Patient Care effect on Career and Education Decision
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Patient Care effect on Career and Education Decision
Discuss how the patient care you have provided has influenced your career and decision to continue your education
What is the meaning of patient care in medical terms? It begins by explaining what “patient” means and what medical practice is. Medical practice is the act of providing health services to those in need. There are different types of health services practiced. One is the medical diagnosis and another is the treatment or health service itself. In the medical field, the patient is one of the most important people involved.
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Advanced Practice Roles
Introduction
Nursing is pragmatically considered to be a profession that is within the Medicare division of the overall concern of diverse families, individuals and the communities so the communities can achieve, sustain or even improve their finest health and the eminence life. Nursing can be distinguished from diverse further Medicare providers because of their aspect of work, their work technique to patient’s care, guidance and the extent of performance as the nurses usually carry out work in a broad range of performance areas that has diverse scope of performance and an intensity of the prescriber influence in every practitioner.
Nursing can be said to be a promotion, safety, and even the optimization of abilities and health, impediment of the illness and improvement of pain by the analysis and the treatment of human reaction.
Advanced Practice Roles
Purposes of nursing
Nursing as a worldwide community is normally for its professional to ensure that there is quality care for everybody as they maintain their diverse credentials, standards, code of ethics a competencies. For an individual to work in the nursing as a professional, all the nurse or the nurses practitioners holds one or even more credentials that normally depends on their scope of practice and their education.
Nurses are usually considered as not truly doctor’s assistants because nurses more often are independently caring for their patients or even assisting other nurses in the healthcare centre. Registered Nurses are mandated to treat patients, provide emotional support, record their medical history, and even provide follow-up care because nurses assist doctors in performing some of the diagnostic tests.
Advanced Practice Roles
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Advanced Practice Roles in Nursing
Roles of the Nurse Practitioner, nurse educator, nurse informatics, and nurse administrator in advanced practice nursing
Nurse educators
Nurse educators are registered nurses who have advanced education that includes advanced clinical training in a health care specialty because they combine expertise and also a passion for teaching into rich and rewarding careers selection. Nurse educators normally plays a paramount role in the aspect of strengthening the overall nursing workforce who serves as a role models in providing needed leadership skill so as to implement evidence based practice.
The nurse educators are similar with nurse practitioners in the aspect of health care provision but majorly differ in their work place because a nurse practitioner is in the health care room while a nurse educator can work from school to school so as to educate diverse people on the importance of nursing as a profession.
Nurse informaticians
Nursing Informatics is considered to be a discipline and practice that incorporates the aspect of nursing, its data and diverse awareness, with the diverse administration of data and the communication skills so as to uphold the fitness of communities. A nurse informatics usually work as developers of information and communication technologies, researchers, the principal information and nursing officers and also as software engineers who advance the healthcare facilities.
Center area of work for nurse informaticians includes the perception illustration and standards so as to sustain the evidence-based performance, education, and research. The nurse informaticians are similar with other advanced roles of nursing in the aspect of health care provision and health care improvement but majorly differ in their work place because a nurse informaticians is in the health care control room such as data centre so as to ensure that sophisticated deices and softwares are installed in the health care for improved efficiency.
Advanced Practice Roles
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Nurse administrator
Nurse administrator is an advanced role in nursing professional who are knowledgeable of the aspect of guidance practices as they have relation to the nursing professionals. This particular aspect may refer to a number of managerial supervisory and diverse tittles that assist the health care facilities in carrying on their esteemed functions. The multifaceted and complex character of contemporary healthcare facilities needs nursing guidance professionals who can craft efficient facility-wide systems and intra-departmental of healthcare delivery as they lead to a useful and proficient employees.
Nurse administrator permits for best possible patient care in any health care environment, from private hospices and hospitals to big medical care centers. Nurse administrator is similar to other advanced roles of nursing professionals in that all of the foster the aspect of healthy environment and the general provision of efficient health care services. Conversely, nurse administrator differ with other advanced roles of nursing profession in that they ensure that all the roles are efficient so as to provide a unity and productive workforce.
Selected Advanced Practice Role
Nurse Practitioner
Nurse practitioner is a sophisticated practice of registered nurses who are usually knowledgeable and vigorously skilled so as to offer health support and diverse protection by the aspect of medical analysis and the handling of severe illness and the persistent conditions (Hamric, 2013). A nurse practitioner normally has maximum capability to provide health care to all people even those who are perceived mental challenge because of their scope of work and advanced training.
Nurse practitioner differs with other advanced roles of nursing because nurses are mandated to carry out his or her duties in the health care room such as recording data and diverse healthcare services to the patients. A nurse practitioner is similar to other advanced roles of nursing as all of them involve the service that will prevent illness and promote health (Speziale, 2011).
Advanced Practice Roles
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Nurse Practitioners regulatory and legal requirements for North Carolina
Nurse Practitioners are considered to be the principal group of highly skilled practice and roles in North Carolina State. The licensure law and state practice usually provide for all the nurse practitioners to assess all the sick people, order, analyze, and then interpret the diagnostic tests with physician supervision so as to instigate and then manage treatments that incorporate recommending medications in the special licensure power of the state panel of nursing (Munhall, 2012).
The supervision physician should provide written instructions that orders medication, tests and the treatment which in turns assesses the information of Nurse Practitioners within a logical time. In North Carolina Nurses are normally taken care by a Joint Subcommittee of the North Carolina Medical Boards and the North Carolina Board of Nursing who promulgates rules so as to control the work of nurse practitioners, that then should be accepted by both panels prior to finishing the rulemaking procedure and then becoming effectual.
North Carolina Organization of Nurse Leaders (NCONL) usually exists to promote the nursing management excellence, shape general population guidelines and also toughen the leaders in nursing profession through teamwork and learning (Speziale, 2011). To become a member of the North Carolina Organization of Nurse Leaders, one is supposed to fill out the membership application that can be downloaded from the website. Membership fees dues are normally paid after January 1st is usually prorated on a quarterly basis because prorated membership dues are commonly considered only after a 12-month lapse in membership.
