NRSG377 - Transition to Professional Practice Critical Phase For Nurse Assessment Answer

Introduction

In the dynamic realm of healthcare, where the intersection of knowledge and practice defines the journey of novice nurses, individuals like Xander traverse a transformative path laden with both challenges and opportunities for growth. The shift from theory-laden classrooms to the intricate wards of clinical practice necessitates a unique blend of resilience, adaptability, and unwavering support (Chang & Daly, 2020). This essay will explore the instrumental role of peer support, mentoring, and structured preceptorship programs in bolstering personal resilience and fostering holistic professional development for graduate nurses like Xander. Moreover, it critically examines and offers evidence-based recommendations for areas requiring refinement, particularly time management and communication skills. Additionally, the essay will underscore the potential of clinical leadership, shedding light on how experienced and senior nurses can profoundly influence the trajectory of novices. Through Xander's narrative, the essay aims to exemplify the pivotal importance of a nurturing environment, strategic guidance, and collaborative mentorship in cultivating the resilience essential to not just survive but thrive in the intricate landscape of nursing.

Role of Peer Support and Mentoring

One highly effective approach is establishing a peer support and mentoring program. This initiative involves pairing the novice nurse, such as Xander in this case study, with experienced mentors or a peer group to facilitate open discussions and shared experiences (Lim et al., 2017). According to Duchscher's Transition Shock Theory, new nurses experience a sense of shock and vulnerability during their initial transition due to the dissonance between their academic knowledge and the complex reality of clinical practice. Peer support and mentoring can mitigate this dissonance by offering a safe space for Xander to voice his concerns, seek guidance, and engage in meaningful dialogue with those who have already navigated similar challenges (Hunter & Cook, 2018).

Literature underscores the emotional support aspect of peer mentoring in nursing transitions. See et al. (2023) highlight that novice nurses often experience emotional turmoil and self-doubt, which can be addressed through open conversations with mentors who provide validation and empathy. Moreover, mentors can play a pivotal role in fostering confidence, as suggested by Hawkins et al. (2019). Positive feedback, sharing success stories, and guidance in handling complex situations can contribute to Xander's self-assuredness in his decision-making and clinical skills (Chang & Daly, 2020).

Structured Preceptorship Programs

Within the nursing profession, the significance of structured preceptorship programs in easing the transition from student nurse to registered nurse is well-documented. Such programs align with Benner's Novice to Expert Theory, which emphasises the role of preceptors in guiding new nurses through the stages of skill acquisition (Landers et al., 2020). As recommended for Xander, a structured preceptorship program ensures that he receives personalised guidance and supervision from an experienced nurse, thus facilitating clinical competence development (Rodrigues et al., 2022). This aligns with the findings of Manetti (2019), who emphasises the importance of supervised practice to enhance clinical judgment and decision-making skills in new nurses.

Furthermore, preceptorship serves as a safeguard against errors and patient safety concerns (Manetti, 2019). Rana et al. (2022) emphasise that under the mentorship of experienced nurses, novices are less likely to make clinical errors and more likely to adhere to evidence-based practices. Additionally, the integration into the interprofessional team is facilitated through preceptorship, mitigating Xander's apprehension in seeking help (Lim et al., 2018). Also, according to Lim et al. (2018), supportive work environments that foster interprofessional collaboration are vital for nurses' job satisfaction and well-being.

Improving Time Management and Communication Skills

Xander's shift demonstrated an opportunity for improvement in his time management and prioritisation skills, which aligns with various elements of the National Safety and Quality Health Service (NSQHS) Standards. Specifically, NSQHS Standard 5 emphasises the importance of providing comprehensive care and coordination of care. In this context, Xander's challenges in managing his tasks, investigating discharge requirements, and performing DD checks could impact patient safety due to delayed assessments and interventions. This resonates with the Nursing and Midwifery Board of Australia (NMBA) Code of Conduct for Nurses, which mandates the provision of safe and timely care to patients. Efficient time management is crucial to ensure timely interventions, preventing potential deterioration in patient conditions and promoting optimal outcomes.

The "ABCDE" approach aligns with the NSQHS Standard 5's focus on providing comprehensive and quality care by systematically prioritising patient needs based on urgency (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2017). This approach helps Xander identify critical patient issues promptly and enhances his communication with the interprofessional team. Implementing the "ABCDE" approach corresponds to the NMBA Decision-Making Framework's principle of providing safe and timely care through systematic and evidence-based practices (Nursing and Midwifery Board Aphra [NMBA], 2023). Additionally, it reflects principle 6 of the NMBA Code of Conduct, which emphasises demonstrating clinical competence and using sound clinical reasoning in patient care (NMBA, 2018).

Xander's communication and team collaboration challenges on his shift align with the NSQHS Standard 6, underscoring the significance of effective communication for safe care (ASQHC, 2017). His difficulty in finding a second nurse for the DD check and in promptly locating the nurse in charge during the critical situation with Mrs. Williams could potentially compromise patient safety. Effective communication and collaboration among the healthcare team are pivotal in preventing adverse events and ensuring high-quality care, as emphasised by both the NSQHS Standard 6 and the NMBA Code of Conduct for Nurses (Levett-Jones et al., 2019).

