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From enrolled nurse to registered nurse in the rural setting: the graduate nurse experience

From enrolled nurse to registered nurse in the rural setting: the graduate nurse experience O R I G I N A L R E S E A R C H From enrolled nurse to registered nurse in the rural setting: the graduate nurse experience 1 2 R Nayda , J Cheri School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia Riverland Regional Hospital, Berri, South Australia, Australia Submitted: 28 November 2007; Resubmitted: 13 May 2008; Published: 13 June 2008 Nayda R, Cheri J Rural and Remote Health 8: 900. (Online), 2008 Available from: http://www.rrh.org.au A B S T R A C T Introduction: This article reports on the findings of a study into enrolled nurse (EN) to registered nurse (RN) transition in South Australian rural settings. Rural RNs are required to be multi-skilled generalists capable of providing a wide range of nursing services to a diverse range of clients. This frequently occurs in situations without medical or specialist assistance. The objective of this study was to gain an understanding of the EN to RN transition process within this unique context. Methods: A hermeneutic phenomenological approach guided the study because this employs the processes of description and interpretation to examine lived experiences. Following ethics approval, four rural hospitals were chosen as suitable sites for the study due to their combined proximity within a rural area. The administrators agreed to support the study and information sheets were distributed. The four participants, one from each hospital, self-selected and took part in an unstructured interview. All participants were ENs who had recently or were currently in the process of transition to RN. Data analysis used van Manen’s holistic and selective approaches in conjunction with Hycner’s more structured guidelines. Significant phrases or units of meaning were then identified and collated into relevant themes. © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 1 Results: Three main themes identified were: (1) great expectations - self-expectations; adjusting to the new role; other’s expectations; (2) support: sink or swim - peer, managerial and medical staff support; (3) Jacks and Jills of all trades - coping with the scope; proficiency equals specialising; positives of rural transition. The study found that these new graduates had very high expectations of their performance and experienced difficulty in adjusting to their new role. This was far more likely when the new RN had previously worked at the venue as an EN. Other staff and administrators expected these new RNs to be experienced beyond the new graduate level resulting in poor skill match to workload allocation and lack of support. Conclusions: The expectations placed on these new graduates by clinicians and managers far exceeded their level of expertise and resulted in them experiencing high anxiety levels. Ensuring this unique group of graduates are well supported throughout their transition phase is of utmost importance and this has implications for nurse managers, organisational administrators, nurse clinicians and future graduates. Rural ENs are increasingly undertaking nursing degrees and are urgently needed in rural settings. Accordingly it is in the best interests of managers and others to encourage and support them through an effective transition process. Key words: enrolled nurse, registered nurse, transition. diverse range of clients. This care is delivered in contexts of Introduction 5,6 minimum peer, medical and specialist support . Budgetary constraints and other limited resources also impact on work This article reports the findings of a hermeneutic conditions and outcomes . Consequently there are anomalies phenomenological study into enrolled nurse (EN) to between metropolitan and rural health units and life styles. registered nurse (RN) transition in two South Australian In conjunction with the diverse multi-skilled role of rural rural settings. As state and federal governments seek nurses, this significantly impacts on the rural EN to RN improvement in the recruitment and retention of nurses and transition. other health professionals in rural areas, this study is timely . A higher proportion of ENs than RNs currently work in rural However, the main focus of the available literature is on the settings resulting in a specific, willing rural nursing transition from student nurse to RN in the USA and the 2-4 4 workforce . Hegney et al. confirmed that ENs are attracted United Kingdom. The Australian perspective is significantly to rural work because of the advanced scope of practice under-represented and what is available concentrates on the expected in comparison with metropolitan contexts. This EN to RN transition in metropolitan contexts. increased responsibility is primarily due to RN shortages . However, these rural ENs are increasingly undertaking A number of factors influence the transition to RN, including nursing degrees, and accordingly it is in the best interests of the impact of work force and work place reality , the managers and educators to encourage and support the knowledge and skills expected of a new RN , the available effective transition from EN to RN. Effective transition will support systems , and adjusting to RN levels of impact positively on nursing retention rates and, ultimately, responsibility and accountability . These factors are on the provision of a high quality rural healthcare system. intensified for the EN transitioning to RN because clinicians and mangers have higher expectations that the EN requires Literature review little or no support in their graduate year , role boundary confusion arises and the likely reluctance of peers and Rural RNs are required to be multi-skilled generalists, superiors to accept the new RNs increase in knowledge and capable of providing a wide range of nursing care to a role change . © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 2 While the transition of EN to RN in the Australian a