Advanced Practice Roles
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Required competencies for North Carolina
In North Carolina, nurse practitioners are normally required to possess high level of education so as to provide great nursing services to the public at large (DeNisco, 2012). Diverse exams are conducted so as to determine the level of competence that an individual contain. Nursing profession is considered to be a profession that needs adequate and necessary skills and knowledge because of its nature and the aspect that the profession deals with life-saving matters.
The required competencies for a nurse practitioner include pass in a nursing exams with high grades as the profession usually offers for all the nurse practitioners to assess all the patients, order, analyze, and then understand the diagnostic assessments with physician supervision so as to instigate and administer treatments that incorporates recommending prescriptions in the special licensure power of the state panel of nurses (Panel, 2011).
Some of the organizations are deemed best in working as I plan to work in North Carolina State Hospital because I feel that the medical facility environment possesses exceptional characteristics that support nursing profession. The state has a lot of people because the profession needs large population so as to embrace efficiency and experiences.
Advanced Practice Roles
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Health Policy and the Advanced Practice Role
Early childhood experience shapes health and the aspect of well being throughout the life
Early childhood social and economic conditions are considered to directly affect their respective health conditions. Diverse education and income, their neighbors resources and economic and the social factors affects their health at each stage of their life but the impacts on the young children is usually dramatic. Hamric et al (2013), the children early ages have the full potential to set up a path they are leading towards a good health or far away.
The diverse impact of these obstacles and opportunities along with diverse health effects that are accumulated over a long period of time can be transmitted in across generations as the children grow up to become parents because some of the social disadvantage in childhood such as a chronic stress can lead to a health disadvantage in adulthood. The effects of these is that, every parent want the best for all their children but it is usually considered that not all the parents have the same resources so as to assist their young ones to grow up healthy.
The policy needs to change the aspect of health care provision in that all the parents should try having the best practice and education for their children. Children should receive good education earlier so that they can embrace their good health from diverse school education that enhances good health. According to Robert Wood Jonson Foundation, nurse practitioners need diverse health policy attributes that will assist him or her ensure that the policies are helpful because as the number of negative childhood experiences increases it also increases the aspect of negative health outcome.
Advanced Practice Roles
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The process required to make the changes in the health policy should be instrumental so as to embrace productivity as a nurse practitioners have the capability to conduct numerous campaigns so as to preach the good parts of early childhood experience as it shapes health and the aspect of well being throughout the life of a child. According to Robert Wood Jonson Foundation, interested parties are normally the health practitioners, government and parents who have the responsibility to ensure that the children have a positive environment that will assist them shape the livelihood of their children.
Nurse practitioners need to be very intelligent in what they are doing so as to reveal any confidential matter that concerns a patient (Hamric, 2013). What I could that may lead the efforts to influence the change in policy is conducting numerous training so as to promote and ensure that the children have a positive environment that will assist them shape the livelihood of their children. I will attain and evaluate those missing attributes by continuous practice because this is considered to be the best way to add knowledge for a nurse practitioner.
Prediction of the effects on healthcare quality if the change is implemented
If the particular changes are implemented, children will have a better life when the attain an adulthood age because of the aspect that they have been shaped because nurse practitioners have diverse responsibilities to ensure that the children have a positive environment that will assist them shape the livelihood.
Advanced Practice Roles
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Conclusions
According to Robert Wood Jonson Foundation, nursing is considered to be one of the professions that promotes, protects, protection of the poor health and injuries, assistance of healing, and lessening of the affliction by the analysis and management of human reaction (Parahoo, 2014). Nurse practitioners use their leadership attributes to ensure that the nursing profession continues providing quality services to the whole world because nurse practitioners normally have maximum capability to provide health care to all people even those who are perceived mental challenge because of their scope of work and advanced training.
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Reducing Nurse Burnout
Introduction
Burnout has been identified as one of the main factors impacting the performance of home healthcare nurses. This mostly results from long working hours and many patients to attend to, such that they end up being too exhausted and stressed out. The nature of work that nurses do is also exhausting, given that it involves standing and running around all day, with insignificant breaks between one assignment and the other.
While the straightforward solution would be to increase the number of nurses so that the work is manageable, this may not feasible due to economic pressures, hence the need to come up with strategies to help the nurses manage their current situation better. This paper is a discussion of the impact of conducting stress management training and implementing a home care visit scheduling system to reduce burnout among nurses.
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Discussion
Stress management training
A stressed nurse is likely to have low productivity and energy levels and thereby more prone to burnout. Stress management training would be highly effective in helping nurses cope with everyday challenges and ensuring that they live a balanced life. Abel, Abel and Smith (2012), note that a majority of people are overwhelmed by stress because they are incapable of making proper decisions and plans to address their daily stressors.
Training would help the nurses in identifying their sources of stress and how these can be managed to make life easier. Training for example could help them learn how to prioritize issues and thus make proper personal plans based on the time available to them.
When people experience symptoms of stress including constant headaches, poor concentration, forgetfulness and insomnia among other signs, there is a significant likelihood that they are not aware that they are suffering from stress. Stress management training would provide nurses with an opportunity to understand stress, its causes and effects (Dhobale, 2009). This way, it is possible for the nurses to evaluate themselves and establish the stressors in their lives so as to deal with them.
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Knowledge of daily stressors ensures that they can be effectively addressed using various strategies in order to relieve the affected person (Dhobale, 2009). Once the causes of stress have been identified, it is easier to anticipate them and make necessary plans to ensure that they do not overwhelm the nurse again.
This in itself addresses the issue of burnout because absence of stress means that the individual has more energy to execute their duties. Dhobale (2009) notes that after training, self-management of stress through psychological techniques, physical exercise, breathing exercise, massage and indulgence in hobbies among other things is likely to be witnessed.
