April, the month when nursing students are finishing up their classes, studying for NCLEX and getting ready to start their journey as a new nurse. I remember those days, the feeling of anticipation, worrying about passing NCLEX, and excitement about starting a new job. These feelings haven’t changed for graduate nurses; what has changed over the past 2 years is how new nurses are transitioning to active practice. The nursing shortage exacerbated by the pandemic has increased the number of nurses who are retiring or are shifting from the acute care bedside to other areas in healthcare. This shift has resulted in a loss of wisdom and expertise.
New nurse orientation was greatly affected by the pandemic. Prior to the pandemic, orientation included didactic lessons and clinical time with a preceptor and lasted up to three months. During the pandemic, healthcare organizations needed to get novice nurses up on the floor as quickly as possible and as a result, decreased orientation time and shifted to more self-directed learning paired with clinical experience. The available number preceptors also declined. This approach resulted in many novice nurses being ill-prepared to practice safely. Prior to the pandemic, research revealed that up to 30% of new nurses leave their jobs within the first few years; it will be interesting to see if this trend continues.
Academia and practice settings need to start a dialogue on what it really means to be a practice-ready nurse. What is needed by all graduating nurses and how can academia evolve their curriculum to ensure graduate nurses are adequately prepared to not only pass NCLEX but start practicing using clinical judgement? Academic/practice partnerships are an opportunity to start the discussion and make this change happen.
We need to reimagine orientation and ensure novice nurses are not released to practice independently before they are ready. Orientation must be a combination of didactic lessons, self-directed learning and training in clinical practice. Investment in nurse residency programs can improve retention of novice nurses. They typically last six months to a year and focus on developing clinical skills and clinical judgement in addition to training the novice nurses in evidence-based practice and quality improvement activities. Healthcare organizations must invest in their preceptor programs since many preceptors have only a few years of nursing experience. It’s important preceptors clearly understand their roles, know where to find support resources, and feel confident and competent to train novice nurses.
Experienced nurses need to support novice nurses. Many of us may have experienced “nurses eating their young.” We need to remember our own excitement interlaced with anxiety in our first year of practice. Novice nurses are the future of our nursing profession. We must be invested in shepherding novice nurses through the novice to expert journey and be patient and tolerant as they learn.
Let’s remember the importance of being tolerant and patient with novice learners by remembering this quote from an unknown source, “You want to know the difference between a master and a beginner? The master has failed more time than the beginner has ever tried.”