Chp 24 Making the Transition from Student to Professional Nurse

From Novice to Expert

Stage One:Nurse with few clinical experiences. Skills are learned by rote. Occurs when nursing education is completed. Stage Two: Advanced beginners able to perform adequately. Able to make some judgement calls on the basis of experiences. Occurs upon entry into the workforce. Stage Three:Competent nurses. Able to foresee long-range goals. Mastering skills. Stage Four: Proficient nurses. Able to view whole situations rather than parts, Able to develop effective solutions. Stage Five: Expert nurses. Intuition and Decision making are instantaneous.

Improve Self-confidence and Self-esteem "You are building a Career"

-Become future-oriented- Do not focus on past mistakes. List areas in which to improve. -List personal qualities that you like about yourself. -Take time to treat yourself. -Engage in positive self-talk. -Set goals and mark them off when complete. -Maintain a positive attitude. -Remember, you made it through nursing school. -Become active in professional organizations. -Offer to mentor students. -Keep balance.

Keys to Survival During Transition

-Never fail to ask for help. -Use available facility resources. -Re-energize with professional associations. -Stay in contact with friends. -Evaluate your growth realistically. -Stay focused on your goals.

**Reality Shock**

Inconsistency between the academic world and the world of work. Phases of reality shock: -Honeymoon phase-Everything in the world is just as the new graduate imagined. -Shock or rejection phase- Conflicting view points. Different ways of performing skills. Lack of security of an expert available as a resource. -Recovery phase-Novice nurse begins to understand the new culture. Novice nurse experiences less anxiety, and healing begins. (Getting comfortable with how everything works). -Resolution phase-Novice nurse adjusts to the new environment. Work expectations are more easily met. The nurse has developed the ability to elicit change.

Special Needs Novice Nurse

Interpersonal skills Clinical Skills Organizational skills Delegation skills Priority-setting skills Assertiveness skills

**Questions to ask to Determine Priorities**

Is this task a priority because of time deadlines? What other personnel can perform this task? Do safety concerns make this a priority? What will be the consequences if this task is postponed? What legal issues are related to the priority of the task?

Inappropriate approaches for dealing with shock phase

Native-New nurses decide they cannot fight the experienced nurse or the administration , thus they adopt the ways of least resistance. These nurses may mimic other nurses on the unit and take shortcuts, such as administering meds without knowing their action and side effects and the associated nursing responsibilities. Runaways- Others choose to runaway. They find the real world too difficult. These new nurses may choose another occupation or return to graduate school to prepare for a career in nursing education to teach others their "values in nursing" Rutter-Some adopt the attitude that "Ill just do what I have to do to get by" or "I'm just working until I can buy some new furniture" They consider nursing just a job. Burned out- The nurses bottle up conflict until they become burned out. In this situation patients feel compelled to nurse their nurse. Inexperienced nurses may become burned out because they assume too many responsibilities in a short period of time. Some common symptoms of burnout include extreme fatigue, headaches, difficulty sleeping, mood swings, anxiety, poor work quality, depression, and anger. The more intelligent and hardworking nurses are the more prone they are to burnout-symptoms can be reversed. Compassion Fatigue- Is the gradual decline of compassion overtime as a result of caregivers being exposed to events that have traumatized their patients. Even experienced nurses, who commonly have a great deal of empathy, working in environments in which patients have suffered trauma, may develop a reaction in which they have a decrease in compassion. Nurses who work in emotionally charged environments, such as hospice, emergency departments, and mental health settings, are likely to experience this reaction. Loners-The nurses that create their own reality. They adopt the attitude of "Just do the job and keep quiet". These nurses may prefer night shifts, during which they are often "left alone". New Nurse on the Block- These nurses change jobs frequently. They go from the hospital setting to community health to physicians office. They are always new in their setting and therefore adopt the attitude of "teach me what you want; I'm new here" Change Agents-These are the nurses who care enough to work within the system to elicit change. They frequently visit the nurse manager or head nurse to suggest change or better way. They keep the welfare of the patient at the forefront.

Culture Shock

Occurs when people are immersed into a culture different from that with which they are familiar and comfortable.

Strategies to Ease Transition

Orientation programs in the work setting. Biculturalism: Joining of school values with workplace values. Allows new nurse to introduce ideas or values from nursing school and integrate them into the work environment. **Role models and Mentors: Experienced professional nurses who provide guidance to the novice nurse regarding goal setting. Attributes: enjoys nursing, compatible professional goals or values,sincere desire to assist the new nurse, trustworthy.** Preceptorships: During the final semester of school, the student is assigned to an experienced nurse, who serves as a preceptor with whom the student experiences everyday practice. One-to-one relationship between preceptor and novice nurse provides security and environment in which to grow. Self-Monitoring: Learn appropriate references. Develop problem-solving skills. Willing to ask questions.

Holistic care VS Work reality

Partial task system in the work world- nurses ensure that tasks are carried out but is not the sole provider of care. Whole task system in the academic world- Requires complete knowledge, encourages loyalty to the profession, and is consistent with what is taught in school.

Meeting Special-Needs of the Novice Nurse

Remember what's Important! -Souse, family, and friends. -Read a novel -Try new recipes -Participate in a health club or aerobic exercise, or just walk. -Enjoy the nursing profession. -Congratulate yourself for your accomplishments.