period greater than 3 years, with the mean average being 11,13 metropolitan area has been addressed , the transition greater than 13 years. experience in the rural setting is yet to receive equal attention. The aim of the study reported on here was to Consistent with the phenomenological approach, the data increase the understanding of this unique transition process source was an unstructured interview with each 14,16 and raise awareness of the specific needs of these graduates. participant at a mutually agreeable time, lasting approximately 60 min and held in a quiet room at the participant’s workplace. A phenomenological interview does Methods not aim to explain, predict or generate theory. Consequently the phenomenological approach to interviewing combines Research methodology both listening and narratives to gain deep insight into each participant’s experiences . Prior to each interview the Hermeneutic phenomenology is both a philosophical participants were given the opportunity to clarify queries movement and human science that uses the processes of before signing a consent form. description and interpretation to examine lived experiences. Phenomenology allows in-depth insight into an individual’s Participants were asked ‘What was it like making the EN to experiences, where hermeneutics goes beyond the RN transition in the rural setting?’ All participants were able description of those experiences to uncovering their to describe their experiences with little prompting. The meaning . Combined these form a suitable methodology to researcher then transcribed the content of each audiotape understand the meaning of the lived experiences of the EN verbatim. The participants each received a copy of their transitioning to RN in the rural context. verbatim transcript to ensure accurate representation of their experiences. All transcripts were returned with no further After receiving ethics approval from the University of South comments or alterations. The credibility and dependability of Australia, the Directors of Nursing from four South this study are demonstrated by the participants’ recognition Australian rural hospitals were contacted to support the of the findings as representative of their experiences, and the study and provide access to potential participants. These audit trail which provides a record of activities that others hospitals were chosen for their proximity and, combined, may follow . they provide health care to a population of approximately 45 000 people. Following this, purposeful and network The data were analysed using van Manen’s holistic and sampling through discussions with transitioning RNs were selective approaches in conjunction with Hycner’s more used to elicit contact from four individuals who had structured approach to analysing phenomenological data. experiences relevant to the research focus . These Van Manen describes the reflection that occurs in individuals were contacted by letter and formally asked if phenomenological research as thematic analysis. Hycner they would be willing to participate in the research. The four complements this process by providing clear steps that participants, one from each hospital, were ENs who had just mirror van Manen’s ideas but offers greater clarity. completed the transition year, or were currently in the Significant phrases or units of meaning relevant to the study process of the first year of their RN transition. The were then identified, coded and placed within a relevant researcher then met with each participant to discuss the study theme. purpose and process. Pseudonyms were used to protect the identity of each participant whose ages ranged between mid- While the study has been successful in providing insight into twenties and early fifties. All participants had undergone EN the experiences of ENs who transition to RNs in rural to RN transition in the rural setting and all had been ENs for settings, it makes no claim to be generalisable to the © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 3 experiences of all such graduates. Phenomenology aims to not meet with reality. While these participants acknowledged understand the experiences of a small number of participants the value of their previous nursing experience in assisting through the generation of in-depth, quality data. Further them to cope with general nursing care, on the other hand it research is required to determine how widespread such resulted in ambiguity when adjusting to the more advanced experiences are and to examine the effectiveness of demands of RN work. This uncertainty mainly resulted from strategies used to assist transition in the rural context. their own high expectations about their performance in the new role. One participant stated: Results My expectations of being an RN were extremely high as I think I was a good EN, as an EN you are usually Analysis of the participants’ accounts of their transition the run-about person ... get this, get that, but as an experience revealed the following three themes: RN you are actually thrust into doing the procedure. 1. Great expectations - self-expectations; adjusting to The final unit of meaning in this theme, other’s expectations, the new role; other’s expectations. highlights management and work colleagues’ expectations 2. Support: sink or swim - peer, managerial and that previous EN experience made the EN to RN transition medical staff support. easier. Kilstoff and Rochester verify that administrators 3. Jacks and Jills of all trades - coping with the scope; and managers also hold this view. There was also the belief proficiency equals specialising; positives of rural that these new RNs would manage at a more experienced transition. RN level. As a result participants felt they did not receive the support they needed throughout their RN transition. This These three themes have units of meaning that are pertinent proved to be even more problematic when the transition was to more than one theme. Given the nature of the occurring in the venue where the new RN had worked as an phenomenon being studied, the overlapping