June 3, 2024

June Newsletter

June Newsletter

June 3, 2024

New at NTF!

We are so excited for our content this month, as we continue to connect with our national nursing bodies and representatives in all facets and fields of nursing. As always, please reach out if you are interested in contributing to our content strategies, need individual or institutional support, or would like to see content we don’t currently have! We are here for YOU so let us know what you need.

On that note, we have been encouraged to reinstate our email campaigns to inform our subscribers of what’s new at NTF. While subscription is NOT mandatory to access NTF content, we would like to encourage you to subscribe HERE to receive important updates on events or new content so that you don’t miss anything. Spread the word!


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Emerging Career Series

(https://nursingthefuture.ca/emerging-career-series/)

Discover the World of Forensic Mental Health and Corrections Nursing!

Are you curious about forensic mental health and corrections nursing? Don’t miss our exclusive interview with the remarkable Professor Emeritus Cindy Peternelj-Taylor!

With years of experience and unwavering advocacy for these critical fields, Professor Peternelj-Taylor takes us through her fascinating career journey, sharing invaluable insights and experiences. From the challenges she faced to the milestones she achieved, her story is both inspiring and enlightening.

In this must-read interview, you'll learn about:

  • The unique roles and responsibilities in forensic mental health and corrections nursing.
  • The evolving landscape of these specialties and the impact of recent advancements.
  • Strategies for addressing the complex needs of patients within the criminal justice system.
  • Professor Peternelj-Taylor’s vision for the future and her advice for those considering a career in these fields.

Join us to get inspired and informed by one of the leading voices in forensic mental health and corrections nursing. This interview is a treasure trove of knowledge for anyone interested in these vital areas of healthcare.

Read more to dive into the compelling world of forensic mental health and corrections nursing!


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Book Club

(https://nursingthefuture.ca/book-club/)

We are so excited to announce our NTF Exclusive Interview with Amie Archibald-Varley and Sara Fung of The Gritty Nurse (https://www.grittynurse.com/): Unveiling 'The Wisdom of Nurses'!

Can you name a nurse leader who isn’t Florence Nightingale? In our exclusive interview, nurse-authors Amie Archibald-Varley and Sara Fung discuss their inspiring new book, ‘The Wisdom of Nurses: Stories of Grit from the Front Lines.’ This captivating work highlights nursing leaders whose invaluable contributions to healthcare often go unnoticed. Through personal anecdotes and reflections, Amie and Sara celebrate the profound impact of nurses on individuals, families, and communities, emphasizing the importance of recognizing and valuing nursing wisdom in healthcare settings.

Check out our podcast for this amazing author interview, and many more! https://nursingthefuture.podbean.com/


Speaker Series

(https://nursingthefuture.ca/speaker-series/)

As a newly graduated nurse, being pulled to another care area can be incredibly intimidating. How do you navigate this new and challenging adjustment? We have just the resource for you!

In our latest feature, the brilliant Stephanie Betker delves into the realities of transitioning to different care areas. Drawing from her extensive experience, Stephanie shares practical tips and strategies to help new nurses confidently step into unfamiliar territories.

In this insightful session, you’ll discover:

  • Key strategies for quickly adapting to new care environments.
  • Tips for managing stress and maintaining composure during transitions.
  • Ways to effectively communicate and collaborate with new team members.
  • Stephanie’s personal experiences and lessons learned from her own nursing journey.

Don't miss out on this opportunity to gain valuable insights and boost your confidence as you navigate the diverse landscape of nursing.

Watch Stephanie Betker explore how a new nurse can successfully engage with these challenging adjustments!


Supporter Spotlight

(https://nursingthefuture.ca/awards/)

At NTF, we are passionate about recognizing and celebrating excellence. When we discover a Rising Star among new graduate nurses or their supporters, we are eager to share their successes with our community!

If you know someone who deserves to be celebrated for their achievements, please let us know by emailing us at newgraduates@nursingthefuture.ca OR go directly to https://nursingthefuture.ca/awards/ and submit your nomination! Your nominations help us shine a spotlight on those who are making a difference in the nursing profession.


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Let’s Talk Transition!

