TRAINING NEWLY licensed RNs (NLRNs) represents a substantial task for nursing administrators, educators, and nurse managers. There is a gap in the transition from nursing school to clinical practice, especially in the oncology and pediatric units and the ICU. NLRNs face the same responsibilities as their more experienced peers, but they often lack the clinical confidence and critical thinking skills from experiential learning.1 This article discusses strategies for educating and supporting NLRNs as they transition into practice.

Beyond residency programs

To combat the learning gap faced by new healthcare professionals, a 2015 progress report from the National Academy of Medicine (formerly the Institute of Medicine) recommended exploring "ways to create and fund transition-to-practice residency programs."2 Nurse residency programs designed to help entry-level nurses transition into practice have been shown to improve retention and job satisfaction, and 45 states now have healthcare organizations with participating programs.3,4

Although attempts have been made to standardize guidelines for these programs, there is "extensive variability in theory, design, implementation, evaluation, and outcomes" among the various models.3,5-8 As such, it is challenging to pinpoint what works and what should be improved. Further standardization of residency programs may be achieved through preceptor training, structured education with didactic and clinical components, universal program length, and evaluation.3

While developing and remodeling residency programs can improve transition to practice on a large scale, healthcare organizations must also acknowledge the power of unit-based support programs. The standardization of residency programs involves time and overarching governing bodies, with administrators and program directors coming together to change healthcare facilities across the country. NLRNs can offer immediate perspectives on workplace transitions to help nurse educators, leaders, and preceptors understand how to support new nursing staff on a more intimate scale. Smaller-scale opportunities and support for NLRNs can be developed alongside residency programs.

Creating opportunities

Standardized competencies are essential for clinical development of NLRNs, but customized professional development geared toward individual interests optimizes engagement in education.3,9 By encouraging NLRNs to pursue opportunities on the unit, such as quality improvement projects or participation in professional governance, nurse managers and leaders can increase engagement. These opportunities foster effective communication and experience among NLRNs, themes that are directly related to improving clinical confidence.1 Experience can be gained via firsthand participation, as well as secondhand through discussions with veteran nurses on relevant quality improvement topics.

Another way for NLRNs to gain experience and become comfortable in their roles is by working with leadership groups in the healthcare setting. This may increase their confidence in their leadership skills and patient advocacy in clinical practice. Similarly, NLRNs may become engaged by participating in the decision-making process, which promotes personal accountability and a sense of empowerment.10

Additionally, NLRNs should be encouraged to take part in professional governance. Those who are new to practice may have a fresh perspective on processes to which more experienced nurses have grown accustomed. Due to the disconnect between nursing school and clinical practice, NLRNs may find that validation seems uncommon at the bedside at first, but it is important for these nurses to feel valued in their professional transition.1 Early participation in professional governance can increase "vigor, dedication, and absorption" in these healthcare professionals.10

Community involvement

Community outreach has substantial implications for professional confidence and individual perceptions of the role of nurses in transforming healthcare. Outreach opportunities include volunteering at food kitchens, conducting health screenings at health fairs, and participating in fundraisers and awareness events. Using nursing skills in different, often less stressful settings such as health fairs and pop-up clinics can have a positive effect on professional confidence.11 For NLRNs, this may help to improve confidence in their new leadership role and in specific nursing skills, such as measuring BP and patient education.

Community outreach also provides a clear picture of the role of nursing within the larger healthcare system. As NLRNs are often focused on tasks, such as creating a routine and keeping up with the demands of the job, these outreach opportunities are especially important. Those who are too focused on tasks may overlook their patients' underlying needs.1

The healthcare needs of the community require a focus beyond acute care to behavioral approaches to modify risk factors.2,12 Community outreach increases professional confidence and leadership and reinforces the paradigm of person-centered care with a focus on coordinating resources and developing skills that support optimal patient outcomes.2,12

Calling on seasoned colleagues

Experience is a foundation of nursing and building up experiential support for knowledge is important in developing clinical competence. During NLRN orientation, more experienced nurses can help with education by recommending nursing journals, books, videos, and other learning materials.

NLRNs can also gain clinical experience by observing their colleagues perform procedures and operate devices. In practice, the nursing staff should be encouraged to enlist NLRNs in critical patient situations and provide the appropriate support; the more often NLRNs participate in acute situations, the more comfortable they become working under stress.

Continuing education

The learning mindset extends beyond orientation. Continuing-education programs play an essential role in helping healthcare professionals and providers stay current on best practices and work effectively.13 In a 2016 study, clinicians who completed a 3-hour opioid education program had a significant increase in knowledge and confidence that extended for 2 months after the program and led to lasting changes in practice.13

Targeted education and orientation are necessary to address essential material, especially in specialty practice. Depending on the specialty, additional certifications may be available; for example, in critical care and trauma nursing. Additionally, nurses can take advantage of hospital-based courses, including Advanced Cardiovascular Life Support education.

Supportive environments

A 2019 literature review stated that the residency program model "was not as important as staff support, which produced the desired outcomes."3 NLRNs may be uncomfortable asking for help, but that mindset can be dangerous for patients. Additionally, NLRNs require a supportive environment to practice safely in acute care settings and strong nurse preceptor relationships to foster clinical competence.3 Similarly, NLRNs must develop the confidence to ask for help and get a second opinion as they develop their critical thinking and clinical decision-making skills. Leaders such as nurse managers, educators, and preceptors can create healthy work environments by encouraging open communication and teamwork.1

Emotional support is also essential. Nursing can be emotionally taxing, especially for new nurses.9 NLRNs may not be accustomed to working with decompensating or dying patients and handling direct conflicts in high-stress environments. Other, more experienced nurses can understand these challenges and provide emotional support with coping activities such as providing outlets for venting and resources for self-care and stress management.14

Nurse managers, educators, and preceptors have a responsibility to support NLRNs in their transition from nursing school to clinical practice. Staff support, combined with opportunities for leadership involvement, community outreach, and education, can foster the development of strong nursing professionals.

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