Nurse Leaders' Perceptions of the Preparedness of Novice Registered Nurses in the Workforce

Novice RNs face a myriad of challenges throughout the first year of nursing practice. These challenges are intensified by complex patient care scenarios and strenuous work environments. In order for novice RNs to be adequately prepared to practice as direct care providers, the nursing profession must seek innovative strategies to recruit, retain, and educate the nurse of the future. Thus, this qualitative study was conducted to gain a current understanding of nursing leaders’ perceptions of novice registered nurses (RNs) preparedness to practice as direct providers of care in an acute care hospital within the first year of licensure. Specifically, the researcher seeks to identify and understand:

• Knowledge, skills, and attitudes (KSAs) perceived as strengths
• KSAs perceived as needing improvement
• Experience with proven strategies for facilitating transition from student to licensed RN
• Innovative strategies for facilitating transition from student to licensed RN (e.g. not yet tested or proven)
• Recommendations for hospital leaders in the C-suite [e.g. Chief Executive Officer (CEO), Chief Operating Officer (COO), Chief Nursing Officer (CNO), Chief Financial Officer (CFO)] for issues around transition to practice
• Recommendations for the nursing profession at-large for issues around transition to practice
• Recommendations for the healthcare industry for issues around transition to practice
• Relationship between the participants’ characteristics and answers

The researcher selected Patricia Benner’s (1982) Novice to Expert: Excellence and Power in Clinical Nursing and Judy Duchscher’s (2009) Transition Shock: The Initial Stage of Role Adaptation for Newly Graduate RNs, a contemporary and traditional theoretical framework to guide the study.  Given the challenges of the healthcare environment and high expectations of novice RNs, Benner (1982) and Duchscher (2009) elected to explore the experiences and transition of nurses in the workplace. Based on the two theoretical frameworks, three research questions were posed to investigate the nurse leader’s perceptions of novice RNs.

A purposive sample was utilized to recruit nurse leaders for the study. Prior to recruiting and enrolling participants, IRB approval was obtained from the University and the acute care hospital. Thirty-five participants were recruited to participate in the voluntary, digitally recorded face-face interview via e-mail. Only seven participants were interviewed due to the early recognition of themes and patterns. Participants’ privacy was respected and interviews were conducted in the participants’ personal office. No identifying information was obtained and each participant was assigned a four-digit code.

Content analysis was performed on the rich data collected to identify themes and patterns. Based on the content analysis performed, 12 themes were identified on the preparedness of novice RNs. The 12 themes identified included: the basics, time/experience, culture change, communication, critical thinking, time management, confidence, support, bullying, orientation, nurse residency program, and clinical hours. The findings from this study support Patricia Benner’s (1982) From Novice to Expert theory that time and experience are necessary to transition from each level of skill acquisition, and Duchscher’s (2009) Transition Shock theory that novice RNs experience various physical, emotional, intellectual and developmental changes throughout the transitional process from graduate nurse to novice registered nurse.

Critical thinking skills, communication, confidence, and time management skills were identified as areas needing improvement. However, each area needing improvement requires experience and time to successfully master. In order to ease the transition, support from multidisplinary team members and all levels of the healthcare management system is vital in holistically empowering and improving novice registered nurses performance. In addition to support, an orientation process specific to the individual’s needs and experience is essential to facilitate a seamless transition. The transition from graduate nurse to professional nurse is difficult and requires adequate support, time, and experience.