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 Table of Contents  
REVIEW ARTICLE
Year : 2015  |  Volume : 2  |  Issue : 1  |  Page : 1-3

New graduate nurses' transition from novice to competence: A step toward quality and safe nursing care delivery


Nursing Consultant, Tata Medical Center, Rajarhat, Kolkata, West Bengal, India

Date of Web Publication8-Jul-2015

Correspondence Address:
Prof. Abanti Gopan
P 286, Darga Road, Kolkata - 700 017, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-1880.160230

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  Abstract 

Nursing Administration globally faces the impact of high attrition of experienced nurses. The challenge of ensuring patient safety and maintaining optimum standards can be taken care of by implementing the preceptorship model and competency based skill development for new nurses easing their transition from novice to competent nurses.

Keywords: Competency based learning, new graduate nurses, novice, preceptorship


How to cite this article:
Gopan A. New graduate nurses' transition from novice to competence: A step toward quality and safe nursing care delivery. J Nat Accred Board Hosp Healthcare Providers 2015;2:1-3

How to cite this URL:
Gopan A. New graduate nurses' transition from novice to competence: A step toward quality and safe nursing care delivery. J Nat Accred Board Hosp Healthcare Providers [serial online] 2015 [cited 2019 May 23];2:1-3. Available from: http://www.nabh.ind.in/text.asp?2015/2/1/1/160230

The quality of patient care delivery and safety of patients in any health care set up is largely dependent on the quality of nursing care provided, the experience, skills, competence, knowledge, and compassion of the nursing staff. This is an area of mounting challenge for all nursing administrators.

Given the current trend of high attrition rates and rapid staff turnover due to lucrative offers overseas, or greener pastures and promising opportunities in other organizations, administrators are left with little choice but to recruit fresh graduates, campus recruitment being a popular method of choosing the best among novices. Often the newly graduated nurses are ill prepared to face the real world scenario of hectic activity, high demand, stressful, and chaotic work environment of hospitals, especially in the corporate sector.

Rather than grudging this rising trend, it is up to managers to innovate means of ensuring safe care to patients for which the ultimate accountability rests with the nursing administration.

The nurse preceptorship program, based on Benner's novice to expert model and the competency based learning model, have proved to be an efficient means of dealing with this problem.

Patricia Benner's stages of clinical competence include five levels of skill acquisition.

  1. Expert
    • No longer relies on rules, guidelines, or maxims.
    • Intuitive grasp of situation based on deep tacit understanding.
    • Analytic approaches used only in normal situations or when problems occur.
    • The vision of what is possible.
  2. Proficient
    • Sees situations holistically rather than in terms of aspects.
    • Perceives deviations from the normal patterns.
    • Decision - making less labored.
    • Uses maxims for guidance whose meaning varies according to situations.
  3. Competent
    • Coping with "crowdedness".
    • Now sees actions at least partly in longer term goals.
    • Follows standard and routine procedures.
  4. Advanced Beginner
    • Needs Guidelines for action based on attributes or aspects.
    • Still limited in situational perception.
    • All attributes and aspects are treated separately and given equal importance.
  5. Novice
    • Rigid adherence to taught rules or plans.
    • Little situational perception.
    • No discretionary judgment. [1]



  Competency based Learning Model Top


This model includes knowledge (cognition) through formal, structured learning through courses either in classroom or e-learning. Knowledge provides the structure underpinned by the standards-based competency framework. [2]

Skill (doing) through opportunities gained by experience and through performing on the job.

Practice (trying) is motivated by coaching, simulation, and practice on the job.

All three stages affect and result in desired behavior for demonstrating competence and assessment is done through all stages in repeated cycles of knowledge, skill, and practice.

The preceptorship program pairs up a novice nurse with an experienced nurse, no less than the competent level. They work together on patient assignments together, even working the same shifts and days off. While working the same shifts, they develop a one-to-one relationship and focus on moving toward competency. The learning needs to be purely flexible, each individual learning at their own pace.

A list of clinical competencies is established depending on the type of work unit they are placed in. The list differs depending on the workplace - Intensive Care Unit, general ward, operation theater, or day care.

For each of the competencies, a checklist guides the novice to the detail steps of competencies to be mastered. Once they are able to perform without supervision, they are considered advanced beginners.

The mentoring process involves building character improving professional competencies, social and professional skills, and infusing love for clinical work. They help to boost the morale of the new graduates; help develops a positive attitude to work and bridge the gap between the ivory tower and reality, individual and organizational goals.

At critical times during high workload and staff shortage, the preceptor may be given a greater caseload along with the novice while overseeing the care provided by the novice.

In practicality, once the novice reaches the stage of advanced beginner according to Benners' model, the new graduate is tested with case assignment on an independent basis, covered by supervisors. However, at this stage they still need to be supervised and guided for safe practices.

Preceptors are selected once they are at the level of competence, with at least 1.5-2 years of experience. This not only boosts their morale but makes them accountable for self-direction toward developing a depth of knowledge and mastering skills.

The advantages of implementing this method are to ease in the new staff to the environment which is new to them, ensure safety and standard quality care to patients, staff feel less threatened and reduces stress at work, helps to develop good interpersonal relations between senior and new staffs, the age old concept of "nurses eating their young" is reduced and a buddy system is developed.

There are drawbacks to this process, which have to be monitored to be prevented.

Preceptor and novice incompatibility may lead to the new staff opting out of the unit or totally quitting the job. There have been cases of bullying or over dominating behavior by the preceptor, where supervisors need to step insensitively or assign new preceptors to the staff.

A good measure to prevent incompatibility is to have a quick preceptor preparation program, sensitizing them to the needs and insecurity of the novice nurses. It has to be emphasized that the focus remains on safe patient care and flexibility according to individual capabilities. Not all competent staff nurses can make good preceptors, so preceptor selection and preparation is important before they are given this role.

A survey on the feedback of the preceptorship program from the nurses at our center revealed that all the nurses who underwent this program found it very useful and important, though they did express that at times due to staff shortage they had to take up individual assignments before completing the minimum 1-month period of preceptorship. All the preceptees recommended that the program should be continued and found their preceptors very helpful and competent, easing their process of moving into the real world.

A feedback from the preceptors was also taken. Some of them felt they required more time for preparing themselves to become effective mentors. They felt the workload and critical situations did not allow them to provide as much guidance as they would have liked to provide.

Our experience over several years have shown evidence that using this system of one-to-one preceptor, mentor or buddy system is extremely helpful in dealing with the issue of high attrition of experienced nurses and managing safe quality care with a fast moving population of nurses, and having to deliver with often inexperienced novice nursing staff.

While it is essential to try means of retaining excellent staff, it is also worthwhile to have methods of being prepared to deal with the situation.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.

 
  References Top

1.
Benner P. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park: Addison-Wesley; 1984.  Back to cited text no. 1
    
2.
Chapell KB, Richards KC, Barnett SD. Transition to practice and clinical leadership model. J Nurs Adm 2014;44:659-68.  Back to cited text no. 2
    




 

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