Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Strategies New Graduate Registered Nurses Require to Care and Advocate for Themselves: A Literature Review

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Strategies New Graduate Registered Nurses Require to Care and Advocate for Themselves: A Literature Review

Article excerpt

Impact statement

A comprehensive resource that educators can use to prepare nursing students for the workplace.

Introduction

In Australia and many other western countries internationally, new graduate registered nurses (NGRNs) are not considered to be work ready by employers and transition to professional practice programmes (TPPPs) are provided as a panacea. In contrast, Zamanzadeh, Roshangar, FathiAzar, Valizadeh, and Kirkwood (2014) noted that some non-western countries focus on the resilience of the NGRN and any formal transition support may extend to as little as 14 days. This observation creates the following causality dilemma: Has the rise of TPPPs influenced the preparation of undergraduate nursing students by lowering performance expectations of graduates or is it the lack of preparation that has influenced the rise of TPPPs? Unfortunately, the western paradigm relies on the latter, that is, transition programmes of health organizations address gaps in practice not serviced by the university sector. This paradigm has the effect of making universities impassive in their preparation of students for nursing practice. For example, one of the first challenges that NGRNs have to encounter is shift work. How do universities explicitly prepare them for this phenomenon? How do they prepare students for inter-professional practice and the practice conflicts, politics and inevitable horizontal violence that occurs? These questions are not often answered in curricula and nursing students are unaware that the reality of the health-care environment is one of limited support, extreme challenge and unpredictability (Duchscher, 2012).

Limited support for NGRNs remains likely into the foreseeable future as overstretched healthcare institutions struggle financially. Even though there were pre-existing (i.e. prior to 2007) concerns (Delaney, 2003), the global financial crisis has contributed even further to the decline of transition support. This has been reported throughout the OECD and world-wide (Morgan & Astolfi, 2014). As a result, the likelihood that promises, such as preceptorships, not being realized are more likely (Parker, Giles, Lantry, & Mcmillan, 2014). The following quote provided by Wangensteen, Johansson, and Nordstrom (2008) illustrates the European Union experience.

We were supposed to have a supervisor - we were supposed to have guidance in groups - it all looked so fine. But we haven't had any ofthat (...) It was very disappointing. (Wangensteen et al., 2008, p. 1880)

Many resilience strategies are advocated in the current literature (Benner, 1984; Duchscher, 2009; McAllister & Lowe, 2011; Schoessler & Waldo, 2006); however, further research is required to identify the explicit resilience strategies NGRNs might adopt to thrive throughout their graduate year. McAllister and Lowe (2011, p. 6) define resilience as 'a process of adapting to adversity that can be developed and learned'.

Being prepared for the reality of diminished support is critical to the NGRNs' success and preparation is essential in the form of practical strategies that enhance their foreknowledge and skill to manage potential dilemmas. The aim of this review was to identify the strategies from previous research that are most likely to assist NGRNs to advocate and care for themselves.

Background

Despite many reports and recommendations to the contrary, the likelihood that NGRNs will find themselves in a chaotic, dysfunctional or unsupportive work environment remains quite high (Adlam, Dotchin, & Hayward, 2009; Berry, Gillespie, Gates, & Schafer, 2012; Chandler, 2012; Clark & Springer, 2012; Dyess & Sherman, 2009; Feng & Tsai, 2012; Hart, Brannan, & de Chesnay, 2012; Kelly & Ahern, 2009; Laschinger & Grau, 2012; Romyn et al., 2009; Thomas, Bertram, & Allen, 2012). The NGRN often experiences both physical and emotional exhaustion and is also likely to experience anxiety, low self-esteem, despair and a sense of hopelessness when trying to 'fit in' to the new health unit environment. …

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