February 1, 2024

February 2024

February 2024

February 1, 2024

New at NTF!

NTFLive

NTFLive serves as a means to CONNECT with our members by delivering high-quality, engaging sessions of support and education based on member feedback. Visit HERE to our latest session, entitled The Resilient Nurse. In February, NTF was honored to feature internationally acclaimed author and speaker Dr. Robert Wicks, who currently resides in Pennsylvania, is the author of over 60 books with best sellers that include Riding the Dragon, The Resilient Clinician (2nd Ed with Mary Beth Werdel), Bounce: Living the Resilient Life (2nd Ed), Night Call: Embracing Compassion and Hope in a Troubled World and Perspective: The Calm within the Storm. Dr. Wicks received the first annual Alumni Award for Excellence in Professional Psychology from Widener University and is the recipient of the Humanitarian of the Year Award from the American Counseling Association’s Division on Spirituality, Ethics and Religious Values. Our second panelist was Dr. Gloria Donnelly, who earned a BSN from Villanova University, an MSN from the University of Pennsylvania with an emphasis in psychiatric nursing, and a Ph.D. in Human Development from Bryn Mawr College. Dr. Donnelly has been the Editor in Chief of Holistic Nursing Practice for the past 45 years, is the author of seven books and the winner of two American Journal of Nursing Book of the Year awards.  Dr. Donnelly is Dean and Professor Emerita at the College of Nursing and Health Professions, Drexel University, Philadelphia (2000-2017) and recently teamed up with Dr. Wicks to co-author the second edition of Overcoming Secondary Stress in Medical and Nursing Practice. This contemporarypublication offers insights into how nursing and other health care professionals can extend their presence to others without losing their own inner fire in the process. Finally, our very own Lia Sanzone is an Associate Professor at McGill University in Montreal, and Director of both the BScN Nursing Program and the Nursing Peer Mentorship Program. Professor Sanzone developed the Nightingale Fellows Program where graduating students are mentored by workplace clinicians who help them understand the challenges of the workplace and develop strategies of resilience. Since 2021, she has been mentoring clinical partners within institutional transition to practice programs to help them support nurses transitioning to their professional roles with the intent to increase retention. The session explored psychological approaches to secondary stress and the reflective regimen that nurses, especially those who have recently graduated, could integrate into their practice to optimize their caring capacity without compromising their own health. See the full recording at https://nursingthefuture.ca/ntf-live/

Emerging Career Series

Check out our Emerging Career Series, featuring interview-based articles in which a broad range of nursing specialties, scopes and care areas are explored through the career progression of inspiring nurses. Newly graduated nurses, and those with emerging and evolving careers can benefit from understanding the often unconventional or unique paths taken by professionals in the broad field of nursing practice.

Read our recent interview with Jon Schmid, exploring his unique rural and remote primary care and teaching experience, medic background and extensive leadership and management career. https://nursingthefuture.ca/emerging-career-series/

The Interview

In this episode of The Interview, Dr. Duchscher engaged in conversation with Dr. Bonnie Clipper (Virtual Nursing Expert, Strategic Advisor, Speaker and Author) regarding 'virtual nursing'— distinguishing what it is and what it is not. The discussion delves into how virtual nursing can be leveraged to address staffing shortages and anticipates future developments in nursing practice with the integration of AI approaches.Visit  HERE to watch this engaging interview!

Speaker Series

For the latest in our Speaker Series, our esteemed guest speaker, Professor Lia Sanzone describes the impetus for, development and impacts of a groundbreaking nurse mentorship program on resilience of the new nurse. Professor Sanzone created this initiative with the support of McGill University.

Regardless of where we are in your nursing journey, mentorship is fundamental to our professional development. Whether it’s for support, expansion of knowledge, skills, resources, and/or professional network, we can all benefit from mentorship! Whether you are a student, a new nurse graduate, an academic or a nurse clinician-leader, come learn what the Ingram School of Nursing at McGill University has developed to: 1) promote a sense of support, 2) help with student transitions to full professionals, and 3) contribute to nursing resilience and retention.

