Since our inaugural month in December 2020, NTF has been on a robust journey through new graduate support, connection and education. Each of our strategies has welcomed amazing guests who provided us with insight on a multitude of contemporary nursing issues. We have hosted multiple NCLEX and CPNRE preparatory sessions in CONNECT, and we still have more to come. In our Speaker Series, Dr. Ruth Lee (Executive Director of CARE) gave an in-depth presentation on being an Internationally Educated Nurse (IEN) in Canada. We welcomed Linda Silas (President, Canadian Federation of Nurses Unions) to provide her thoughts on social justice and healthy public policy while Courtney Blake (Past President, Canadian Nursing Students Association) joined Speaker Series and touched upon the state of nursing in Canada with a lens on the challenges faced by students as they prepare to transition to their professional roles.
Our conversations with frontline nurses in The Interview welcomed Victor Ejike, a first-year nursing student in Regina, who spoke about his experiences as an international student and the importance of cultural diversity. Lionel Tancrede joined Anna Offiah to talk about being a male nurse in a largely female dominated profession, and his journey from undergraduate student to nursing professor. In our latest episode of The Podcast, Madison Cook spoke with Kim Scherr on the poignant experiences as a Nurse Practitioner leading the care of critically ill patients during COVID. Resiliency was discussed with Satvir Kaur, who shared her thoughts on the importance of resiliency in new graduates through the stages of their transition to professional practice.
Our latest Blog covers tips for writing the CPNRE, by Jessica Green: what resources are available, how are the questions are formatted and how does one dissect the questions in order to select the correct answer (aka what are they REALLY looking for in a question)? Lastly, make sure to check out the Book Club for an interview with Dr. Cynthia Clark, author of Creating and Sustaining Civility in Nursing Education (2nd Ed).
We encourage you to subscribe to NTF to receive updates on our upcoming events. Stay tuned and stay connected, there’s so much more to come!
(nominated by Natasha Klassen)
For my nursing mentor, I nominate my aunt Ladine Klassen. Ladine is a Registered Nurse working in a community health clinic, specializing in women’s health, in Winnipeg, Manitoba. Ladine took on a mentoring role in my life when I was in my mid-twenties and struggling to find my place in the world. My aunt and I have always been close; she has made sure to establish herself in the lives of her nieces and nephews as someone we can confide in. While discussing with Ladine my interests in sciences and in people, she invited me to shadow her at her workplace. Entering the exam room to meet our first client, we encountered a nervous young woman. The client was hesitant at first to discuss her health concerns, but Ladine worked to make her comfortable. She demonstrated patient centred care, tailoring the discussion to meet the client’s comfort level. She provided holistic care by inquiring about the client’s social and mental health needs. Shadowing Ladine in this role, I knew I had found my place. Ladine encouraged me to join her clinic’s volunteer counsellor program, through which I grew confidence and a passion for women’s health care. Ladine’s unique approach welcomes new nurses to the profession through the same warm, non-judgemental approach she uses with her clients and her nieces. She creates a safe space for trainees to debrief and seek guidance. I am grateful to have her as a mentor.
Nominations for the Torch Award are open! Head to our site to nominate a nurse leader, researcher, educator or frontline practitioner who recognizes the complexity of the transition experience, promotes initiatives aimed at supporting the healthy integration of new grads in professional practice settings, researches new graduate issues with the goal of advancing the knowledge base in this area of scholarship, evaluates new graduate initiatives with the goal of improving them for the future, implements supportive networks for the benefit of the new graduate population.
Nursing The Future is all about supporting and celebrating new nursing graduates from all practice pathways. Each newsletter, we highlight a new graduate who is blazing the trail upon which they tread. TrailBlazers take on their roles with courage, exemplifying the standards and principles of excellent nursing care in their daily practice. Nominated by their peers, TrailBlazers have demonstrated outstanding attributes as new professionals making a difference in their patients’ lives.
This month’s TrailBlazer is Haille Sparling from Kamloops, British Columbia. Haille graduated in April of 2020 and entered nursing practice during the height of the COVID19 pandemic. Transitioning during an unprecedented time in health care history, Haille not only persevered through various challenges, but has flourished in her nursing career.