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Poor time management is a leading factor in triggering stressors as noted by Abel, Abel and Smith (2012). This is a common problem among home healthcare nurses and can be a major cause of stress. It is difficult for nurses to determine how much time they will spend with a patient because of lack of a properly laid out time plan. Stress management training places major focus on time management as a strategy to reduce stress.
Through this training, nurses would be taught how to schedule their home visits and how to plan their time to ensure that they only take the necessary amount of time to attend to a client. This will ensure that the nurses attend to more patients with lesser time, thus reducing burnout to a great extent. The fact that the nurse is likely to have adequate time for non-work activities in order to create a proper work-life balance leads to a reduction in the occurrence of burnout.
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Stress management training for nurses is not only useful to them but it can also help close acquaintances and colleagues. Milliken (2007) notes that the knowledge gained from the training may be passed on to other people, who would also benefit from better stress management. Assuming that the beneficiaries are mostly other nurses, the result would be a less burnt out workforce.
Home visit scheduling program
Designing a system that effectively schedules home visits would play a great role in reducing burnout among nurses. In the absence of a well designed system, nurses design their own schedules and often maintain unpredictable hours (Hall, 2011). In most cases, home visits are not well planned and nurses mostly end up spending so much time in one home and hence rescheduling consequent visits. They also have to travel frequently to keep up with the visits, hence increasing exhaustion.
Furthermore, a majority of nurses do not have a structured home visit plan to guide the visit and this often results in poor time planning (Mankowska, Meisel and Bierwirth, 2014). A system to schedule home visits would clearly indicate the number of homes to be visited each day, the number of hours to be spent in each house based on client needs and the issues to be addressed by the nurse during the visit. This would save time and thus reduce burnout.
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A scheduling system for home visits would ensure better coordination between healthcare workers and thus reduce conflicting schedules and information gap. Where there are different healthcare workers attending to the same patient, there may be conflict of schedules and thus difficulty in coordinating services (Pinelle and Gutwin, 2003). In the event that a nurse finds a patient being attended by another healthcare worker, they are forced to wait for them to finish with the patient or postpone the session and thus end up wasting a lot of time (Mankowska, Meisel and Bierwirth, 2014).
Due to the fact that each healthcare worker makes their own notes which are rarely shared because they are made on paper, it is difficult to track reports of other healthcare workers attending to the patient, which may bring confusion. It also becomes difficult for synchronous communication to be initiated because health workers cannot trace other healthcare workers’ schedules to know when they are available (Pinelle and Gutwin, 2003).
Such kind of communication breakdown can be addressed through the use of a scheduling system, which ensures that each healthcare worker logs in information concerning their sessions with the patient. Through the system, it is easy to follow schedules made by other healthcare workers, such that nurses can plan the most appropriate time to see clients to avoid time wastage, as well as identify the best time for synchronous communication (Pinelle and Gutwin, 2003). Improved efficiency is not only expected to increase productivity but it also reduces the probability of burnout among nurses.
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The home visits scheduling system is bound to improve efficiency in terms of number of homes visited per day and also save nurses long exhausting hours of travel (Mankowska, Meisel and Bierwirth, 2014). The system would cluster homes according to location in order to plan for effective travel. Visits would be scheduled in such a way that homes in the same area are clustered for same day visits as opposed to visiting different areas the same day. This would reduce the travelling time and also reduce exhaustion, consequently reducing burnout.
Considering the fact that the system has all the information about clients in one place, the nurse can easily retrieve information and make well-versed decisions based on the information. This works better than using client files because not only is the information easily retrievable, the nurse can make updates and easily compare notes for different clients. Such information can guide the nurse on areas of care to concentrate on, based on client history. Availability of information at the click of a button would go a long way in reducing burnout among nurses and thus enhance productivity.
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Conclusion
It is undeniable based on the discussion that stress management training and introduction of a home visit scheduling system would be effective in reducing burnout among home healthcare nurses. Notably, training nurses on stress management will ensure that they are more aware of their daily stressors, why they occur and how to deal with them. Time management taught during this training is also highly important in promoting efficiency and reducing burnout.
The home visit scheduling system would make it easier for nurses to plan visits, avoid conflict visits and promote communication synchronization. Through this system, visits would be well planned and there would be reduced rescheduling of visits. This essentially translates into less burnout by the nurses. The stress management training and home visit scheduling would therefore impact home healthcare nurse burnout in a significant manner.
Hall, R. (2011). Handbook of Healthcare System Scheduling. New York, Springer Science & Business Media.
Mankowska, D., Meisel, F., & Bierwirth, C. (2014). The home health care routing and scheduling problem with interdependent services. Health Care Management Science, 17(1), 15-30. doi:10.1007/s10729-013-9243-1. Retrieved from eds.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=12&sid=a576b81a-91da-4e90-bca3-a6f0a26ae995%40sessionmgr114&hid=111
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Advanced Practice Nurse
Introduction
As a nurse in Plainfield community at union county New Jersey, it is essential for me to prepare for the metamorphosis within the nursing practice. Expanding my role of practice within this region remains an essential factor that needs to be achieved through the advancement of nursing practice that entails a transformative effect within the healthcare system of Plainfield community at Union County in New Jersey. This paper therefore needs to analyze the significant roles and status of my practice within the state of New Jersey as an advanced practice nurse.
The States Report Card
According to the New Jerseys report card, the state of New Jersey has a population estimate of 8,938,175 with the poverty rate of this state standing at 11.4%. The health indicators within this state indicate that some of the chronic diseases that are prevalent among this population include cancer, asthma, diabetes, chronic kidney diseases, HIV/AIDS, Heart diseases and stroke, and tuberculosis (Centers for Disease Control and Prevention. 2013).
The reports also clearly indicates that the access to health care services and resources is more than the lack of health insurance with the understanding of public health care systems and having care providers remaining some of the key elements that determine the manner in which access to these services are employed(Green, Tones, Cross & Woodall, 2015). This indicates the reason why this state is captured in the health report card.