From the Nursing Peer Mentorship Program to the Nightingale Fellows Program to the Transitional Mentorship Program in clinical settings, mentorship is at the heart of our profession!

View the presentation HERE!

Bookclub

This month we are delighted to share two new book reviews from NTF. Firstly, explore the experiences of Dr. Maureen Mayhew in her book "Hand on my Heart: A Canadian Doctor’s Awakening in Afghanistan" for valuable insights into working abroad. Drawing on a decade with Doctors Without Borders in Afghanistan, Dr. Mayhew shares compassionate perspectives on the Afghan people, emphasizing the importance of learning the local language to engage with communities, treat trauma, teach contraception, and gather public health data. Her precise descriptions offer poignant insights into navigating cultural differences with curiosity and respect, making the book a compelling read for those interested in global health and understanding diverse perspectives.

In "The Immortal Life of Henrietta Lacks", an African American woman whose cells, taken without her consent in 1951 became the world's first immortal human cell line known as 'HeLa,' transforming medicine. Rebecca Skloot delves into the ethical implications of cell research, highlighting the impact on Henrietta's family and underscoring its relevance to nursing. The book addresses the complex interplay between scientific advancements, ethical concerns, and their practical implications for medical history and nursing practice.

Read both reviews HERE!

Masterclass with Dr. Jean Watson

Watch the growing series on caring as a philosophy, where Drs. Duchscher and Watson share deep experiential insight into the many facets within and understandings of ethics of caring as a nurse. Greenhouse - Master Class - Nursing the Future

Our Voices

Join in reading Dr. Kim McMillan’s deeply insightful, evidence-driven submission describing the tenuous and challenging experiences of Entry to Practice for graduates who experienced pandemic learning. While the shift to virtual nursing and altered paths of education were clearly required, read on to find out more about the encouraging findings of Dr. McMillan’s research; new graduates coming away as confident, capable professionals brightening the future of nursing. Read Dr. McMillan’s work HERE!

The Need is Enduring, and NTF is Responding to the Call!

Recently, Dr. David Keegan \ shared his vision for a new healthcare campaign that has been shared by many outside Alberta, creating a new ribbon that visually captures the stark state of healthcare in Alberta and indeed nationally.  https://twitter.com/drDavidKeegan/status/1745246983550648705 . In this campaign, Dr. Keegan is asking others to share demands for healthcare change, as our system is at times literally held together by duct tape. As new graduate nurses and their supporters, we are asking our members to share in this campaign, and others like it, where we are demanding change for the safety of ourselves and our patients. Remember that as a nurse, you are part of a widespread professional body known for its trustworthiness, care, and significant abilities. Reach out to your local union bodies and representational groups to lend your voice to growing demands for change.

Let’s Talk Transition:
Foundational Elements of Professional Role Transition Success for New Nurses

Categories of Influence in the Experience of Transition

Through my research I have been able to generate 4 core categories that I suggest influence, and are influenced by the professional role transition of the new nurse. I have identified these core categories as: 1) roles, 2) relationships, 3) responsibilities, and 4) knowledge.

Roles. As a new nurse, you can’t help but notice a subtle but distinct change in your overall role from one of dependent learner to one of independent practitioner and, ultimately, interdependent collaborator. While you may have enacted some of your professional ‘roles’ as a student (care provider, advocate, counselor, teacher to name a few), the change in accountability and responsibility for the process and outcome of those same roles as you enter the world of professional practice can alter your perception of them. They can take on a relative ‘unfamiliarity’ that is surprising to a lot of graduates—things you did with relative ease prior to graduating ‘look’ different through the lens of your new credentialing. Suddenly (and sometimes VERY suddenly), the safety net of faculty or preceptorial collaboration and consultation is no longer available and even the permission not to know because ‘I’m a student’ is no longer an acceptable fall back (although ‘I’m a grad nurse’ can have a similar effect during those months prior to national licensure). The weight of the ultimate responsibility can strangely alter your perceptions and interpretations of situations that are really quite similar to those you dealt with as a student. This contributes to role stress and can weigh heavily on you.