Haille notes self-awareness and reflection as two vital pieces of her nursing practice. For both her patients and herself, she recognizes the value of acknowledging and validating the emotions that arise for both caregiver and patient, while working to reframe our responses to be more solution-focused. Haille recognizes that reflecting on her nursing practice, including what went well and what can be improved, will always make her a better nurse – and it shows. In these trying times, as a new graduate Haille has now practiced in three separate cities. Although this presents its own challenges, for Haille this experience has inspired her to become an exceptionally caring, knowledgeable, and courageous nurse. Now living in a new city, in a new country, Haille has taken her nursing career to new heights and continues to persevere through the COVID19 pandemic.
After graduation, Haille worked on a pediatrics unit in Kamloops, BC. From there, she worked on an adult medical unit in Penticton, BC. Most recently, this new graduate has taken a nursing residence position at Seattle’s Children’s Hospital where she will be specializing in the post-operative care of transplant pediatric patients. This one-year residency program will offer Haille the opportunity to build her nursing knowledge and receive ongoing mentorship, allowing her to become a well-rounded nurse who is able to treat patients holistically with respect, kindness, and compassion. As Haille begins this new journey, we cannot help but admire her courage, intelligence, and commitment to the nursing profession. Although Haille is interested in continuing her formal education in nursing, she’ll wait to see where her new position takes her before making any decisions.
We at NTF are so excited to see where nursing takes you Haille! Your attitude, compassion, and hard work is admirable and inspiring. Well done, you truly are a TrailBlazer!
Becoming a Nurse
BY JULIA LOWE
Throughout my undergraduate education, I’ve learned the skills it takes to be a nurse. I’ve learned anatomy, lab values, physiological processes, and the importance of caring. As I come to the end of my four-year RN degree, I’m faced with a new, unexpected lesson: what it takes to be a nurse. Nurses make nursing look easy. They walk with grace and confidence and are witness to some of the greatest intimacies of our lives. What they don’t show us is what is going on inside their minds. Nurses are thinking three steps ahead of others and preparing for multiple outcomes all at once. They respond to our health needs with urgency, honesty, compassion, and a little bit of humour.
As a student, we’re wrapped up in our theoretical learning, often with limited time and space to apply that knowledge to real life. Our schedule and our focus of study is constantly changing and at times we feel that we are running just to keep up. How do we make time during these years to understand what it means to be a nurse? We think we know… and then it hits us: nursing is big. As nurses we have immense responsibility, not only to our patients, but to our colleagues and to ourselves. As an emerging nurse, how do I balance these responsibilities, while maintaining a level head, healthy habits, and a dedication to my chosen profession? As new graduates, these questions and challenges flow through our brains almost every day, while we continue to be present in our practice and in our personal lives.
The reality of the workplace juxtaposes our protected cove of post-secondary education by immersing us in the reality of the sick and the healthy. After four-years of textbook reading and test writing, we now lay witness to the effects of comorbid health conditions on an individual’s quality of life. We see the effects of smoking on tissue composition, and the emotional toll that accompanies an adverse health event. We’re at the bedside as someone takes their last breath and in the operating room as a mother welcomes her newborn into the world. I’ve enjoyed and I value my undergraduate nursing education, but how could we be prepared for the unknown being thrown at us?
The most valuable lessons I’ve gained from baccalaureate nursing education is the importance of compassion, preserving dignity, and beneficence. No matter what the situation, carrying these principles close at heart is what makes nurses who they are. These principles are just as important in specialty areas as they are in medical-surgical areas. For my final practicum, I am in the operating room and these principles come into play with patients, my colleagues, and myself. Patients arrive to the operating room for an experience that most cannot prepare for until it is actually happening. For most patients in the operating room, it’s their first time being under anaesthesia: what’s going to happen to me while I’m not in control of my body? How will I know if the surgery is successful?
As perioperative nurses, we often do not know what has led to the need for the specific surgery for the patient, thus we must opt for the assumption that something unwarranted has occurred and treat the patient with compassion and empathy. The interdisciplinary surgical team works together in order to achieve a shared goal. Just as our patients deserve compassion and empathy, so do our colleagues. For most, we do not know what they are coming into work with, and the importance of beneficence in our interactions is imperative to the wellbeing of the team and successful reaching of the goal. Without our colleagues, our workplace would not exist, and maintaining the health of our care teams is imperative to maintaining the health of our patients.
