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HLT54115 Diploma Of Nursing Question: Discuss about the Journal of Continuing Education in Nursing.     Answer: Nursing is an important professional field owing to the fact that graduate nurses act as important members of different healthcare teams in specialized areas and provide patient centered care.  Nurses acquire clinical knowledge and gain competence in their skills during the training and education periods. Therefore, the nursing curriculum plays an essential role in their growth. Ideal training facilities help them learn the different clinical strategies that need to be adopted in order to obtain positive patient outcomes, reducing length of hospitalization and improving the quality of care (Rush et al. 2013). However, new graduate nurses face several issues during their transition from being a university student to carrying out the responsibilities of a registered nurse. Considerable research has been carried out on the assimilation of new registered nurses at their workplace. This essay will include a reflective practice that will illustrate the different issues that we face as a nursing graduate during our transition. I will further elaborate on the strategies that should be adopted to overcome these difficulties.   Transition to practice helps in supporting new nurse practitioners, during their transition from nursing academia to the professional field. Novice practitioners get adequate assistance through this transition to gather sufficient clinical skills, knowledge, and competence. These skills help the graduate nurses to demonstrate an efficient and safe performance (Thomas, Bertram and Allen 2012). Kramer was the first person to study the transition experience from the academic field to professional practice for new graduate nurses and coined the term ‘reality shock’. It was used refer to the conflicts that arose in nursing practice due to the influence of school-bred values on work ethics and duties. There exist discrepancies between our understanding of nursing roles from our education and what we begin to experience, once we enter the real-time healthcare service settings (Phillips et al. 2014). My experience as a nursing graduate provided exposure to certain dominant and intellectually oppressive behaviors that are considered to be cognitively restricted. The major problem that arises during transition is assimilation of the graduate nurses. The major problems related to assimilation that are usually faced by new graduate nurses like us are consist of the fact that the skills and knowledge that we had acquired during our nursing degree are generally not accepted by the senior nurses and superiors who have been working for several years within the clinical settings (Clipper and Cherry 2015). Assimilation issues create difficulty to fit in the complex hospital setting. Our role as a nursing student often involved management of two or three patients under the supervision or direct monitoring of a senior registered nurse. However, the transition creates a reality shock when we might be given the responsibility to manage more than 5 or 6 critically ill patients during our paid shifts. The transitions of that I experienced during my clinical placement were associated to development of interpersonal conflicts that resulted in violence at my workplace. I experienced negativity from the senior colleagues regarding my education and lack of capability of demonstrating my clinical experience.    It is a common perception that experienced colleagues and senior nurses often display negative attitudes towards the clinical expertise and nursing proficiency gathered by novice practitioners during their graduation course (Goodwin and Candela 2013). I did not get sufficient support from the senior enrolled nurses which led to a setback and decreased my self confidence.  Complete lack of constructive feedback and inadequate mentoring resulted in development of a reality shock. After the clinical placement sessions, I wanted to fit in comfortably and become a part of the team in the real time hospital setting. However, the process of becoming a part of nursing team was not easy.  Newly graduated nurses often require time to learn the routines that are followed in a ward (Leong and Crossman 2015). They are expected to focus on building healthy working relationships with the health care professionals.  Another concern that contributes to the shock is rotation of new nurses in different specialized departments. It created assimilation anxiety made me feel isolated as I was unable to adjust quickly to the different departments within the short time span.   Furthermore, it becomes difficult to gain professional acceptance from the senior colleagues while trying to improve our clinical skills and nursing expertise. Assimilation shock also involved my difficulty to impress the senior staff which hindered my acceptance into their team (Missen, McKenna and Beauchamp 2014). Therefore, it is essential for new graduate nurses to understand about the unacceptable rules in the professional context. Strong disapproval from senior registered nurses often makes it difficult for new graduate nurse to fit in. In addition, nurses who hold a higher rank in the hierarchical setting create stressful and conflicting situations that lead to burnout among new nurses (Caliskan and Ergun 2012).  Therefore, I can state that the work culture within nursing organization does not sufficiently support the transition of new graduate.    There are several other factors that contributed to my transition shock in the clinical setting. I demonstrated lack of time management skills.  Lack of experience in demonstrating adequate time management made me compare myself with experienced nurses. Identification of my inadequacy lowered my self esteem (Rudman and Gustavsson 2012).  This created a pressure beyond my capabilities. Time management issues result in a failure in providing positive health services, which in turn reduces patient satisfaction.  The other aspect of transition stock was related to being held ethically and legally responsible for the life of my patients.  It is the primary duty of registered nurses to save their patients through the delivery client centered care plans.  Absence of adequate mentoring contributed to my failure to manage deteriorating patients.  This usually terrifies new graduate nurses and the associated legal complications create considerable stress. Furthermore, fear of asking questions and making mistakes lead to personal stress. My lack of experience of interacting with physicians made me avoid contacting them upon encountering sudden deterioration in the patient.  