Role stress turns into role strain when you are unable to reconcile for yourself or others what role you are assuming (are you a student or a professional nurse). It is possible that you could experience something similar if you practiced as a Licensed/Registered Practical Nurse or Enrolled Nurse (UK) on a unit and then return to that unit as a Registered Nurse—the point is that if your ‘formal’ title, and therefore your ROLE changes you should expect a period of adjustment for you and those you work with. The best approach is good communication and transparency, particularly with those you are working alongside, as to what roles and responsibilities you are assuming at any given time. Patience with yourself and others will put you ahead of the game as well.

I believe that students who experience a capstone/consolidation practicum on the unit to which they will be transitioning, or who take employment in that unit prior to graduating as a new nurse can significantly reduce overall transition shock. Having said that, there is something quite phenomenal that occurs for even those graduates that they don’t expect; the nurses with whom they worked collaboratively as a senior student (maybe even just a short week ago) appear to treat them differently.  Sometimes your status as a new nurse in the eyes of your experienced colleagues is enhanced and the new role feels empowering, while sometimes the more senior nurses’ expectations rise more rapidly than your confidence can balance, rendering you vulnerable to feelings of inadequacy and incompetence. It is hard to know if this ‘change’ was in the receptivity of senior co-workers to the new nurse’s altered role designation, or if the change was in the self-perceptions of the graduates themselves; but an adjustment to new role expectations was necessary by all. Along these lines, the challenge of returning to a unit where you were previously a senior student may result in staff expecting you to know more than other ‘new graduates’ and therefore assume that you require less orientation or transition support. This may not be a fair assumption and I encourage you to discuss this potential issue with your manager, educator and unit manager prior to employment.

Finally, the roles you will be assuming in this newest chapter of your life are as PERSONAL as they are PROFESSIONAL. The fact is that family (parents, spouses, children) and friends know you graduated and now they have changing expectations of you. It might be something as simple as no longer being able to ‘escape’ the clutches of unwanted social invitations by saying ‘I have to study’ or something as complex as trying to explain to your 4 year old daughter how your mind, body and soul have been depleted by the past 3 years of school and that you need to rest awhile; your child who simply wants your attention believes all that celebrating that occurred for graduation was reason to believe you’re back! Those who have ‘stuck by you’ during the challenging times are ALSO experiencing a transition of sorts—it may be that they have ‘buffered’ aspects of their own lives in order to give you space to study or put off advancements they have wanted to pursue in order to be the stabilizing force you required during your education. It may even be that they sacrificed material purchases or the even more precious commodity of ‘time’, in order that you could pursue your dream. Brace yourself for this possibility. Your experience going through nursing school and graduating has likely changed you fundamentally. It is hard to imagine watching life being born and ending, seeing for yourself how the homeless navigate the streets at night, holding a heart in your hands and playing games with your 10-year old pediatric oncology patient while his chemo is running and NOT find your perspective about life transformed. Be prepared for the experience of re-entering a life that looks different than it did before you started school.  Friends you had before may not understand why or how you’ve changed and your relationships with them may need some tweaking. Sadly, there may be relationships that you will simply outgrow and you may find yourself needing to move on.

As much as you have gained during your education, there is a sense of loss as well—knowing this should give you permission to grieve what you have left behind as you move forward with the next chapter of your life. For parents to whom you now owe money in student loans, spouses whose social lives have been a series of lonely nights, children who have been inordinately patient with your absence, and friends who tolerated your theorizing and stories of calamity, sacrifice and growing pains simply want you back. You can’t blame them! Their demands on your now ‘free’ time may be premature for where you are actually at emotionally, physically and socially. You may find it stressful and challenging in the early months after graduation as you come to realize that the next level of your education has just begun and it is taking more out of you than you originally thought it would. If you can, sit down with those individuals in your life and explain beforehand what they can expect from you as a newly graduated professional nurse. Outline for them the challenges you may be facing over the initial 12 months so that you might stem the tide of expectation at least for the first stage of your transition (up to 4 months post orientation). In the end, many graduates say that friends and family simply don’t understand what they are going through during the initial transition to practice. Spending time with other new graduates may take on an important role in sustaining your sense of normalcy and reminding you that it’s not just you that is experiencing this disconnect!

