New Graduate Supporters

Nursing students new graduates New Graduate Supporters

What are the different staffing schedules available in nursing?

Depending on the position you were hired into, you could be considered full-time equivalent (FTE) or part-time equivalent (PTE). Other types of employment are permanent, temporary, and casual. There are benefits to all types of employment depending on your life circumstances.

Full-time Permanent: These positions are usually the most sought after upon graduating from a nursing program as your debts are often higher and, quite simply, you need the cash! FT status means that you are guaranteed FT hours, you usually have a predictable ‘line’ (shift schedule), you receive full benefits and the assurance of permanent work. Countries have different representations of FT equivalent rotations and hours, so check with your employment agency to determine what that means for you!
Full-time Temporary: These positions are beneficial when no permanent positions are available but you want FT hours. Most are long-term appointments (many for a year) and often they are positions that someone has left for ‘temporary’ reasons such a maternity, sick or other sanctioned ‘leaves’. You may not receive benefits (pension, health and dental) as quickly as you would if you were permanent so check with human resources for details if you choose this option.
Part-time: In the posting for the position, it will tell you how many shifts per rotation are being offered. Always ask the manager of the unit if there is an opportunity to have shifts added by scheduling extra shifts or by picking up casual work.
Casual/Relief/Agency: If the area in which you want to work has no positions available and you want to ‘get your foot in the door’, an option is to work casual/relief or to apply to work with an external nursing agency that provides staff for that institution. This may work very well for you if you are a flexible, easy-going person who doesn’t mind an unpredictable work schedule. A word of warning to the ‘planners’ out there – it is VERY DIFFICULT to plan your life if you work casual and want to work a lot. On the other hand, YOU are in control of what shifts you accept and what shifts you turn down.

What does professionalism in nursing mean?

Professionalism in nursing is complex. Often understood as an individual’s adherence to a set of standards, code of conduct or collection of qualities that characterize ‘best’ practice (aka evidence-based) within a particular area of activity, professionalism also speaks to the behavior undertaken while enacting skills and knowledge. Being professional means, you fully understand your role as a caregiver on an interprofessional health care team and that you appreciate how your actions influence the health care experience of both the client and your colleagues.

Can you share any tips about transitioning from a Licensed Practical Nurse (LPN) to a Registered Nurse (RN) Scope of Practice?

Continuing your education and changing roles from LPN to RN is a very personal decision. Most LPNs who make the commitment to the process of becoming an RN find that their previous experience as an LPN helps them transition into the new role with more ease. There are many schools that offer programs that recognize the education and skills already earned by the LPN. The programs typically spend close to two years to complete. Once you complete the NCLEX-RN, the biggest transition is the increased breadth of responsibility and the difference in role expectations (you may be given more acute patients and your skill portfolio may change as advanced practice skills are added to your role).

As a male nurse, I often find my female coworkers are better at expressing themselves and empathizing with patients. How can I demonstrate to my patients that I care as much as my female peers?

One of the first steps that may be helpful is to reflect on your own caring practices- How do you show that you care? As mentioned before, men often show they care differently than other genders, so reflecting inwardly to understand how you demonstrate empathy or support others may be a good place to start.

What type of supports exist for men in nursing who are struggling?

Many people find speaking with a peer or mentor in the field helpful, even if it’s not another man in nursing. Opening a dialogue with a trusted source who can offer insight or perspective often helps to make work-related hardships more tolerable and overcoming those hardships more achievable. Moreover, with the increasing number of men in the profession, many unions now have a male representative or group to help address any inequities that you may be affected by in your practice.

What tools or strategies can men in nursing use to overcome these barriers?

Communication is an excellent tool to offer both education and transparency. It helps to establish a trusting bond and promote collaboration while also developing an understanding that works to overcome pre-existing assumptions or biases. Whether it be with patients, peers, or another group of people, approaching each situation with an open mind and ready to have active discussions is one of the best ways to promote visibility, gender diversity, and a narrative that supports all nurses.

What are some barriers men face in nursing school, separate from women?

Gender discrimination and bias, lack of history regarding men in nursing, and even isolation to name a few. Evidence suggests that men choose nursing for many of the same reasons women do: the desire to make a difference and the opportunity to care for others.

How can I help change the narrative towards men in nursing as a female nurse?

