In nursing school, the main goal of many students is to pass the program and graduate, but we must keep in mind that we aren’t only studying to pass an exam, we are studying to save our patients’ lives. After graduation, the focus is on studying for the NCLEX and hoping to pass it with 75 questions. While waiting for the results, some may start applying for jobs or applying to school for their Bachelor of Science in nursing. Regardless of what these new nurses may be doing, how many of these nurses are prepared to start working as a registered nurse? We have to realize that there is a gap between completion of nursing school and entry into employment. This is an important issue in nursing that needs to be addressed. A solution to closing this gap is transition to practice programs and ensuring academic integrity in nursing education. According to Huston, “Transition to practice programs report fewer patient (medication) errors and better patient safety practices, higher competency levels, less stress and increased job satisfaction as well as lower turnover rates for new graduates” (2017). Transition to practice programs should be a requirement for nurses after completion of nursing school, just as how other health care professionals are required to do residencies or internships.
First off, I would like to start out with how important academic integrity in nursing education is. Nurses hold the well-being of their patients in their hands and lack of academic integrity puts their future patients’ lives at risk. Understanding the material we are taught in nursing school is essential and it requires putting in time and dedication to learn and understand. Some students may have many responsibilities, such as full-time jobs, a family to take care of, other classes or emergencies in which they may not have enough time to fully study. Regardless of the hardships many face, nursing students should not resort to cheating. Cheating will not help nursing students in the long run. Educators need to develop an environment of honesty and trustworthiness, so their students maintain academic integrity. Students should also be made aware of the consequences of cheating and that it will not be tolerated. Although there isn’t enough evidence to say there’s a definite link between academic integrity and professional integrity, there is some evidence to say there is a correlation (Huston, 2017). Students who see nothing wrong with cheating could possibly think it’s okay to make up vital signs, lie about medication administration, falsify treatment observations and avoid reporting medical errors. Being aware of this issue, although the evidence isn’t definite, faculty should model ethical behavior and provide clear guidelines of ethical behaviors to their students.
Another issue with nursing education is that it doesn’t adequately prepare nurses to transition smoothly into the workplace. According to Wu, Fox, Stokes and Adam, “One of the most important tasks for nursing faculty is to consider how to better prepare student nurses with a realistic view of the type of daily work-related stressors that they are likely to encounter in their RN role in order to decrease the shock and dissatisfaction with role transition after graduation” (2011). From my perspective, I believe I didn’t learn enough during my clinical rotations. During the associates nursing program, I never got the chance to administer an intramuscular injection, PEG tube feedings, suctioning, etc. I feel as if I missed out on a lot and I’m unprepared to transition into the workplace after I graduate with my Bachelor of Science in nursing; which is why I believe more lab simulations should be done in school and clinical rotations should give us the opportunity to learn more. I think it’s essential that all clinical instructors and professors observe their students one on one while they complete physical assessments and procedures. When professors observe a group of students at a time, he or she can miss a student making a mistake and miss the opportunity to correct the student and provide essential feedback. This student will then go on and continue to make this mistake until someone else corrects them and hopefully such mistake doesn’t cause an adverse outcome on their patients. During clinical rotations, we aren’t assigned a full load of patients, instead we are given one patient, when in reality a registered nurse is assigned to many patients with numerous problems at the same time. Clinical rotations aren’t preparing us for the reality of nursing, which is why many nurses are overwhelmed and stressed out during their first year. There needs to be a program in place at the end of nursing school to prepare new graduates for the workplace. Such programs would help new nurses get a sense of what they should expect as a staff nurse, instead of being completely shocked and dissatisfied.
