You're Not Going to Learn It All: Graduate Nurses' Perceptions of Preparedness for Clinical Practice

In addition to assuming traditional responsibilities that are mandated by the nursing profession, current health care systems demand that new graduate nurses quickly develop into efficient, capable professionals who will provide safe, high quality care to increasingly complex patients under strenuous circumstances (Parker, Giles, Lantry, & McMillan, 2014; Watt & Pascoe, 2013). Oftentimes, nurse graduates are expected to sink or swim in the complexities of the health care environment; this pressure can cause stress, anxiety, and challenges in role adjustment that may lead these new nurses to question whether their nursing education adequately prepared them to provide patient care at the bedside (Feng & Tsai, 2012; Hatlevik, 2012). The need to be prepared to enter clinical practice, also known as ‘practice readiness’ or ‘work readiness,’ has been widely discussed within nursing literature, and a common theme that has been identified by stakeholders in the profession has been a lack of practice readiness among graduate nurses (Watt & Pascoe, 2013). Due to the need for safe, competent registered nurses to provide patient care in acute settings, in addition to the increasing rate of turnover among newly hired graduates, ensuring the preparedness of students to function within their professional roles after graduation should be a priority focus for nurse leaders.

The purpose for conducting this qualitative phenomenological study was to explore the lived experiences of nurses who graduated from baccalaureate degree programs within the last two years regarding their perceptions of preparedness to enter clinical practice. The intent of this research was to achieve a greater understanding of how educational experiences may influence novice nurses’ preparedness to assume their professional roles and responsibilities in clinical settings. The study was conducted to provide information to guide the development of socialization strategies that can promote graduates’ successful transitions into the nursing workforce.

Face-to-face interviews were conducted with a sample of 10 BSN prepared registered nurses who graduated from six different nursing programs that were located in three states. The participants were employed in various settings in two acute care facilities and had one to two years of practice experience as registered nurses. A semi-structured interview guide was used to elicit the participants’ perceptions of how their educational experiences prepared them to enter clinical practice as graduate nurses.

Thematic analysis was conducted to identify prevailing themes by coding and categorizing the narrative data. Three major categories and themes emerged from the coded data. The first category identified was: “It’s Hard for Nursing School to Prepare You for Everything.” The theme for this category was: All of the graduate nurses in this study perceived that their nursing education provided them with the basic knowledge and skills necessary to enter the registered nurse workforce; however, it was not realistic to prepare them for every patient situation that may be encountered during their careers. They acknowledged that applying nursing knowledge and skills in professional practice was an invaluable learning experience that could not be replicated in academic settings. The second category was: “Being in the Workforce is Different.” The theme for this category was: All of the graduate nurses in this study identified differences in students’ and registered nurses’ responsibilities in patient care situations. They discussed various aspects of their professional roles that they had not been exposed to during their nursing education. Many of the graduate nurses described recognition of the reality of their jobs and their level of professional responsibility after being on their own after orientation. The final category was: Pearls of Wisdom. The theme for this category was: All of the graduate nurses in this study freely shared recommendations that were based on their experiences to better prepare novice nurses for entry into professional nursing practice. They emphasized the importance of mentoring from instructors, preceptors, and experienced staff members; more hands-on experiences in nursing education; and the need for students to develop lifelong learning skills to ease the transition to the role of the registered nurse.

The findings from data analysis resulted in the following final assertion: All of the graduate nurses stated that their nursing education gave them the necessary background to enter clinical practice as registered nurses but that their education could not completely prepare them for the reality of their professional responsibilities. They emphasized distinct differences between the role of a student and the role of a nurse and identified knowledge and skills that could only be gained through experience as a registered nurse. All of the graduate nurses in this study offered advice for students/novice nurses, academic institutions, and health care employers to better prepare graduate nurses to assume their professional roles and responsibilities. As a result of this research, recommended strategies for nurse leaders to use to promote preparation and socialization of graduate nurses into the nursing workforce include, but are not limited to, additional clinical requirements for pre-licensure programs, interprofessional education, nursing internships, graduate nurse residency/mentoring programs, and academic-practice partnerships.

The findings of this research supported the need for a scholarly collaborative approach among nurses in practice, education, and research settings to better prepare graduates to navigate the challenges associated with entry into professional nursing practice. Socialization strategies should be implemented by nurse leaders to enhance graduate nurses’ knowledge, skills, and abilities and provide support to these novices as they transition into the nursing workforce. These strategies can promote knowledge transformation and lifelong learning to better prepare graduates to assume professional roles and responsibilities. Facilitating graduate nurses’ successful transitions into the workforce is an important strategy that can address turnover and retention among graduate nurses, the emergent and ongoing nursing shortage, patient safety, and other related issues that pervade current health care systems (Laschinger, 2012; Walker & Campbell, 2013).