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How this Impacts Community Needs In Terms Of Access to Health Care
In other words, this factors impact the needs of the community in relation to access to resources as a result of the decentralization of resources and nursing staff that is steadily rising. This critically points to the need of advancing my nursing knowledge in order to provide quality services within this community.
How These Community Needs May Impact my Nursing Roles
It is vital to consider that the needs within this community have an impact in my nursing roles. In this case, there is a need of developing good skills through the acquisition of education with the aim of performing the required roles within this region. On the other hand, there is a need of having a clear understanding of the community and their health needs in order to perform my nursing roles effectively (The National Organization of Nurse Practitioner Faculties, 2012). This therefore requires the application of knowledge on the specified areas that are of challenge within this community in order to meet there health needs.
The role of the advanced practice nurses in my practicum clinic setting and how they differ
In determining the role of my practicum setting and the manner in which they differ with that of an advanced practice nurse within my community, it is vital to consider that the aspect of resource dispensation and nursing education varies to a wider extent. These roles are considered to vary in accordance to their purposes and the philosophy that critically focuses on specified roles within the environment (U.S. Department of Health & Human Service, 2013). However, this points out to the need of effective skills and education in achieving the expected outcomes within this community.
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My Community and the Impact It Has On My Clinical Practice
On the other hand, it is also vital to consider that my community has an impact on my clinical practice. This is attributed to the fact that there are several health needs that need to be met and that require the appropriate skills in handling. As a result of this, there is need to ensure that appropriate measures are in place to aid in addressing the communities health needs including staffing the community health centers with an advanced practice nurse.
Conclusion
Expanding my role of practice within remains an essential factor that needs to be achieved through the advancement of nursing practice that entails a transformative effect within the healthcare system of Plainfield community at Union County in New Jersey as an advanced practice nurse.
References
Centers for Medicare & Medicaid Services. (n.d.). Retrieved June 11, 2013, from http://www.cms.gov/
Green, J., Tones, K., Cross R., & Woodall, J. (2015). Health promotion: Planning and strategies (3rd ed.). Thousand Oaks, CA: Sage. Chapter 5, Information Needs? (pp. 211-256)
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Nurse Managers Career Planning
Nurse Managers have demanding and complex responsibilities that involve coordinating work of individuals with varying education, skills, and personalities of providing safe, high quality patient care. The Nurse managers are accountable for staff performance, resource utilization, financial management, and patient outcomes. The Nurse Managers also ensure that patient care is delivered in line with the standards of practice and organizational ethics and policies. According to Anonson et al., (2014), good nurse managers provide leadership and ensures that his/her department runs smoothly.
After evaluating myself with the skills inventory, I found that I have the various strengths and weakness in the following areas;
Personal and Professional Accountability
First, I noted that I am competent enough when it comes to personal growth and development. This is because I hold a Bachelors OF Science Nursing (BSN) degree which has equipped me to meet the demands weighed on today’s nurse. With this degree, I have acquired skills in critical thinking, case management, and health promotion in order to practice across various inpatient and outpatient settings. I also possess leadership skills that are crucial for anyone that would like to serve as a nurse manager. In my practice, I adhere to the expected nursing codes of ethics.
However, I am a novice when am required to make appropriate decisions surrounding the several ethical dilemmas in my practice. For instance, a teen who had been diagnosed with syphilis due to unprotected sex asked me to lie to her mum about her condition. Moreover, I am also an active member of several nursing associations such as the American Nursing Association (ANA); an important institution that safeguards our welfare as nurses.
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Career Planning
I am an expert in this area because I understand my role as a BSN nurse and what is expected of me. I also intend to pursue a master’s degree in Nursing. However, I have not yet decided on the program I need to pursue.
Personal Journey Disciplines
I noted that I am an expert in this area. I have vital management skills that can aid me in educating and supervising staff without micromanaging. I can use conflict resolution and negotiation skills to enhance collaboration between physician, staff, and clinical leaders. I can also mentor and coach stuff at all levels. Moreover, I am flexible hence I can adapt quickly in the field of healthcare as patients usually develop problems. However, I find it a bit challenging to make agent decisions of care on my own in accordance to the changing needs. I prefer consulting someone else before I can implement a decision.
Reflective practice reference behaviors/tenets
After rating myself on this area, I found that I uphold integrity and transparency in all my dealings. I also have the desire of developing my potential. For instance, I usually challenge myself to attain the standards that some of my predecessors in the field of nursing have set. This aids me to discover my potential, know my weaknesses and strengths whenever I want to attain certain goals.
However, I do not know how to create and maintain a balance that renews and regenerates my spirit and body so that I can grow continually. This is because I usually find myself being caught up in the profession, squeezing some personal time relax and rejuvenate has always been a challenge to me risking work burn out.
Reflective practice is one of the most important pillars in my career. It aids my making sense of human frailties such as mental and physical health and the dynamics between the relationship between human beings and the system in which they function.
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Often, leaders are charged with the responsibility of creating change processes in an organization (Schaffer et al., 2013). Change processes that involve upgrade of tools and techniques, human resources, and basic rules and controls within a hospital are the mandate of managers within the organization. With my leadership set, I will be able to make the change initiatives real and tangible rather than abstract.
I will also ensure that I awaken the enthusiasm and ownership of the proposed change within the organization. My leadership set also helps me to be accountable for filling the gap between strategic decisions and the certainty of executing the change within the workforce and structure of the institution. I will use my communication skills to ensure that the staff is updated on all change activities that are taking place and what we expect to achieve.
Thinking strategically is one of the goals for my leadership growth. I intend to improve my ability of seeing the big picture and learn to step back from daily tactical details of my practice and concentrate not only on the “how” and “what” but also on the “why.”By being a critical thinker, I will hold all my views and reasoning to intellectual reasoning standards. This will aid in reducing ambiguity and confusion in the understanding of ideas and thoughts. Achievement of this goal will place me at a suitable position thinking deeply and broadly. My thinking will be driven towards being adequate, precise, and logical for my intended purpose.
Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence‐based practice models for organizational change: overview and practical applications. Journal of advanced nursing, 69(5), 1197-1209.
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New Graduate Nurse (NGN)
Transitioning from a student into a professional practitioner is a difficult experience for most people. However, the transition experience is especially difficult for graduate nurses who are ushered into a demanding work environment. Most new nurses are shocked at the sheer contrast between student life and work. Just a few weeks after employment, Graduate nurses are expected to take up serious responsibilities including patient care and supervisory duties.
This review explores literature on the New Graduate Nurse (NG) transition experience with the aim of discovering shortcomings in this knowledge area. This research hopes to bridge the gap in knowledge about self-care strategies that NGNs can use as the transition to Registered Nurses.
Background
Waves of research have studied the experiences of nurses as they transit from student to practicing Registered nurses. The first research wave focused on the experiences of individual nurses during the transition phase. The second wave, investigated the effectiveness of interventions meant to support nurses during the transition. Most studies into the experience of New Graduate Nurses (NGNs) used survey and interviews to arrive at their conclusions. The studies reported that NGNs initially found the role of practicing nurse extremely stressing and they reported many challenges.
However, role stress decreased as NGNs gained confidence, obtained clinical support and developed competence (Casey, Fink, Krugman, &Propst 2004; Halfer& Graf, 2006). NGNs described the transition as a difficult time filled with feeling or incompetence, fear of physicians, an overwhelming sense of responsibility, and difficulties in prioritizing, organizing or delegating tasks. Bowles and Candela (2005) carried a study in Nevada that sought to find the attrition rates of new nurse.
It was reported that approximately 30% of NGNs quit their first nursing jobs within the first year of employment. In just two years, 57% had moved from their first jobs. According to Bowles and Candela (2005), the high nurse turnover hinders work productivity, quality patient outcomes and the morale of the staff. Moreover, high turnover means healthcare organization have to incur the cost of rehiring and retraining new nurses to take the roles of those who leave.
While training more nurses may solve the nurse shortage problem, the problem of deficient patient care and supportive work environment needs to be handled to smooth the nurse transition. Casey et al (2004) found that NGNs are not satisfied with their working environment as they lamented the lack of a consistent preceptor, struggles with authority, a feeling of being undervalued, and workload issues. Chi, Laschinger and Wong (2006) carried out a study on transition among 226 nurses with less than 2 years practice experience.
The study reported similar results to Casey et al (2005); they indicated that there were high burnout rates among new nurses. The nurse complained about the lack of support, limitation of access to resources and opportunities as their main barrier to productivity at the transition phase. However, the job satisfaction outcomes of NGNs improved significantly after the first 18 months of practice. Halfer and Graf (2006) reported high job satisfaction rates among 84 subject of their research.
The two authors argued that nurse started to enjoy their work once they were able to organize their time, prioritize tasks, access resource, understand job expectation, and were made aware of the availability of professional development opportunities. Studies of nursing thought processes also indicate support the conclusion that the transition is a stressing time for graduate nurses.
According to Pellico, Brewer and Kovner (2009), NGNs’ confidence was initially low as they were unsure about the experience and knowledge , they also feared the interaction with patients as they felt they would not be able to understand their issues. NGNs were also worried about acting autonomously and deciding when it was necessary to call physicians. By the 9 month, NGNs had significantly boosted their confidence and were able to make competent patient care decisions.
The research wave on NGNs’ transition experience was followed by studies that investigated institutional initiatives to smooth the transition. The second wave was concerned with the preceptor and recognized him/her as a crucial component of the NGN transition process (Bowles and Candela, 2005). This phase of research proposed formal classes; evidence based practice, and guidance and mentoring as crucial precepts of nursing practice.
The studies proposed that all medical care should be involved in precepting, the presence of a designated preceptor and rewards for those who successfully carry out the preceptor’s role (Bowles and Candela, 2005). Some studies indicated that extended residencies and structured orientation to support the NGN transition improved job satisfaction and reduced the high nurse turnover. NGNs have complained about limited orientation, disorientation, feelings of confusion and loss, overwhelming responsibility as the main barriers to successful transitions.
The difficulties of the NGNs transition to practice are further complicated by other changes in their life (Scott, Engelke and Swanson, 2008). NGNs may have moved to a new town, become married or changed schools. Obviously, the new nurse transition face is fraught with difficult and there is need for support and self-management strategies to handle the stresses of this phase of a nurse’s career.
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Experiences of New Nurses
NGNs transitioning issues can be classified into four broad themes; demands on nurses, support at the workplace, the control of their role as employees, and perceptions of self efficacy (Bowles and Candela, 2005).
Workplace Demands
Demand in the workplace on new nurses is a theme that has been explored by many studies. NGNs identified workplace demands such as staff shortages, workload, decision making responsibilities and administrative duties as overwhelming issues (Casey et al, 2004). A survey of newly licensed nurses around the US found that demands relating to time were among the most stressing issues for NGNs. Nurses complained that they were often required to work hard or fast by their supervisors.
Casey et al (2004) also noted that nurses found it stressing to take responsibility for patient care provided by unregulated staff. Unfortunately, nursing has the dubious distinction of being the only profession which requires new practitioners to assume supervisory duties. Studies exploring the expectations of the multidisciplinary team working with new nurses reveal too high expectations of the (NGNs Waite, 2004). At eight weeks, the multidisciplinary team studied in the research expected new nurses to be able to make specific clinical assessments, be able to use laboratory data, and be able to react to emergencies (Dyess and Sherman, 2009).
In addition, the team expected the NGNs to be knowledgeable about the whole health systems. Many employers have complained about the deficit of key skills and the readiness of NGNs to deal with the demanding clinical environment. NGNs critical thinking skills and approaches to medication administration have also been called into question by some scholars. Romyn et al (2009) argued that NGNs are often responsible for near misses and medication errors as they are not proficient enough handle the medication demands of the job.
