Into the fire

Study find early-career staff in rural settings must take on more responsibility and need more support. 

A senior nursing lecturer at the University of New England has found rural graduates need more support when completing transition-to-practice programs.

Although “workload, skills mix and organisational pressures” affect most graduates both in Australia and internationally, these factors are often exacerbated in rural settings.

For her PhD, Dr Jackie Lea followed a group of new graduates for 12 months to explore their support needs when completing a transition-to-practice program.

One of the biggest challenges for new nurses, which Lea outlines in a recent article in the Journal of Clinical Nursing, is being able to delegate tasks confidently to junior staff. Findings show they are often doing the work themselves instead.

“Many of the new graduates were required to be team leaders fairly early on in their graduate program,” Lea says. “In the first three to four months, they were acting as team leaders and they didn’t really feel they had refined those skills at all.”

Lack of supervision, feedback and support from senior nurses was another major concern. Lea said many new nurses were unable to have consistent access to an RN throughout their shift.

In rural settings, it is common for new graduates to be responsible on weekends or after hours for covering whole wards – as well as attending to any presentations to the ED.

“The emergency department [is often] attached to the ward, so if a rural new grad was on that shift they would be required to do an assessment and triage,” Lea says, adding they require additional educational development in that area.

Describing the experience, a graduate nurse says: “Nearly every shift I have been assigned team leader. The evenings are the busiest time and you don’t have much support. There is really not anyone around to help you.”

Another speaks of her concerns about having to lead a team very early on. “The most difficult aspect is being so much younger than a lot of staff,” she explains. “They have been doing it for years and taking that leadership role and trying to delegate … I feel like I haven’t really earned their respect yet.”

Lea also interviewed experienced senior rural nurses who felt many staff were unsure how to provide adequate support to new graduates. Their thoughts will be shared in another article, which will be published early next year.

“Given the workload and skill mix they often have to cope with in these environments, there was often only an experienced rural nurse and a new graduate staffing the area at any one time,” Lea says. It’s difficult to provide practice support when there is no other nursing staff around.

“The staffing level and the skill mix and workload were often a barrier to being able to provide effective, timely, on-ward support to the new graduates,” she says

Other key stressors included juggling vast amounts of paperwork and communication with medical staff and other health professionals. These issues continued all the way through to the six-month mark.

Lea believes rural programs need to consider the incremental stages of a transition-to-practice program, rather than placing most emphasis on support in the first three months.

“[Those developing graduate programs] need to look at the stages new graduates are going through and have the education tailored accordingly,” she says. “They need to look at what can be offered at the ward and unit level with respect to mentoring, workload and skill mix and … structuring that so it meets the needs of the new graduate.”

Lea hopes the findings will help rural health services and experienced nurses “develop and implement adequate and timely support mechanisms” for recent grads.

She will publish guidelines for contextualising a rural transition-to-practice program next year.

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