Nurses And Effective Health Care Delivery

McKenna, L., & Newton, J. M. (2009). After the graduate year: a phenomenological exploration of how new nurses develop their knowledge and skill over the first 18 months following graduation. Australian Journal of Advanced Nursing, 25. Retrieved from http://web.a.ebscohost.com.proxymu.wrlc.org/ehost/pdfviewer/pdfviewer?sid=57a243af-c0d3-4f81-addf-041456493db3%40sessionmgr4005&vid=1&hid=4206

Staff nurses have great responsibilities in caring for patients. Often, these nurses experience heavy workload. Heavy patient load and stress contributes to burnout. Why is burnout important to discuss in relation to nurses? Burnout affects the performance of the nurse and the quality of care he or she provides to the patient. Therefore, it is imperative that staff nurses decrease the possibility of burnout and increase or maintain excitement and enjoyment in the field of nursing. If nurses do so, they will find joy in their work and quality of patient care will be increased. Contributors to burnout and

The rising rates of seasoned nurses have resulted in replacing the more experienced and skilled professionals by infusing fresh graduates who lack the required skill and experience needed to effectively adapt to a clinical environment. This is coupled by the booming level of workload witnessed by these graduates who many are unable to cope with. Adding fuel to fire the initial work experience is discouraging for many graduates who hence are exhausted .This results in numerous fresh graduates completely burning out in just 18 months of their introduction to professional medical environment (World Health Organization, 2006).

When most experienced registered nurses hear the word shock, they begin to use their critical thinking skills to determine the patient’s immediate need. However, new graduate nurses in the career field are faced with a different type of shock; they are faced with transitional shock. Transitional shock is a theory created by Judy Duchscher. Her theory is based on reality shock which is a term coined by Marlene Kramer. Reality shock is when new nurses recognize clinical practice and the classroom setting are two different worlds (Hentz and Gilmore, 2011, p.134). When new graduates transition to a registered nurse position, it does not happen with ease. Over the years, there has been a rise in concern with this transition. As new graduates move in the career field, they may feel anxious and uncertain about their new responsibilities. Unfortunately, when there is a high demand of nurses, new graduate nurses are expected to begin a new job at full speed, but they are not able to handle the fast pace position they are placed in. When new graduates are expected to accomplish task they are unprepared for, it sets them up for transitional shock. To minimize transition shock for new graduates, finding a mentor, preceptor, seeking an internship or residency program may help ease the transition.

For this paper, there are 2 interviews required that are related to the nursing careers. The two interviews that were conducted were from a Charge Nurse, and from a Head Nurse. Each of the interviews are discussed in detail below, separately.

The new graduate nurses (NGN) are faced with various issues and challenges especially in their first year of nursing practice. The period of transition from a student to a graduate nurse is a demanding period that is filled with new experiences and there are several concerns and factors that can affect the transition process. The research into the issues has recommended some strategies that can be utilised to ease the transition process from being a student to a professional practicing nurse. Exhaustion, reality shock and time management are some of the factors and issues that the new graduate might encounter during their first year in their career.

Transitioning from nursing school to working in a hospital setting can be a challenging time for a new graduate. Due to the nursing shortage, new graduate nurses are being hired with little to no experience. This is overwhelming for new nurses, especially when they are not getting adequate support or training from the hospital. The amount of stress, pressure, and lack of training is leading to a high turnover rate for new graduate nurses. With patient acuity on the rise, new graduate nurses that are filling these vacancies in the hospitals, need to be competent nurses to provide proper and safe care to the patients.

Workload was described to be heavy, stressful, increase in intensity and overtime hours. As a result 25.8% consider resigning, 20.2% consider retiring and 25.6% consider leaving profession. Another problem that was observed at individual level was poor commitment to care. One of the factors that often limited nurses to provide therapeutic care was the change in nurse to patient ratio. As nurses assignments increase with the increase in the number of patients (i.e. 1 nurse to 6-8 patients) the quality of care provided decreases. Nurses’ ability to maintain safe environment became challenging. As part of caring, nurses also showed decreased amount of time spent with their patient. This eventually led to nurses being less satisfied with their current job. Self – efficacy was often low. Nurses felt that they did not have enough knowledge and skills required for professional practice (Newhouse, Hoffman, & Hairston, 2007). This often led into stressful transition and the ability to care for a patient even harder. New graduate nurses often had difficulty maintaining leadership role. They often felt that they did not have the ability to self advocate and raise their voice to be heard by others. They often feared that they would be over heard and that no one would listen to them (Mooney, 2007).

