Nursing is a career in which those who are new to the profession are faced with many obstacles and challenges. Learning to make the transition from theory to practice is an important journey. Content taught in nursing school equips a student to think critically, but a student must also have the opportunity to gain experience by applying these fundamental concepts to clinical practice. When a student transitions from an academic environment to a professional role as a registered nurse, he/she is expected to analyze and react to an array of new demands including understanding the importance of quality and safety, socializing into a new professional role, managing challenges, and identifying personal learning outcomes to achieve success.
To explain the transition a new nurse will make, Patricia Benner developed a concept known as “From Novice to Expert.”
Benner’s concept is based on a theory that a nurse passes through five levels of developmental stages: novice, advanced beginner, competent, proficient, and expert (Benner, 1982).
Benner believed that a nurse develops skills and an understanding of patient care through the synthesis of acquired knowledge and personal experience. As a nurse advances to becoming an expert in the profession, he/she will acquire experience, knowledge, and intuition through repetitive skills. The transition from novice to expert is as follows. Stage one: novice. A novice nurse has no experience and universal rules are used as the basis for practice (Jewell, 2013). These nurses lack confidence and they require more assistance and reassurance. For example, when I observed an orientee refer to her handbook to find steps on how to insert an intravenous line.
When performing the task, she needed cues and affirmation from her preceptor.
Stage two: advanced beginners. Theses nurses can process information based on recurring clinical situations, called aspects, to demonstrate acceptable performance (Benner, 1982). For example, when I observed a relatively new nurse asking the charge nurse for help in setting priorities for her day. Stage three: competent. A competent nurse has worked in the same clinical area for two to three years. These nurses are able to use conscious and deliberate organizational skills to effectively and confidently make a plan towards a long-term goal. For example, I saw that a nurse was being assigned to a new patient but she still had to pass meds and send another patient down to CT. The nurse was able to cope with and manage the situation by organizing a plan of action using analytical thinking. Stage four: proficient. A proficient nurse is able to individualize care and make decisions based on skill and intuition. For example, when the nurse had the perceptual ability to read the situation and respond appropriately when her patient was declining. She was able to look at the big picture to develop a holistic plan of action.
Stage five: expert. An experts’ practice is guided on reflection, flexibility, and a high level of proficiency. An expert uses experience and a profound understanding of the situation to direct operations. For example, when I observed a nurse portray comfortability and confidence with her intuition. Her patient was on pain medication, but she felt that something was off with his presentation. The nurse called the doctor because she had a gut feeling that her patient was using unprescribed drugs. The doctor reluctantly ordered tests; it turned out that the patient was positive for other substances since being in the hospital. To transition to this level of an expert nurse, novice nurses must use their acquired fundamental skills while simultaneously learning how to apply experience and intuition to produce high quality patient care. A novice must also learn how to use critical thinking skills to develop and implement a solution for complex issues. The expert nurse has mastered these aspects of care while the novice is still fixated on an inflexible agenda. To become an expert, a nurse must also be able to move away from seeing patient care as fragments of unrelated information (Benner, 1982). An expert will be able to integrate the pieces of unrelated information into a meaningful plan of care. Before a novice nurse begins the transition to becoming an expert, he/she must be ready to learn, to accept constructive criticism, and to adapt to different cultures and everchanging environments.
As with many new graduate nurses, my current practice lies as a novice. When organizing my day, my plan is concrete and inflexible. Adapting to a change in my plan becomes a challenge. My performance is also structured, step-by-step, and guided by rules. For example, as I was learning how to use the computer system at the hospital, I needed direct instruction and rules to learn how to use the platform. I thought to myself “just tell me what I need to do and I will do it.” Another example is when I perform a task, I go step-by-step and visualize the checklists I used in nursing school. Although I have little experience with some of the tasks, I know how to be a safe nurse. It is important for me to recognize when I do not know something and how I can find the right answer. Because of this awareness, I seek frequent affirmation, feedback, and guidance from my preceptor.
Before I started this journey, I had multiple fears and apprehensions. I often ask myself: am I capable; what if I do not fit in? Aside from these worries, I have positive hopes and goals. I want to show myself that I can integrate my theoretical knowledge and apply it to practice. In order to successfully transition into the role of a professional registered nurse, I need to remind myself that I am more prepared than I think I am. I need to focus on my strengths and have more self-compassion and confidence. I know I will make mistakes, everyone does. My preceptor has taught me that the most important thing to do when a mistake is made is to recognize it and then to keep moving forward. She also taught me that I need to be an advocate for myself because the more experiences I am exposed to, the better nurse I will become. Although this experience was a bit of a transition shock, I learned many invaluable concepts during this preceptorship. This experience has left me hopeful and excited to start working as a registered nurse.