Recognize and understand the challenges that men face in a female dominated profession. Addressing and challenging topics that encourage inequality in the workplace, such as referring to someone as a male nurse, instead of simply a nurse. There is no singular perfect solution that exists. It is important to verse yourself on ways that men express caring as well – some evidence indicates that while no ‘less’ caring, how men express that caring to their patients may be different than their female professional counterparts. Bottom line is nursing BENEFITS from a diversity in representation – talk to the men you work with to get their sense of what the experience is like for them.

What can I do as a healthcare provider to better care for Indigenous patients?

Check your biases first. Everyone has them, be aware of them. Ask yourself what prejudices you may have towards the Indigenous populations you interact with. How have these biases affected your practice? Why do you have these biases? Take time to research and ask questions of the Indigenous populations surrounding you, let their thoughts, experiences and health practices inform and guide your holistic approach.

As a non-Indigenous person, how can I better inform myself of the inequities Indigenous peoples face?

A great place to start is by learning and acknowledging the land in which you have the opportunities to work and live on. Researching local bands/reserves and listening to the stories of people in these Indigenous communities is always wise as they are the best experts about the experiences they have.

Recommended Reading:
DiAngelo, Robin, 2018. White Fragility: Why It’s So Hard for White People to Talk About Racism: https://www.robindiangelo.com
See Interview with DiAngelo at https://nursingthefuture.ca/book-club/

In Plain Site: Addressing Indigenous-specific Racism and Discrimination in BC Healthcare

https://nursingthefuture.ca/wp-content/uploads/2021/05/In-Plain-Sight-Summary-Report.pdf

Lisa Bourque Bearskin, Brenda L. Cameron, Malcolm King, Cora Weber-Pillwax,

Madeleine Dion Stout, Evelyn Voyageur, Alice Reid, Lea Bill, Rose Martial. Mâmawoh Kamâtowin. Coming together to help each other in wellness: Honouring Indigenous Nursing

Knowledge. International Journal of Indigenous Health, Volume 11, Issue 1. DOI: 10.18357/ijih111201615024

Kennedy, Andrea; Bourque, Danielle H.; Bourque, Domonique E.; Cardinal, Samantha; and Bourque Bearskin, R. Lisa (2021) Reconciling Taking the "Indian" out of the Nurse. Quality Advancement in Nursing Education - Avancées en formation infirmière: Vol. 7: Iss. 1, Article 6. DOI: https://doi.org/10.17483/2368-6669.1276

Does Canada have any regional or national professional nursing bodies for specific ethnicities?

Unfortunately, there are no national professional organizations for specific ethnicities, but this does not mean that support and community are not out there. Each province has professional organizations with grassroots approach to supporting nurses of colour.

For example, in Manitoba, you will find the Philippine Nurses Association of Manitoba. The Chinese Canadian Nurses Association of Ontario advocates to end classism and anti-Chinese racism. As part of the Registered Nurses Association of Ontario (RNAO), the Black Nurses Task Force provide educational resources and a community platform for networking. Nationally, the Canadian Indigenous Nurses Association works towards improving Indigenous health through the support of Indigenous nurses.

It is our hope that, through our anti-racism conversations and the advocacy work being conducted nationally and regionally by a plethora of nurses across our country, that access to these nursing organizations will become more equitable with accessible resources.

Can I refuse to care for a patient who makes racialized comments? What are my options and resources if I encounter this?

All nurses in Canada are protected under the Canadian Human Rights Act (the Act). Within the Act, harassment is defined as “improper conduct by an individual, that is directed at and offensive to another individual in the workplace.” Offensive conduct includes discriminatory acts, comments, and displays. As such, a patient/client making racialized comments towards a nurse is considered harassment.

The Act states that the conduct must be repetitive in order to be considered harassment. This means that the patient/client makes a racialized comment more than once. If you have asked a patient/client to NOT make racialized comments and they continue to do so, it is your right to refuse care. That being said, a single act of racism can be considered harassment if it is so severe that the nurse is significantly impacted for a longer period.

In addition to the Act, nurses in Canada are covered under the Work Place Harassment and Violence Prevention Regulations. These regulations protect workers by outlining what is considered a “work place,” further defining acts of harassment, and your employer’s obligations to ensuring a psychologically safe work place.

If you encounter a patient making racialized comments, the first step is to approach your nursing supervisor to discuss changing your patient/client assignment. Other people that you can reach out to as resources include your local nursing union and regulatory body.

References:

Canadian Human Rights Act
Is it Harassment? A Tool to Guide Employees
Work Place Harassment and Violence Prevention Regulations

What is the big difference that you notice between working in remote versus urban-based communities?