Although I will be working on a medical unit upon graduation in April, I value my 13-week experience in the operating room and have surmounted an invaluable body of knowledge which I will take with me throughout my journey in nursing. The knowledge gained from this specialty area will provide me with a unique lens to utilize in my approach to care, not only for my patients and colleagues, but for myself as well. I have learned the importance of self-care, self-kindness, and self-understanding, for without these, we cannot do unto others as they so deserve.
I say goodbye to my nursing education and enter professional practice with excitement, elation, pride, and little bit of fear. I look up to senior nurses and my peers for their perseverance, knowledge, and continuation of this magnificent profession.
A Brief Scope of Nursing Mentorships
Programs at McGill University
Lia Sanzone, NPMP Director
What started off as: “Let’s make sure our students in their first year of nursing feel supported and welcomed?” back in 2014, has multiplied into numerous initiations to ensure the students’ success, not only as students, but as new nurse clinicians and as nursing faculty.
The Nursing Peer Mentorship Program (NPMP) , encourages liaisons between junior-yeared and senior-yeared students within the Ingram School of Nursing. It provides a platform for them to meet with the goal of helping new students feel welcomed and incorporated into a university-based professional program. Dyads are matched and workshops are organized based on various themes based on the students’ needs, such as ongoing French language workshops as well as Clinical Survival Skills Workshops. And we can’t forget our food-filled NPMP celebrations!
Over the years we have grown as a program starting from 35 to now 125 dyads per academic school year. Students can be involved from year 1 to as long as they like as graduated nurses.
Some student quotes describing their experience with NPMP at McGill’s ISoN:
“having a mentor who came from a similar background to me (came from [the] same province, looking to go back and work in the same province) helped me to see myself as a future nurse, especially since it was during a time where I didn't think I would be able to finish the program “
“this program has allowed me to feel less isolated during my studies, because as much as you have school friends, they will not always be the ones who you are comfortable to go to or who understand your situation”
“being a mentor in this program has really helped emphasize how important teaching is in the role of a nurse.”
“developed skills in relation to time management, but especially how to organize gatherings with a large group of people”
“the workshops and working with the NPMP team throughout my studies helped me to be flexible in terms of managing multiple roles while being a student.”
“learning the importance of teamwork and building strong bonds in the workplace is the best way to cope through adversities”
“this program has allowed me to be more aware of all the resources available and that everything is achievable either by yourself or with the help of others.”
“recognized the importance of resilience while working when facing challenges with colleagues, patients etc.”
“I've been an RN for 4 years now - if anything the program has helped me see how my resilience has grown over the years compared to when I was a student"
The African proverb of "it takes a village to raise a child, " highlights the importance of having our entire nursing community interact in nourishing ways with students, new graduates, clinicians and faculty to ultimately grow in safe and healthy environments.
Should you have any comments or questions please email me at firstname.lastname@example.org.
About the Author:
Lia Sanzone completed her undergraduate and graduate studies in Nursing at McGill University and has obtained a graduate certificate in health care management from Université Laval. She is involved in teaching at both the undergraduate and graduate levels of study in nursing at McGill University. Prior to taking on a full-time position at McGill , she worked in various clinical and administrative positions in community health. She has held several leadership roles in multiple committees at different organizational levels. Since becoming the Director of the Nursing Peer Mentorship Program (NPMP) in 2015, she has become a consultant for other national and international nursing schools and other schools at McGill University. In 2016, she was the recipient of the Excellence in Academic Advising by the Dean of Students and the McGill University Faculty of Medicine Excellence in Teaching Award. In 2021, she was also the recipient for Teaching Innovation in McGill’s Faculty of Medicine and Health Sciences for her work in the development and implementation for Inquiry based learning (IBL) pedagogy in the various nursing curriculums. As of June 2020, Professor Lia Sanzone has been appointed as the BScN Program Director at the Ingram School of Nursing at McGill University.
