Transition to Professional Nursing Practice

Rob Burton, Graham Ormrod, Rob Burton, Graham Ormrod

• Publisher: SAGE Publications Ltd
• Year: 2020
• ISBN:
  9781526482150
• Edition: 2
• Topic: Medicine
• Subtopic: Nursing

Provides final year nursing students with comprehensive guidance on how to make the leap from student to registered nurse, helping you to master the skills needed toprogressfromsupervised to professional practice. Packed with key information, theory and advice, this book covers essential topics such as leadership and management, decision-making, professional development, assessment, law and ethics. It also provides you with an insightful overview of global nursing, exploring the issues of nurse migration and outlining the specific requirements for registering as a nurse in countries outside of the UK. To further support your learning, the book includes engaging activities that encourage you to use critical reflection, real-life example scenarios to help improve your decision-making, and references to the author's personal experiences of professional development.

Chapter 1 Becoming a Qualified Nurse

Rob Burton, Graham Ormrod and Angela Darvill

The aims of this chapter are to:

• Explore the expectations of a newly qualified nurse.
• Discuss the challenges involved in the transition from student to qualified nurse.
• Highlight the experiences of newly qualified nurses.
• Discuss the roles of the nurse in different fields of nursing.
• Provide an overview of the structure and rationale of the book.

Introduction: How this Book Can Help you to Become a Qualified Nurse

Becoming a qualified nurse is quite an achievement. After three or four years of education involving experiences both in practice and in the academic context, entering the nursing register of whichever field of nursing you qualify in is something to be proud of. The hard work pays off and you are able to become a professional in your own right. Undoubtedly this achievement brings with it challenges as well as rewards. You may now find that there are different expectations of you, and a set of roles and responsibilities that are different from those that you experienced as a student under supervision.

The aim of this book is for you to be able to explore and develop understanding of the varied important aspects of the roles and responsibilities of the qualified nurse in order to prepare you to successfully make the transition from student nurse to registered professional. It can also be used as a resource for those who may already be qualified and registered, but who are looking for helpful advice and are wishing to continue their professional development.

The roles, responsibilities and accountabilities of a qualified nurse include essential professional skills described as ‘platforms’ by the Nursing and Midwifery Council (NMC). The seven platforms are:

• Being an accountable professional.
• Promoting health and preventing ill health.
• Assessing needs and planning, providing, coordinating and evaluating care.
• Leading and managing nursing care and working in teams.
• Improving safety and quality of care.
• Making ethical and legal decisions.
• Teaching others.

(NMC, 2018b)

The focus of the book is not about clinical practice, or the theory of nursing interventions or clinical nursing skills, because in order to become a qualified nurse these aspects should be addressed satisfactorily within the nursing course undertaken to demonstrate proficiency in order to register with the Nursing and Midwifery Council (NMC, 2018b). Instead, the intention is to prepare you for the challenges that you will face on being a newly qualified nurse by providing the knowledge, skills and values required to become effective and accountable practitioners. Clinical decisions will still have to be made in relation to meeting the needs of the people within your care; however, becoming a qualified nurse brings with it wider responsibilities in making and taking decisions related to the nursing team, other staff, and the work environment as a whole. These changes require a large shift from the experience of being a student and a supervised learner, so it is essential that you are equipped with all of the skills required to successfully make the transition. There are countless texts available on providing clinical nursing care, but there are few designed specifically to help final-year student nurses to develop the transferable professional skills necessary for the role of the registered nurse, and so this text sets out to assist final-year students by clearly outlining these.

The professional skills that you require as a nurse must be developed in a contemporary context in which nursing careers are changing radically, with nurses now working in a wide array of new roles in a variety of healthcare settings. Today, you must be able to demonstrate these skills in job applications and interviews as well as develop employability skills for a career in which continuing professional development will be a key to success. Throughout your career, you may work in a variety of care settings and specialized nursing roles, but you will always require skills in teamworking, leadership, management, decision-making, and teaching.