of these units of EN. The following participant quote confirms this. meanings is necessary to produce structure and understanding. This reiterates van Manen’s view that the ‘meaning’ or ‘essence’ of a phenomenon is never Because I went to work at the same place that I had straightforward or basic. Therefore, the identified themes previously worked as an EN …they just presumed I knew things. and their units of meaning cannot be seen simplistically from a single view point; rather, together they form the meaningful whole of these participants’ transitional This last unit of meaning is closely interlinked with the next experiences. theme, Support: sink or swim. The high expectations of others often meant the new RN was left to cope in situations Great expectations beyond their knowledge and experience level. This first theme is made up of three units of meaning: self- Support: sink or swim expectation, adjusting to the new role and others’ expectations. The theme draws attention to the participants’ This theme also encompasses three units of meaning: peer expectations that their previous EN experience would make support, managerial support, and medical staff support. their RN transition easier. They explained that, in reality, Study participants explained that they felt insecure and this was not the case. Kilstoff and Rochester confirm that frustrated at limited management and peer support because the expectations of individuals undergoing transition may their previous EN experience suggested to others that their © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 4 transition would be unproblematic. Studies confirm that The participants explained that anxiety and frustration appropriate support is an issue for all nursing graduates increased when they were left unsupported in situations 9,18 making their transition . Such absence of consideration left beyond their capabilities because of the assumption they these new RNs in many situations that increased their would cope. The participants reported that the educational anxiety. Further, the allocation of responsibility was benefits of mentoring and constructive feedback were rare. inconsistent and occurred when other staff were not Clare et al. question the preparedness of the new graduate to available, or taking tea breaks. This repeated absence of function in rural health settings because of the anomalies supervision by senior staff could be viewed as systematic rural nurses encounter in their daily practice. In the absence malpractice . One participant explained: of constructive feedback, these already disadvantaged graduates may continue to struggle. The hierarchy in the hospital…presumed that you Jacks and Jills of all trades were OK so they sort of left you to your own devices and thought you were capable because you had worked there before as an EN. This theme includes three units of meaning: coping with the scope, proficiency equals specialising and the positives of rural transition. The theme draws attention to the impact of Another participant added: rural practice on these participants’ transition experiences and their subsequent professional future. Participants You would say to … who ever was in charge, .. ‘you explained they were not prepared to cope with the extensive know that I haven’t worked in here and you don’t knowledge and skills required of the ‘generalist’ rural RN normally let me work in here, so why am I [here] role. A participant explained the situation. now?’… They would say ‘Oh you’ll be right we are just in the office… and you can ring us’. [The] expectation [is] that you will be capable in all areas in a country hospital. People seem to think you Goh and Watt stress the importance of nursing graduates know…something about everything, and you might receiving timely open communication and constructive know little bits and pieces [as a new RN] but feedback about their performance. These actions raise a you…don’t know exactly the correct thing to do, graduate’s confidence, enabling them to learn and settle into especially if you get sent to outpatients [accident and their new role . Unfortunately the participants in this study emergency] . Expectations are fairly high that you spoke of lack of constructive communication and feedback will be able to function in any situation and I don’t from senior nurses, doctors and ward managers. They think that’s actually possible when you’re a first year RN. believed this impacted negatively on their ability to acclimatise to their new role and, therefore, hindered their professional development. Other staff are likely to continue Novice RNs are usually fragile and, when placed in to see the new RN in their EN role and omit support for their situations that prevent them operating effectively, their development. As one participant said: confidence can be negatively influenced . This is compounded by the fact that rural RNs are expected to Being an EN my transition was that I was expected to function in multi-dimensional roles, providing nursing care know more than I did [as a new RN] and I was to a diverse range of clients with different health needs. One questioned when I did not know. participant explained: © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 5 One day you are in surgical the next day you could be never know what’s coming through the door but you out in casualty with somebody with chest pain, and learn heaps [in the country setting]. then you back on the ward and you are looking after a mental health patient…mastering this diversity as a So the graduates also saw the challenges of rural practice in new RN. a positive light. They believed the vast array of clinical experiences they were exposed to in the rural setting assisted Such diversity of practice meant participants did not receive their professional development, even though it may take time the repeated exposure to situations that would increase their to have repeated exposure to situations and feel fully skills, knowledge and confidence, a concept that is supported competent. They believed the key to positive