Many actions and policies are being discussed nationally and provincially of late that have significant impact on nursing and healthcare. At NTF we are keen to bring the desperate reality of nursing through chaos to the forefront, recalling the repeated challenges in acceptable standards of care delivery in many places across the nation. Amongst what is common in all these scenarios is that the problem is not relenting. The needs of Canadians will always include a strong and supported nursing workforce.
What can a new graduate supporter do? Only your best, and we suggest that in this climate that often doesn’t feel like enough. We do ask you to consider the experiences of those entering the incredible profession of nursing. Simple conversations conveying calm and hope (even if that thread of hope is frayed and threatening to snap) can make a difference to a new graduate on a career-ending precipice. Decisions to leave practice in a time of self-doubt and despair happen with documented frequency in the initial months and years of practice. There remains no doubt that the work of nursing is and has always been difficult. We implore those currently practicing to build newcomers up.
I can’t do much on my own! Evidence suggests that much of the impact on new graduates does come from close workplace connections, but we would like nothing more than to help! For decades, we have served as consultants for new graduate needs big and small- please reach out to us today!
(https://nursingthefuture.ca/book-club/)
"Always Pack a Candle" is a gripping memoir by Dr. Marion McKinnon Crook, who takes readers on her journey through life as a nurse in British Columbia during the 1960s. Dr. Crook's storytelling is both vivid and heartfelt, making it a compelling read about the challenges and wild adventures of providing public health care in remote areas of British Columbia. Her writing provides a rare glimpse into the realities of nursing in isolated locations, and underscores the importance of nursing work in underserved areas. For nurses, and even the public, this book provides a very authentic portrayal of the profession's challenges and rewards, especially in the field of public health nursing. McKinnon Crook describes the patient, family, and community interactions that are the hallmark of her work and emphasizes the value of being prepared and learning to rely on ingenuity and resourcefulness when practicing in rural and remote contexts. Not only does this read offer a unique perspective on nursing work, but follows the author’s experiences as a young nurse experiencing life (and love!) in a small and closely connected community. McKinnon Crook paints an encompassing picture of rural living, the landscapes, and the resilient and culturally diverse people she encountered. Notable themes consisted of perseverance, compassion, and of course the vital role of community healthcare.
Overall, "Always Pack a Candle" offers a warm connection to the experiences and lessons that can help new nurses understand the realities and rewards of working in challenging environments. The key takeaways include the importance of adaptability, compassion, and community engagement in nursing practice.
(https://nursingthefuture.ca/the-interview/)
Watch Judy Duchscher interview the incredible nurse-advocate Roxie Danielson in our latest Interview!
Roxie is a Registered Nurse and advocate for people who are homeless and people who use drugs. She received her Bachelor of Science in Nursing degree from The University of Ottawa in 2013 and immediately started working in primary care at South-East Ottawa Community Health Centre. From there, she moved to Toronto and began working as a Street Nurse at Inner City Family Health Team in April 2014. Soon after she started this job, she realized the tremendous work that needed to be done to really support her clients, understanding the challenges that homelessness brings. Roxie has been part of various activist groups, such as the Street Nurses Network and the Shelter and Housing Justice Network, and is often at anti-poverty marches, rallies and protests. She also regularly advocates for her clients through in-person discussion and through social media.
(https://nursingthefuture.ca/our-voices/)
This month, we are so pleased to feature “The Challenge of Choosing your Practice Area as an Early Career Nurse” by Gessica Hulse, BScN, RN. Read on to find out about Gessica’s journey to medical aesthetic nursing at her co-owned BCI Clinic, where she discusses why she describes 15 years of practice as her ‘early career’! Gessica details not only her path from obstetrics, medicine, surgery, cardiology and dialysis before embarking on her passion-filled pursuit of business ownership in the beauty industry.
(https://nursingthefuture.ca/greenhouse-master-class/)
We are honoured to present the first in our unfolding series on the State of Nursing in Canada, beginning with an incredible conversation between Director Dr. Judy Duchscher and Canada’s Chief Nursing Officer Dr. Leigh Chapman!
Dr. Leigh Chapman is committed to advancing the nursing profession in Canada to ensure equitable access to quality care. As CNO for Canada, she provides strategic advice to Health Canada, plays a convening role on key nursing issues, and represents the Federal Government at public forums. Leigh is a registered nurse (RN) who received her PhD from the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing. Over the past 20 years, she has gained a deep understanding of nursing by working in both frontline and clinical leadership capacities. In addition to her role as CNO for Canada, Leigh continues to work at a community-based consumption and treatment site in Toronto, where she provides harm reduction services and frontline care.
(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.