One word - SERVICES. Lack of funding and services in rural communities is something that larger urban locations don’t experience as frequently. Nurses play multiple roles (sometimes outside their scope of practice) because of lack of interdisciplinary team healthcare providers. In some communities, equipment is antiquated and optimal resources are hard to come by. As well, many practitioners work alone or have support that is ‘at a distance’ (by phone or virtual). Finally, a lack of physician on-site support is notable as most consults are done over the phone.

What is the most difficult part of rural nursing? What are some common challenges you face working rurally/remotely?

If you get a chance to work in an urban hospital, we would encourage you to work on a resource (float) nursing team. This allows you to gain as many different experiences as possible and learn adaptability in critical situations. When working in rural areas, there are differences between smaller rural communities and fly-in remote Indigenous communities. If you wanted to work in fly-in remote reserves, they require 5 years’ experience in specialities fields, for example ER/ICU/Peds/NICU/MH/public health (not all but at least one). This is primarily related to ensuring patient safety while protecting your practice in the context of high levels of autonomous decision making.

How can we retain new grad rural/remote nurses after going to the effort/expense of orientation?

Improving rural nurse retention starts with recognizing and mitigating some major stressors unique to rural practice. New grad nurses stay (and return) to where they are NURTURED. Offer opportunities to become subject matter experts (e.g. the diabetes expert or advanced training in managing labour or the trauma expert). Offer continuing education on-site or via telehealth. New grad nurses also stay where their families can grow, so help new nurses make connections with the community. For these practicing rural nurses, supportive relationships within the workplace represent a pragmatic commitment that entices them to stay.

What supports do new rural/remote nurses need on the job?

New graduates here may need longer orientation than expected if new to rural setting. It would be beneficial for educators to sit down one-on-one and create an individualized orientation plan to address gaps in preparation (e.g. may not have had experience with telemetry), benefit from orientation with a pair or group (not being the only 'new one' when possible), offer 'ride alongs' with community partners such as: Emergency Medical Services (EMS), police services, outpatient clinics or hospital setting (if new grad is working in clinic). When possible, connect the new grad with an Elder in the community as a way to integrate socially and culturally.

How can I best help the new nurse feel welcomed and trusted in the community?

Provide a tour of the community

Introductions to community members and groups

‘Welcome Wagon’ type basket with maps, historical/current community information

What is the difference between ‘assigning’ and ‘delegating’ care of a patient?

Assigning care implies that you are collaborating with another healthcare professional who is licensed and works within a scope of practice for which they can be held accountable. IF you are ‘assigning’ care, it is assumed that you are transferring responsibility and accountability for care to the individual to whom you are assigning the task.
Delegation encompasses requests for the performance of a task for which the individual to whom the skill or task is being delegated is not licensed and therefore is not able to be held ultimately responsible for the performance of that skill within their professional scope. In this case, you (the delegator) retain responsibility and accountability for the outcome of the performance of that skill or task.

What are the most recognized barriers to GIVING feedback?

There are barriers to providing effective feedback. One of the most common is the lack of TIME. This encompasses not only lack of time to give feedback but also insufficient time spent with the learner. You may feel that you are just beginning to develop rapport with this individual and start to fear the relationship with the learner may be damaged by feedback that is taken more as criticism than constructive facilitation. However, most times this is not the case, as you are most often perceived as trying to improve the learner’s practice. Just know that feedback should be brief but focused, based on an observed action and followed up with an action that can be taken to improve. It is hard to hear we are not perfect – and new graduates are particularly vulnerable to feeling criticized as they seek only to IMPRESS you. Start with what they are doing WELL, but make sure you mean it – graduates have a nose for false platitudes. Now, if you observe UNSAFE practice you may have to step in! Asking them why they are about to do what they are about to do….helps THEM to see the issue without your having to tell them. Keep asking them questions so that by answering them they uncover the ‘error’ themselves. These conversations are best done in a private area.

How can I be a better nurse preceptor?

It’s a mutual effort from both the preceptee and preceptor to create an environment that promotes learning and open communication. Being a preceptor is not just having a new grad being assigned to you to do your work. It is a responsibility to EDUCATE and SOCIALIZE the new nurse into becoming an independent, critically thinking team member who will be a valued and respected part of your workplace! Think about what a preceptor did for YOU that you really appreciated? Or what was something that you didn’t appreciate and want to avoid doing to someone else? Being mindful is already a start to being a better nurse preceptor.

Is your graduate nurse suffering from transition shock? What can this look like?

Most graduates begin to experience transition shock after the orientation and supernumerary period has finished, and the daily grind sets in.

