The Transition from Student
Nurse to Clinical Nurse
Nicole McDonald
NURS 450
Ferris State University
Objectives
• Discuss the difficulties of the transition into nursing
• Look at the implications of a difficult transition on nursing
retention
• Examine theories related to the transition
• Assessment of the healthcare environment related to the
transition
• Implications and consequences of this problem on patients
and new nurses
• Examine policies related to the transition
• Perform a root cause analysis on the issue
• Recommendations for quality and safety improvement
• Examine QSEN competencies and ANA standards related to
the transition
The Problem
• Up to half of new RNs consider leaving within
the first year (MacKusick & Minick, 2010).
• 30-50% of new RNs change jobs or leave
nursing in the first 3 years (MacKusick & Minick, 2010).
• Less than 50% of practicing nurses would
recommend it as a career (Duscher, 2009)
• 25% of practicing nurses would actively
discourage someone from going into nursing
(Duscher, 2009)
Why is this an issue?
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Transition Shock/Reality Shock
Bullying
High patient to nurse ratios
Orientation & Preceptors
Lack of support
Exhaustion
Staffing
The Nursing Shortage
Transition Shock Theory
Dr. Judy Boychuk
Duchscher
Nursing the Future
Initiative
Schlossberg’s Transition Theory
4 S’s
• Situation
• Self
• Support
• Strategies
Dr. Nancy Schlossberg
Professor of Counseling Psychology
Assessment of the Health Care
Environment
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Transition Shock/Reality Shock
Expectations vs. Reality
Unfriendly environment
Emotional distress
Fatigue and exhaustion
Lack of comfort in challenging situations
Implications, Inferences &
Consequences
For patients:
• Decreased quality of care
• Decreased safety
• Delayed care, increased time in hospital
• Negative outcomes
• Decreased confidence in nursing staff
Implications, Inferences &
Consequences
For new nurses:
• Increased risk for errors
• Decreased job satisfaction
• Helplessness
• Staffing
• High turnover rates
• High costs
Spectrum Health Policies
• Code of Excellence
– Non-retaliation policy, p. 6
– Disclosure of potential conflicts, p. 11
– Building relationships with colleagues, p. 14
– Maintaining respectful treatment, p. 15
– Preventing workplace violence, p. 16
Spectrum Health Initiatives
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•
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Leadership training
Relationship-based Care Model
Shared Governance Model
EXCEL Nursing Professional Development
Model
Root Cause Analysis
Lack of
Support
Bullying
Staffing
Peers
Call-ins
Isolation
Supervisors
Physical
↑Pt load
Low
Retention of
New Nurses
Lack of
experience
Cut short
Emotional
Fatigue
Judgment
↑ acuity
Preceptor
Confidence
Orientation
High Stress
Recommendations for Quality & Safety
Improvements
• Program emphasis on leadership, communication,
conflict management, collaboration in final semester
(Casey et al., 2011)
• Simulation experiences (Casey et al., 2011)
• Intensive preceptor-guided clinical (Casey et al., 2011)
• Novice Nurse Leadership Initiative (Dyess & Sherman,
2011)
• Nurse Residency Programs (Bratt, 2013)
• New nurse networking programs
• Education on new nurse support - peer and supervisor
• Performance evaluations
Nurse Residency Programs in Michigan
• Children’s Hospital of Michigan – Detroit
Medical Center
• St. Joseph Mercy Health System
• Beaumont Health Systems
• Sparrow Health System
• Munson Medical Center – Critical Care
Internship
QSEN Competencies
• Teamwork & Collaboration
• Quality Improvement
ANA Standards
• Communication
• Leadership
• Professional Practice Evaluation
References
American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Springs, MD:
Nursebooks.org
Anderson, M. L., Goodman, J., & Schlossberg, N. K. (2012). Counseling adults in transition: Linking Schlossberg’s Theory with
practice in a diverse world (4th ed.). New York, NY: Springer Publishing Company LLC.
Boychuk Duchscher, J. E. (2009). Transition shock: The initial stage of role adaptation for newly graduated registered nurses.
Journal of Advanced Nursing, 1103-1113
Bratt, M. M. (2013). Nurse residency programs: Best practices for optimizing organizational success. Journal for Nurses in
Professional Development, 29(3), 102-110.
Casey, K., Fink, R., Jaynes, C., Campbell, L., Cook, P., & Wilson, V. (2011). Readiness for practice: The senior practicum experience.
Journal of Nursing Education, 50(11), 646-652.
Dyess, S. & Sherman, R. (2011). Developing the leadership skills of new graduates to influence practice
environments: A novice nurse leadership program. Nursing Administration Quarterly, 35(4), 313-322.
MacKusick, C. I. & Minick, P. (2010). Why are nurses leaving? Findings from an initial qualitative study on nursing attrition.
Medsurg Nursing, 19(6), 335-340
Pellico, L. H., Brewer, C. S., & Kovner, C. T. (2009). What newly licensed registered nurses have to say about their first experiences.
Nursing Outlook, 57(4), 194-294
Quality and Safety Education for Nurses (2014). Competencies. Retrieved from http://qsen.org/competencies/pre-licensureksas/
Spectrum Health (2014). For nurses: Nursing excellence providing world class care. Retrieved from
http://www.spectrumhealth.org/nursing