By Casey Hobbs, RN, Director of Nursing, Sequoia Living, and Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse, Health Learning, Research and Practice, Wolters Kluwer
The dynamic of moving from classroom to practice is transformational for any nurse. It’s a sizeable step—one that cannot be taken lightly.
Consider the following real-life experience of a brilliant new nurse who just entered the workforce. Highly recommended, this nurse looked great on paper in terms of grades, but he also possessed the tremendous recall ability of a photographic memory. Yet, his first experience with an emergent situation spoke volumes about preparedness for practice. When he encountered a patient who was not breathing, the newly-graduated nurse froze, unable to take the necessary steps to initiate an emergency “Code Blue.”
Reactions like these are not uncommon for new nurses, especially when entering today’s fast-paced, high-acuity healthcare environments. The reality is that nurses are expected to do more today, than they have historically, even from the day they graduate. That’s why it’s critical that all new nurses feel confident and ready to solve the many complex problems they’ll face using clinical judgement skills in their practice.
Unfortunately, an estimated 17.5% of new RNs leave their first job within a year of employment, while one in three leave within just two years. This shocking turnover rate is often due to burn-out created by lack of on-boarding or internship programs to adequately prepare them for the clinical realities of a fast-paced, high-acuity healthcare environment.
To help newly graduated nurses be “practice-ready” from day one, it is necessary that they receive the right clinical training to prepare them intellectually as well as emotionally. It is also important that healthcare organizations deploy efficient, impactful orientation and preceptor programs that can move new nurses to productivity faster and equip them to play a greater role in direct patient care.
Education Shortfalls: Nurses Weigh In
In a recent survey conducted by Wolters Kluwer of nearly 2,000 healthcare professionals, over three-quarters (78%) of nurses and almost four in five hospital executives (79%) say there is inconsistency in how nurses are trained. Physician and nurse respondents also indicated that practice readiness can impact another of healthcare’s goals – eliminating care variability – and indicated the need for more consistency in training and education for new clinicians.
In addition to the need for standardized, evidence-based training, current higher institution classroom approaches often fail to expose new nurses to the speed and scale of responsibility common in today’s clinical environments due to ongoing clinical site shortages. Often, caseloads expand from one or two patients in education environments to upwards of six to 10 in real practice settings, and clinical situations demand quick, appropriate response.
Nurses entering practice are now responsible for balancing all aspects of care—including clinical care, family interactions, interdisciplinary communication and transitional care—while also staying alert to changes in a patient’s condition. This enlarged scope of work contrasts from traditional responsibilities that were solely dedicated to general care when they were in school.
Consequently, training must evolve to address more than just direct patient care needs such as medication administration, treatments, and IV infusions. Nurses must also build skills that focus on inter-disciplinary team management and the ability to:
manage rapidly changing patient conditions
facilitate end-of-life conversations with the patients and families
handle difficult patients
communicate clearly and openly with physicians and other care team members
prioritize care effectively
Elevating Nurse Competencies Through Lifelong Learning
From the classroom to onboarding and orientation to ongoing practice, the healthcare industry must embrace and advance the concept of continued professional development of nurses and provide them with advanced resources necessary to help nurses navigate a fluid healthcare climate, enable critical decision making, and allow them to feel confident in practice.
Higher education classrooms are increasingly benefitting from a ‘flipped classroom’ model with personalized learning methods. Adaptive learning models that engage students though virtual simulation allow self-directed learning through ongoing performance assessment that ensures mastery of competencies and the development of greater critical thinking skills. The result is a more engaged student in the classroom setting vs. a traditional approach.
In addition, traditional lecture-based orientation programs and comprehensive online courseware, which can sometimes be long and daunting for many nurses, must give way to the most up-to-date, evidence-based training methodologies to build clinical confidence of new and experienced nurses. While traditional orientation programs are often characterized by a level of information overload that many nurses are unable to process, more effective models that blend classroom training with online courses have emerged in recent years that foster better engagement and tighter, more impactful training.
In tandem with comprehensive approaches to lifelong learning, clinical leaders are wise to equip their clinical teams with all the necessary evidence-based, point-of-care tools needed to hone clinical reasoning and decision making skills and help them effectively balance art and science in practice.
The more healthcare organizations can acquaint new nurses with daily pain points that occur in the healthcare setting, the better equipped they are to respond. This level of readiness helps minimize anxiety and promotes the kind of successful entry that increases career longevity.
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