Creative Continuing Education
in the Context of Covid-19
Dr Sheri Lynn Price, PhD RN
I have spent the last 15 years studying nurses’ professional socialization – specifically attempting to understand the perceptions, expectations, and experiences aligned with a career in nursing. One consistent theme across all of these research studies has been a focus on knowledge acquisition, not only during the early stages of becoming a nurse or during transition to practice, but across nurses’ entire career span. Nursing and other healthcare professions are evidence-based practices that require ongoing continuing education. The COVID-19 pandemic has created many challenges for nurses, health professionals, healthcare and educational institutions in providing the best patient care. The need for evidence-based care in the context of this pandemic is significant. Researchers, educators and practitioners alike have been challenged over the last year to not only rapidly acquire, but also disseminate, evidence in a timely fashion that can enhance outcomes for our patients and populations around the globe.
Even though COVID-19 has changed the way we engage in some traditional continuing education and research dissemination activities (i.e., in-person learning), the exchange of knowledge must still take place. As a researcher, in addition to generating academic publications, presenting my findings at local, national and international conferences is an important dissemination strategy. Attendance at these research conferences are also popular continuing education and knowledge- acquisition strategies. Pre-COVID-19, I would attend several conferences a year - all requiring in-person attendance and associated expenses for registration, travel and accommodations. Although conference attendance is part of a researcher’s daily “job”, very few practising nurses or health professionals get the time and financial support to attend these events. As our world has swiftly evolved from in-person to online interactions, I have realized that there have been several unexpected advantages arising from our creative responses to knowledge-sharing during the pandemic. For example, the switch to virtual conferences can enable more participants to attend these events since there is no longer the need for travel and therefore no associated travel expenses. In addition, some of the conferences now record or post presentations which allows participants to ‘attend’ more sessions than they would if they had participated in- person given that you often had to choose among a group of concurrent events. In fact, given the budget and logistical (staffing) constraints that are often associated with sending a few staff members to attend conferences, the move to virtual attendance could be a way for healthcare organizations to support the continuing education needs of even more nurses and health professionals.
As a professor, I have also seen a pedagogical shift in how we educate. The pandemic has accelerated the adoption of a many creative approaches that can be applied to continuing education for nurses and health professionals, including a variety of digital strategies such as videos and podcasts, along with combined asynchronous and synchronous learning forums. The advantage to using some of these virtual educational approaches in the digital age, among an increasingly tech-savvy generation, is that we can increase access to new knowledge and new ideas. In addition, given the popularity of TED talks and presentations in 20 minutes or less to share ‘ideas worth spreading’, educators and researchers should be encouraged to employ a variety of creative, engaging and succinct strategies to disseminate knowledge.
There is much to be learned from the COVID-19 pandemic- not just about the virus itself, but also in regard to how it has impacted all aspects of our lives. My hope is that some of the arising pandemic-related research will also explore the impact and outcomes associated with new approaches to teaching and learning. Given that evidence-based practice and continuing education are expectations of health professional practice, I believe continuing education strategies must also be based on the best available evidence. I also believe that it is a shared responsibility between practitioners and employers to ensure that continuing education takes place. Across all of my research studies, regardless of career stage (student; early, mid or late career), nurses describe the importance of continued opportunities to develop new skills and knowledge. These needs are heightened during times of uncertainty such as what we are facing now in response to the pandemic. Finding innovative ways to bring knowledge to nurses and health professionals, where they work, in more accessible ways, can only enhance professional development and optimize evidence-based patient care.
Anita Robertson, RN CCCI CCNE
This past year has brought so many unexpected challenges for nursing education. Program delivery has changed, clinical placements have been cancelled, and milestones like graduation and awards ceremonies have been very quiet – if they occurred at all. It can be difficult to see the positives in this situation, but I would like to take a moment to celebrate the resilience and adaptability of nursing students and talk about some of the successes of the past year.
At Nunavut Arctic College, we work in partnership with Dalhousie University to deliver our BScN program. Given our remote location and small population, students travel to Halifax, Nova Scotia for a clinical placement in the spring semester of year 3 to gain experience with larger and more acute patient populations. For the class of 2021, this placement was cancelled due to travel restrictions. This class had also had the prior clinical placements cut short due to college closures and changes in Nunavut Public Health restrictions.
And yet, this group continues learning and developing, showing great flexibility and adaptability. We have replaced lost clinical hours with lab simulations, online clinical platforms, and group activities. We have been creative and negotiated non-traditional placement with agencies like the Department of Health Epidemiology Program, and started a leadership placement in which the Year 4 student functioned as a co-instructor for the Year 3 clinical group. The students have adapted to a combination of classroom and online learning for the theory components of their final year.
