The study, carried out by Victoria University of Wellington nurse researchers, involved analysing 54 reflective essays written by 27 graduate nurses during their nursing entry to practice (NETP) programme.
The research team, led by Professor Jo Ann Walton, said the analysis shed light on the experiences of new graduates and showed that the reflective essay was a “powerful tool” for helping both new graduates (and their lecturers) to learn from clinical practice.
The analysis also backed other researchers who found that new graduates find it “challenging to deal with their own emotional reactions, to stand up for themselves and their patients,to feel part of the team, and to ask for help (which they fear may signal failure)”.
“We suggest that there is scope for more focus on emotional labour, resilience, and professional composure in programmes leading to nursing qualifications,” said the researchers. “Arming new graduates with these skills would ease their transition into a workplace where emotional work is core.”
The researchers identified five key themes (see below) and shared examples illustrating these themes from some of the graduates’ reflective essays.
For example Clare identified a situational challenge that required her to regain her composure and draw on both personal and professional attributes:
It was a typical busy afternoon. I went in to the patient’s bedroom to take
a set of observations. I noticed his breathing appeared laboured and a slight
decrease in consciousness. I had a bad ‘gut feeling’ about the situation. I
called over a nursing colleague and the nurse in charge to assist with my
assessment.
At the time I was feeling anxious, I was not sure how I was going to
objectively describe the slight change nor did I know how to explain my ‘gut
feeling’ to the nurse in charge. I was feeling worried because if I did not act
quickly he may rapidly deteriorate. I knew at that point I was stressed. I
remember my face feeling hot, palms sweaty, thoughts becoming disorganised
and feeling like I just wanted to cry. I knew I needed a minute to
compose myself and so I stepped out of the room while the nurse in charge
waited for me to handover my assessment. I took two deep breaths and wiped
away the tears. I walked back into the room with a smile on my face and
spoke to my nursing colleague, nurse in charge and patient in a concise, kind
and succinct manner.
In another example Lucy reflected on the situational challenge of dealing with a very distressed client with an intellectual disability and her own inexperience in dealing with the distressing verbal assault:
This experience was so emotionally challenging that it shook and tested
my whole philosophy as a genuinely kind and caring nurse. The insults were
extremely derogatory and against my cultural values. I resented the patient
and knew I definitely had disengaged with the patient. I was feeling and
thinking like a victim and not the nurse that I knew I was.
Through my training I learnt that a good nurse needs to know when to
ask for help. I had to ask for assistance from my mentor who advised administering
a depot [intramuscular injection] to settle the patient for safety
reasons. After the incident I had a good talk with my preceptor which made
me feel better. My colleagues said I had looked defeated, so maybe the client
had noticed as well and responded negatively. It also helped when my colleagues
gave me their maximum support by validating my feelings, sharing
similar experiences and checking on me regularly to give me breaks. I wish I
had talked to them sooner.
In a third example a pressured new graduate Paula gets spoken to abruptly by charge nurse manager (CNM) after Paula intervened to stop a patient being discharged:
I felt uncomfortable and embarrassed, as she had belittled me, my nursing
practice and rationale in front of the wider multi-disciplinary team
(MDT) who are my professional colleagues. The CNM made me feel as
though I was doing an inadequate job, when in fact I knew I was delivering
safe, kind and patient centred care.
When discussing the situation privately with a fellow nursing colleague, I
learnt that this outburst was not personal towards me or my nursing practice.
I was able to better understand the ward culture and I felt more positive that
my nursing practice was not inadequate. In hindsight, I realise I could have
requested the RMO (doctor) to review the patient’s pain and whether they
were (ready) for discharge earlier. I had not done this due to the pressure he was also
put under to complete discharge paperwork. I also should have discussed the
concerns I had with the shift coordinator. This could have prevented the
situation from arising, as the coordinator and CNM communicate (about) where
patients are regarding their discharge.
The researchers concluded that their analysis showed the reflective process worked and could be used as a “means of unearthing students’ concerns” and helping them understand what they had done well, could have done differently, why something arose and how to handle challenging events.