The recommendation to adopt the SBAR communication technique directly aligns with NSQHS Standard 6's goal of improving communication for safer care. SBAR provides a structured framework that supports explicit and concise communication among team members (Clarke et al., 2018). This approach also resonates with the NMBA Code of Conduct's requirement for nurses to communicate effectively and collaborate with colleagues (NMBA, 2018). Utilising SBAR aligns with the NMBA Decision-Making Framework's focus on recognising and valuing effective communication as a critical element of nursing practice, contributing to safe, efficient, patient-centred care (Verghese, 2023).

Clinical Leadership and Guidance

A senior registered nurse could have exemplified clinical leadership by providing guidance to Xander on prioritisation and delegation, which are pivotal skills for nursing practice. Chan et al. (2018) highlight that experienced nurses often excel in prioritising patient care tasks based on clinical urgency and complexity. In this context, the senior nurse could have initiated a brief pre-shift discussion with Xander, reviewing patient assignments and collaboratively identifying priorities. This aligns with clinical leadership principles, where senior nurses mentor and guide less experienced colleagues, as the NMBA’s Decision-Making Framework emphasises (NMBA, 2023). By discussing potential priorities based on patient acuity and stability, the senior nurse would not only facilitate efficient task execution but also demonstrate leadership through knowledge sharing and clinical judgment (Stanley, 2019).

Delegation, as a crucial component of nursing leadership, could also have been demonstrated by the senior nurse. Walker et al. (2021) emphasise that effective delegation requires assessing task complexity and considering the competency of team members. In this scenario, the senior nurse could have advised Xander on tasks that could be appropriately delegated to licensed and competent personnel while ensuring adequate supervision. This aligns with the NMBA Code of Conduct for Nurses, which mandates registered nurses to delegate tasks to ensure safe and competent care delivery (NMBA, 2018). By guiding Xander in delegation practices, the senior nurse would promote a culture of teamwork and collaboration, fostering a sense of shared responsibility in patient care (Dolan & Overend, 2019).

Amid the critical situation with Mrs. Williams and the subsequent MET Call, a senior registered nurse could have displayed clinical leadership by taking charge of crisis management and team coordination. Daly et al. (2020) stress that clinical leadership involves stepping up during challenging scenarios and effectively coordinating the healthcare team's efforts. Here, the senior nurse could have assumed a leadership role, ensuring a swift and organised response to the emergency. This aligns with the NMBA Decision-Making Framework, which underscores registered nurses' responsibility to lead and coordinate care delivery (NMBA, 2023).

Furthermore, the senior nurse could have demonstrated clinical leadership by guiding Xander in employing effective communication strategies throughout the crisis. Effective communication is paramount during emergencies, as underscored by McCormack et al. (2013). The senior nurse could have modelled clear and concise communication methods, such as the SBAR approach, when liaising with team members, physicians, and other healthcare professionals (Gorod et al., 2021). Such an approach aligns with the NSQHS Standards 5 and 6, which emphasise effective communication and teamwork, contributing to informed decision-making and coordinated care (ACSQHC, 2017).

Conclusion

In conclusion, this essay underscores the pivotal role of peer support, structured preceptorship, and evidence-based methodologies in fortifying nursing resilience. Tackling issues of time management and communication using tools like the "ABCDE" method and SBAR framework contributes to heightened patient safety. Seizing the expertise of senior nurses to navigate prioritisation, delegation, and crisis management showcases adept clinical leadership. Through the harmonious integration of these multifaceted strategies and emerging opportunities, nurses are empowered to enhance their skill sets and ensure top-tier patient care while advancing their professional journey.

References

Australian Commission on Safety and Quality in Health Care (2017). National safely and quality health service (NSQHS) Standards. https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf

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Chang, E., & Daly, J. (2020). Transitions in Nursing eBook: Preparing for Professional Practice. Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=&id=woKlDwAAQBAJ

Clarke, S., Clark-Burg, K., & Pavlos, E. (2018). Clinical handover of immediate post-operative patients: A literature review. Journal of Perioperative Nursing, 31(2), 29-35. https://search.informit.org/doi/epdf/10.3316/informit.944870730073123

Dolan, B., & Overend, A. (2019). A nurse’s survival guide to leadership and management on the ward. (3rd ed.). Elsevier.

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Lim, A. G., North, N., & Shaw, J. (2018). Beginners in prescribing practice: Experiences and perceptions of nurses and doctors. Journal of Clinical Nursing, 27(5-6), 1103-1112. https://doi.org/10.1111/jocn.14136

Lim, J. H., MacLeod, B. P., Tkacik, P. T., & Dika, S. L. (2017). Peer mentoring in engineering:(un) shared experience of undergraduate peer mentors and mentees. Mentoring & Tutoring: Partnership in Learning, 25(4), 395-416. https://doi.org/10.1080/13611267.2017.1403628

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Rodrigues, N. G., Han, C. Q. Y., Devi, K. M., Chi, Y., Selvam, U. P., Wee, F. C., & Wu, X. V. (2022). Perspectives of nurse preceptors on a web‐based clinical pedagogy program and clinical teaching: A descriptive qualitative study. Nursing & Health Sciences, 24(1), 214-223. https://doi.org/10.1111/nhs.12916

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Walker, F. A., Ball, M., Cleary, S., & Pisani, H. (2021). Transparent teamwork: The practice of supervision and delegation within the multi‐tiered nursing team. Nursing inquiry, 28(4), e12413. https://doi.org/10.1111/nin.12413

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