professional by Hoffman and Elwin . Subsequently participants development rested in learning in circumstances that foster identified a delay in the ‘gelling’ of deeper understandings of job satisfaction and professional autonomy. Hegney et al. RN practice, less than expected levels of confidence in their confirm that many rural nurses enjoy the diversity, RN role, and later onset of professional autonomy. One challenges, and autonomy of their role. participant explained that the repeated exposure to new situations meant consistent uncertainty about how she would Implications for practice cope. The transition from one nursing role to another is fraught As a [previous] EN I think a certain level of care and with challenges and opportunities. Hermeneutic knowledge is expected at a higher level, that you phenomenology has been used to gain insight into this know what you’re doing so you don’t need quite as transition process and to propose change. The findings of much support. [But] ... you have never been exposed this study have implications for nurse educators, nurse to certain things; until you are you don’t know how managers, organizational administrators, policy-makers, you are going to function. nurse clinicians, and future graduates All participants expressed the desire to gain experience and Education: This study confirms the findings of research confidence in their RN role and be seen as ‘specialists’ with evidence that a general bachelor of nursing degree does not advanced nursing skills. They believed this was necessary to adequately prepare undergraduates making their RN cope with the vast range of circumstances that arise in the transition in the rural context to managing the diversity and rural health setting. However, they believed they could only challenges of rural practice. Even graduates with previous become specialists if they gained experience elsewhere, such EN training may not feel any better prepared for these 20 21 as the city, and completed specialised courses. The challenges . Francis et al. believed the level of expertise unpredictability of the rural health environment may make it required by the rural RN can take years to achieve. Therefore difficult for RNs to feel they have control and to see that there is a need for undergraduate educators and rural nurse they are specialists in their own right. They did, however, managers to collaborate on strategies that facilitate an recognise the knowledge growth gained from their rural improved undergraduate educational preparation for nursing experiences. graduates making their RN transition in the rural context. Nurse educators, nurse managers, and administrators need to It would be good to specialise and I would love to do recognize it is not merely the undergraduate preparation that some critical care stuff…but I wouldn’t want to stay in that environment forever…. But I’ve learnt heaps is an issue for a nursing graduate’s RN transition in the rural as a country nurse and love it… I would shrivel up… context. The provision of appropriate educational support as a city nurse. I like the trauma side of things, you © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 6 must continue throughout a graduate nurse’s transitional support and nurturing requiring the combined efforts of journey from novice to competent nurse, then proficient administrators, clinicians, and educators. nurse and finally expert nurse. Such support needs to be readily available within a work place which also identifies Organisational administrators: Health administrators are the need for appropriately educated mentors. These mentors increasingly aware of the difficulties and problems caused need both clinical experience and the ability to identify the by the current reluctance of RNs to practice in the rural support needs of individual graduates, to foster learning and setting. Presently there is a greater proportion of ENs than 2-4 increased autonomy. RNs practising in the rural context . These ENs seeking RN qualifications are a new and willing workforce. Therefore it Nurse managers: Nurse managers need an awareness of the is advantageous for health administrators and policy process individuals undergo when making role transition developers to encourage and support the EN to RN transition within the workplace. This is essential because the way new in order to increase the number of practising RNs. This RNs manage the variances of the healthcare environment is transition needs to occur under circumstances that foster job instrumental in influencing their decisions to stay in satisfaction and so is likely to positively impact on staff 18,20 nursing . Nurse managers must acknowledge that morale, retention and recruitment, and on patient care. although a graduate’s previous EN education and experience Ultimately this means that health budget planning and may assist with practical nursing work, the new RN role implementation must support appropriate staffing levels in requires a different level of critical thinking and practical order to foster educational support, job satisfaction, and application. Subsequently RN graduates with EN training professional autonomy of the rural RN. require a similar degree of guidance, support, and understanding to that provided for other nursing graduates Nurse clinicians: Nurse clinicians must remember that role entering the healthcare sector . transition creates ambiguity and conflict, and that it has the potential to generate feelings of insecurity and unfamiliarity It is in nursing managers’ interests to understand how the for individuals undergoing this process. The expectation that anomalies of a rural practice impact on a graduate nurse’s graduates with previous EN training require less support transition, and to ensure that the appropriate infrastructure is than other graduates is best addressed through appropriate available to support nursing graduates cope with the staff development. Work colleagues must align their challenges. Managers also have a responsibility to ensure expectations with individual graduate’s abilities and ensure