“It can be used as a means to bolster their confidence, and to discriminate between personal success (or failure) and systemic strengths and weaknesses,” said the team. “It also provides teachers with rich data on which to build discussions, support students and aid them in their transition to fully fledged professionals.”
FIVE KEY THEMES
Source: Jo Ann Walton, Natalie Lindsay, Caz Hales & Helen rook. Glimpses into the transition world: New graduate nurses’ written reflections. Nurse Education Today. (published online prior to print publication in 2018)
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As an 18-year-old fresh out of high-school, I chose nursing based on the vague idea that it was a profession that involved helping people.
Or as I defined nursing at the time: “a career in which human beings get to look after other human beings”.
I was relatively sure I’d made the right decision from day one of nursing school. My lecturers inspired me as they talked about nursing being a career of compassion and caring.
However, there was always a host of niggling doubts in the back of my mind. What if I can’t handle it? What if I’m not good at it? What if I don’t like it? These thoughts continued right up until the end of my first year, when it was finally time for our first-ever clinical placement – a two-week hospital placement.
On the first morning my stomach felt like a washing machine. I was so nervous. All of those bothersome doubts were running through my head on replay, intermixed with the constant “don’t be sick, don’t be sick” and “remember to breathe, remember to breathe”.
But that afternoon an inspired and energetic student nurse emerged from the hospital with all doubts expelled and the security of knowing that nursing was for her.
What had convinced me in that short shift that nursing was for me? I loved the interaction with my patients. My favourite part was being able to chat to them after I had done my tasks (after, not during, because at that point there was no way I could count a heart rate and talk at the same time!).
I enjoyed building relationships and seeing the way the simple, thoughtful things made a world of difference. I remember taking a wet sponge to moisten the lips of a nil by mouth patient. She was so thankful for some relief and this led to an outpouring of gratitude.
I also loved the challenge of ‘difficult’ patients and working out how to interact with them. It was the interpersonal intertwined with the practical nature of providing healthcare that I loved, and that led to my revelation that “this is for me”.
After reflecting on my own experiences, I began to chat to some of my fellow third year classmates. I found that they all had their own unique experiences of realising that this was the right degree for them.
“I loved the purpose that I found in my relationships with patients. All of a sudden it seemed real and these experiences made me value the important things in life.” – Rachel M
“For me it was when I once put a towel behind a patient’s neck, and the amount of relief she felt was enormous; she was so grateful, and it made me realise how much of a difference I could make, even if it was small.” – Rachel R
“As soon as I started to get along with the team and was able to feel confident in completing tasks, I knew that nursing was for me.” – Mady
“On my first day of placement I knew I had made the right career choice. I just sat with my patients and really got to know their stories; it was a privilege for me to hear and from there I felt the conviction to make a positive difference in their health journey.” – Amy
It was the patients who had inspired us to continue. It was the patients who let us know that we were in the right place. It was the fact that our degree was allowing us to move into a career of caring for these people, a career where we knew that we would have purpose and could make a difference.
As I was reflecting on this more I began to think, if what we are doing for others is giving us a sense of purpose how can we also help our patients to find a sense of purpose?
If we are driven by this purpose and knowledge that we can make a difference, would giving our patients a sense of purpose help them to find that extra drive to get better? Would it help them to be more than just better? Help them to thrive rather than just survive? Thriving is a state in which we do more than just live at a normative level; it enhances wellness and helps us to enjoy life and purpose is a part of this (Perlman, 2017). Imagine if we were able to aid ALL our patients to thrive.
So I love nursing. I know that this is the place I want to be and upon reflection I have worked out why.
My challenge to you is to work out your ‘why’ too.
My challenge to myself is to remember my ‘why’. To remember the patient, to remember that ‘nurse’ will not only be my job title – it will be an opportunity to make a difference. Being a nurse will be a way of living my life so that I thrive, not just survive and get the chance to help others to do the same.
Author: Larissa Sproul is currently a third year nursing student at the University of Auckland’s School of Nursing.
Perlman, A. (2017). Helping People to Self-Actualize: Revising the Role and Goal of Our Healthcare System. Explore: The Journal of Science and Healing 13(1), 6-8. doi http://dx.doi.org/10.1016/j.explore.2016.10.009
]]>In this article I share some advice I think could be useful for you beforen start your clinical placement.
