unit 3 chapter 24 Making transition from Student to Professional Nurse

ANA and work place violence

ANA developed a zero-tolerance policy

Goals of Transition shock (4)

Stability predictability familiarity consistency

Goals of transition shock Stability

Stability- questions to ask when interviewing: What are staffing levels?, What is the acuity and average length of stay of patients on this unit?. Are socialization activities planned? How many nurses have left in the last year?

From Novice to expert 5 stages

Stage 1 Novice nurse Stage 2- Advanced beginner Stage 3- Competent Nurse Stage 4 Proficient Nurse Stage 5 Expert nurse

The NCSBN Transition to Practice Model

The NCSBN model suggests the new nurse will have the same preceptor for 6 months. Then the new nurse will have a team of preceptors they can go to for an additional 6 months. Take full advantage of your orientation period.

Strategies to ease transition preceptorships

Usually done during the last semester of nursing school. Can be part of an orientation program.

Transition shock stage 2 being

Usually occurs at 4-5 of starting job months. Nurses have advancement in thinking. As they become more comfortable they are confronted with their inconsistencies and inadequacies. But they see the areas they lack more clearly.

Transition shock stage 1 Doing

Usually occurs in the first 3-4 months. The new nurse is trying to keep up. They are expected to take a full load without the assistance they did. They are also unaware of what they don't know; stressed about everything.

Workplace violence 4 types

Violence by a stranger with criminal intent Violence by customer or client Coworker Horizontal or lateral violence

Loner

adopts the attitude to "just do the job and keep your mouth shut"

Native

adopts ways of least resistance and mimics other nurses. don't do how in nursing school. could lead to errors

burned out

bottles up conflict until become burned out; fatigued, depressed, angry, stressed, poor decision making, can cause increase infections in patients caused by horizontal violence, heavy workload assignments, complex patients,

New nurse on the block

changes jobs frequently and is always the "new" nurse who has to be taught

Rutter

considers nursing just a job. go to work job, dont enjoy it, do minimum to get pay check.

compassion fatigue

decline in compassion over time from exposure to events that have traumatized patients, they may be hopeless,emotional and physical exhaustion lack meaning of work, giving care, prolonged exposure to suffering,

Culture shock partial task system

each person is in charge of certain tasks (PT-ROM, CNA-hygiene). Also known as functional nursing delivery care model. in this there are cnas and other people involved to help.

Honeymoon Phase of reality shock

everything in the work world is just as the new graduate imagined. Most often occurs during the orientation period. mostly orientation period,

Special Needs of Novice Nurses Priority setting skills

if not done correctly consequences can occur. What are the patient's needs? How much time is required for task? What tasks can be delegated?

ATI critical thinking clinical reasoning

is a mental process to analyze the elements in clinical situations. It supports clinical decision-making process by: guiding the nurse with assessing and collecting data, decide what information is important and what isn't, use the nursing knowledge to make clinical decisions about the client's care. and problem solving

Culture shock Evaluation methods

is how you're evaluated on what you did. in nursing school your taught the correct step by step tested off but when you are employed at a facility you need to know their policies and procedures. See case study 24-2. you may initial your name next tot he task you were supposed to do.

ATI critical thinking what is it?

is used when analyzing patient issues. Critical thinking uses interpretation, analysis, evaluation, inference, and explanation.

Special needs of novice nurses Interpersonal Skills

lack of comfort with interpersonal skills (e.g., making rounds, clarifying orders, participating in team conferences) Attend unit meetings and volunteer for committees Take an active interest in the nursing unit Participate in professional organizations at the local, regional, state, and national levels Make rounds with physicians and assist with procedures

Shock phase of reality shock

nurses may encounter conflicting viewpoints, different ways to perform skills, and lack of security of an expert available as a resource. Nurses may feel frightened or may react by forming a hard, cold shell. When you actually get out into the real world, on your own, may get behind and want shortcuts. but keep in mind patient safety.

Maslow's Hierarchy of Needs

physiological- food, water,warmth, rest safety- security, safety love/belonging- intimate relationships, friends esteem- prestige and feeling of accomplishment self-actualization-achieving ones full potential including creative activities

Runaway

real world too difficult; leaves profession or returns to graduate school with a goal to teach nursing.

Violence by someone in a personal relationship

sexual harassment

Culture shock whole task system

similar to what you are use to in nursing school. The nurse provides total patient care. do baths, turning,

Causes of transition Shock 3 stages

stage 1-doing stage 2- being stage 3- knowing

Reality shock and transition shock leads to

stress which can cause nurses to feel anxiety, phobias, depression, change in mood and behavior, stress, and physical illness. Stress contributes to nurse turnovers. According to the NCSBN 25% of new nurses leave their job within the first year. New nurse turnover is estimated to cost $1.4-2.9 billion per year. New nurse need to be assisted through the transition.