In prior newsletters, Dr. Duchscher has talked about critical components of the first 4 months of transition, or the DOING stage of professional role transition for the newly graduated nurse. It is important that we all understand the adjustments being made by newly graduated nurses as they enter professional practice so that we can provide the ‘right’ support strategy at the ‘right’ time – when the grads are actually ready to receive it. For the next few newsletters, Dr. Duchscher will introduce the components related to the 2nd Stage of Transition: BEING. This newsletter will introduce the reader to this second stage of professional role transition.
The 2nd stage is characterized by overwhelming exhaustion as the new graduate becomes more comfortable with practice competencies, starts to ‘settle in’ to their new practice culture, and begins processing everything that happened in the whirlwind of Stage 1. The tremendous energy that was consumed learning, performing, concealing, adjusting and accommodating to all the new situations and relationships introduced during their initial 4 months of practice, combined with the stress of taking responsibility for clinical decisions in challenging scenarios that they may have had little to no experience with as students, results in a level of terminal exhaustion from which they now need to recover. The graduates in this stage tend to want to withdraw from the intensity of their initial months, giving their minds, spirits, and bodies a chance to rest. The good news is that they are moving from SURVIVING to THRIVING mode as a new nursing professional! The next 4 to 5 months of the graduate’s post-orientation transition experience will be marked by a consistent and rapid advancement in thinking, knowledge level, skill competency and….best of all, their confidence.
I’ve definitely learned a lot more about time management. Like if I need to give somebody this med and I need to flush their catheter I need to grab them a gown, so I’ll do it all at once. Where as before I’d be in and out of the room four times to do all these things. But now, I can think better in my head and I’m like ‘OK, I’ve got to do all this before I go in’.”
I’d probably say [the biggest change is] the confidence. Just being confident in my knowledge and what I know, and confident that I know where to get the answers or who exactly to go to instead of going to ten different people. Just being more confident in myself and my knowledge so I know when I need to do something. I’m not always second guessing what I’m doing.
While the 2nd stage is not as ‘daunting’ as the 1st, this stage can spark disquieting doubt regarding the new graduate’s professional identity and purpose.
The reason I’m finding this part of the transition to be the most difficult is because the excitement about being done and the shock that I was in has worn off. I feel as though I’m on a raft that is drifting farther and farther away from the shore (my safety net of being a student or a new grad). And I’m floating toward an island where the experienced nurses are, but I keep losing sight of them.
To date, the transition has been dominated by physical adjustments to the hours and demands of work (particularly if they are working shifts in a hospital environment); emotional ups and downs brought on by the anxieties of practicing ‘on their own’ or taking responsibility for practice (in particular skills and decision) that they had significant support for when they were a student; and intellectual strain from having to THINK ABOUT EVERYTHING with a level of intensity that can be more draining than invigorating. Now their energy is going more to the social (establishing relationships with colleagues, adjusting to individual personalities in the workplace, and reconfiguring a personal life while being a working professional), cultural (understanding how ‘power and influence’ are exercised in their workplace and who the formal and informal leaders are), and political (determining what control they have over their practice and how to use that power to ‘get’ what they need for those under their care) aspects of their life as a nurse. These are elements of day-to-day functioning as a professional that they might not have noticed before; now that they are able to ‘lift their gaze’ from the more immediate tasks before them, they will start to notice what is going on AROUND them. It is worth noting that the need to coexist in all 6 of these spheres (physical, emotional, intellectual, social, cultural and political) at the same time accounts for the majority of energy consumption during this stage. As one new grad put it: “This is why you are SO SO utterly bagged and tired in this stage”.
During the 2nd stage (approximately between 4-8 months of post-orientation practice), the graduate may find themselves challenging pre-graduate notions of nursing and becoming acutely aware of inconsistencies and inadequacies in the health care system. This can be very disruptive to the impressions of nursing they had come to believe when they were still students.
I like the nursing aspect of it, it’s not stressing me out much anymore. It’s other things now. It’s the politics…everyone’s burnt out. I’m not even focusing on myself and my skills anymore, it’s my surroundings and just the atmosphere.
This can be a stage of significant ‘flux’ for new nurses—a time of ‘awakening’ to all that IS and all that IS NOT. Restoring a sense of equilibrium is the name of the game in this stage, marked by: 1) searching, 2) questioning, 3) doubting, 4) examining, and 5) revealing.