You are likely to encounter situations and cases you have never been exposed to before. Take a moment to process these experiences and, if needed, vent to your family and friends (while protecting patient confidentiality, of course).
Introducing yourself helps start a friendly and open relationship with your colleagues. Being a positive team member makes you stand out as someone who wants to be there. And you won’t be labeled as just ‘the student’.
We are only human! Try not to dwell on your mistakes. Instead focus on what you could have done better and how you can learn from the situation. Don’t be afraid to talk through your mistakes with your preceptor; they are there to support and guide you on how to learn from your mistakes.
Watching families and friends in emotional pain while their loved one dies is a hard pill to swallow. You may be present for the deaths of babies, children, adults and older people. I found the best way to support someone who is grieving is by providing privacy and comfort. This may involve being ‘all ears’ or simply providing cups of tea. It all makes a difference.
If you’re anything like me you may not be used to working 8-12 hour shifts for three to four days a week. Standing and walking for eight-plus hours, holding your bladder, moving and handling patients weighing more than 120kgs; these are just a few of the physical battles you may deal with each day. So it is important to take care of yourself too. Many nurses develop back problems from lifting patients, so learn to use proper techniques and don’t be afraid to ask for a helping hand. A good pair of comfortable shoes is also essential!
We’re there to learn, right? So don’t shy away or expect the nurse to always come to you. Be assertive and step out of your shell. The best learning happens with practice, so give it a try while you have supervision.
I know these aren’t the best jobs and you’re probably thinking I didn’t come to nursing school to make a bed, however you are part of a team. Helping out your team members and doing little jobs really makes the difference. It shows people you are a helping set of hands and are willing to do pretty much anything.
It’s easy to feel like you’re in the way of nurses and doctors when there’s an emergency. Ask your preceptor what your role should be if an emergency occurs. This may just be clearing and decluttering the surroundings or being a runner. But be ready to put yourself out there and ask if you can do the vital signs or assist in other ways.
I’ve found it helpful to have a notebook in my pocket to jot down medications, illnesses, procedures, and anything I need to learn at a later date. It’s hard to remember things when you have a busy schedule, so this helps get around that.
Students can sometimes be seen as a burden for nurses who don’t want a long, dragged-out shift. My advice is to tell your preceptor upfront what you can currently do within your scope of practice, and what you would like to achieve from the shift. This will hopefully sway the preceptor to seeing you as an asset rather than a burden.
Try not to get frustrated if you have a new preceptor daily and you are repeating the same small tasks each day. Your preceptor needs to see that you are competent doing these tasks in order to build trust.
If bullying does occur, try to raise the topic with the preceptor in a nice manner. However, this is way easier said than done. Don’t suffer in silence. I’d recommend speaking to either the charge nurse or your nursing school clinical mentor if an issue arises. And don’t leave it until it’s too late to solve.
Also, try not to lose focus on the real reason why you are there.
Letting your preceptor know your weekly goals is essential as it gives them direction on what they need to teach you. Tell them what you’re not so confident in doing and what you would like to learn, so they can make sure you get hands-on practice.
Preceptors like to hear feedback just as much as students do. Let them know if they are doing a good job and ask them for feedback too. For example: “Did I do this well? or “What can I do better next time?”
Show initiative by answering not only your call bells but also other nurses’ call bells. And, if you are near the phone, answer phone calls too. There is nothing more frustrating to staff than seeing a student sitting next to a ringing phone and not answering it.
Answer the phone professionally by introducing yourself and naming the ward. Always take a message or pass the phone on. And always remember to report information back to your nurse.
Instead of clock-watching, show that you’re willing and excited to be there learning. When drawing up medications or doing an assessment, ask reasonable questions that show you have insight and critical thinking skills. For example, ask why something is happening and what the outcome will be, as this shows forward thinking.
Home baking works a treat! This may seem like a bribe, but it really is a great way to show your appreciation for your preceptor’s support and time.
Author: Mady Watt is currently a third-year nursing student at the University of Auckland’s School of Nursing.
NB First published online September 21. Re-published October 27 in Issue 5 of Nursing Review.
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