Evidence shows that communication failures are a prominent factor when dealing with patient harm. Formalized education addressing efficient communication has been missing (Tocco & DeFontes, 2014). However, in my placement setting, creating a culture of quality and safety within newly hired employees is essential. One way this is achieved is through the use of Team STEPPS. I was happy to observe this tool being used in a professional setting for the first time since I completed the training in J1. This tool helps to transform power-based relationships; it helps professionals to work together as a multidisciplinary team by encompassing solid communication and conflict resolution in order to result in positive clinical outcomes.
All team members are also encouraged to speak up with patient safety concerns. Evidence suggests that healthcare professionals do not always speak up because they fear being viewed as incompetent, ignorant, negative, and/or disruptive (Tocco et al., 2014). Because of the common fear with these situations, employees in this setting are taught to use the “CUS” tool (Tocco et al., 2014). When new nurses are hired in this setting, a preceptor works with them to instill and teach the importance of TeamSTEPPS and CUS.
To further esablish quality and safety in patient care, new nurses are also provided with an extensive orientation program. The orientation allows new nurses to participate in many opportunities including simulations, shadowing, and workshops. Working in healthcare is challenging and stressful due to time pressures, emotional exhaustion, a lack of support, increasing patient acuity (Jewell, 2013). Because nurses experience these physical and emotional demands, workshop content includes stress management and access to available resources. Successful orientation has been proven to promote satisfaction, socialization self-concept, professional development, and competence with new nurses. If new nurses are supported during this orientation and transitional process, quality and safety with patient care can be secured.
Transitioning from a nursing student into the role of a professional nurse is thrilling yet challenging. Making this transition brings about a journey full of ups and downs, all of which can impact one’s confidence and overall achievement. While socializing into the role of a professional nurse, one may experience stress, incompetence, and social isolation. I can relate to a lot of the things that were mentioned in the article “Supporting the novice nurse to fly” (Jewell, 2013). Throughout my transition from day one of nursing school to now, there have been many times where I felt undervalued, judged, criticized, and questioned. Apprehension, self-doubt, and anxiety regarding my abilities are the biggest challenges I face as I socialize into this new role.
I realize that I need to work on feeling that I am an important part of the team. My fear of judgement or being looked at as the “new nurse” holds me back from showcasing the intelligence and strengths I possess. Another challenge I am faced with is feeling uncomfortable seeking advice and help from some individuals. “Eating our young” is a true notion in this occupation (Jewell, 2013). It is imperative that I feel like I can trust others and voice my questions or worries to co-workers without feeling incompetent or belittled by seasoned nurses.
In all reality, my experience of socializing into the role of a professional nurse within the culture of my current placement has been better than expected. I found my preceptor and other nurses, providers, and techs to be approachable and engaged. I believe that educators play an essential role in assisting new grads to develop practical and critical thinking skills, and to feel like a true nursing professional (Jewell, 2013). My preceptor has pushed me to establish my skills, intuition, and logic, when making clinical decisions. Because of this support, I have noticed a marked transition both personally and professionally.
I also think it was important that my preceptor reflected on personal experience, opinions, and values. In order for me to identify and operate as a new nurse, it has been important for me to observe the authentic struggles that nurses face. Although this transitional process has provoked stress and new challenges, it has served as a beneficial experience as I socialize into the new profession. Overall, this experience has started the process to mold me into becoming a great nurse.
(need to finish) 2 personal learning goals explain what did to achieve the outcomes, what degree you achieve
As a new graduate, it is important to understand that the learning curve may loo impossible at times. It is challenging to enter into any field as a newcomer, especially one with little experience. However, it is essential to have a positive outlook while socializing into this new professional role. It is okay to feel that clinical experiences are unexpected. While embarking on this unfamiliar journey, new nurse must always keep quality and safety at the forefront of practice. Asking for instruction and advice from an expert nurse shows that a novice nurse is accountable for his/her present state. Together a novice nurse and an expert nurse can create a successful team. It is crucial to keep in mind that both novices and experts are meaningful members of the team. Eventually, I will become an expert nurse and I will be able to help other new novice nurses’ transition into beaming a professional nurse.