In the May newsletter, Dr. Duchscher talked about how progress through the stages of transition will vary according to the length and quality of your orientation, the transition and integration programs you are enrolled in upon hiring, and the level of support you feel (or don’t feel) from the experienced colleagues you are working with. Within Duchscher’s transition theory, Stage One begins AFTER your initial orientation or introduction into the workplace; the start of this stage correlates with your first shift ‘on your own’ where, for the first time since graduating you feel the weight of a full clinical workload. If you are fortunate enough to have an extended support period (like a residency or mentorship program), you may experience a more ‘muted’ intensity and duration of this stage, though my research tells me that new nurses will experience each of these processes (learning, performing, concealing, adjusting, and accommodating) to some degree within their first year of practice. Let’s tease out the components of this first 4 months of transition.

Learning

Learning that all is not as you might have come to expect it would be in the professional practice setting can be disconcerting. Having said that, it is unreasonable to expect that your educational program would be able to afford you insight into every possible clinical situation, have you perform every possible skill required of you as a professional, or expose you to the range of relational dynamics that you might face working within a team of professionals under the kind of pressure that is now commonplace for the contemporary healthcare workplace. As a result, life as a newly graduated nurse often becomes a flurry of learning and performing.

“They’re not my arms because, although it’s my practice and I’m doing it, I still feel a bit like I need so much help from other people that my actions are not my own and I’m doing them but they’re being orchestrated by other people.  I still need so much help and I’m asking so many questions that I might be making the decision and I am talking it through with someone, but their making it with me so they’re not completely my arms yet cause they’re not my decisions completely yet.”

At this stage of your transition you are likely discovering ‘what you don’t know’; which makes it easy to get trapped into thinking you don’t know anything! That is clearly not true, but it can be humbling, and even daunting to realize how much more there is to learn after you graduate! We encourage you to take comfort in the skills you come with—they will ground you, reassure you and save you so much time.

A final note here about where you work during the early months of your transition. If you recall the comment earlier, the importance of consistency, predictability, familiarity and stability for a new nurse cannot be overstated. Remember to consider these elements in the whole context of 1) the patient/client population, 2) the staff, and 3) your personal life. If you believe that the workplace to which you are going can provide these, PACK YOUR BAGS AND GET ON THAT BUS!!

But…..even if you are being encouraged, enticed or otherwise ‘courted’ to take employment in a particular workplace, but in your estimation it can not provide these fundamental elements of success, please reconsider.

“I think we’re just trying to put everything together of what you learned in school and trying to think back on things and… you go though a lot of, “should I do this, should I not be doing this, should I go back to school”…I found I was very hard on myself. Very critical of what I was doing and wanted to quit a few times. I think it really makes a difference on where you start and how you’re experience is at that time. It changes your opinion of nursing.”

You have a lifetime to secure employment in a variety of nursing contexts so what’s the rush? Transition theory suggests that it is wise to spend the first 12 months gaining a secure sense of yourself professionally, developing a strong set of basic competencies, understanding workplace ‘culture’ and what it means to navigate professional dynamics, and HAVE A LITTLE FUN while you’re still young enough to (speaking now to the 2nd degree/accelerated track graduates)!

“I’m on my 2nd of three nights here on [unit]. What a TREAT! I love the work here. Sure it’s heavy, but it is mentally heavy, challenging my knowledge and skills, and at the end of the day allows me to be proud of myself for knowing what to do or how to react. I honestly can see that my confidence is increasing. I guess that is what working on the same unit for three days in a row will do. As compared to my wishy washy schedule where I am tossed between two units and never have time to really grasp what’s going on. I have applied for a temporary at [hospital] so that I can find a little more consistency (participant emphasis). I don’t feel that float position allows for adequate learning. It seemed like such a good idea at the beginning, but now I am really finding the downfalls.”

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.

Rose, H., Skaczkowski, G., & Gunn, K. M. (2023). Addressing the challenges of early career rural nursing to improve job satisfaction and retention: Strategies new nurses think would help. Journal of Advanced Nursing, 79(9), 3299-3311.

The retention of nursing staff in rural areas is a growing global concern. In Australia, projections indicate a nationwide shortage of 123,000 nurses by 2030. The average age of the nursing workforce is higher in rural areas compared to major cities, making the recruitment and retention of early career nurses in these regions a priority. This issue has been further exacerbated by COVID-19, with an influx of people to rural areas and increased demand for services and support. The recruitment and retention of early career nurses in rural regions are particularly challenging due to various factors, including an ageing nursing workforce and limited resources. Despite previous research on the challenges faced by rural nurses, translating this knowledge into effective retention strategies remains a priority.