This sense of insecurity created major safety issues and I considered myself unprepared for the transition period. Shortage of nursing staff creates pressure to recruit new nurses in specialized areas and employ their decision making capabilities. New graduate nurses should be employed in specialized areas later, after they have exhibited high decision making skills.  However, huge workload requires them to take up leadership responsibilities early in their career which also contributes to transition shock (Spiva et al. 2013). There are various strategies that I intend to implement to overcome the transition shock. Owing to the fact that novice nurses face difficulty in communicating with their colleagues and with the patient families, it is essential to improve the interpersonal communication skills. I intend to develop my relationship with my coworkers and establish a rapport with the patient in order to maintain effective communication. This will improve my decision making skills (Lea and Cruickshank 2015).  Learning good skills and attitudes from the colleagues will help in improving self confidence and will give an idea of the steps that need to be taken while managing critically ill patients. Keeping a reflective journal will also help me to reflect on my clinical practice.  The reflections will provide a clear understanding of the wrong practices that are demonstrated in the hospital setting and will help in identifying the aspects that need further improvement. Evidences suggest that keeping a reflective journal reduces the likelihood of nurses from suffering from transition shock (Hatlevik 2012). It will allow me to integrate the clinical knowledge that I have acquired over the years into my nursing practice. Another effective strategy lies in the implementation of graduate transition programs. The Healthcare organizations should develop provisions for such programs that will allow senior enrolled nurses to mentor new graduate students when they enter the professional field (Dyess and Parker 2012). This will increase our self confidence and make us develop commitment towards our practice. It will further act as a platform through which we can transfer our nursing knowledge into the professional scenario. Improving problem solving skills and seeking support from senior professionals such as nursing managers and physicians also help in reducing transition stress (Dicke et al. 2015). Development of problem solving skills will help us to avoid conflicts at the workplace and will enhance decision making capacity in highly specialized wards. To conclude, I can state that the shift of graduate nurses into professional settings is accompanied by transition shock and high anxiety, which creates negative influences on their professional commitment.  It increases burnout rates and affects staff retention, turnover rates and the quality of care that is being delivered to the patients. The assignment analyzed different perspectives of transition and reality shock that occurred after my graduation as a nurse. Lack of time management skills, workplace conflicts, negative attitude of senior nurses, inadequate communication skills, and my inability to provide treatment to critically ill patients are some of the common factors that contributed to transition shock.  This made it difficult for me to gain acceptance in the professional team.    Therefore, it is imperative to increase our self confidence through improvement of time management, problem solving capabilities, decision making power to reduce rates of burnouts.  This can be achieved by maintaining a reflective journal and closely monitoring the senior colleagues.  Thus, it can be stated that structured mentoring programs and integration of clinical knowledge into professional practice will help in development of healthy relationship between new graduate nurses and seasoned nurse practitioner, thereby reducing the likelihood of transition shock.   References Caliskan, A. and Ergun, Y.A., 2012. Examining job satisfaction burnout and reality shock amongst newly graduated nurses. Procedia-Social and Behavioral Sciences, 47, pp.1392-1397. Clipper, B. and Cherry, B., 2015. From transition shock to competent practice: Developing preceptors to support new nurse transition. The Journal of Continuing Education in Nursing, 46(10), pp.448-454. Dicke, T., Elling, J., Schmeck, A. and Leutner, D., 2015. Reducing reality shock: The effects of classroom management skills training on beginning teachers. Teaching and Teacher Education, 48, pp.1-12. Dyess, S. and Parker, C.G., 2012. Transition support for the newly licensed nurse: a programme that made a difference. Journal of Nursing Management, 20(5), pp.615-623. Goodwin, M. and Candela, L., 2013. Outcomes of newly practicing nurses who applied principles of holistic comfort theory during the transition from school to practice: A qualitative study. Nurse education today, 33(6), pp.614-619. Hatlevik, I.K.R., 2012. The theory?practice relationship: reflective skills and theoretical knowledge as key factors in bridging the gap between theory and practice in initial nursing education. Journal of advanced nursing, 68(4), pp.868-877. Lea, J. and Cruickshank, M., 2015. The support needs of new graduate nurses making the transition to rural nursing practice in Australia. Journal of clinical nursing, 24(7-8), pp.948-960. Leong, Y.M.J. and Crossman, J., 2015. New nurse transition: success through aligning multiple identities. Journal of health organization and management, 29(7), pp.1098-1114. Missen, K., McKenna, L. and Beauchamp, A., 2014. Satisfaction of newly graduated nurses enrolled in transition?to?practice programmes in their first year of employment: a systematic review. Journal of advanced nursing, 70(11), pp.2419-2433. Phillips, C., Kenny, A., Esterman, A. and Smith, C., 2014. A secondary data analysis examining the needs of graduate nurses in their transition to a new role. Nurse Education in Practice, 14(2), pp.106-111. Rudman, A. and Gustavsson, J.P., 2012. Burnout during nursing education predicts lower occupational preparedness and future clinical performance: a longitudinal study. International Journal of Nursing Studies, 49(8), pp.988-1001. Rush, K.L., Adamack, M., Gordon, J., Lilly, M. and Janke, R., 2013. Best practices of formal new graduate nurse transition programs: an integrative review. International journal of nursing studies, 50(3), pp.345-356. Spiva, L., Hart, P.L., Pruner, L., Johnson, D., Martin, K., Brakovich, B., McVay, F. and Mendoza, S.G., 2013. Hearing the voices of newly licensed RNs: The transition to practice. AJN The American Journal of Nursing, 113(11), pp.24-32. Thomas, C.M., Bertram, E. and Allen, R.L., 2012. The transition from student to new registered nurse in professional practice. Journal for Nurses in Professional Development, 28(5), pp.243-249.

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