The transition from student to nurse: What does it involve?

Shortage of registered nurses

It is widely documented that there is a UK-wide shortage of registered nurses. This isn’t because there are not enough applicants coming to university, rather we are not training enough for the increasing demands of an ageing society, and then don’t look after the nurses we have well enough to retain them in sufficient numbers. In other words, employers need to ensure that once nurses are trained and in their jobs they have the right pay, working conditions, professional support, post-registration access to education and training, and career prospects. A big part of looking after nurses is supporting them during the transition from student to registrant.

From student to nurse

When students graduate and enter the world of work, there is always a period of transition from being, primarily, a student to a worker. This can be a difficult time in an individual’s life and career. changing from the role of student to that of staff nurse is stressful, as well as an exciting achievement.

The stress comes from the reality shock of moving from the protected role of student to the professionally responsible role of registered nurse. However, for nurses and other health professionals, this is a time when they must put the caring and life supporting skills and knowledge that they have been accumulating into action. This has been noted as a particularly stressful time since at least the 1970s when Marlene Kramer presented her research into this, “Reality Shock: Why Nurses Leave Nursing.”

This was prompted by statistics at the time indicating that a large proportion of newly qualified nurses (NQNs) left the profession within the first few months or years after qualifying. The stresses or “reality shock” of becoming a nurse that she described 40 years ago, have, if anything, increased.

Best way to support newly qualified nurses

Fortunately, this hasn’t gone unnoticed and there has been a good quantity of research conducted to find the best ways to support newly qualified nurses (NQNs). Part of this body of research has been conducted by myself and researchers at the University of Derby, in collaboration with Chesterfield Royal Hospital and other Derbyshire and East Midlands’ health industry employers.

The process of support for NQNs in the UK is called preceptorship. Almost all employers now provide preceptorship support for NQNs and other health professionals. From looking at previous research on support for new nurses, the majority is on whether providing preceptorship is better than providing no support for NQNs.

Our systematic review showed that this was undoubtedly the case and, consequently, research is now focused on how to provide the best form of this support.  Our primary research outcomes were that NQNs need a supported preceptorship period with good support from more experienced nurses and the employing organisation as a whole. We found that NQNs were competent to complete the role of the nurse but often lacked the confidence in themselves to meet their ability.

More specifically the three headline recommendations for employers to provide were:

A culture of support for preceptors and preceptees to make them feel valued and supported in the workplace

Recognition of the preceptorship role within a governance framework including clinical educators to support both preceptees and their preceptors on the shop floor
An individualised programme of support for each preceptee based on their own needs and the needs of their first area of employment
We also found that the investment made in supporting NQNs is well worth it as it improves recruitment, retention and builds on skills and knowledge. This leads to better patient care which is the objective of all nurses.

The Nursing and Midwifery Council has recently reviewed its standards for nursing and continues to recommend a period of preceptorship support. Investment in good quality support of NQNs will become increasingly important as the demands upon new graduates become greater with improvements in healthcare technology and the increasing demands for care worldwide.

Top tips for nursing students when transitioning to the workplace

Make the most of placements

During your training make the most of your placements and try to put yourself into the shoes of the registered nurses that you are working with. The more that you practice the full range of nursing activities and thinking as a student the easier it will be to make the transition from student to staff nurse.

Work hard at university

It may not always be obvious why you need to learn the things presented in the classroom or lecture theatre but it is part of the expected professional knowledge base for all nurses.  When you wear the uniform people will expect you to know these things.

Ask what support is available

When you are being interviewed for your first registered nurse position always ask what support will be available during your preceptorship. If you don’t feel supported find an employer where you do.

Ask questions and do your best

As a NQN, remember that our research showed that you are likely to be less confident in your ability than you should be. Look after yourself, ask questions and do your best. No one can reasonably ask for more.

A toolkit for employers, devised as an outcome of our research project, is available for free download.

Dr Bill Whitehead and Michelle Brown, Deputy Head of Department for Healthcare Practice at the University of Derby, recently had a book published by Open University Press Transition to Nursing: Preparation for Practice.

Our papers on this subject are available on UDORA.