While we all have struggled with the isolation and lack of connection that 2020 brought, there has also been a great deal of learning and positivity that we have experienced. Living in the Arctic brings its own challenges. Communities in Nunavut are very far apart and only accessible by air. In the winter, a blizzard can bring a whole community to a standstill and prevent medical and emergency teams from coming and going. In the summer, fog can prevent planes from bringing in groceries and essential supplies. And yet we grow and thrive because we help each other, we learn from our experiences, we prepare for emergencies and unexpected events, and most importantly we listen to our elders who have walked this path before us.
The graduating class of 2021 will come out of this experience with a great deal of knowledge that is not immediately obvious, but that will be invaluable in their future nursing practice. Learning online requires a great deal of drive and self-discipline, as well as the ability to recognize one’s own learning needs and how best to fulfill them. Time-management and organization has become even more important as the line between work, school, home, and family has become blurred. How many of us have now learned how to write a paper while simultaneously making dinner, doing laundry, and entertaining a grumpy toddler? We never could have guessed that this would be the way nursing education would look, but we have all kept going.
Nursing in the Arctic is exciting and rewarding, but it also requires a level of dedication and preparedness that cannot be explained, only experienced. I congratulate our graduating class of 2021 for their tenacity and resilience. From this experience they will be strong, flexible, and compassionate in their nursing practice and help to bring culturally safe care to the people of Nunavut.
The Provision of Equitable
and Inclusive Care
Nadine Rae Henriquez, RN, MN
Brandon University, Brandon MB
New graduates are entering practice at a time of incredible adversity due to the Covid-19 pandemic. Populations are increasingly diverse resulting in rapidly evolving care-delivery settings. With rising demands across all settings, creating a climate of respect, inclusivity and equity, while maintaining the dignity of patients and families has become more critical than ever. This is a daunting task for new graduates. How can new nurses begin to provide equitable and inclusive care?
Inclusive care is about creating a space that not only acknowledges and accepts differences, but values and celebrates them. Inclusive care begins with recognition and understanding of the patient’s culture, unique life circumstances, and social context. Nurses must also be aware of their own personal beliefs, values, and culture, and how these affect the therapeutic relationship. Awareness begins with a process of self-reflection, and according to The Code of Ethics for Registered Nurses (2017), it is an essential component of ethical practice. Nurses inevitably carry their own unique beliefs, values, and stereotypes, influenced by media, religious communities, and friends and family. Self-reflection creates an awareness of these unconscious feelings, assumptions and biases. Biased assumptions and beliefs can create environments that, however unintentionally, contribute to health inequities and even human rights violations. Improved awareness of our own internalized prejudices and assumptions helps us to understand and become sensitive to how they can impact our patients, their families, our colleagues, and the quality of care provided (Eliason & Chinn, 2018).
The words we use and the body language we convey also have a lasting impact, not only in the moment but every time patients access healthcare in the future. Our words and actions can come back to comfort them – or to haunt them. What this means is that language can create accessible, inclusive, welcoming environments that provide respectful and person-centred care; or it can create impossible barriers for individuals who might already face stigma, discrimination, and marginalization. Experiences of discrimination and stigma can influence how individuals perceive and interact with all aspects of society, including contact with healthcare professionals and services. These experiences create fear and mistrust that play out when these individuals access future healthcare services (Eliason & Chinn, 2018). We must consistently ask ourselves whether we have created an environment of mutual trust and respect that allows patients to discuss their real lives with us.