mentors have the skills, knowledge and time to do their job consistent mentoring . Recognition that this role is new to of supporting new graduates . The response, ‘You’ll be these graduates, and that the resulting unfamiliarity can right just ring if you need anything’ is not what nursing impact on professional development and practice, should be graduates need when faced with the prospect of a patient considered by those working with the transition RN . The with chest pain coming through the accident and emergency learning of another role within the same work context can be door, nor is it legally acceptable. The provision of unnerving, requiring added understanding and support. appropriate orientation and suitably educated mentors who Graduates need to be able to freely communicate concerns are regularly rostered with graduates (especially during the and feel they will be responded to appropriately. They need initial months of a graduate nurse’s transition) is important. to be given time to develop their clinical practice and to Shift rostering must consider appropriate skill mix and increase in confidence and autonomy at their individual workload allocation to ensure continued job satisfaction and pace. The provision of positive constructive feedback is also retention and to foster increased professional autonomy. important to successful professional development. Job Jones and Cheek point out that practice development is a satisfaction will occur in a work environment that provides concern for all, and that it is a complex system of learning encouragement - not humiliation. © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 7 Future graduates: While the findings of this study cannot encouraged and supported the EN to RN transition in this be applied to all nursing graduates, these participants’ unique setting. experiences are none-the-less important, for they can assist future graduates and those responsible for their transition to This study has achieved its objective through the recognise that the RN role is not a mere extension of an EN identification and discussion of three essential themes which qualification. The education and experience of the EN will were identified from the participants’ descriptions of assist a new RN with general nursing duties involving transitioning from EN to RN in a rural setting. While the clinical dexterity and work place familiarity; EN to RN experiences of these participants cannot be applied to all transitions can also create challenges concerning role rural RN graduates with previous EN status, one cannot ambiguity, self-expectation, and others’ expectations. A new dispute its strengths in drawing attention to the needs of such graduate RN’s previous EN status is likely to lead to new graduates. Appropriate actions taken by nurse workplace assumptions of better coping and the need for less administrators, managers and educators who oversee practice support. Therefore, these new RNs need to develop the and staff development in rural venues will result in a better ability to clearly articulate concerns and needs to educators prepared and more stable workforce. Perhaps the most and workplace managers. In addition graduates will need to important change agents are the new RN graduates be proactive in regard to professional development needs themselves, who must voice their needs to their managers and developing support systems, which include work and educators, and participate in strategies and further mentors, colleagues, and friends that will assist and support research to ensure beneficial transition processes for future them throughout their RN transition. graduates. Further research will determine what is needed, what References resources are available and the ideal process for implementing or encouraging these changes. Clare and van 1. Bushy A. International perspectives on rural nursing: Australia, Loon recognise that the first 3 to 6 months of a new Canada, USA. Australian Journal of Rural Health 2002; 10: 104- graduate’s transition are the most crucial in terms of positive professional adjustment and nursing career commitment. Therefore positive interventions at this time are essential. 2. Baldock D. Profile of the registered and enrolled nurse workforce in South Australia 2002. Adelaide, SA: Department of Conclusion Human Services, 2002. Phenomenology seeks to discover what a phenomenon 3. Bradley C. Final Report: Research into Recruitment, Retention means and how it is experienced. The aim of this study was and Role of Rural Enrolled Nurses in South Australia. Adelaide< to explore the lived experiences of ENs making their RN SA: Centre for Research into Nursing and Healthcare University of transition within rural contexts. Currently there is a shortfall South Australia, 2000. of RNs prepared to practice in the rural setting. However, there is a higher proportion of ENs to RNs working in rural 4. Hegney D, McCarthy A, Rogers-Clark C, Corman D. Why health care, with many of these ENs undertaking nursing nurses are attracted to rural and remote practice. Australian Journal degrees. This identifies a nursing workforce prepared to of Rural Health 2002; 10: 178-186. practise in the rural context, and one possible means of addressing the RN shortage. For example, RN shortages could be reduced if healthcare units and policy-makers © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 8 5. Blue I, Fitzgerald M. Interpersonal relations: case studies of 14. van Manen M. Researching lived experience. Human science working relationships between Registered Nurses and general for an action sensitive pedagogy. London, ON: State University of practitioners in rural Australia. Journal of Clinical Nursing 2002; New York Press, 1990. 11: 314-321. 15. Streubert Speziale H, Rinaldi Carpenter D. Qualitative 6. Hegney D, McCarthy A. Job satisfaction and nurses in rural Research in Nursing Advancing the Humanistic Imperative, 3rd Australia. Journal of Nursing Administration 2000; 30(7/8): 347- edn. Philadelphia, PA: Lippincott, 2003. 