According to Edwards et al (2015), the concerns about the competence of NGNs are not unwarranted as competent performance is not guaranteed while working with graduate nurses. The lack of a consistent system to measure the performance of NGNs also further complicates the expectation of competence placed upon them. One of the common criteria for measuring competence in nursing is speed and ability to complete specific tasks (Romyn et al, 2009).
Unfortunately, the speed of New Graduate nurses may be quite low and they may not have the same capability to handle patient issues as experienced nurses (Delaney, 2003). This method of evaluating the performance of NGNs sees their work condemned as unsatisfactory and is often associated with stress among the new graduates joining the workforce.
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Control
Many NGNs report concerns about the control or autonomy of their new roles as practicing nurses. Many new nurses complained that being responsible and accountable to patients was stressing (Delaney, 2003). Duchscher and Cowin (2004) pointed out student nurse roles did little to equip NGNs for the responsibilities awaiting them in practice. Duchscher and Cowin (2004) support the view that patient care decision and outcome responsibilities often overwhelm new nurses.
However, the reactions of the NGNs varied as some embraced the new responsibilities, but most reported a feeling of being overwhelmed (Delaney, 2003). Researchers have argued that control is a double edged sword in the transition period. For nurses who embrace responsibility and accountability easily, it is exhilarating and exciting. In contrast, control brings about a feeling of anxiety for nurses who are unprepared for the new responsibilities.
NGNs may also suffer disorientation and poor sense of control as a result of unfamiliarity with the practice environment. NGNs are surprised when they realize that the practice environment is significantly different from the school context (Duchscher, 2001). Chang and Hancock (2003) argue that NGNs can experience as a result of uncertain expectation of the new role which gives rise to role ambiguity.
Support
Support by supervisors or coworkers plays a significant role in easing the NGN transition process. Often NGNs expend much effort in trying to familiarize themselves with existing workers in their healthcare setting (Casey et al, 2004). Duchscher and Cowin (2004) note that NGNs are in need the support of other members of the multidisciplinary team. Majority of NGNs report that there are adequately supported by preceptors and colleagues (Delaney, 2003).
They also reported that they felt part of the team. However, new nurse could not challenge established ways of doing things as they lacked support in doing this. Nurses also need support from family and friends outside the workplace. In fact, nurse reported that they performed better when they received support from outside the workplace.
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Self-efficacy
Casey et al (2004) reported that NGNs feel incompetent and inadequate as they begin practicing as nurses. Many new nurses report feeling as if they did not posses the necessary skills or knowledge to work as Registered Nurses (Delaney, 2003; Duchscher and Cowin, 2004). NGNs also greatly doubted their clinical competence as they lacked a frame of reference unlike experienced healthcare workers (Duchscher and Cowin, 2004). Duchscher and Cowin (2004) points out those NGNs felt their inadequate knowledge was a serious limitation. However, NGNs reported higher self-efficacy and confidence scores as they continued to gain clinical experience.
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Transition Impacts
Job stress
Job stress is one of the most widely reported results of the NGN transition (Delaney, 2003; Duchscher and Cowin, 2004; Twibell et al 2012; Pellico, Brewer and Kovner, 2009). Despite the emphasis on job stress in many studies, few have investigated the intensity of stress affecting NGNs. Chang and Hancock (2003) reported that the transition experience resulted in moderate amounts of stress among NGNs. According to Casey et al (2004), NGNs comfort and confidence is initially very high as the new graduates join the profession, however, it decreases with time in the job.
Fortunately, nurse comfort and confidence starts to increase as they gain experience and peaks one year after commencing practice. Chang and Hancock (2003) reported that nurses experience many stressors during the transition process. According to the two, the initial stressors include role ambiguity and responsibilities. After one year of employment, the main stressor is role overload.
Job Satisfaction
One of the most ignored outcomes of NGN transition is the job satisfaction impact. Common studies have emphasized on the challenges experienced during the transition phase but rarely have the satisfying job aspects being explored. Delaney (2003) reported that some new nurses reported that they found their new roles as practicing nurses satisfying. Nurse’s satisfaction with their work increased when they started to recognize available opportunities for personal growth and development.
Some NGNs reported that it felt exciting to finally take up the role of a practicing nurse. However, NGNs also reported many dissatisfying elements in their work, these included dizzying pace of work, inadequate staffing and too much autonomy and responsibility (Pellico, Brewer and Kovner, 2009; Casey et al, 2004; Chang and Hancock, 2003). Nurse who were satisfied with their work also were also more intent on staying with their employer.
Further research explored job satisfaction as an independent variable and presented interesting research findings. Delaney (2003) reported that nurses who were satisfied with their jobs felt a strong sense of belonging to the organization. Satisfaction in jobs was also negatively associated with role stress, role ambiguity and conflict during the transition process (Chang & Hancock, 2003).
Research has also explored outcomes such as turnover intent and nurse turnover. Many of these outcomes increase when there is shortage of nursing manpower. A high patient:nurse turnover is likely to precede and increase in patient mortality and has been indicated as an accelerator of nurse burnout (Bowles and Candela, 2005). Nurses report that the main causes of high turnover among NGNs are poor work design and emotional exhaustion.
These result support the need to research into self-management strategies that nurses can use to cope to the stressing experiences of the transition process. Twibell et al (2012) have hypothesized that self-care strategies may help nurse achieve higher levels of satisfaction with their jobs.
Interventions to support NGNs
Decades of research have popularized the notion that NGN transition is a process that needs to be addressed (Bowles and Candela, 2005). Many interventions have been applied to assist is making the transitioning process easy. However, there are few reports of intervention that aim to teach nurses how to self-manage the transition by performing recommended self-care practices.
Early studies recommended the use of internship programs and preceptor pairing to expose the nurse to the “real world” prior to commencing practice (Bowles and Candela, 2005). However, the value of preceptor and internship programs have come into questions recently and new research is needed to clarify the value they add to the NGN transition process.
