Transition To Practice As a Nurse Professional and Growth Strategies

The Transition To Practice As a Nurse Professional and Growth Strategies. What strategy can a nurse use to facilitate the transition from nursing education to professional practice? (New nurses can facilitate the transition to practice with a mentor to guide them through the process.)

What Is Transition To Practice As a Nurse Professional and Growth Strategies

The transition to nursing practice requires both practical skills and professional development. Strategies for a successful transition include mentoring, continuing education, and building a strong professional network. In addition, self-care and time management are critical for long-term success in the demanding field of nursing.
Transitions in nursing practice occur when an individual completes their training and obtains their first or new nursing license, when a practicing nurse transitions to a new nursing position or responsibility at the same level of licensure, or when returning to work after an extended period.

The new nurse undergoes a “becoming” process into a fully functioning professional, considering socioeconomic, emotional, intellectual, and physical factors that may influence the process. The transition to the professional role occurs in three phases: doing, being, and knowing.

Transition To Practice

Transitioning from a student to a newly licensed RN is very exciting as well as challenging, and it can cause feelings of uncertainty and stress. The basic education of new nurse graduates “cannot alone meet the requirements for the newly licensed nurse to be confident and competent as they transition into his or her professional role” (American Organization of Nurse Executives [AONE], 2010, para. 1).

Factors such as the increasing complexity of health care, the nursing shortage, high-acuity patients, and the looming retirement of many experienced nurses support the critical need for the successful transition of new nurse graduates from the academic setting to the clinical practice setting. One of the recommendations of the IOM (2011) is to implement “nurse residency programs to provide nurses with an appropriate transition to practice and develop a more competent nursing workforce” (p. 148).

According to the National Council of State Boards of Nursing (NCSBN, 2016), new nurses care for patients in a complex health-care environment and experience high levels of stress that cause 25% of these nurses to leave a position within the first year of nursing practice. These factors negatively influence safe and quality care and result in poor health-care outcomes. In an integrative review, Rush and colleagues (2013) found that transition to practice (TTP) programs that integrate formal and informal education, preceptorships, mentorships, and unit-specific orientations are significantly effective in retraining new nurse graduates.

The NCSBN developed an evidence-based TTP program to ensure successful transition from the academic setting to the practice setting. The model integrates education, practice, and regulations for successful transition from the classroom to the clinical practice setting and beyond (NCSBN, 2016).

Current research suggests that residency programs can reduce turnover rates in the first year of practice and promote growth in clinical decision making and leadership skills (Al-Dossery, Kitsana, & Maddox, 2013). Spector and colleagues (2015) conducted a study to examine the impact of the NCSBN TTP program on quality and safety and new nurse graduate stress, competence, job satisfaction, and retention. These investigators found that a substantial improvement in quality and safety outcomes as well as in self-reported stress, competence, and job satisfaction.

AONE (2010) has made a commitment to the success of new nurses by developing guiding principles for new nurses’ transition to practice. The guidelines recognize the importance of the successful transition of new nurses to promote quality outcomes. Moreover, the principles outline the importance of the nurse leader and manager’s support for the transition, the need for preceptors with a strong desire to teach and coach new nurses, the value of strategies for stress management, and effective policies and procedures related to zero tolerance of lateral violence (AONE, 2010).

Nurse leaders and managers are vital to the success of TTP programs. They provide support for knowledge acquisition and build new nurse graduates’ confidence in skills (D’Addona, Pinto, Oliver, Turcotte, & Lavoie-Tremblay, 2015). In addition, nurse leaders and managers are critical in the socialization of new nurse graduates by providing a safe environment where new nurses can share concerns and receive support.

Preceptors And Mentors

An effective orientation program can be critical to retaining new nurses. The most common form of orientation program for new nurse graduates involves the use of preceptors. Typically, a preceptor is a staff nurse who is recognized for his or her clinical competence, leadership abilities, organizational skills, and desire to orient new nurse graduates. The role of the preceptor is to ensure that the new nurse graduate expands his or her basic nursing education and further develops the knowledge, skills, and attitudes necessary to function competently in the nursing position.

The preceptor serves as a role model as well as provides the new nurse graduate an orientation to the unit, socialization within the unit culture, assistance with skill mastery, and a resource regarding policies and procedures. The new nurse graduate typically demonstrates marginally acceptable performance as an advanced beginner, according to Benner’s (1984) Novice-to-Expert model. The competent nurse, the third stage of Benner’s model, is an appropriate preceptor for the novice or advanced beginner (NCSBN, 2016) because he or she experiences a sense of mastery in the clinical setting and can discern relevant from irrelevant assessment data (Benner, 1984).