As nurses, without the trust of those we care for, we have no hope of building or even establishing a therapeutic and effective nurse-client relationship. Trust is foundational to meaningful communication and building relationships, and conscious effort is required on the part of the nurse to establish and build trust in order to understand people’s needs and concerns (CNA, 2017). Nurses have an ethical and moral responsibility to facilitate interactions that are welcoming and inclusive, including being attentive to signs of capacity and capability as well as the presence of barriers which limit opportunity. Healthy engagement also means coming to interactions with an open-mind to differing values and perspectives. Simply put, we need to be prepared to listen and meet people where they are at, creating spaces to share so that patients feel free to unpack their life stories. For example, listening to and mirroring the patient’s language choices, and wording questions in a way that communicates both acceptance and respect for a diverse range of family and relationships are helpful steps. Strategies includes using terminology such as ‘partner’ when referring to relationships or ‘parent ‘or ‘guardian’ (as opposed to mother or father) for caregivers who may not be biologically related; asking individuals how they wish to be addressed, or what pronoun they prefer help practitioners avoid making assumptions about identity or groups based on external physical appearances. Assumptions, frequently based on stereotypes and bias, are not a reliable indicator of gender, sexuality, relationship status, race, age, or of any beliefs and values. Healthcare settings can send strong messages of welcome or lack thereof, and require examination to determine if the language choices available, the visual images displayed, or the intake forms used, reflect the diversity of the populations served.
Being new to the professional practice role, new graduates may feel they lack the experience to voice concerns regarding care. Maintaining connections with other new graduates, consulting with trusted colleagues, other team members, and professional nursing associations, can help increase new graduates confidence in addressing concerns around inequitable practices. Inclusion is about creating a space where everyone is valued, and it is about inviting all to share what they have to offer, including new graduates. With new graduates being up-to-date on current issues, trends, and innovations in practice, they are in the ideal position to provide fresh perspectives, and to model inclusive approaches by being the change they wish to see.
Canadian Nurses Association. (2017). Code of ethics for Registered Nurses. Author.
Eliason, M. J., & Chinn, P. L. (2018). LGBTQ cultures: What health care professionals need to know about sexual and gender diversity (3rd ed.). Lippincott Williams & Wilkins.
Foundational Elements of Professional
Role Transition for New Nurses (Part 1 – STABILITY)
BY DR. JUDY BOYCHUK DUCHSCHER
There are foundational intersecting elements that feed into your initial experience in the workplace: 1) stability, 2) predictability, 3) familiarity, 4) consistency and 5) success. This is PART 1 of a 4-PART series on this topic.
It is important to say at the outset that the underlying issue here is ‘control’ – having an environment that is stable, predictable, familiar and consistent allows you to feel in control of what is happening to you, including when it happens, how it happens, and with whom. These elements, when in ‘order’ put us in the driver’s seat of our own life. The challenge with a major change like professional role transition is that much is happening that is outside of our control—leaving us stranded on this island of uncertainty—and we consume a lot of our energy just trying to get things BACK to ‘normal’. Often times our limited knowledge of what is ahead translates into ‘let’s get things back to the way they WERE’ as we recognize this way of being and know how to cope with it—it’s comfortable. But, often without realizing it, doing just that prevents us from moving ahead to what is beyond that which we currently know, making it hard for us to accept, adjust, adapt, and ultimately grow.
STABILITY refers to how steady the circumstances and situations are for you during your transition experience; essentially, stability refers to that which is unlikely to change or ‘deteriorate’. If we think about you as a PERSONAL being, this translates into having a POST-GRADUATION life that you recognize as similar to what life was like BEFORE your transition to professional practice took place. Now, there are individuals who thrive on chaos (hhhhmmmm, well, I don’t really know too many who truly thrive on chaos outside of the fact that it can be motivating and exhilarating for limited periods of time and may be familiar if one was exposed to chaos a lot as a child….) and therefore they may have well developed skills that can help them cope with instability in their life. But stability is the quest of the human ‘being’—it is a fundamental feature of ‘homeostasis’, which even from a purely bio-physiologic perspective is something all humans seek.
“My 1st 6 months were horrible. Absolutely horrible….it was just the whole confidence, being in a new place,…not knowing what to do as a nurse cause I’m just starting out and just the situations that I don’t know – that you get put into and you’re not confident and you don’t know what you’re doing.”
If you are a student about to graduate, you might want to think about how many decisions you can ‘put off’ until you have experienced the initial 4 months of your transition so that those personal changes don’t contribute unnecessarily to your transition stress. When you are considering all the changes you are anticipating, remember that POSITIVE changes are still changes—moving, purchasing a home or car, getting married. While these are clearly exciting and wonderful events in your life that will bring you much joy, remember that they will also consume your energy and contribute to ‘instability’ in your life. Just keep in mind that if you CAN delay other MAJOR decisions until you have been working for at least 6 months, it will allow you to conserve needed energy that may get you through the initial stress of this life change.
