The Transition – Nursing Student to New Grad

As I countdown the days until graduation, and even more so count down the days until I take the state boards, the mix of nervousness and excitement running through my veins is increasing at an exponential rate. I am beyond thrilled that I accepted my dream residency position at a level one trauma center. I’m having nightmares about the NCLEX and I lay awake at night fantasizing about what my life is going to be like in six months.

I know it’s been a while since I’ve posted, but I wanted to talk about something that I feel is extremely important, but neglected in the nursing programs. I want to talk about the transition. I came across an article in the Nurse Education in Practice journal from 2016 written by Jennifer Ortiz. It talks about professional confidence during the first year after graduation and the common setbacks that graduate nurses experience.

Transition Theory

There is a theoretical framework for the phenomenon that new grad nurses experience. To keep it short and sweet –

Doing: First 3-4 months – The grad nurse feels anxiety and self-doubt in the new role of a registered nurse.

Being: Next 4-5 months – Competency is increasing, but self-doubt and anxiety continue as the transition between dependence to independence solidifies.

Knowing: Final 8-12 months – The new grad has established him or herself as a professional and feels like a contributing member of the field.

I don’t know about you, but knowing that these stages have been studied and written about makes me feel better that soon I will be sharing these feelings with my colleagues.

Communication

Ortiz found that a huge lack in nursing programs is communication with other healthcare providers. In my school clinicals, I seldom interact with doctors, and I was never given the opportunity to give report or SBAR for a change in condition or critical lab result. The only experience I have with this is through the nursing internship that I applied for. Only a handful of students from my school participated in an internship; it was not a regular part of the baccalaureate program.

I have about 70 hours of clinical left for nursing school (out of almost 900), and each time I have offered or asked to pick up the phone and page the mid-level, pharmacist, or respiratory therapist, I was rejected with, “no, I need to do it,” by my preceptor. Many of those times, I was fully prepared and confident to deliver a concise SBAR. I am not bashing clinical preceptors. They need to protect their license and I fully understand that, but as Ortiz mentions in the study, “new graduates nurses recounted many difficult experiences which involved communicating with other members of the healthcare team,” even after six months.

If you are a nursing student reading this, I encourage you to elicit the help of your instructors to be more involved in multi-disciplinary communication. I regret not speaking up for myself more often. Although we practice communication in lab and with each other, I am not 100% confident in this skill.



Mistakes and Errors

Another challenge reported in the Ortiz study that has “a negative effect on professional confidence” is the occurence of mistakes. I already feel guilty for making small mistakes, like leaving too many air bubbles after priming IV tubing, or grabbing the wrong size Foley kit for my patient as a student, so I can’t imagine having a license and making larger errors. Throughout nursing school, they nearly tattoo the rights of medication administration on our foreheads, yet we always hear stories about lethal medication errors.

The fear is real. Will I ever make a mistake that results in a sentinel event? If I am being completely transparent, I’m a major people-pleaser. Years of retail experience toughened me up, but some days I feel like a failure if one little thing goes wrong. I’d like to think that I would never make a huge mistake, but it would definitely dampen my professional confidence.

One time in clinical, I put a dirty pillow in the wrong place, and my preceptor reprimanded me in front of a patient. I felt humiliated! I wanted to go home after that, and the relationship between that preceptor and I was effectively ruined.

I hope that I have a preceptor who stays on the positive side and encourages learning instead of punishment. I hope that my preceptor encourages autonomy early in the game. If you are a new grad or a preceptor of a new grad, I would love to hear your feedback on communication and errors!


Ortiz, J. (2016). New graduate nurses experiences about lack of professional confidence. Nurse Education in Practice19, 19–24. doi: 10.1016/j.nepr.2016.04.001

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