Research and Education

The breadth of nursing knowledge extends to the pursuit of evidence through programs, initiatives, and research. Join us as we highlight and discuss what emerging findings mean for the contemporary field of professional nurse transition, and the profession as a whole.

Van Bewer, V. (2023). Trauma and survivance: The impacts of the COVID‐19 pandemic on Indigenous nursing students. Nursing Inquiry, 30(1), doi: 10.1111/nin.12514

In this article, Van Bewer utilizes a sharing circle and Indigenous conceptual framework to explore the under-reported experiences of Indigenous nursing students in Canada related to the COVID-19 pandemic.The nature and delivery of nursing education has been impacted by the COVID-19 pandemic and studies suggest that the impacts such of pandemic education are disproportionately experienced by Indigenous students. Psychologically, anxieties and stressors related to situational unpredictability or COVID-19, or social isolation have been reported by nursing students. Previously face-to-face education was shifted to online learning and resulted in a loss of opportunity for skill-building. Prior to the pandemic, Indigenous nursing students reported challenges related to racism and cultural safety that has contributed to higher attrition rates, though evidence from Canada is lacking in this area.

Through respect, relevance, reciprocity and responsibility as guiding principles, a lens of self-determination and cultural safety was applied. Sharing circles were commenced by smudging and Knowledge Keeper teaching occurred during the picking of sage, where tobacco was gifted. The 17 purposefully sampled Indigenous nursing students participants engaged in sharing circles, which differ from focus groups in their community and connective intent.

Results

Worsening psychological distress

Pandemic-related uncertainty was identified as a significant stressor, impacting routines and structure. In addition, participants indicated added caring responsibilities and personal losses increased psychological distress. Relocating from a home community for education during the pandemic caused significant distress over the forced isolation.

Learning Losses

The suspension of clinical placements led to profound setbacks for some, leaving students feeling unprepared and overwhelmed during later clinical experiences. Online learning exacerbated the situation with inadequate teaching strategies and negatively altered communication from faculty. Evaluation methods lacked equity considerations, due to wrong assumptions about personal support and the availability of others in the home able or willing to assist with learning. Loss was also experienced regarding peer relationships and peer support for learning, as connecting in person was restricted during the pandemic.

Loss of Cultural Safety

Pre-existing challenges in terms of cultural safety for Indigenous students were intensified during the pandemic. Verbal abuse, humiliation, and microaggressions from nursing educators contributed to a lack of cultural safety. The closure of the Indigenous Student Centre and the loss of cultural activities furthered the feeling of cultural disconnection. A poignant and shameful example was provided by a participant who relayed that their non-indigenous classmates described smudge smoke as smelling “gross”. Participants also reported feeling forced to teach other students about cultural practices while they were supposed to be a student themselves.

Silver Linings

Despite causing losses in practical skills, online learning brought about flexibility, cost savings, and increased access to education. Pre-recorded lectures became valuable resources for students with additional responsibilities, and for some reduced stress. Participants, despite facing hardships, found personal growth, resilience, and strength during the pandemic. Humour was reported to increase resilience by healing through laughter.

Community Disconnections

Participants experienced disconnection from family and communities due to public health restrictions, social distancing, and discordant vaccination statuses. The inability to share important life events and ceremonies created a sense of isolation and irreparable loss within communities. Opposing views regarding COVID-19 and vaccinations also contributed to issues  and distress within families during this time of isolation.

Strength and Need of Community

Despite challenges, the pandemic reaffirmed the strength of Indigenous communities. Some participants found greater appreciation and healing within their families, while others experienced increased stress and difficulties. Indigenous communities demonstrated resilience through leadership, strong demonstrations of solidarity, and supportive measures during the pandemic.