Different from a preceptor, a mentor is an experienced individual (who may or may not be a nurse) who is willing to maintain a long-term relationship, empowering, nurturing, advising, and guiding the new nurse graduate throughout his or her professional career (Masters, 2014). The mentoring relationship can benefit nurses at all levels, not just new nurse graduates. When selecting a mentor, nurses should consider someone who is easy to communicate with and willing to commit time to the mentoring relationship.

“All nurses have a responsibility to mentor those who come after them, whether by helping a new nurse become oriented or by taking on more formal responsibilities as a teacher of nursing students or a preceptor” (IOM, 2011, p. 244). An effective mentor inspires and challenges the new nurse to a high level of professionalism. The mentoring relationship can be mutually beneficial and result in growth for both the new nurse and the mentor (Grossman & Valiga, 2013).

Strategies For Professional Growth

Nurses today cannot stop learning just because they have earned their degree, attained licensure, and become working nurses (Johnson, 2015). Health care is rap idly changing and requires nurses to keep up with those changes to provide safe and quality care. Patients deserve to have highly competent nurses who are adept at caring for them across all settings (IOM, 2011). For nurses to thrive in this complex environment, they must be committed to lifelong learning.

It is imperative that nurses maintain current knowledge by reading professional journals, attending continuing education offerings, and seeking certification in their specialties to enhance and validate their knowledge and skills in clinical practice (Johnson, 2015). Competence is situational and dynamic and requires performing at an expected level that integrates knowledge, skills, attitudes, and nursing judgment (ANA, 2015c, p. 44). Nurses must attain and maintain competencies after graduating from nursing school.

Competence is both an ongoing process and an outcome (ANA, 2014b, 2015c). Therefore, attaining and maintaining competence are important. Being a competent nurse has both legal and ethical implications. “The ability to perform at the expected level requires a process of lifelong learning. Registered nurses must continually reassess their competencies and identify needs for additional knowledge, skills, personal growth, and integrative learning experiences” (ANA, 2015c, p. 45).

Competence affects not only the safety and quality of care but also self-respect, self-esteem, and meaningfulness of work (ANA, 2015a). Ensuring that nurses maintain competence is the shared responsibility of the profession, individual nurses, professional organizations, regulatory agencies, credentialing agencies, and nurse leaders and managers (ANA, 2010, 2014b).

Nurse leaders and managers must be committed to providing an environment that is conducive to competent nursing practice. “Employers who provide opportunities for professional development and continuing education promote a positive practice environment in which nurses can maintain and enhance skills and competencies” (ANA, 2015c, p. 47). In essence, nurses at all levels must embrace a culture of nursing competence, a culture in which shared beliefs, attitudes, and values promote lifelong learning result in an environment of safe and quality care (Porter-O’Grady & Malloch, 2013).

Becoming a Lifelong Learner

Inherent in the ability to provide competent, safe, quality nursing care is a commitment to lifelong learning. A lifelong learner is one who seeks continuing education opportunities to increase his or her knowledge and skills and improve his or her attitudes throughout his or her professional and personal life. According to Provision 5.1 of the ANA Code of Ethics for Nurses With Interpretive Statements, nurses have a responsibility to maintain competence and continuation of professional growth, which requires a commitment to lifelong learning (ANA, 2015a). In an address to her nursing students in May, 1872, Florence Nightingale said:

For us who Nurse, our Nursing is a thing, which, unless in it we are making progress every year, every month, every week, take my word for it we are going back. . . . The more experience we gain, the more progress we can make. The progress you make in your year’s training with us is as nothing to what you must make every year after your year’s training is over.

A woman who thinks in herself: “Now I am a ‘full’ Nurse, a ‘skilled’ Nurse, I have learnt all that there is to be learnt”: take my word for it, she does not know what a Nurse is, and she never will know; she is gone back already. . . . Conceit and Nursing cannot exist in the same person, any more than new patches on an old garment. . . . Every year of her service a good Nurse will say: “I learn something every day.” (Florence Nightingale to her nurses, 1914, p. 1).

Lifelong learning includes learning about new concepts, issues, and controversies relevant to evolving nursing practice. Learning can occur through many activities such as continuing education, networking with colleagues, reading professional literature, achieving specialty certification, and pursuing advanced degrees in nursing (ANA, 2015a). To attain and maintain the knowledge, skills, and attitudes necessary for professional practice, nurses must engage in continuous formal, informal, and reflective learning activities (ANA, 2014b).

Formal learning occurs through engaging in structured, academic, and professional development activities, whereas informal learning is related to the experiential learning that occurs in the workplace, com munity, and home settings (ANA, 2014b). According to the ANA, reflective learning “represents recurrent thoughtful personal self-assessment, analysis, and synthesis of strengths and opportunities for improvement” (2014b, p. 4). Weaknesses and opportunities identified through reflective learning should be what drive a nurse’s plan for career development and lifelong learning.