The approach taken throughout the rest of this book will be to provide a discussion of the main theories, concepts, and issues related to the professional skills listed above. We will discuss the meaning of these concepts and their importance for nurses and provide some practical contextual examples. Throughout the book, you will find exercises designed for you to read and reflect on the material presented and to encourage you to recognize how to use these in your own field of practice. Examples from all fields of practice will be used to illustrate the theories, with the inclusion of scenarios to illustrate how to consider and apply these to nursing practice. We also recognize that a pertinent issue in the transition from student to qualified nurse is that of getting a job and building a career, so skills such as preparing for interviews, interview skills, and continuing professional development are also included.

Changing Expectations: From Student to Qualified Nurse

Many student nurses will tell you that their nurse education course passed quickly. Within that time, a student would have had a vast range of experiences and been exposed to many theoretical and practical aspects in their educational and practice settings. On qualifying, nurses are required to demonstrate a high level of knowledge, understanding, and application of high-order skills, not only with patients/service users, but also with other team members and those within, entering, and leaving the workplace. These are all skills that they should have developed in their journey to qualifying and are also highlighted as required standards of proficiency (NMC, 2018b).

The seven platforms within the standards of proficiency (NMC, 2018b) also include essential aspects of care, such as communication and relationship management skills; assessing needs; planning; provision and management of person-centred care; use of evidence-based practice in meeting the needs for care and support with rest, sleep, comfort and maintenance of dignity, hygiene and skin integrity, nutrition and hydration, bladder and bowel health, mobility and safety, respiratory care and support, prevention and management of infection, end of life care and medicines administration and optimization.

With registration comes a shift in professional accountability, together with wider clinical, leadership, management, and teaching responsibilities.

On becoming a qualified nurse, the expectations and dynamics of relationships change fundamentally. Suddenly, the newly qualified nurse is the one who must ‘know the answer', whether it is a query from a patient, a carer, a work colleague or a student. As a newly qualified nurse you will encounter many challenging situations in which you must lead care delivery. This includes dealing with care management within the team, dealing with patients/service users, dealing with other professionals, and dealing with the needs of the whole workplace environment and those within it. The NMC requires a student nurse to demonstrate professional values in leading and coordinating evidence-based, compassionate person-centred care. They should be able to work autonomously within interdisciplinary teams, demonstrate emotional intelligence communication skills, decision-making, and show personal and professional development in order to join the register (NMC, 2018d).

The Challenges of Moving from a Student to a Newly Qualified Nurse

You may find that moving from being a student to a newly qualified nurse is an exciting but challenging time. As a newly qualified nurse you may need to adapt to working independently in a workplace environment that is rapidly changing, fast paced, may have staff shortages and an increased patient workload. A study by Halpin et al. (2017) found that workload was consistently the highest reported stressor for newly qualified nurses with inadequate staffing and managing multiple role demands. In addition, attrition is a consistent problem, with 18 percent of nurses leaving the profession within three years of qualification, and the highest figure being apparent within the first 12 months of registration (RCN, 2017a). According to the NMC, during 2016–17 more than 29,000 registered nurses allowed their registrations to lapse. Therefore, there is the real potential for newly registered nurses to leave the profession due to a lack of personal resilience and adequate coping strategies when their experiences in practice do not match their expectations (RCN, 2017a). According to the NHS Long Term Plan (NHS England, 2019a: 4.35) the leaver rate for nurses was eight percent in 2017 up from six point eight percent in 2013. Current insights into the experiences of newly registered nurses entering the world of work are founded on the concept of transition (Darvill et al., 2014). This concept will be developed further in Chapter 2.

The transition from student to newly registered nurse is acknowledged as having a significant social, physical, intellectual, and emotional response that is also influenced by the context of the individual's situation (Boychuk Duchscher and Windey, 2018). Overall, it is a complex process of evolving professional development, socialization and adaptation (Boychuk Duchscher and Windey, 2018). Therefore, to fully understand responses to transition and develop strategies to ameliorate adverse effects, it is important you understand the conditions that influence it, including the factors that facilitate and disrupt progress towards a positive outcome (Darvill et al., 2014).