This study aimed to explore the experiences of early career registered nurses in rural hospitals in Australia and to identify strategies that could increase job satisfaction and retention. While some aspects of nurses’ experiences have been studied previously, this research sought to provide novel insights into retention strategies. The study employed a qualitative descriptive approach grounded in an essentialist epistemology. Essentialism focuses on straightforward descriptions of phenomena, making it suitable for understanding nurses’ perspectives. Semi-structured interviews were conducted with participants between February and April 2022 via Zoom due to COVID-19 restrictions.

Results

Newly graduated nurses working in rural hospitals appreciated the diverse scope of practice and strong sense of community but faced challenges such as feeling underprepared and the need for ongoing education. Strategies to improve retention included accommodation and transport assistance, social gatherings, sufficient orientation and mentorship, and flexible work arrangements. The findings suggest that implementing these strategies could improve job satisfaction and retention among early career nurses in rural areas.

One of the key findings of this study is the importance of the diverse scope of practice in rural settings. New graduates in rural hospitals have the opportunity to broaden their skills across various areas of healthcare, making them well-rounded professionals. This aspect of rural practice is often cited as a motivating factor for nurses to work in these areas. However, it also presents challenges, as they may feel overwhelmed by the breadth of their responsibilities, especially early in their careers.

The strong sense of community prevalent in rural areas is another important finding of this study. Newly graduated nurses in rural hospitals often have the opportunity to develop deep and meaningful relationships with their patients, which can be personally fulfilling. This aspect of rural practice is often cited as a major benefit by nurses working in these areas. However, the close-knit nature of rural communities can also be challenging, as new graduates may feel isolated if they are new to the community or find it challenging to know who to reach out to when experiencing conflicts with colleagues.

The findings of this study suggest several strategies to improve retention among new nurses in rural hospitals. These include providing accommodation and transport assistance to ease the relocation process, organising social gatherings to enhance connections with colleagues and the community, and ensuring that new nurses receive sufficient orientation and supernumerary time to ensure they are ready for the challenges of rural practice. Participants in the study highlighted the importance of regular support and check-ins from clinical facilitators and mentors, emphasising the positive impact even brief interactions can have on job satisfaction and support. They also stressed the need for facility-provided education, funded by the government, to expand nurses' knowledge and confidence, particularly in rural areas with diverse healthcare needs. Nurses expressed a desire for more autonomy in choosing rotations and clinical areas, believing this would improve their experience and potentially retain them longer. Additionally, many nurses sought more flexibility in work hours and rostering to better manage their work-life balance, suggesting that greater flexibility could improve job satisfaction and reduce burnout. Overall, the study underscores the importance of supportive work environments and tailored support strategies in retaining early career nurses in rural hospitals.

Future research could explore the experiences of newly graduated nurses in other rural settings and use quantitative methods to provide a more comprehensive understanding of the factors influencing retention in these areas.

In conclusion, the findings of this study highlight the unique challenges and opportunities faced by early career registered nurses in rural Australian hospitals. By addressing these challenges and implementing strategies to improve retention, healthcare organisations can ensure that new graduates are supported in their roles and can contribute effectively to the delivery of healthcare services in rural communities.

Transition Theory

(https://nursingthefuture.ca/transition-theory/)

NTF will be publishing summaries about all established transition theories over the coming months (see above link).

Executive Summary- Dr. Marlene Kramer’s Reality Shock Theory

This summary provides insights into Dr. Marlene Kramer’s Reality Shock Theory addressing the hurdles encountered by new nurses transitioning into professional healthcare settings from educational environments and the support required for their professional adjustment.