Continuing Education

Once licensed, RNs must maintain current licensure to continue nursing practice. Depending on the state, the requirements for license renewal may include renewal fees, current work address, current home address, notification of criminal activities, and proof of a specific number of continuing education hours. Nurses attain and maintain competencies during their professional career through continuing education activities. Continuing education is often provided by hospitals, community agencies, professional organizations, and professional meetings and can be provided in various formats (i.e., face to face, online, self-study, conferences, workshops, and seminars).

The American Nurses Credentialing Center is responsible for accrediting standards of continuing education programs and courses. Continuing education credits reflect the length of programs. One credit of continuing education is equivalent to 50 minutes. In some states, university and college course work may meet continuing education requirements. Different states may have different numbers of continuing education hours required for license renewal.

Specialty Certification

Specialty certification validates specific knowledge, skills, and attitudes demonstrated by a nurse in a specialized area of practice . Certified nurses are role models of professional accountability (Altman, 2011). By becoming certified, nurses demonstrate they are responsible for their own practice by seeking further education and being motivated to provide high-quality nursing care. In addition, nurses who continually renew their certification demonstrate their commitment to increasing their knowledge in their nursing specialty (Foster, 2012).

Nurse leaders and managers prefer to hire certified nurses if possible because they have a proven knowledge base, documented experience in their clinical specialty, and a demonstrated commitment to lifelong learning and career advancement (Altman, 2011; Stromborg, Niebuhr, & Prevost, 2005). In addition, research suggests that specialty certification improves patient safety outcomes (Boltz, Capezuti, Wagner, Rosenberg, & Secic, 2013; Kendall-Gallagher & Blegen, 2009).

Nurse leaders and managers can promote certification by seeking certification themselves and advocating for organizational support for certification such as financial incentives, public recognition, and including credentials on name tags. Specialty certification has a positive impact on staff, patients, and the organization (Altman, 2011).

Advanced Degrees

Safe and quality care depends on nurse leaders and managers hiring a well-educated workforce. Research indicates that care provided by nurses at the baccalaureate level and higher results in lower mortality rates, fewer medication errors, and better patient outcomes (AACN, 2014). In its report The Future of Nursing, the IOM recognized that associate degree nurses are essential for the current health-care system. However, the IOM recommended that 80% of all nurses obtain a baccalaureate degree or higher by 2020 and that the number of nurses with doctorates double by 2020 (IOM, 2011).

Increasing the percentage of baccalaureate-prepared nurses to 80% by 2020 is “necessary to move the nursing workforce to an expanded set of competencies, especially in the domains of community and public health, leadership, systems improvement and change, research, and health policy” (IOM, 2011, p. 173). The Tri-Council for Nursing, an alliance of the AACN, ANA, AONE, and the National League for Nursing, contend that more nurses with baccalaureate and higher degrees in nursing are needed to provide safe, quality care needed in the current and future complex health-care system (Tri-Council for Nursing, 2010).

Nurse leaders and managers play a pivotal role in the educational future of nursing. First and foremost, nurse leaders and managers must seek advanced degrees themselves. Next, nurse leaders and managers must support other nurses who want to pursue further education. The AACN encourages nurse leaders and managers to “foster practice environments that embrace lifelong learning and offers incentives to nurses seeking to advance their education to the baccalaureate and higher degree levels” (AACN, 2014, para. 2).

Nurse leaders and managers can become involved at the organizational level by spearheading initiatives to establish or increase tuition reimbursement programs for nurses with a desire to return to school and other staff members who are pursuing additional education in nursing or another health-care field.

Contributing to the Nursing Profession

Membership in professional nursing organizations can provide many opportunities to contribute to the profession. Part of being a professional is belonging to a professional organization. Nursing professional organizations are vital to the profession today and in the future. Members of professional organizations work collectively to “define and promote standards of behavior and practice” (Beyers, 2013, p. 388).

The primary roles of professional organizations include professional development, advancing the profession, developing and promoting health-care policy, and advocacy for members and consumers of health care. All nurses at all levels must contribute to “the advancement of the profession through knowledge development, evaluation, dissemination, and application to practice” (ANA, 2015c, p. 27). In fact, nurses are expected to use current research and evidence in their practice.

Nurses should also contribute to the profession by leading and serving on institutional or health policy committees. Nurse leaders and managers should participate in the promotion and implementation of health policies. Nurse leaders and managers are responsible to ensure that the organization supports nursing research and evidence-based practice. They must become involved at the administrative level to promote and create processes and structures that are conducive to scholarly inquiry (ANA, 2015a).

In addition, nurse leaders and managers should promote communication of information and advancement of the profession through writing, publishing, and presentations for professional or lay audiences (ANA, 2016). Nurse leaders and managers are also responsible for promoting the advancement of the profession by participating and encouraging staff participation in professional organizations.

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