Dealing with transition shock "need to do"

you need to know your boundaries and know when to say "no" to protect yourself and your patients.

Special needs of novice nurses Intuition

your "gut feeling". You walk into a patient's room and feel there is something wrong with the patient but there is no signs or symptoms that would indicate this. Nurses trust their feelings.

Strategies to ease transition self mentoring

Self mentoring New nurses need to be willing to ask questions, learn appropriate resources, and develop problem-solving skills.

Dealing with transition shock "need to think about"

" - where is the safest for you to work that will help you with the transition.

Dealing with transition shock "need to know"

"need to know" you've been educated but you are not an expert yet.

Prioritization principles in client care

: Prioritize systemic before local- shock versus limb injury Prioritize acute before chronic- new injury/illness (mental confusion, SOB), including an exacerbation of a previous illness, before someone with a chronic illness. Acute issue is has less opportunity for physical adaptation than a chronic issue. Prioritize actual problem before potential future problems- just because a patient has chest tubes doesn't mean they are a priority if they are stable. A patient in acute pain should come first. Listen carefully to clients and don't assume - ask patients what they know about their illness or why they are in the hospital. Recognize and respond to trends versus transient findings- watch for slow deteriorating level of consciousness. Recognize indications of medical emergencies and complications versus expected findings- recognize the s/s of intracranial pressure in stroke patients versus expected s/s. Apply clinical knowledge to procedural standards to determine the priority action- administering medications at a certain time for pain or diabetes versus other meds.

Strategies to ease transition Role models and mentors

A new nurse is paired with an experienced nurse to help learn intangible skills and be there for questions and guidance. Mentors can be key in a new nurse's success. It is important to have the right mentor for each new nurse. Mentors can help new nurses develop confidence, organizational skills as well as provide emotional support.

From Novice to Expert stage 5

Expert nurses Intuition and decision making are instantaneous. make decisions without thinking of what it is for too long, they just know.

Goals of transition shock Familiarity

Familiarity- developing routines and getting to know the staff and the unit.

Special needs of novice nurses Organizational skills

Organizational skills: feeling disorganized. May be based on being overwhelmed by the new environment Use report sheets/ organizational sheets Contact former nursing instructors to discuss challenges Learn to delegate appropriately.

Inappropriate Approaches for Dealing with the Shock Phase

Native Runaways Rutters Burned Out Compassion Fatigue Loners New Nurse on the Block

Strategies to ease transition

Orientation Programs NCSBN "Transition to Practice Model" Biculturalism Role Models and Mentors Preceptorships Self-Mentoring Residency Programs Preprofessional and Professional Organizations Self-Confidence and Self-Esteem ANA Webinar

From Novice to Expert stage 2

Advanced beginners able to perform adequately Able to make some judgment calls on the basis of experiences in school Occurs on entry to the workforce when you graduate.

Strategies to ease transition Preprofessional and professional organizations

Allows nurses to meet other nurses and help develop leadership skills.

Special needs of novice nurses Assertive Skills

Assertiveness communication is important to the novice nurse. It's important that you are able to say "no" when it is appropriate and stand up for yourself. This is important for you and your patients.

Time management Strategies Implementing

Attack priorities- attacking priorities will help to gain control of your time. Large tasks should be broken down into smaller tasks. Find "extra" time- how you use your time. Multitask when able to. Don't sacrifice downtime or relaxation time. Avoid procrastination- bad habit; high on the list of time wasters. Usually seen when there is an unpleasant task. First step is to recognize it and be able to admit it then identify the tasks, and why are you avoiding it. There are other steps to fight procrastination. Delegate appropriately- give other tasks to be done. At home give kids chores to help out. Control interruptions- frequent causes of interruptions is the telephone, meetings, and visitors. Learn the art of saying "no"- No is a small word but can be one of the most difficult to say. Be polite but firm when saying no. Reward yourself- find what motivates your and use them to help accomplish long-term goals. Use technology to be more efficient- online calendars can be useful. Health care uses EHR - electronic healthcare record multiple users can view patient data at one time.

Strategies to ease transition Biculturalism

Biculturalism- "joining two contradictory value system." The values you learn in nursing school are not necessarily the same in the workplace. Some nurses will do things one way because they have always done it that way. Always think of patient safety.

