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Understanding the theoretical foundations of the transition to practice that new graduate nurses experience is important as an educator. As you explore these theories, reflect on your own transition and the transitions you have helped to facilitate, how do these theories apply?
Transition Shock/Transition Stages Model
Transition Shock/Transition Stages Model
Transition shock is a phenomenon experienced by new nurses as they enter the profession; it describes the feelings, climate, adjustments, mental and physical stamina, and overall new orientation related to entering the profession. This is experienced uniquely by each new nurse as they begin their careers, however, all new nurses undergo the same phases of change as per the Transition Stages Model (Duchscher & Windey, 2018).
Stage 1 - Doing
Stage 1 - Doing
This occurs 3 to 4 months after orientation to the new workplace and role. It is focused on the new professional becoming acquainted to practice as a regulated member with all of the responsibility and accountability they did not have while protected in the post-secondary setting. The novice nurse is continuously engaged in aspects of patient care and has difficulty “turning off” due to a desire to demonstrate their competency and capacity.
(Duchscher & Windey, 2018).
Stage 2 - Being
Stage 2 - Being
This stage occurs immediately following the Doing stage for 4 to 5 months. In this stage, the new nurse displays exponential growth in nursing processes and execution of skills. They remain hesitant to provide alternative views or perspectives to authority figures in the workplace, and begin to realize the shortcomings of the healthcare system in relation to the care they are able or unable to provide. At approximately 5 to 7 months, the new nurse is overwhelmed by doubt with regards to their own abilities, and instances of imposter syndrome; this serves as a precursor to further development of nursing practice and own goals.
(Duchscher & Windey, 2018).
Stage 3 - Knowing
Stage 3 - Knowing
In this stage, the new nurse establishes and becomes sure of their unique identity and comfortable with the duties associated with their role. Barriers to establishing this new identity include burnout from shift patterns, lack of power to effect change, and dissatisfaction with work conditions. The new nurse becomes knowledgeable and approachable with questions and is confident in assisting their colleagues. Roles that the nurse may be ready to accept in the knowing stage include charge nurse, preceptor, quality improvement, and experienced nurse capable of caring for acutely ill patients.
(Duchscher & Windey, 2018).
Benner From Novice to Expert
Benner From Novice to Expert
Benner's From Novice to Expert provides usefulness in developing the new nurse in and outside of nursing practice. The five stages of skill acquisition build upon one another:
Novice (lack experience, rule followers)
Advanced beginner (starting to gain experience and recognize patterns in clinical situations)
Competent (becoming experienced and intentionally methodical in their practice)
Proficient (perceptions of situations broaden and the nurse becomes adaptive when changes are needed)
Expert (intuitive and capable of executing multiple strategies for problem-solving in the clinical setting while maintaining the adaptive behaviour from the Proficient phase).
(Melrose et al., 2021).
Trauma-informed education in nursing
Trauma-informed education in nursing
Realize, Recognize, Respond, Resist
Required in order to educate those graduating from nursing programs that experienced the COVID-19 pandemic
Focused on relationship building and strengthening interactions with others/peers, emotional intelligence, and creating an environment of support through empathy of others’ emotional perspectives and experiences.
Four domains:
Realize: realize that new graduates have undergone a traumatic and unique experience, and recovery is possible. Educators in this stage inquire about student experiences, and sharing by the new nurses creates trust and psychological safety.
Recognize: In this stage, educators are aware of presentation of trauma symptoms in new nurses, and relieve these symptoms temperature checks and offerings of support
Respond: Response includes continued demonstration of compassion and support. Approaches in this phase include immediacy and validation of feelings and emotions.
Resist: This stage refers to the intentional and conscious action of ensuring the trauma is not repeated. Educators and leaders supporting new nurses focus on healthy and effective approaches to teaching and orientation to the profession, and providing adequate preparation.
(Goddard et al., 2021).
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