Like in the real world you are understaffed and you are working hard. It was a real eye opener to me. You know, the things that go on and the things that they let fly. Like do you know that now we have patients in the hallways on our units? I had a patient in the T.V. room the other day. Like this is the real world and welcome to it, you know? You’re nursing someone in the T.V. room today! It’s a bit bizarre. It’s just we’re full to the max mostly with medicine on a surgical unit and we have these surgeries that the surgeons don’t want to cancel so we take our least sick patient and put them in, well we could put them in the equipment room or in this case the T.V. room, and you nurse them there and hope nothing goes bad ‘cause you don’t have any suction, you don’t have any oxygen. So you put a note on the door saying ‘Patient Room. Please don’t enter.’ I just think it’s crazy. Like I just couldn’t believe it when they were asking us to do this. I thought are you nuts? Like on a general day I take care of ten patients. I can’t take care of twelve or thirteen patients! That’s too many—there’s a lot going on. And the other thing that happens is if we need a bed early in the morning, the patients that are being discharged later that day have to get out of that room and go sit in the T.V. room until someone can come pick them up. But they’ve just had surgery, they’re in pain and maybe they would like to rest for another three hours until their husband can come pick them up, you know? But we need that bed, we need it cleaned, we have a fresh O.R. coming in so, ‘Pack up your stuff cause you’re in the T.V. room.’ I feel like the hospital is being run a bit more like a business than a caring community. It’s really business-like so whoever is making these decisions obviously has no idea what goes on in a nursing unit.
Tune in next month as we tease out the components of searching, questioning, doubting, examining, and revealing that characterize this next progression in the transition to practice for newly graduated nurses.
Research and Education: Richard Beckhard’s Model for Organizational Change
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. Read on for the latest in our Transition Theory series, and visit our transition theorist page https://nursingthefuture.ca/transition-theory/ for more!
Richard Beckhard is remembered as an individual who has made significant contributions to the field of organizational development. He first worked as an actor and later became a Broadway stage manager for troops in the Pacific. He was intrigued by how the troops seamlessly adapted to changes and wanted to delve deeper into the subject. In the 1950s, he began collaborating with Professor Douglas McGregor, the individual who established the Organization Studies Department at the Sloan School of Management. The two later collaborated with Dewey Balch to commence a project aimed at helping organizations manage their change processes. In 1963, he became an Adjunct Professor at the Massachusetts Institute of Technology (MIT) Sloan School of Management. He collaborated again with Warren Bennis and Edgar Schein to launch the Addison-Wesley Organization Development Series. Dr. Beckhard achieved prominence in the field of organizational development by focusing on widespread organizational changes, then an emerging field. The first training program for specialists in Organizational Development was launched by Beckhard in 1967. In 1970, he established an organization purposely for supporting family-owned businesses and named it the Family Firm Institution. The author of numerous books and articles, Beckard retired from academia in 1986 but continued to disseminate his work to managers, business executives and anyone who desired to be a change agent. After his retirement, the faculty of MIT Sloan School of Management instituted the Richard Beckhard Memorial Prize to recognize him for his contributions to the field. Though Dr. Beckhard passed away in 1999, his legacy of understanding how individuals and organizations adjust and adapt to change continues to contribute to organizational effectiveness.
Summary of Beckhard’s Model for Organizational Change
Beckhard asserted that existing organizations are often compelled to alter how they conduct their affairs as a result of the rapid ongoing changes occurring around them. Managers who are usually at the helm have the daunting task of ensuring that these changes are implemented seamlessly, even though the process may require multiple adjustments in various aspects of the organization. A myriad of considerations must be made by the manager to guarantee the change initiative's success. Further, the manager must have the requisite knowledge and skill set to decipher what the current state of affairs of the organization is, have a clear image of what the desired future should look like, know the actions that must be undertaken to accomplish the desired future and have an idea of how things should be in the interim before the desired future is reached.
This ‘interim phase’ between the present state and the desired state is what Beckhard called the transition state. He suggested that the desired future will be attainable if the transition state is managed properly. According to Beckhard, a manager must first understand the exerting environmental factors and their impact on the outcomes before initiating any organizational change. This awareness ensures that the best strategies are selected for the impending change.
The current stateis the starting point of every transition process and representative of what the organization wants to shift away from. Environmental factors often trigger the desire to effect a change initiative. Organizations must sometimes adjust in order to meet a set of defined expectations. Beckhard recommended that an initial detailed analysis of the present state be conducted to minimize unforeseen interruptions and interferences with the transition. This involves knowing the specifics of the changes to be made in the present state in relation to the human resources and organizational structures. Actions can then be defined around these specifications. Beckhard added that managers should ascertain whether there are any impediments to reaching the desired future and address them prior to engaging in the transition process.
The various facets of an organization must be assessed for readiness and capability when undertaking a change. This can be determined by utilizing a formula first introduced by David Gleicher. Beckhard introduced this formula as a means to determine the organization’s readiness and capability for impending change. This formula is diagnostic and helps to identify problem areas that require redress.The formula is C = (ABD) > X, where C = Change, A = Level of dissatisfaction with the status quo, B = Clear desired state (well-defined goal to be attained), D = Practical first steps toward a desired state (an awareness of initial steps to be taken to reach the desired state), and X = Cost of change.Inferring from the formula, people are less likely to resist a change when they are dissatisfied with the current state, desire a new state, and are on board with the practical first steps to reach the desired state.