Strategies to ease transition Residency Programs

Can help ease the transition from nursing school to practice. Provide didactic or program activities and one-to-one preceptor experiences. Usually runs 9-12 months. Focus is retention and job satisfaction. It can be time in the classroom too at your job

Health care today

Health care is focusing on improving access, quality, reducing costs, and efficiency. Managing time is going to be essential. This includes organizing care, maintaining personal health, and maintaining a balance between work and personal life. Health Care Environments High-acuity patients- Vigilant and knowledgeable family members Ever-growing information technology Tight quarters in which to deliver high-tech care.Little time to interact with patients. Different disciplines functioning in parallel work. Need to transition patients quickly from one site to another. Intimate human element in health care makes it like no other work Changing Health Care Environment Patients are moving from one site to another in a very short time. Time Management

4 phases of reality shock

Honeymoon Phase Shock (rejection) Phase Recovery Phase Resolution Phase

Perspectives on time

Carefully consider how these obstacles may affect your personal ability to develop productive, energetic work habits Unclear goals and priorities -if you are unsure of a purpose or expected outcome it can be difficult to meet your goals. Constantly in chaos - if you are overburdened with tasks you will be a better crisis manager than a manager of time. Fear of downtime - some individuals are afraid of taking time-out or time off; they feel guilty. This can also cause them not to think about long-term plans. Need to be a caretaker - when this becomes unbalanced it can cause feelings of resentment or unappreciated. Fear of failure - if you don't have goals then you don't have to worry about not meeting them. Take time to think about your fears and how you can overcome them. Fear of success - others may have told you that you won't be successful. This can cause anxiety for you. Fear of disrupting the status quo - fear of going after your goals because family or friends won't approve. Fear of completion - fear of completing one project that you enjoy and not finding another one you will enjoy. Need for perfection - if you're a perfectionist you have high expectations for all tasks which will make it difficult to get things done. Fear of losing creativity - some feel creating an organized time-management structure will take away their creative nature.

AtI critical Thinking Clinical Judgement

Clinical judgement- is the decision that was made based on the course of action.

Special needs of novice nurses clinical skills

Clinical skills: doubt in ability to perform skills without supervision. There isn't an instructor near by to ask questions of. Observe experienced nurses as they perform skills Provide the nurse manager and mentor with a list of skills that need further practice Use the policy and procedure manual

From Novice to Expert stage 3

Competent nurses Able to foresee long-range goals Mastering skills. Example-OB nurse

Goals of transition shock Consistency

Consistency- "sameness" getting use to the patients and the routines.

Special needs of novice nurses Delegation skills

Delegation skills Uncertainty with delegation Related to: limited exposure to delegation activities the personnel to whom one is delegating Communicate face to face: body language important Follow up by putting tasks in writing Be pleasant and open to suggestions Be willing to change task assignments, if indicated Offer help Provide sincere, positive reinforcement

Reality Shock/Transition Shock definition

Inconsistency between the academic world and the world of work. new nurses need help from job transitioning so they keep their job and job doesn't lose money and nurses.

Special needs of novice nurses (8) skills nurses new nurses need to work on

Interpersonal skills Clinical skills Organizational skills Delegation skills Priority-setting Skills Assertiveness skills Dealing with horizontal violence Intuition

time and energy external distractions

Interruptions👋 Socializing or visitors👋 Lack of information Ineffective communication Inadequate policies and procedures Incompetent or uncooperative coworkers Poor filing systems Personnel or coworkers with problems Duplicating efforts Confusing lines of authority, responsibility, and communication Procrastination Inadequate planning Failure to set goals and priorities Inability to say no Indecisiveness Cluttered desk Personal disorganization Shifting priorities without good rationale Leaving tasks unfinished Not listening

Transitional Shock- was built off of

Kramer's reality shock. Transition shock is for today's environment.

Priority Setting Frameworks

Maslow's Hierarchy of Needs ABC framework Safety/Risk Reduction Assessment/Data Collection Survival Potential Least Restrictive/Least Invasive Acute vs Chronic, Urgent vs Non urgent, Stable vs Unstable

Priority setting frameworks

Maslow's Hierarchy of Needs is one of them ABC framework - airway, breathing, circulation, disability, and exposure. Safety/Risk Reduction - Is there a risk? What is the risk? How significant is the risk? Assessment/Data Collection- Always assess first and then determine if more information is needed. Survival Potential - Used more during mass casualties. Those that have little chance of survival are not as high of a priority. Least Restrictive/Least Invasive - Chose an intervention that is least invasive such as moving a patient closer to the nurses station versus putting them in restraints. Acute vs Chronic, Urgent vs Non urgent, Stable vs Unstable- Acute problem before a chronic problem Urgent needs before non urgent needs Unstable patients before stable patients

Practicing mindfulness

Mindfulness allows you to focus on the present and pay attention to what is happening right at this moment. It takes practice! Positive impact of adopting a mindful attitude Helps you to stay focus on the task at hand May lead to a more balanced and effective focus to carry out activities Several ways to practice mindfulness-(Meditation Yoga Reflective journaling music, art, and nature into your daily life)

Strategies to ease transition Orientation programs NCSBN

NCSBN "Transition to Practice Model" The NCSBN model suggests the new nurse will have the same preceptor for 6 months. Then the new nurse will have a team of preceptors they can go to for an additional 6 months. Take full advantage of your orientation period.

