February 21, 2024

Navigating Entry to Practice in the Covid-19 Pandemic

In the winter term of 2020, I witnessed the immense stress and uncertainty students in my undergraduate courses, notably fourth years, were experiencing as the Covid-19 pandemic began to restructure students learning experiences. I knew new graduate nurse transition already had a variety of unique challenges, but I was really worried how the pandemic would further challenge entry to practice, especially as healthcare work environments were also trying their best to adapt, and the impact of that on supporting new grads wasn’t known. So, I did a little research! I asked New Grads from the 2020 cohort to tell me about their experiences during their first year of practice. Below I’ve summarized what they had to say, through four themes. The publication is also available open access (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9843155/) for readers who want more detail.

The data from this first study was collected in the summer of 2021, I asked new graduate nurses in Ontario who graduated during the first year of the pandemic to tell me about their transition into practice and what, if any, additional supports they felt they needed during their transition in this incredibly unique time. I interviewed new grads who worked in a variety of places in Ontario, including acute care, community and outreach, public health, and who worked with both adults and children. Many of them held multiple nursing jobs at the same time. What was interesting about this group, which I hadn’t set out to look at when I was recruiting, was that all of the participants wound up being second-entry nursing graduates, which means they already had a degree and prior work experience, which meant they didn’t complete the traditional 4-year program, they completed an accelerated program. It reminded me that there are different paths to becoming a new graduate nurse, and it’s important we learn more about how these different entry points into the profession may shape transition experiences. This includes students who transition from Licensed/Registered Practical Nursing to Registered Nursing.

The first theme identified was “virtual didn’t cut it”. Traditional consolidation was described as the capstone that ties it all together and serves as the gatekeeper to new graduate nursing. Participants described traditional consolidation as a time when they felt they would truly embody the nursing process; developing time management skills, further developing inter and intrapersonal skills and navigating complex political and power structures in the workplace. Whereas virtual consolidation, which all participants had now completed, was described as reductive and simplistic, and did not capture the complex dynamics of the work environment. These new grads really reflected on the need for education and support when it comes to managing the complexities of work environments, like managing multiple patients, and figuring out how to communicate in a variety of ways, and in challenging circumstances. New grads acknowledging these needs is fantastic, it speaks to them understanding how social and political structures do in fact, mediate so much of nurses’ work.

Theme two, “go where you know” resulted from participants feeling ill prepared in the absence of consolidation, so they made very calculated decisions about where they started their nursing careers. Participants deliberately chose to start their careers in places they had good clinical experiences in the past. Participants chose to work in environments they knew would support them, and where a culture of inquisition was supported, and expected. All participants spoke about the need to be able to safely ask questions, especially in light of their insecurities as it pertains to the absence of consolidation. I can’t emphasize how important this kind of thinking is, especially for new grads, to critically appraise whether a work environment seems as thought it will or will not be supportive and making a career decision based on that. This is new grads taking control over the work, and I was so thrilled to see this in the data!

Now the next theme, “picking up the pieces”, was a big theme, and speaks to that feeling of needing to fix the profession. These participants felt they were picking up the pieces of a very broken system and workforce, in a variety of ways. First, picking up the pieces within themselves, for example, participants spoke of having to rectify and reconcile what they thought nursing would be, to what it actually was, notably during a pandemic. A majority of participants also discussed having to work through the moral distress experienced from enforcing Covid policies, most notably visitor restrictions. At the collegial level these new grads were acutely aware of the immense burnout and psychological distress their more senior colleagues were living. This actualized itself in practice in many ways: one being overall poor morale, and another being apathy towards mentorship, which for a few of these new grads meant they were now preceptoring 2021 graduates. They were also seeing really high rates of attrition throughout the workforce, which they were seeing across Canada, not just in their workplace, which scared them, and made them feel their early careers would be very difficult in the absence of a strong workforce, worrying they would have to rebuild the profession and envisioning a really tough next five years. They were also, without prompt from me, speaking to how political structures were mediating nursing work and nursing morale, for example, many of them spoke to bill 124, which was the 1% wage cap on nurses in Ontario [now deemed unconstitutional], and highlighted how it directly contributed to sense of disregard from the government, and for these participants, made them feel that the government didn’t care about nurses or value their contributions to the wellbeing of people in Ontario.

But what they did with this witnessing was not what I expected, they took what they saw and began to set boundaries to protect themselves from the very burnout and attrition they were witnessing, which led to the fourth and final theme, “knowing when to say no and let go”. Participants spoke of knowing when to say no to work environments that contributed to burnout. Others also described overcoming other engrained narratives in the profession – like the idea of having to “put in your time” in acute care – over ½ of these participants had already left acute care, and half of them did not even start in acute care. All participants highlighted that acute care could not be a long-term career as it fosters high levels of burnout, so that was not where they saw themselves long term. Many were transitioning to community jobs that supported a better work life balance. Lastly, this group of participants were very comfortable with letting go of toxic work environments that did not support their own health and wellbeing and moving on to new workplaces.

What really stood out to me in this data, and this is more good news: These participants did not waver in their commitments to nursing and had no intention of leaving nursing. These participants were not scared to challenge their workplaces to give them what they needed to successfully transition, which often came down to the ability to safeguard their own mental health and wellness through supportive environments, and if they didn’t get that, they were more than willing to walk away and find an employer who did support them. They were willing to walk away from the employer, but not the profession, and I can’t stress how important that finding is. I hope this serves as a point of reflection for you all, and serves as encouragement, you do not have to fix the profession. You can move the profession forward by honouring your mental health and wellbeing, by setting those boundaries and calling people and workplaces out when they don’t support your psychological safety, and don’t take action to prevent burnout. These new grads mobilized something called socio-political knowing, this is when we understand and take into consideration how the social and political world around us mediate our lives, and for these new grads, they understood how nursing and their own nursing work was impacted by the social and political, and they used that knowledge to make career decisions, which is really important.

These new grads were setting really important boundaries to keep themselves well while simultaneously understanding that they are not responsible to fix an ailing healthcare system, as these complexities are mediated by so many social and political entities. This kind of thinking, and action to safeguard our own psychological and physical health is the future of nursing.

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Nursing The Future™ acknowledges that nurses across this country live, work and play on the lands of our Indigenous Ancestors and we join our members in expressing respectful gratitude for this privilege.
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