As current nurses continue to age and retire and the need for health care continues to grow, the need to retain new nurses in the workplace is essential. Studies need to be conducted on the reasons why many nurses leave their jobs or the profession altogether and develop solutions to this global issue. Its imperative to improve retention of newly graduated nurses because if they continue to quit their jobs, in effort to find a better one, they will continue to interrupt their learning process and hinder their ability to develop their skills. During the first few months at their new job, nurses are learning the hospital’s policies, their unit’s routine, new tasks and how to care for many patients at a time. Depending on the work environment, the new nurse is either going to be supported or pushed to quitting. A negative work environment consists of unkind staff, bullying, no support, feelings of loneliness and undervalued and lack of just culture. On the other hand, a positive work environment consists of supportive nurses, kind and welcoming staff, just culture and opportunities to learn, improve and grow professionally. Unsupportive staff could be a result of under-staffing and burnout and having to mentor new nurses is more stress added to their workday. For this reason, I believe preceptorship at the end of the nursing program should be a requirement. This will allow new graduates to familiarize themselves with how the workplace runs, the responsibilities of the nurse, how to carry out procedures correctly, how to communicate with other members of the health care team, job satisfaction and so on. Without this opportunity, new nurses go into the workplace blind, increasing their anxiety and stress levels. New nurses need to be supported with a transition to practice program to help these new graduates stay in their jobs longer and develop their skills.
According to Bennett, “Nursing programs that implement a transition period during school which allows students to work in a clinical environment with a full patient load alongside an experienced nurse may help increase clinical knowledge and competence of the new graduates” (2017). With the growing complex patient population, it’s unrealistic to expect new nurses to provide safe and competent care without additional support. Studies have proven that transition to practice programs increase new nurses’ level of confidence in their ability to provide competent patient care, communicate with other healthcare team members, critical thinking skills, effective time management skills and coping skills. The ability to increase a new graduate’s confidence levels in many areas is essential because this will help new nurses deal with and cope with the high demands of their job. It will also help decrease turn over rates and increase positive healthcare outcomes. Transition to practice programs, such as residencies and internships, have proven to improve new nurses’ confidence levels and increase retention rates of nurses.
Although residencies and internships have many benefits, there are also barriers that impede its use. One of the biggest concerns are, who is going to pay for these programs? Fortunately, residencies for other health care professionals such as doctors, pharmacists, and others are funded by the centers of Medicaid and Medicare, residencies for nurses will have to rely on funds provided by hospitals (Huston, 2017). The cost of turnover is higher than the cost of residency programs, so the long-term benefits of these programs should be considered. Other problems are that facilities worry that these programs will shift their senior staff away from more critical tasks, not enough faculty to teach new nurse graduates and residencies will reduce the number of clinical placements for nursing schools (Javelona & Kurtzman, n.d).
Transition to practice programs are essential for all new graduate nurses. It is known that many new nurses face several issues during their first year of practice and end up leaving their jobs or profession altogether. Experienced nurses face many issues during their shift, resulting in burnout, so imagine a new nurse having to adapt to this work-style without prior assistance. Its imperative that residencies and internships become a requirement in the nursing profession. As the acuity and complexity of patients continue to increase in various facilities, it’s imperative that new nurses are prepared to care for such patients. Not only are these programs essential for nurses, it will ensure that their patients are in safe and competent hands. I hope transition to practice programs become a requirement for all new nurse graduates in the near future.
References
Bennett, L. L. (2017). The Gap Between Nursing Education and Clinical Skills. ABNF Journal, 28(4), 96-102.
Huston, C. J. (2017). Professional issues in nursing: challenges and opportunities (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Javelona, G., & Kurtzman, Y. (n.d.). Journal of Nursing | RN Journal. Improving Patient Care While Decreasing Costs: The Benefits, Barriers, and Student Perspectives on Nurse Residency Programs. Retrieved April 8, 2018, from http://rn-journal.com/journal-of-Â Â nursing/improving-patient-care-while-decreasing-costs
Wu, T., Fox, D. P., Stokes, C., & Adam, C. (2012). Work-related stress and intention to quit in newly graduated nurses. Nurse Education Today, 32(6), 669-674. doi:10.1016/j.nedt.2011.09.002