16. Cohen M, Kahn DRS. Hermeneutic phenomenological research 7. Johnson D, Preston B. An overview of issues in nursing a practical guide for nurse researchers. London: Sage Publications education. National Review of Nursing Education 2002, The 2000. Nursing Workforce. Canberra, ACT: Commonwealth of Australia 2002, 125-173. 17. Hycner R. Some guidelines for the phenomenological analysis of interpretive data. Human Studies 1985; 8: 279-303. 8. Clare J, White J, Edwards H, van Loon A. Curriculum, clinical education, recruitment, transition and retention in nursing. 18. Cowin L, Jacobsson D. The nursing shortage: part way down Adelaide, SA: Flinders University, 2002. the slippery slope. Collegian 2003; 10(4): 25-30. 9. Goh K, Watt E. From ‘dependent on’ to depend on’ the 19. Nayda R. Registered nurses' communication about abused experience of transition from student to registered nurse in a private children: rules, responsibilities and resistance. Child Abuse Review graduate program. Australian Journal of Advanced Nursing 2003; 2004; 13: 188-199. 21(1): 14-20. 20. Johns C. Transition of the enrolled nurse to registered nurse in 10. Hoffman K, Elwin C. The relationship between critical thinking the rural setting. Honours thesis. University of South Australia, and confidence in decision-making. Australian Journal of 2005. Advanced Nursing 2004; 22(1): 8-12. 21. Francis K, Bowman S, Redgrave M. Knowledge and skills 11. Kilstoff K, Rochester S. Hitting the floor running: transitional required by rural nurses to meet the challenge of a changing work experiences of graduates previously trained as enrolled nurses. environment in the 21st century: a review of the literature. Wagga Australian Journal of Advanced Nursing 2004; 22(1): 13-17. Wagga: NSW: Charles Sturt University, 2000. 12. Gibson T, Heartfield M, Cheek J. Final Report to the Australian 22. Jones J, Cheek J. The scope of nursing in Australia: a snapshot Nursing Council Inc: an examination of the role and function of the of the challenges and skills needed. Journal of Nursing enrolled nurse and revision of competency standards. Adelaide, Management 2003; 11: 121-129. SA: Centre for Research in Nursing and Health Care University of South Australia, 2002. 23. Thompka L. Graduate nurses' experiences of interactions with professional nursing staff during transition to the professional role. 13. Paech S. Making the transition from enrolled to registered Journal of Continuing Education in Nursing 2001; 32(1): 15-19. nurse. Collegian 2002; 9(3): 35-40. 24. Clare J, van Loon A. Best practice principles for the transition from student to registered nurse. Collegian 2003; 10(4): 25-30. © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 9 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Rural and Remote Health Unpaywall

From enrolled nurse to registered nurse in the rural setting: the graduate nurse experience

Nayda, Robyn; Johns, Cherie
Rural and Remote Health – Jun 13, 2008
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Abstract

O R I G I N A L R E S E A R C H From enrolled nurse to registered nurse in the rural setting: the graduate nurse experience 1 2 R Nayda , J Cheri School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia Riverland Regional Hospital, Berri, South Australia, Australia Submitted: 28 November 2007; Resubmitted: 13 May 2008; Published: 13 June 2008 Nayda R, Cheri J Rural and Remote Health 8: 900. (Online), 2008 Available from: http://www.rrh.org.au A B S T R A C T Introduction: This article reports on the findings of a study into enrolled nurse (EN) to registered nurse (RN) transition in South Australian rural settings. Rural RNs are required to be multi-skilled generalists capable of providing a wide range of nursing services to a diverse range of clients. This frequently occurs in situations without medical or specialist assistance. The objective of this study was to gain an understanding of the EN to RN transition process within this unique context. Methods: A hermeneutic phenomenological approach guided the study because this employs the processes of description and interpretation to examine lived experiences. Following ethics approval, four rural hospitals were chosen as suitable sites for the study due to their combined proximity within a rural area. The administrators agreed to support the study and information sheets were distributed. The four participants, one from each hospital, self-selected and took part in an unstructured interview. All participants were ENs who had recently or were currently in the process of transition to RN. Data analysis used van Manen’s holistic and selective approaches in conjunction with Hycner’s more structured guidelines. Significant phrases or units of meaning were then identified and collated into relevant themes. © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 1 Results: Three main themes identified were: (1) great expectations - self-expectations; adjusting to the new role; other’s expectations; (2) support: sink or swim - peer, managerial and medical staff support; (3) Jacks and Jills of all trades - coping with the scope; proficiency equals specialising; positives of rural transition. The study found that these new graduates had very high expectations of their performance and experienced difficulty in adjusting to their new role. This was far more likely when the new RN had previously worked at the venue as an EN. Other staff and administrators expected these new RNs to be experienced beyond the new graduate level resulting in poor skill match to workload allocation and lack of support. Conclusions: The expectations placed on these new graduates by clinicians and managers far exceeded their level of expertise and resulted in them experiencing high anxiety levels. Ensuring this unique group of graduates are well supported throughout their transition phase is of utmost importance and this has implications for nurse managers, organisational administrators, nurse clinicians and future graduates. Rural ENs are increasingly undertaking nursing degrees and are urgently needed in rural settings. Accordingly it is in the best