Now, as for the change that you can’t control……life has its way with us more often than not and controlling change is not always possible. Sometimes you simply have to roll with it. In such cases, simply being aware that you ARE experiencing instability in your relationships, your financial situation, your living arrangements or other areas of your life will be a step toward managing those stressors that could ADD TO the stress of making your professional role transition as a new nurse.
So how do you manage the level of stability in the workplace? The factors feeding instability in the workplace are less likely to be ‘in your court’ as they say – you may not have as much control over these factors, but you DO have some control over whether or not you choose to be employed there and ultimately, we all have control over how we RESPOND to what is happening around us.
To begin, ASK QUESTIONS!!!! For instance, when you meet key individuals with whom you may be working in the near future (and you should ALWAYS meet with the manager, the clinical educator and several nurses—senior and junior—in the area to which you are seriously considering working), think about questions you might ask them:
- how many nurses have left in the past year and for what reasons;
- what kinds of staffing levels do they maintain (what is the nurse-patient ratio, how often are nurses called in on overtime and how much sick time does the unit manage on a weekly basis);
- how long is the average length of stay for patients on this unit/in this health center; on average, what is the ‘census’ of the unit (how many beds are full on average each day);
- what is the level of acuity of the patients (how SICK are the patients on the unit – how is that measured and if patients deteriorate over the course of a shift, what system adjusts for that in the workload of the nurse);
- what kinds of social activities do they organize for their staff (how ‘social’ the staff are often tells you a lot about how ‘happy’ they are working there – even high workloads can be managed if staff work together and enjoy each other);
- how much time does the manager spend ON the unit interacting with staff;
- what are the opportunities for continuing education (when was the last educational session for nurses, how many attended, were they replaced on the unit, and what was the session about);
- do they employ support staff (housekeeping, unit clerks, porters) after 4pm;
- do people enjoy working there (are their ‘humour boards’ or cartoons scattered about the unit/workplace, do they have a social committee and when is the last event they organized);
- what does a typical day look like for a nurse on this unit;
- on average how many breaks do the nurses actually take each day;
- how do staff collaborate on the provision of care (how do Registered Nurses and Licensed or Registered Practical Nurses/Certified Nurses Aides discuss and distribute the care required from their team during a shift).
I need to make a comment at this point about the ‘clinical’ stability of the patient demographic you choose to care for as a new nurse. My research in the emergency department was particularly enlightening for me around this. New nurses, though often highly intellectually competent and skilled, have had very little experience witnessing acute decompensating patterns of change in patients as they are associated with high levels of risk (likelihood of catastrophic outcome). The new nurse’s ability to recognize subtle changes in a patient’s clinical condition is significantly limited by their inexperience. The lack, or absence of ‘tacit’ knowledge (that knowledge you get by practicing and SEEING patterns of change) may render the patients, new practitioners and their colleagues vulnerable. If you add to this mix the highly unpredictable (rapidly changing situations that cannot be anticipated), unfamiliar (the potential for numerous clinical conditions being presented), inconsistent (the variation in clinical presentations of a given condition) and emotionally charged (patients whose health may be threatened or families who are often in crisis) context of high acuity practice areas such as the emergency room and critical care, you have a potentially volatile environment with a high risk for an unhealthy, ineffective and potentially unsafe transition.
Remember that your primary task as a new practitioner is to develop (NOTE TO SELF: this does not say ‘HAVE’):
- a strong base of organizational skills, time management competencies;
- foundational skills in the assessment of the ‘normal—abnormal’ continuum (be that clinical pathophysiology or community and relational dynamics);
- the capacity to prioritize and delegate;
- cultural and social knowledge related to working on ‘a’ team and working with ‘this’ team;
- an understanding of how expectations of a graduate nurse differ from those of a senior student and even from those of a recent (1-2 years experience) graduate or a senior nurse;
- the ability to balance your personal and professional life (or actually FIND your personal life again….);
- the flexibility to navigate the circadian and lifestyle flux that is synonymous with shift work;
- an understanding of how to collaborate, consult, and practice interdependently with allied health professions (physicians, social workers, physio).