Common signs to watch for include:
1. Feelings of anxiousness
2. Fear of failure
3. Inadequacy and ‘imposter syndrome’
4. Isolation
5. Lack of hope and/or
6. Fatigue.

Do nurses really “eat their young?”

The phrase “NURSES EAT THEIR YOUNG” became an informal ‘idiom’ intended to represent some of the interactions between senior and new nurses. An interesting thing about the expression is that almost every nurse you talk to will know the saying. It demonstrates that bullying and harassment, at some level, has been normalized. Some units/practice communities are better…some not so much. The culture of nursing IS changing, but every workplace will have their challenges – bringing together people of varying experiences, coping mechanisms, personal challenges and personalities is not a simple exercise. If you are a victim of bullying or harassment, tell someone. If you observe someone being harassed or bullied, tell someone. The person may not even be aware of their actions and you might even assist them by sharing how it makes you feel. Together, we can change the adage to “NURSES SUPPORT THEIR YOUNG!”

Just try to stay grounded in the fundamental objectives of a newly graduated nurse to start which in turn will promote perseverance.
• Gaining a sense of the roles and responsibilities of a graduate nurse;
• Creating a workload organizational system that works for you;
• Learning how to manage your time within a workload of GRADUALLY increased complexity;
• Learning the routines of your workplace;
• Debriefing with a trusted experienced colleague, nursing education, or mentor about clinical situations to gain a depth of understanding of ‘clinical patterns’ and the relationships between those patterns and the judgements that arise out of them;
• Gaining confidence in performing the fundamental skills required of a nurse in the setting where you work…;
• Learning how to work ON a team – and learning ABOUT your team; ‘
• Gaining a balance between your personal and professional life;
• Learning to have FUN again!

It all begins with the right mind-set.
Click to learn more at Transition Theory

How can we meet the needs of our multigenerational nursing workforce?

Generations are evolving, the differences are growing exponentially and the eras that define them are shrinking. This means we are beginning to see an increasingly diverse representation in our workforce. For the first time in history, five generations of nurses are working TOGETHER. Now we need to recognize that each generation has their own needs, avoid stereotyping, and take a peek into the strengths each generation has to offer.

Remember, the future is built by giving the next generation a reason to HOPE!

References
Christensen S., Wilson B., & Edelman L. (2018). Can I relate? A review and guide for nurse managers in leading generations. Journal of Nursing Management. 26(6), 689-695. doi: 10.1111/jonm.12601.

Duchscher, J., & Cowin, L. (2004). Multigenerational nurses in the workplace. Journal of nursing Administration, 34(11), 493-501. doi: 10.1097/00005110-200411000-00005

How do you handle conflict with others?

Due to the dynamic and high-stakes context of health care, managing conflict with others is a skill set that a health care provider needs to develop as they gain practice experience. The approach taken to manage conflict can determine whether opportunities for growth will be created. Here a few tips that might help:
• Try to listen and understand what the other perspectives on the situation are;
• Give the other person the benefit of the doubt;
• Be cautious about interpreting ulterior motives – ALWAYS check with the person directly before ‘assuming’ anything about their intents;
• If you are unable to resolve the situation with the person directly, ONLY THEN do you elevate your concerns to the educator or manager;
• Seek guidance from a trusted mentor ;
• CRITICAL CAVEAT: When patient safety is at risk you must elevate the concern immediately!

How do you handle situations when your values are being challenged?

This is a very difficult aspect of nursing. When your values are challenged by a clinical context, try first to solve the problem in a grassroots manner with the person/s directly involved, seek out a more responsible person in your workplace (senior nurse you trust or the unit educator or care coordinator), or find a trusted friend or mentor to talk through the issue with. Use the self-reflection skills you used in nursing school to identify where the internal conflict is for you, if there is a change you can or should make in your personal or work life to resolve it, or if the change required is at the unit or institutional level. If you continue to feel a disconnect between your values and a work situation, you may need to consider making a change or advocating for one where you work. Be on the lookout for maladaptive coping mechanisms (not sleeping, feeling sad or angry a lot, withdrawing from friends or family, or using substances to sooth your anxiety) – work stress that goes unresolved can sneak up on you – it can steal your joy. Remember that there are occupational health resources you can access in any workplace – these are skilled practitioners who are there to help you cope and it is 100% confidential!

How is nurse migration affecting nurses?