interests of managers and others to encourage and support them through an effective transition process. Key words: enrolled nurse, registered nurse, transition. diverse range of clients. This care is delivered in contexts of Introduction 5,6 minimum peer, medical and specialist support . Budgetary constraints and other limited resources also impact on work This article reports the findings of a hermeneutic conditions and outcomes . Consequently there are anomalies phenomenological study into enrolled nurse (EN) to between metropolitan and rural health units and life styles. registered nurse (RN) transition in two South Australian In conjunction with the diverse multi-skilled role of rural rural settings. As state and federal governments seek nurses, this significantly impacts on the rural EN to RN improvement in the recruitment and retention of nurses and transition. other health professionals in rural areas, this study is timely . A higher proportion of ENs than RNs currently work in rural However, the main focus of the available literature is on the settings resulting in a specific, willing rural nursing transition from student nurse to RN in the USA and the 2-4 4 workforce . Hegney et al. confirmed that ENs are attracted United Kingdom. The Australian perspective is significantly to rural work because of the advanced scope of practice under-represented and what is available concentrates on the expected in comparison with metropolitan contexts. This EN to RN transition in metropolitan contexts. increased responsibility is primarily due to RN shortages . However, these rural ENs are increasingly undertaking A number of factors influence the transition to RN, including nursing degrees, and accordingly it is in the best interests of the impact of work force and work place reality , the managers and educators to encourage and support the knowledge and skills expected of a new RN , the available effective transition from EN to RN. Effective transition will support systems , and adjusting to RN levels of impact positively on nursing retention rates and, ultimately, responsibility and accountability . These factors are on the provision of a high quality rural healthcare system. intensified for the EN transitioning to RN because clinicians and mangers have higher expectations that the EN requires Literature review little or no support in their graduate year , role boundary confusion arises and the likely reluctance of peers and Rural RNs are required to be multi-skilled generalists, superiors to accept the new RNs increase in knowledge and capable of providing a wide range of nursing care to a role change . © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 2 While the transition of EN to RN in the Australian a period greater than 3 years, with the mean average being 11,13 metropolitan area has been addressed , the transition greater than 13 years. experience in the rural setting is yet to receive equal attention. The aim of the study reported on here was to Consistent with the phenomenological approach, the data increase the understanding of this unique transition process source was an unstructured interview with each 14,16 and raise awareness of the specific needs of these graduates. participant at a mutually agreeable time, lasting approximately 60 min and held in a quiet room at the participant’s workplace. A phenomenological interview does Methods not aim to explain, predict or generate theory. Consequently the phenomenological approach to interviewing combines Research methodology both listening and narratives to gain deep insight into each participant’s experiences . Prior to each interview the Hermeneutic phenomenology is both a philosophical participants were given the opportunity to clarify queries movement and human science that uses the processes of before signing a consent form. description and interpretation to examine lived experiences. Phenomenology allows in-depth insight into an individual’s Participants were asked ‘What was it like making the EN to experiences, where hermeneutics goes beyond the RN transition in the rural setting?’ All participants were able description of those experiences to uncovering their to describe their experiences with little prompting. The meaning . Combined these form a suitable methodology to researcher then transcribed the content of each audiotape understand the meaning of the lived experiences of the EN verbatim. The participants each received a copy of their transitioning to RN in the rural context. verbatim transcript to ensure accurate representation of their experiences. All transcripts were returned with no further After receiving ethics approval from the University of South comments or alterations. The credibility and dependability of Australia, the Directors of Nursing from four South this study are demonstrated by the participants’ recognition Australian rural hospitals were contacted to support the of the findings as representative of their experiences, and the study and provide access to potential participants. These audit trail which provides a record of activities that others hospitals were chosen for their proximity and, combined, may follow . they provide health care to a population of approximately 45 000 people. Following this, purposeful and network The data were analysed using van Manen’s holistic and sampling through discussions with transitioning RNs were selective approaches in conjunction with Hycner’s more used to elicit contact from four individuals who had structured approach to analysing phenomenological data. experiences relevant to the research focus . These Van Manen describes the reflection that occurs in individuals were contacted by letter and formally asked if phenomenological research as thematic analysis. Hycner they would be willing to participate in the research. The four complements this process by providing clear steps that participants, one from each hospital, were ENs who had just mirror van Manen’s ideas but offers greater clarity. completed the transition year, or were currently in the Significant phrases or units of