One of the gaps in NGN transition research is the lack of measurement of the effectiveness of interventions to support NGN transition (Bowles and Candela, 2005). Many of the early studies, presented subjective results of the effectiveness of the interventions they were studying. Later studies in the late 1980s started to include quantitative measures of the effectiveness of the interventions (Casey et al 2004). However, most of the studies failed to measure the impact of the studies on patient outcome. Some of these studies are included in this review.
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Conclusion
The NGN transition process is a well researched area within the nursing profession. Most stakeholders seem to be aware of the problems that face NGNs as they transition into their practice. Decades of research present findings detailing mostly ineffective interventions to deal with the NGN transition process. One of the most common intervention experimented in research was the use of internship, residencies and preceptors. However, many researchers call into question the usefulness of these interventions in addressing the problems of new nurse’s commencing practice.
This research reveals two reasons why intervention to smooth the NGN transition failed to work despite decades of research. First, the early interventions were never objectively evaluated and thus the opportunity to gauge their effectiveness and increase their impact was missed. Furthermore, most of the intervention were designed to address problems identified in specific health care settings and were not backed by an understanding of the issues facing NGNs.
Few of the interventions sought to get to the bottom of the stress experienced by NGNs. Secondly, the interventions failed to take into consideration the many elements of the practice environment. This review presents some of the environmental factors that lead to a difficult experience for NGNs transitioning to practice. NGNs perception of their own abilities and knowledge is among the most stressing factors.
Many NGNs feel incompetent and inadequate when there are starting out. This attitude contrast sharply to the work demand, high expectation, and responsibility that characterize their work environment. Other healthcare workers expect nurses to exhibit the same level of competence and skills as experienced practitioners less than two months after being employed.
Few nurses are prepared for the sudden responsibility and autonomy they have over patient care decision. Many find the new responsibility overwhelming and are stressed. However, a substantial number of new nurses are excited and exhilarated to work autonomously. This review also indicates that support from colleagues, supervisors, family and friends are important for a successful transition. Nurses who receive support express confidence in their ability, Skills and knowledge.
This review has revealed that the NGN transition process can be an extremely stressing period. Many studies point to the stress and emotional distraught that is experienced by NGNs during the transition. Most studies report that new nurse feel overwhelmed by the demands of the new environment, feelings of inadequacy and fear of failure. Very few studies have investigated the possible positive impact of self-care mechanism that may assist nurse’s cope with the difficult transition period. This research will seek to address this gap in research and provide valuable evidence that may be used to improve the NGN transition experience significantly.
References
Bowles, C., & Candela, L. (2005). The first job experiences of recent RN graduates. Journal of Nursing Administration, 32(3), 130Y136.
Casey, K., Fink, R. R., Krugman, A. M., & Propst, F. J. (2004). The graduate nurse experience. Journal of Nursing Administration, 34(6), 303-311.
Cho, J., Laschinger, H., & Wong, C. (2006). Workplace empowerment, work engagement and organizational commitment of the new graduate nurses. Nursing Leadership, 19(3), 43Y60.
Duchscher, J. E. B., & Cowin, L. S. (2004). The experience of marginalization in new nursing graduates. Nursing Outlook, 52(6), 289-296.
Dyess, S. M., & Sherman, R. O. (2009). The first year of practice: New graduate nurses’ transition and learning needs. The Journal of Continuing Education in Nursing, 40(9), 403-410.
Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2015). A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse.International journal of nursing studies, 52(7), 1254-1268.
Halfer, D., & Graf, E. (2006). Graduate nurse perceptions of the work experience. Nursing Economics, 24(3), 150.
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), 194-203.
Romyn, D. M., Linton, N., Giblin, C., Hendrickson, B., Houger Limacher, L., Murray, C., … & Weidner, A. (2009). Successful transition of the new graduate nurse. International Journal of Nursing Education Scholarship, 6(1).
Scott, E. S., Engelke, M. K., & Swanson, M. (2008). New graduate nurse transitioning: necessary or nice?. Applied Nursing Research,21(2), 75-83.
Twibell, R., St Pierre, J., Johnson, D., Barton, D., Davis, C., Kidd, M., & Rook, G. (2012). Tripping over the welcome mat: Why new nurses don’t stay and what the evidence says we can do about it. American Nurse Today, 7(6), 357-365.
Waite, R. (2004). Psychiatric nurses: Transitioning from student to advance beginner RN. Journal of the American Psychiatric Nurses Association, 10(4), 173-180.
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Nursing is a very challenging and demanding career. I am willing to follow a career in which I am able to help and care for people, becoming a nurse would allow me to achieve this determination. Nursing is a career for enthusiastic, consistent, trusting people who are able to improve relations with patients quickly.
I have this expertise and I sincerely want to make a difference to people, to contribution them and their families over and done with challenging times when they are at their most vulnerable. The role of nursing is changing as nurses are distant more involved in the prosperity of patients and this is insertion more responsibility on nurses.
Nursing has constantly been there an ambition of mine and appreciative this takes potentials such as being faithful, spontaneous, supportive and appreciating outstanding communication skills. The ability to play delicately and being self-confident when handling the suffering of parents. Nursing profession plays an important role and also be reliable, trusting, able to develop relationships, be interactive, compassionate, motivated, ambitious and hardworking.
My course has given me the opportunity to gain new and inspiring understanding from each of the various units we have studied. I believe I have these potentials and will improve further knowledge, skills, and abilities. Overall I believe I am right for this course I am very much a people person, easy going and very responsive.
I can correspondingly manage in a multiplicity of situations, I always effort my inflexible as I am highly enthusiastic as well as self-motivated. In my opinion, it is significant to have good communication skills, be caring, concerned and open-minded and always be point toward to improve.
There are times when I find my job concentrated and strenuous but it agrees me to grow as a being and develop as a caring expert. I want a job that is inspiring, that will reduce my restrictions and always make me learn. I am responsive of the implication research plays in improving healthcare and accomplished a research project. This involved a lot of arrangement, training and time management. My study turns around sustaining self-respect and high opinion in the care of older patients.