Dr. Kramer is a renowned American nurse, educator and author who has contributed significantly to our knowledge on the role transition of new nurses.  Her groundbreaking theory of reality shock remains relevant in the role transition of new graduate nurses. She undertook her undergraduate studies in nursing at St. Louis University in 1953 and received her Master of Science in nursing at Case Western Reserve University in 1958. In 1966, while at Stanford University, she pursued her doctoral studies in sociology and education. Kramer held faculty positions at the University of California, San Francisco, the University of Connecticut, and the University of Nevada, Reno, where she was the first occupant of the Orvis Chair in Nursing Research. Dr. Kramer believed nurses possessed influence at the bedside that could be leveraged to improve patients' overall outcomes hence the need to equip nurses for their professional role.

Theoretical Origins

New nurses enter the workforce with the vision of providing comprehensive and idealistic care. Often, they are confronted with discrepancies in their work world that contradict their professional socialization. The resultant disillusionment precipitates physical, social, and emotional responses that can potentially lead to a decision to leave the nursing profession altogether in the absence of adequate support systems.

Kramer’s theory on Reality Shock (1974) stemmed from her fervor to gain a deeper and better understanding of the experiences of new nurses as they transition from nursing school to clinical practice, alleviate the stressors experienced during the transition period and offer solutions that result in effective transition, job satisfaction and nurse retention. Her research focused on resolving the professional-bureaucratic conflicts that can inadvertently alter the new graduate nurse’s vision of the nursing profession and practice. This work led to the concept of “reality shock” which was built on concepts from Oberg’s culture shock (1960). Both culture and reality shock require a transformation that allows the new professional to navigate unfamiliar circumstances.

Reality shock is described by Kramer as the startling discovery and subsequent reaction to the discovery that the professional values taught during the nursing student’s education conflict with work-world values. This reaction can elicit social, physical, and emotional responses that are unexpected, undesirable, or unwanted.

Tenets of the Theory

Kramer identified four distinct and cyclical phases experienced by the new graduate during the transition period; the honeymoon phase, the shock or rejection phase, the recovery phase, and the resolution phase.

New nurses are often excited and enthusiastic at the onset of their careers and are shielded from the realities of the work world. This honeymoon phase is characterized by a desire to make positive impacts in the profession. Soon, the new nurse is confronted with the realities of the clinical environment and forced to abandon idealistic expectations.

The inconsistencies between professional training and the bureaucratic expectations of the work environment result in shock and rejection as experienced by the new nurse. The new graduate exhibits varying responses to their new normal, often adopting maladaptive coping mechanisms that may further stall growth and inhibit self-discovery. Rejection manifests either as negative feelings toward oneself or the educational institution that ‘misled’ them, a total embracing of the new norms of the workplace with total abandonment of their professional ideals, displays of protective coping mechanisms whereby they either withdraw from, or band together with, individuals possessing similar frustrations, or simply act aggressively towards colleagues or the institution that has adopted the seemingly discongruent values.

During the recovery phase, the new nurse is more open-minded and begins to build the capacity to objectively evaluate situations with minimal tension.

In the final resolution phase, the new nurse develops a sense of the nursing profession and appreciates the dynamics of the clinical environment.  Their experiences are critical to the decision to either remain or change workplaces or leave the nursing profession. Encountering new and unfamiliar situations by new nurses could result in destabilization or regression.

Application of the Theory

An adapted version of culture assimilation programs was used by Kramer to identify shock-producing conflicts in values and behaviours between school and work subcultures in nursing. Findings suggest that the shock new graduates experience emanates from the disparities existing between the professional mode (expectations) and the bureaucratic mode (reality) and their inability to adjust to their new role and its expectations.

Undesirable effects of reality shock and high new nurse turnover can be mitigated by effective socialization and providing adequate support for the new nurse to navigate the transition period confidently. Timely interventions and support such as enhanced curriculum, well-structured orientation programs and mentorships are crucial for developing competent and confident nurses who can provide high-quality patient care and make an impact in the nursing profession.

Dr. Judy Duchscher worked with Dr. Kramer for approximately 10 years to understand how Kramer’s reality shock theory applied in clinical practice, and utilized the reality shock theory as the framework for her own program of research into the contemporary transition to practice being experienced by new nursing graduates.

Coming Soon!

Our popular seminar series NTFLive is back with an incredible partnership! We are so pleased to be joining Nurse it Like you Mean it, a nursing reference and resource team, to discuss all things med-surg! This is CERTAIN to be a fantastic experience for all those who join this FREE event! Watch our Social Media and become an NTF subscriber for updates and tickets!

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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