Welcome to Nursing: Millennial Nurse Graduates' Perceptions of Transition to Professional Practice

Monday, 30 October 2017

Joanie Weigel, MSN, BSN
Division of Nursing, Univeristy of Mary Bismarck ND, Bismarck, ND, USA
Julie E. Klein, PhD
Division of Nursing, University of Mary, Bismarck, ND, USA

The profession of nursing is experiencing a nursing shortage that is anticipated to surpass 500,000 by the year 2022 (AACN, 2014). Nursing is looking to the millennial generation to help alleviate this shortage. Andrews (2013) found that only 18% of Millennials born between the years of 1980-2000 intended to stay with their employers long-term. Cleary et al. (2013) add that 43% of graduates two to four years post-graduation planned to leave the profession. Graduating from a nursing program and beginning a first job as a nurse is a highly anticipated transition for nursing students. As students, a great deal of time and effort has been dedicated toward achieving this goal. This anticipation is often replaced by “uncertainty, self-doubt, anxiety, and fear, as the safety net of the academic environment is gone and they are awakened to the reality of the true healthcare setting” (Jewell, 2013, p. 324).

For many Millennials, the decision to choose nursing for a career was based on their perceptions of nursing. For many, nursing is viewed as a caring, compassionate profession that serves others. Price, Hall, Angus, and Peter (2013) discussed that Millennials believe that nursing is a good career choice as they encompass the virtues that represent nursing that include altruism and compassion. Millennials recognize that they were of a generation that valued helping others and believe that nursing could enable them to make a difference. Millennials who enter nursing solely based on its virtues may neglect to recognize the knowledge, skill, and expertise that are required to be a nurse as well as the adaptability to survive in a changing healthcare environment. As healthcare has evolved over the years, so have the expectations of nursing graduates who are entering the profession. “One well-documented source of low job satisfaction is conflict between what nurses anticipated or expected upon entering the profession and what they experience in the workplace” (Andrews, 2013, p. 153). Cleary et al. (2013) reported that many graduates were dissatisfied with the reality of nursing and the lack of care that they were able to provide to patients. This disappointment can stem from challenges that graduates may face that include decreased confidence; insufficient clinical and/or theoretical preparation; and inadequate support systems. Jewell (2013) found that graduates enter the nursing profession with a great deal of textbook knowledge but have yet to develop proficient practice skills.

Millennials grew up in education systems that were federally funded and were required to provide customized education plans for children (Riegel, 2013). Thus, individuals from the millennial generation expect various options with customized alternatives for orientation. Millennial nurse graduates expect an orientation process that reflects their undergraduate nursing experience with classes and unit training (Riegel, 2013).

There is a great deal of literature surrounding reality shock, but few studies have been conducted specifically to determine how this phenomenon affects millennial nurse graduates. Understanding Millennial graduate nurses’ transition from the role of nursing student to professional nurse is an area that needs further study in order to understand expectations of millennial nurse graduates. The purpose of this study was to obtain Millennial graduate nurses’ perceptions of their lived experience of preparedness as they transitioned from the role of nursing student to that of a professional nurse. The theoretical framework for this study was the concept model of novice to expert by Patricia Benner. This study utilized the qualitative research design of phenomenology. Semi-structured interviews were conducted. The sample consisted of eleven nurses who were all members of the Millennial generation and graduated from a Baccalaureate nursing program. This study’s participants had less than two years of work experience as professional nurses and practiced in a wide range of work backgrounds.

The three major categories that were derived from the interview data were: You Know It’s not the Same, Orientation to Reality: Chaos, and Now That I’m Comfortable with Working and Stuff. The majority of the Millennial nurse interviewees began their first nursing positions as floor nurses in acute care settings; they soon realized incongruence between professional and personal role expectations. The majority of the interviewees stated that while they believed that their undergraduate nursing curricula had prepared them with knowledge, they did not feel prepared to meet clinical challenges and perceived that they were unable to apply knowledge that they gained from classroom lecture to clinical practice. Although the majority of the interviewees left general medical-surgical nursing within 6 weeks to 18 months, they acknowledged the value of experience in this area of nursing to develop their foundation of nursing skills. After gaining experience and obtaining employment in a specialty area, the majority of the interviewees planned to remain in the nursing profession and would recommend it to others.

Recommended changes for baccalaureate education programs to better prepare prospective Millennial nurse graduates included: the amount of time spent in clinical; the acuity and number of patients students provide care for in clinical; increased exposure to experiences associated with professional nurse role responsibilities; more realistic simulations to acquire experience; and improved orientation processes both in length and quality. This information can improve the transition for from student nurse to professional nurse to help reduce the nursing shortage; which can ultimately result in the increased safety of patients and reduce the financial burden of healthcare organizations.