The transition from student to newly registered nurse is a temporary phase which involves a period of adjustment and change. Transition begins with the first anticipation of the change and continues until stability occurs in the new status and within a defined time frame. Every newly registered nurse will experience this transition; however, each nurse will interpret the experience from their own subjective and unique perspective. You will have differing expectations, will require differing levels of support and yet undoubtedly require a certain amount of resilience in what is recognized as a crucial stage in your professional career.

Experiences of Newly Qualified Nurses

With registration and a career as a qualified nurse comes a shift in professional responsibilities and, on becoming a qualified nurse, the expectations and dynamics of relationships change fundamentally. The NMC requires a registered nurse to demonstrate professional and ethical practice and provide, lead and coordinate care that is compassionate, evidence-based and person-centred. The nurse is accountable for their own actions and works autonomously and as an equal partner with other professionals in teams, and they must be emotionally intelligent and resilient and able to manage their own health and well-being. This is a large leap from the culture of being a student and a mentored, supervised practitioner, so it is essential that student nurses are equipped with all of the skills required to successfully make the transition. The different fields of nursing undeniably have differing roles and differing priorities of care, however there is also great similarity in the skills and knowledge required by all qualified nurses, and these broad, transferable skills that can be applied to all fields can certainly be developed.

All newly qualified nurses have been deemed fit for practice and have been robustly assessed as proficient to practice as a registered nurse. However, many newly registered nurses often identify significant concerns about their preparedness and frequently perceive themselves as not being ready for some aspects of their clinical practice. This can be attributed to anxiety and shock generated by a greater awareness of the increased responsibility and accountability, the expectation of extensive knowledge and skills and a subsequent confidence deficit, particularly at the start of the first stage of transition, and particularly if there is a perceived lack of sufficient support (Kumaran and Carney, 2014; Morrell and Ridgway, 2014; Whitehead et al., 2013).

There are a variety of strategies and interventions that are available to support you during your transition. Edwards et al. (2015) identified that these transition interventions and strategies can help to develop confidence and competence, job satisfaction and critical thinking, and reduce stress and anxiety in newly registered nurses.

Other studies have also identified that preparation for transition can ease some of the detrimental effects of reality and transition shock (Kaihlanen et al., 2018; Morrell and Ridgway, 2014). Identifying the strategies that might be helpful for managing your transition may enhance the process and outcome. These strategies will be further discussed in Chapter 2, but include mentorship/preceptorship type supervision for a period of time, formal induction/orientation/transition programmes and online or simulation courses as well as strategies for developing resilience.

In meeting the NMC (2018b) standards of proficiency for registered nurses, the nurse should have demonstrated the relevant knowledge and skills in order to practise in their relevant specialized fields. However, it is important to recognize that not every nurse knows everything about everything in their field, especially if they are practising in highly specialized fields. What they need is to be able to develop and adapt to changing situations. This is similar to the popular saying:

Give someone a fish and you feed them for a day, teach them how to fish and they feed themselves for a lifetime!

Therefore, as a newly qualified nurse, it is impossible to know everything, but you should have developed the skills to find out relevant information, reflect on it, and apply this to your practice. In essence, you should have learned how to learn. There is a great deal to be learned once qualified – especially related to a nurse's ‘new’ area of work – and a good deal of the development needs to take place ‘on the job'.

Issues and Expectations for Newly Qualifying Nurses

Currently, in the United Kingdom, nurses undertake a three- or four-year programme, which is split 50/50 between theory and practice. In practice, student nurses are supervised throughout by approved practice supervisors, practice assessors, mentors, and registrants (NMC, 2018e) to support the application of the theory to practice and to assess the competency and skills of the nurse in clinical health and social care settings. The NMC (2018a) explicitly identifies that the qualifying nurse should be competent to practise safely. Therefore, the experiences that nurses are exposed to throughout their nursing course should be a vehicle for this. On qualifying, this competence is accepted as a given and highlights that the skills the nurse requires for professional practice incorporate not only the need for clinical skills and knowledge but also ‘people’ and environmental management abilities underpinned by finely tuned interpersonal skills.

In this way, positive outcomes for both service users and staff can be ensured. As a qualifying nurse you are given the remit to practice, yet the need to continually and consistently meet the standards of proficiency means that further and...