Dealing with transition shock (3)

Need to know need to think about need to do

Strategies to ease transition Violence prevention

New nurses are often victims of horizontal violence. The ANA and OSHA have resources to help new nurses conflict and horizontal violence. There is an webinar from the ANA on workplace violence prevention.

Workplace violence protection

No federal requirement for workplace violence protection

Resolution phase of reality shock

Novice nurse adjusts to new environment and work expectations are more easily met. Most new nurses will experience each phase of reality shock but when and to what degree will vary.

Recovery phase of reality shock

Novice nurse begins to understand the new culture and experiences less anxiety. A definite way to know you have entered the recovery phase is the return of your sense of humor.

From Novice to Expert stage 1

Nurses with few clinical experiences Skills are learned by routine, step by step. Occurs when nursing education is completed. during nursing school

Strategies to ease transition Self Confidence and Self esteem

Nurses with high self-esteem have skills that allow them to succeed. They are able to accomplish more because of their high self-esteem. Take the self-esteem questionnaire (Box 24.6, p 425). If your score is low use the link to learn how to stop your inner critic. The Positive Way website talks about how you can build self-confidence and self-esteem.

Culture Shock (3)

Occurs when people are immersed into a culture different from that with which they are familiar and comfortable. Maybe on a complete different unit youve never worked on.

Culture shock (3)

Partial-task system Whole-task system Evaluation methods

From Novice to Expert

Patricia Benner, a nursing theorist, created From Novice to Expert from the Dreyfus Model. The Dreyfus Model was developed in theory that learning is experimental. The more practice you have the better you will be at something.

Time management strategies:organizing

Personal organization is an important component of time management The stacked desk syndrome- cluttered desks are distractions to accomplishing goals. Remove all personal items and place phones out of sight. Eliminate clutter from patient's rooms. Each person should have a designated space at the nurses station. The art of "no detourism" - concentrate on one activity until it is accomplished Art of "Wastebasketry"- involves "circular filing" (trash can/delete button). Handle a piece of paper only once; act of it, toss it, or pass it on to someone else. Mental wastebasketry invovles organizing your mind with priorities. Systematically manage emails and paperwork- email is a channel of communication. Emails should contain a greeting, a clear body of text, specific and clear requests for information, and an acceptable closing. Should be free grammatical and typographic errors.

Four sources of energy required to perform our best

Physical energy: First component of a productive, highly energizing work life includes paying attention to eating well, getting plenty of sleep, and exercise. It is also important to take regular breaks at work and drink plenty of water. Mental energy- Ability to maintain sustained concentration on a task and move flexibly through broad and narrow issues. Mental energy involves preparation, visualization, positive self-talk, effective time-management and creativity. Spiritual energy- Reflect on what's important & identify your purpose and direction in life. Meditation is a great way. Emotional energy- Ability to manage emotions skillfully. The other three provide fuel for building our emotional capacity. Emotional intelligence is managing emotions skillfully in service of high energy and full engagement.

Time management strategies-Planning

Planning is the most important step in time management. 👋 Important to engage in planning before beginning any task, project, or the day's activities.👋 Three goals in planning: set goals and establish priorities, schedule activities, and make to-to lists.👋 Set priorities using defined approach ABC approach- A absolutely needs to be done now. B-better if done sooner than later (Bs eventually become As), C-can wait Pareto principle approach 80/20 rule-select the most important activities. Example 80 percent of problem compared to 20 percent of taking care of the problem will fix the 80 percent of the problem Continuum approach: intrinsic, urgency, delegation, and visitations and conferences. Schedule activities- allows you to know how much time each activity will take. Schedule activities during your "prime time". Most important is medications Create "To-do Lists"- helps people stay on track and focused. Feels good to cross items off when they are accomplished.

Goals of transition shock Predictability

Predictability- Knowing what your schedule will look like, what type of patients will be on the unit.

ATI Prioritization Principles in client Care

Prioritize systemic before local Prioritize acute before chronic Prioritize actual problem before potential future problems Listen carefully to clients and don't assume Recognize and respond to trends versus transient findings Recognize indications of medical emergencies and complications versus expected findings Apply clinical knowledge to procedural standards to determine the priority action

From Novice to Expert stage 4

Proficient nurses Able to view whole situations rather than parts Able to develop effective solutions.

Activities for continued success

Time-management take time to achieve, it requires continual attention and energy. Lakein recommends the following to succeed at time-management. When feeling overwhelmed, always stop and plan activities Keep focused on priorities, and act accordingly Avoid favorite forms of procrastination Maintain a positive attitude about established goals, or revise them so they coincide with your values Do something for yourself every day Continue to work on overcoming your fears Resist doing the easy but unimportant tasks

Transition Stage 3 knowing

Trying to separate from the established nurses but engage as a professional.