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Getting to know you - Supporting transition from student to qualified nurse through pre-employment workplace contact

Dr David Barrett & Dr Jane Wray, Faculty of Health Sciences, University of Hull

The transition from student nurse to registered practitioner can be a challenging and turbulent time. Newly-qualified nurses (NQNs) often feel pressure as a result of taking on accountability for their own practice and having to move from supervised student to independent practitioner. The impact of this change in role and function can be exacerbated when NQNs are working in an unfamiliar environment with a new team of colleagues.

These factors all lead to some NQNs experiencing what is sometimes labelled ‘transition shock’ (Duchscher, 2009) or the ‘flaky bridge’ (Health Education England, 2018). In turn, this can impact on the wellbeing of NQNs and their ability to practice effectively. As a result, the risk of nurses leaving employment (or even the profession) is particularly high in the first year following qualification (Brook et al, 2019).

To address transition shock, healthcare employer and Higher Education Institutions (HEIs) implement a range of interventions that support NQNs during transition. Examples in the literature include use of preceptorship and structured induction/orientation programmes (Brook et al, 2019). Though there is evidence that these interventions can be effective in easing transition, the development of additional support mechanisms can expand the ‘toolkit’ of interventions available to employers and HEIs.

Method

As part of the University of Hull’s ‘Supporting Transition and Retention’ (STaR) project – a mixed methods study that supports the development of a ‘transition toolkit’ – a single cohort of pre-registration student nurses were given the opportunity to spend a proportion of their final clinical placement working in the setting where they had secured post-qualification employment that was due to commence upon completion of their course.

This initiative was developed as a result of feedback from students and clinical leaders from interviews carried out earlier in the study. This included suggestions that spending time with a future employer might “…give them the opportunity to meet people…you know the code for the door…silly little things, it will make them less anxious on the day they start” or might help with “…simple things, like you know where the coffee room is…you know how things work …they know your work ethic…they know what you are like”

Students were given the option to spend up to 75 hours of their final placement working within their place of first employment (PFE). This could either be through ‘day release’ from their core placement area each week, or in longer blocks of placement time. Students were able to maintain supernumerary status during their time with their PFE, but their performance was not formally assessed. Permission to spend time with their PFE was conditional on them making good progress with their final placement and receiving approval from their practice supervisor and personal tutor.

To evaluate the success (or otherwise) of the initiative, the student cohort was asked to answer a series of questions during a face-to-face classroom session. Data were collected using ‘Mentimeter’, an online system that allowed the students to answer questions via digital devices and for real-time data to be collected.

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Student filling in a Mentimeter survey on a mobile phone

Results

Of the 228 respondents, 64% reported having spent some time working with their first employer.

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Bar graph illustrating the results to the question 'Did you spend any time working with your first employer during your final placement?'; 147 'Yes'; 81 'No'

We asked those who had spent time with their PFE to rate (on a scale of 0-10) how useful the time had been. Orientation to the area (mean score 8.3) was deemed the area in which the initiative was most useful, followed by building confidence (7.9) and understanding the RN role (7.7).

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Mentimeter survey result graph illustrating the usefulness of the time spent by students in their place of first employment

We also asked the students what they found most useful. Many students highlighted that the time enabled them to meet their future colleagues (and vice versa) – “Getting to know the staff”; “Getting my face recognised before starting”. For other, there were practical benefits – “…getting uniforms and shifts and booking holidays” – and the ability to become orientated – “Understanding the ward’s routine”. One unexpected ‘benefit’ was raised by five respondents whose time on their PFE made them realise that they had made a mistake in accepting the post: “I learnt I did not want to work there”.

Given the potential benefits of the initiative, we were keen to get feedback on barriers to participation from those who chose not to spend time with their first employer. For some, organising the time with the PFE – which involved gaining permission from the University, their placement mentor and their future employer – was perceived as being too complex and time-consuming (“Too much hassle sorting it out”). Others reported that they had previously worked in – and were familiar with – the area where they had secured employment, so saw little benefit of spending extra time there. Some had not yet secured employment, so could not take part in the initiative.

On reflection, there were issues with the implementation of the scheme. Awareness amongst practice areas – particularly smaller organisations and those that were more geographically distant from Hull – could be better, and the processes for arranging and recording time with the PFE could be enhanced. We are continuing to review the student feedback, and that from our partners, to refine the process and governance around this initiative.

Plans for a 2020 repeat of the opportunity were side-lined due to the Covid-19 pandemic and the request for final year students to commence extended, paid placement to support NHS services. However, the pilot suggests that the opportunity to spend time with their first employer did help students prepare for the transition from student to employee, so it will become an initiative embedded within the final year curriculum from 2020/21 onwards.

References

Brook J et al (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: A systematic review. International Journal of Nursing Studies 91: 47-59

Duchscher JEB (2009) Transition shock: the initial stage of role adaptation for newly graduated Registered Nurses. Journal of Advanced Nursing 65(5), 1103– 1113.

Health Education England (2018) RePAIR: Reducing Pre-registration Attrition and Improving Retention Report. Available from: https://www.hee.nhs.uk/our-work/reducing-pre-registration-attrition-improving-retention [Accessed June 20th, 2020]

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