a set of clear principles embedded in a national transition framework designed to ensure the support for nurses who are new to the profession or are established nurses who wish to move from one area of practice or setting to another.  The proposed framework would offer support across the health system, including primary care and aged care.

A framework such as this would acknowledge avenues to support transition, such as mentoring and educational requirements, and provide project materials for employers offering supported clinical transitions. This would enable health services to be more responsive to changing population health needs and ensure the quality of nursing care. The aim is to increase confidence and competence in transition, reducing the initial pressure on nurses. This would also make it clear for nurses already in the workforce what reasonable expectations can be held and how they can play a role in supporting new workers. It’s about creating healthy environments that foster long-term learning, allowing nurses to provide the best quality care.

Debra Thoms is CEO of the Australian College of Nursing.

References

Chang E & Daly J 2012, Transitions in Nursing: preparing for professional practice, 3^rd Ed. Elsevier Australia.

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