Nurse migration (movement across positions or institutions) is one factor compounding nursing shortages in Canada. The lack of full-time positions and job insecurity in the younger generation of nurses makes moving out of country an enticing prospect. Any trend that worsens nursing shortages affects ALL nurses on the frontline, and can reduce the supports available to nurses who are new to practice. It is important that we collectively create a health care context in which all nurses want to work and stay.

When does the process of professional role transition begin?

Usually once the new nurse leaves the safe and predictable confinement of their nursing education program. In other words, after completing their final practicum and entering their New Graduate Orientation. Having said this, the graduates often feel ‘safe’ while still in a supernumerary position or orientation because they are in the familiar learner role. It is when they are ‘on their own’ that they feel the true weight of the responsibility of their role. The longer you can draw out the support, even minimal support, and the slower the withdraw of that safety net, the less transition shock the graduate will experience.

Why do new grads appear over-confident?

Overconfidence in a new nurse is rarely as it seems. New nurses have a strong developmental desire to be accepted – they will do what is necessary to ‘belong’ and this often includes ‘appearing’ confident so as not to draw unwanted criticism or attention. They might balance their sense of inadequacy by giving off a sense of theoretical expertise – and they may well know the theory behind practice, but are unable to actualize that theory in the ‘real’ world. Remember that theory is the grounding that has helped them get through school for the past number of years. They want others to respect them and so they want to show what they have to offer. Many senior nurses, having experienced the same steep learning curve when they started, often understand that graduates will need a significant amount of time to learn the complex role of nursing. Posturing oneself as knowing all the complexities of the profession immediately after graduation is usually a defensive mechanism where a new graduate fear that under intense and knowing scrutiny, their skills will come up lacking. If they are supported to ‘fail’ without consequence (particularly to the patient), the new nurse can more easily learn from the experience, and rise to a more advanced level of knowledge in their practice.

What can we do to help a new grad on our unit?

Communicating and supporting are two main ways of helping a new graduate in your area. Clarifying a new graduate’s priorities and needs for the shift early on in the day can help all involved to get a sense of what is currently understood, and what is needed for support. Extending a clear lifeline of 'come and talk to me when you have questions' cements that it is normal and healthy to utilize other nurses in making decisions. Getting to know other new graduates may help to make these new practitioners feel more at ease with their needs (normalizing ‘not knowing’). Many of these graduates have spent time in relevant or specialized fields, or indeed have previously held a related healthcare job. They are NOT a ‘blank slate’ either personally or professionally. Support may be perceived as micromanagement or distrust, so interactions should be approached thoughtfully. Involving new graduates in break room conversations can be a considerate way for them to feel connected to the unit.

What are the signs that a new grad is struggling?

New graduate nurses may present very differently when it comes to struggling. Some clear warning signs may include asking the same questions repeatedly, easily observed signs of emotional distress, an inability to take breaks or leave the shift on time, or a prolonged inability to recognize or respond to urgent situations. Some new graduates may share (or overshare) their struggles, while others may avoid sharing as a means of protecting themselves. Bringing the graduate into a circle of trust is a sure way to get them to disclose any concerns they might have about their practice; the worst scenario is that the new graduate, feeling ‘unsafe’, conceals their feelings and makes errors (or almost makes them) because they have no one to talk to. Most of these situations can be prevented by open and trusted dialogue with colleagues.

Why is there such a divide between new nurses and the more senior generations?

It is common for younger generations of nurses to feel distinct, A multitude of factors have changed the face of nursing in recent years. Emerging technologies, procedures and healthcare professions have met with healthcare restructuring and sociopolitical prioritization in health spending. Nurses have experienced constant change as they navigate ways to meet the needs of others. Relating to the education and experience of previous generations of nurses may take some effort, but is likely to result in the valuable sharing of knowledge. ALL generations have both attributes and challenges in the workplace – the important thing is to figure out what strengths each of us brings because of who we are (how we were raised, our education), and then work to help each other balance out what we do NOT bring to the workplace. Be the Ying to your colleagues Yang!

Should I feel bad about declining hospital shifts?

Reflecting on your own limitations is a necessary part of providing responsible care to others. Evaluating and investing time in maintaining personal wellness is important when providing care is often demanding. While many new graduates historically work overtime at the beginning of their careers, the need for balancing work and life soon becomes apparent. This is a marathon, not a sprint – the challenges that an institution is having with workload and human resource management is NOT the sole responsibility of the nursing staff. While the odd extra shift is reasonable, new nurses should weigh the risks of working too much when it comes to their cognitive sharpness and their ability to feel engaged and committed over the long term.