The transition state is the phase where the change is actively occurring and is considered a dynamic period. It is marked by notable changes in the organization and involves a cycle of learning and unlearning. The transition period is characterized by considerable confusion due to the many ongoing adjustments in the organization. These adjustments must be managed effectively. A plan showing how to reach the desired end state and an outline of strategies to foster a commitment to the organization’s change agenda must be in place. Some useful strategies Beckhard has suggested include providing educational and training support, redesigning organizational structures to accommodate ongoing change, creating an awareness of the importance of the change, maintaining open communication lines, identifying critical starting points for the change, assigning roles and responsibilities, clearly defining job descriptions and expectations, and identifying influential individuals to champion the change agenda. An independent system must be established to oversee and monitor the progress of the change process.
The future stateis the desired outcome or endpoint of the change process. Beckhard recommended that this phase be viewed as dynamic as well, in that although the desired future may have been attained, it is not uncommon to have systems regressing to old patterns. New systems must be in place to ensure that the desired state is continuously evolving to meet the changing times. Feedback channels should be kept open to facilitate the flow of information within the organization.
Application of Model to New Graduate Nurse
Upon graduation, new graduate nurses transition into practice contexts that exist within complex healthcare systems. Applying Beckhard's model to this process helps position the healthcare organization in readiness to support the integration of the new nurses. Managers can navigate this process by first conducting a thorough analysis of the organization to identify potential barriers or facilitators to the new nurse integration process. A comprehensive action plan can then be developed on how to support the new nurses to succeed in the profession and the organization. Well-planned programs such as orientation sessions, onboarding courses, and mentorships can be incorporated into the integration experience to improve their outcomes. The process must be continuously monitored, and adjustments to the support systems made as needed to ensure that new nurses receive the guidance needed to succeed in developing confidence and competence.
References
Beckhard, R., & Harris, R. T. (1977). Organizational transitions: Managing complex change. Addison-Wesley.
Massachusetts Institute of Technology. (2000, January 26). Sloan Adjunct Professor Richard Beckhard dies at age 81. MIT News. Retrieved from https://news.mit.edu/2000/beckhard-0126
Massachusetts Institute of Technology. (2021, September 8). The 2021 Richard Beckhard Memorial Prize. MIT Sloan Management Review. Retrieved from https://sloanreview.mit.edu/article/the-2021-richard-beckhard-memorial-prize/
Opex Learning. (2019, February 3). Richard Beckhard and his contributions to organization development. Retrieved July 26, 2024, from https://opexlearning.com/resources/27874-2/27874/
Wikipedia contributors. (2023, May 13). Richard Beckhard. Wikipedia. https://en.wikipedia.org/wiki/Richard_Beckhard
Our popular seminar series NTFLive is back with another amazing seminar planned! Join us in the live session discussing all things NCLEX November 27 at 2pm EST with Shelly Luhning, Owner and CEO of NCLEX Education! Don’t miss this informative and fun session designed to explain the testing process and how you can best prepare! Be sure to bring your questions!! Watch our Social Media and become an NTF subscriber for updates and your FREE tickets! Be sure to share these events with your new graduate peers, coworkers, and senior students!
After more than twenty years of national leadership in supporting nursing students and newly graduated nurses through professional role transition, Nursing the Future (NTF) is concluding its current operational chapter.
Since 2004, NTF has served as a vital bridge for new nurses, educators, and leaders navigating the vulnerable early months of practice. Through evidence-based programming, national partnerships, and a commitment to building a safe “cul-de-sac” for early-career nurses, NTF has supported thousands across Canada in cultivating connection, confidence, and professional identity.
We extend deep gratitude to our partners, including the Canadian Nurses Foundation, the Canadian Nurses Association, the Canadian Nursing Students Association, provincial ministries, healthcare institutions, and countless contributors whose belief in transition-to-practice support made this work possible.
While formal operations conclude, the scholarship, curriculum, intellectual property, and program infrastructure developed over two decades remain intact and available for strategic partnership and collaboration. For further dialogue on potential collaborations, please contact Dr. Duchscher directly: newgraduates@nursingthefuture.ca
We welcome conversations with ministries, health regions, academic institutions, and professional associations interested in advancing initiatives such as:
The mission of healthy and supported professional role transition remains urgent. The work continues, sustained through scholarship, partnership, and shared commitment to the future of Canadian nursing.
With enduring gratitude,
Dr. Judy Duchscher - Founder & CEO, Nursing the Future
Kathryn Corneau - Program Director, Nursing the Future
For our FULL letter of Gratitude CLICK HERE