Discussion

This study delves into the profound impact of the COVID-19 pandemic on Indigenous nursing students, unveiling multifaceted challenges and opportunities. The study underscores the imperative for tailored mental health assessments and resources to address the distinct challenges faced by Indigenous nursing students, signaling a critical area for improvement.

The closure of cultural resources during the pandemic exacerbated feelings of isolation, coupled with experiences of racism and microaggressions during the pandemic that resonate with intergenerational memories of trauma. Resilience and posttraumatic growth emerged for some, transforming adversity into opportunities for personal development.Recommendations include a renewed commitment to culturally safe nursing education methods and resources, a trauma-informed approach to teaching, and fostering antiracist faculty and staff. Collective values, such as community and humor, can be beneficial tools for both students and educators in the ongoing processes of indigenization of nursing education and reconciliation in Canada.

Gibbons, C., Shamputa, I. C., Le, M., & McCloskey, R. (2023, February). Strategies used in Canadian nursing programs to prepare students for NCLEX-RN® licensure exam. Healthcare (Vol. 11, No. 4, p. 613). MDPI. https://doi.org/10.3390/healthcare11040613

The study delves into the intricacies of the NCLEX-RN® exam, an assessment tool designed to gauge the proficiency of new registered nurses, with a primary focus on the Canadian context. The NCLEX-RN® exam evaluates not only the theoretical knowledge but also the critical thinking skills essential for safe nursing practice. Given its fairly recent Canadian implementation in 2015, nurse educators are motivated to determine effective strategies that support and develop existing curricula, leading to optimal student preparation and exam performance.

The significance of student performance on the NCLEX-RN® extends beyond individual achievement; it serves as a measure for investigating how nursing programs are equipping future nurses for their upcoming independent practice. Failing to meet American pass rate minimums has resulted in nursing program sanction, though no standardized response to pass-rates has been adopted in Canada. While the overall pass rates for Canadian-trained candidates have demonstrated improvement since the exam's adoption in Canada, challenges persist among internationally trained candidates and those opting for the French-language version of the exam. The overarching goal of nursing programs is to nurture generalist nurses possessing the requisite competencies and clinical judgment for licensure. Consequently, faculty members harbor reasonable concern regarding student performance on the NCLEX-RN® exam, emphasizing the critical role it plays for shaping the healthcare workforce.

Results

Historically, nursing programs have navigated the landscape of NCLEX-RN® preparation through a trial-and-error approach. The existing literature, primarily emanating from the American experience, sheds light on the challenges associated with transitioning to a new licensure exam. Unfortunately, current publications provide limited guidance to Canadian nurse educators seeking effective strategies tailored to their unique context. The featured study seeks to bridge this gap by exploring and describing the diverse strategies employed in Canadian nursing programs to develop students' ability to succeed in the NCLEX-RN® exam.

Study findings underscore the diversity of approaches adopted by Canadian nursing programs, encompassing a spectrum of strategies such as third-party product integration, computer-based testing, preparatory classes, and the infusion of NCLEX-RN® content across multiple courses. However, it's noteworthy that some programs do not offer specific preparatory activities, revealing variations in the level of emphasis placed on NCLEX-RN® readiness. As reports on examinee success are available for purchase, some participants identified that their program used this data to inform course development. Others indicated that the reports lacked the details needed to advance effective change and all claimed the reports were not circulated amongst teaching faculty. This gap in faculty access to licensure reports impedes optimal use of data for program evaluation and curriculum enhancement.

The study predominantly focuses on classroom activities, and not the role of clinical instruction in NCLEX-RN® preparation. Future research avenues could explore the efficacy of preparatory clinical and classroom activities, assessing their impact on both faculty and student outcomes. With upcoming changes to the NCLEX-RN® format, the incorporation of clinical judgment into teaching methodologies increases in priority. Additionally, the experiences of Francophone examinees, and those of Internationally Educated Nurses remains underexplored, and evidence gathering in this area would benefit these populations.

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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