Hogston and Simpson (2002) describe this traditional task-orientated method of nursing care as contrary to the nursing process, compromising the concept of individualised patient centred care. Price (2006) supports this view, suggesting that patient-centred care requires the nurse to be flexible and not confined to set care pathways or task-orientated methods. I complied with functional nursing and completed tasks assigned to me which Higginson (2006) states many first year nursing students do as they are preoccupied with worries about their ability to perform nursing duties. However, through this I found that I did not engage completely with the patients which according to Squire (2001) would have built a good, therapeutic and interpersonal relationship with the patients. Reflecting using Benner (1984), in terms of starting to become a proficient and capable staff nurse, I was a novice. Rather (2007) states that novices are taught rules to help them perform, and although I was not taught these rules within my first placement I still adhered to them and reflecting back I would consider my practice as limited and inflexible due to these rules. Consequently I saw managerial skills such as time management, prioritising and delegation beyond my capabilities, Hill and Howlett (2005) state feeling incapable of managing patient care is normal for a first year student nurse.

Nursing can be a demanding career, but the benefits far much outweigh the challenges. Most importantly, it’s the rewards it offers by allowing an opportunity to make a difference in another person’s life through the provision of care when they need it. Just as Patricia Benner theorized in her book “Novice to Expert,” nursing encompasses both educational knowledge and extensive clinical experience acquired throughout one’s career. This far, I continue to acquire knowledge and clinical knowhow which will promote proper and efficient care to patients. Since I began practicing one year ago in a long-term healthcare facility, I have interacted with patients, families, physicians and other members of the healthcare team to coordinate patient’s care which has enabled me to gain confidence in myself. While I cannot deny that it was difficult to transition from a student to a licensed nurse, I learnt to overcome these challenges and focus on my strengths. Practicing as an LPN has provided a platform to learn and gain experience even though the duties and responsibilities are limited by the scope of practice.

The beginning of a new graduate nurses career rarely begins easily, there seems to be a distinct disconnect between the fantasy of what it means to be a nurse and the reality of bedside nursing. Nursing school seems to feed into this disconnection, in that it does not prepare the new graduate registered nurse (NGRN) for their professional practice. What nursing school does is give the NGRN the basics, a peak into what is to come. The NGRN has to find out for themselves what the true meaning of being a nurse is and if it fits their preconceived ideas.

The expectations for any nursing student, dedicated and compassionate, is not easily found. A hard worker is made through the experience of rigorous academic courses, balanced with character building

Throughout the first year Foundations of Professional Nursing course, I have gained a better understand of nursing and thus my perspective on nursing has developed a lot. After learning about the different concepts and theories in nursing, I feel I understand the role of nurses better and it makes me proud to have chosen this profession. I have also realized how much the concepts I have learned this year have affected my perspective on nursing and have helped shape me into becoming a nurse. In addition, I have been able to develop a personal philosophy of nursing. This paper will examine the importance of a sub- concept to nursing, reflect on my personal journey of development as a nurse and discuss my personal philosophy of nursing.

Transitioning from a practical nurse to a registered nurse will build upon my already existing knowledge and expertise by developing my skills and gaining more experience. My future role as a registered nurse will involve being able to think critically and analyze issues more deeply. I also must be able to consider underlying conditions and how they relate to my patient’s status. As a registered nurse I must examine my personal qualities and analyze whether I have the mental or emotional capacity to do what is required of me.

Nursing is one of the most popular professions in healthcare. To become a professional nurse, one must acquire certain level of education, whether it is at associate or baccalaureate degree level. Once becoming a nurse a number of professional standards must be maintained to stay abreast with the profession. In that respect, the Institute of Medicine (IOM) in its 2010 report had suggested many recommendations focusing on the future of nursing. The aim of the report is to put forth recommendations that allow nurses to “(1) ensure that nurses can practice to the full extent of their education and training (2) improve nursing education, (3) provide opportunities for nurses to assume leadership positions and to serve as full