It is a topic I feel intensely about and one which I reflect every day at work. Although training as a work-related therapist, I worked together with other healthcare medical practitioner and became progressively more interested in the nursing profession. I worked with people of all ages with physical, mental and learning ill health in a range of diverse backgrounds and saw the positive effect nurses had on people. Resulting finishing point of my degree I initiated work as a health care associate.
To become a nurse would be to live my life doing something I am passionate about. I will bring determination, a preparedness to learn and a positive frame of mind. I want to do a job that difficulties to people and I want to be able to increase vitality and encouragement the mental state of patients.
I am both motivated and anxious at the observation of becoming a nurse and I am more than agreeable to set all I can interest in pleasant a great one. I am self-confident of taking on this challenge and to take advantage of these changes and opportunities and use them to further my career. I am deeply obsessive about nursing and I am now looking forward to an extensive and achieving career in this field.
The need for a trajectory plan cannot be ignored in the life of a nurse. This is based on the fact that it ensures that goals are set to guide the career path. Despite the career path chosen by a nurse, there is a great need to have this plan, both on a short- and long-term basis, and revise it regularly so that appropriate adjustments can be made. For a novice advanced practice nurse intending to transit successfully to a professional informatics role and specialize in the same, the trajectory plan can help to a very great extent.
Purpose statement; for me to be able to transition properly to the informatics nurse specialist role, being very dynamic and focused can promote efficiency.
The plan
As a nurse I possess some strengths that have enabled me practice effectively with time, as well as ensure positive outcomes at the work environment and for the patients. I possess strong communication skills and I can manage applying problem solving skills to different scenarios to solve practice issues. Whenever offering care, I use the patient-centered or individualized approach, that enables me assess the personal factors contributing to the state of health.
I have strong critical analysis and judgment skills, and I normally apply the various ethical frameworks and code of practice, as well as the professional standards when offering care. This enables me practice based on the requirement. To develop as the informatics nurse specialist, I would need to be more computer competent and be more knowledgeable about the various technologies (Robin, Xavier & Agrawal, 2016). My coordination and time management skills would also need to improve so that I would not cause delays and inconvenience other multidisciplinary team members.
As an informatics nurse specialist, I can easily become a nurse educator or nursing administrator. In case I intend to concentrate on information technology, then I would easily become an information technology nursing advocate or even a chief information officer. At the same time, I would be acting as the bridge between information technology and the clinical universe spheres. Therefore, both professional growth and career opportunities are immense in this role (Robin, Xavier & Agrawal, 2016). Other related specialties include consumer needs consultant, research nurse or public health nurse.
The talents and strengths that I would need to focus on so as to be highly competent in the role include decision making and judgment. This would enable me choose appropriate actions considering the relative benefits and costs. Moreover, critical thinking, active listening, and reading comprehension would enable me remain highly relevant to the needs of my patients. At the same time, the complex problem solving skills would need to be emphasized. Monitoring and assessing performance would enable uptake of proper actions at all times.
Additional skills and knowledge would also help. One of these is instructing, that is, teaching others on how they can do different things. Technology design would enable me adapt and generate technology and equipment to the server user needs. At times, it would be necessary to apply mathematics in solving problems, making this a very essential skill.
The coordination skills would greatly help me to adjust actions based on the actions of other people. With negotiation skills, I can easily manage personnel resources by directing, developing, and motivating people as they carry out their various roles. These skills and knowledge are indispensable in enabling me function appropriately as an informatics nurse specialist (Nelson & Staggers, 2013).
One of the strategies for promoting a successful transition would be reading and attending trainings where I would learn more about the role and what it requires to be effective in it. While acquiring the different knowledge and skills, I would visualize myself in the role and begin practicing while applying these. The second strategies would be talking to people who are already practicing as informatics nurse specialists.
This would be done with the aim of ensuring that all the challenges they face are highlighted so that while getting into the practice, I can know what to expect. The essentials would also be highlighted, making me prepare my mind effectively so as to be effective (Robin, Xavier & Agrawal, 2016). Apart from attending trainings, I would also carry out personal researches to know how the experiences of people has been. At the start of my role as an informatics nurse specialist, I would work alongside a more experienced person who can guide and orient me accordingly.
Within the next 2 or 5 years, I intend to join a network of informatics nurse specialists, either online or at the workplace. this will enable me remain connected and be conversant with all the issues that are coming up and how to address them. I intend to contribute actively in the network and in case there is none at the moment, I can create an online group. I also intend to have explored one or more of the career growth and advancement opportunities I have.
I am really interested in being a nurse education, as this will enable me transfer the immense knowledge and skills I have to others (Fitzpatrick & Ea, 2012). While doing this, I will also be learning a lot. At the same time, I intend to explore the research nurse role, where based on the issues that are being raised by the nurses I am educating, I can conduct some researches. This would enable me transform the practice and promote the uptake of the evidence-based practice.
To achieve these goals, I intend to manage my time very well. On a daily basis, I will have a list of the most important things I should do and ensure that procrastinating is avoided. Through proper time management, I will have adequate time to do many of the things I intend to engage in, as well as assist my colleagues (Fitzpatrick & Ea, 2012).
The second action will be ensuring that I am focusing on efficiency and keeping away from errors. This will greatly prevent a situation where the errors can make me keep going back, which would mean wasting a lot of time. at the same time, the need for a proper work-life balance cannot be ignored. This will constitute of ensuring that work time is dedicated to work while personal issues and family have their time.
Conclusion
The trajectory plan above can greatly promote success as an informatics nurse specialist. It is apparent that there are career growth opportunities with this role, and proper time management and planning can greatly promote success. Moreover, coordinating with others through networks can promote acquisition of knowledge. More importantly, efficiency would ensure that errors are avoided, which would prevent time wasting.
References
Fitzpatrick, J. J., & Ea, E. E. (2012). 201 careers in nursing. New York, NY: Springer.
Nelson, R., & Staggers, N. (2013). Health informatics: An interprofessional approach. New York, NY: Springer.