meaning relevant to the study process of the first year of their RN transition. The were then identified, coded and placed within a relevant researcher then met with each participant to discuss the study theme. purpose and process. Pseudonyms were used to protect the identity of each participant whose ages ranged between mid- While the study has been successful in providing insight into twenties and early fifties. All participants had undergone EN the experiences of ENs who transition to RNs in rural to RN transition in the rural setting and all had been ENs for settings, it makes no claim to be generalisable to the © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 3 experiences of all such graduates. Phenomenology aims to not meet with reality. While these participants acknowledged understand the experiences of a small number of participants the value of their previous nursing experience in assisting through the generation of in-depth, quality data. Further them to cope with general nursing care, on the other hand it research is required to determine how widespread such resulted in ambiguity when adjusting to the more advanced experiences are and to examine the effectiveness of demands of RN work. This uncertainty mainly resulted from strategies used to assist transition in the rural context. their own high expectations about their performance in the new role. One participant stated: Results My expectations of being an RN were extremely high as I think I was a good EN, as an EN you are usually Analysis of the participants’ accounts of their transition the run-about person ... get this, get that, but as an experience revealed the following three themes: RN you are actually thrust into doing the procedure. 1. Great expectations - self-expectations; adjusting to The final unit of meaning in this theme, other’s expectations, the new role; other’s expectations. highlights management and work colleagues’ expectations 2. Support: sink or swim - peer, managerial and that previous EN experience made the EN to RN transition medical staff support. easier. Kilstoff and Rochester verify that administrators 3. Jacks and Jills of all trades - coping with the scope; and managers also hold this view. There was also the belief proficiency equals specialising; positives of rural that these new RNs would manage at a more experienced transition. RN level. As a result participants felt they did not receive the support they needed throughout their RN transition. This These three themes have units of meaning that are pertinent proved to be even more problematic when the transition was to more than one theme. Given the nature of the occurring in the venue where the new RN had worked as an phenomenon being studied, the overlapping of these units of EN. The following participant quote confirms this. meanings is necessary to produce structure and understanding. This reiterates van Manen’s view that the ‘meaning’ or ‘essence’ of a phenomenon is never Because I went to work at the same place that I had straightforward or basic. Therefore, the identified themes previously worked as an EN …they just presumed I knew things. and their units of meaning cannot be seen simplistically from a single view point; rather, together they form the meaningful whole of these participants’ transitional This last unit of meaning is closely interlinked with the next experiences. theme, Support: sink or swim. The high expectations of others often meant the new RN was left to cope in situations Great expectations beyond their knowledge and experience level. This first theme is made up of three units of meaning: self- Support: sink or swim expectation, adjusting to the new role and others’ expectations. The theme draws attention to the participants’ This theme also encompasses three units of meaning: peer expectations that their previous EN experience would make support, managerial support, and medical staff support. their RN transition easier. They explained that, in reality, Study participants explained that they felt insecure and this was not the case. Kilstoff and Rochester confirm that frustrated at limited management and peer support because the expectations of individuals undergoing transition may their previous EN experience suggested to others that their © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 4 transition would be unproblematic. Studies confirm that The participants explained that anxiety and frustration appropriate support is an issue for all nursing graduates increased when they were left unsupported in situations 9,18 making their transition . Such absence of consideration left beyond their capabilities because of the assumption they these new RNs in many situations that increased their would cope. The participants reported that the educational anxiety. Further, the allocation of responsibility was benefits of mentoring and constructive feedback were rare. inconsistent and occurred when other staff were not Clare et al. question the preparedness of the new graduate to available, or taking tea breaks. This repeated absence of function in rural health settings because of the anomalies supervision by senior staff could be viewed as systematic rural nurses encounter in their daily practice. In the absence malpractice . One participant explained: of constructive feedback, these already disadvantaged graduates may continue to struggle. The hierarchy in the hospital…presumed that you Jacks and Jills of all trades were OK so they sort of left you to your own devices and thought you were capable because you had worked there before as an EN. This theme includes three units of meaning: coping with the scope, proficiency equals specialising and the positives of rural transition. The theme draws attention to the impact of Another participant added: rural practice on these participants’ transition experiences and their subsequent professional future. Participants You would say to … who ever was in charge, .. ‘you explained they were not prepared to cope with the extensive know that I haven’t worked in here and you don’t knowledge and skills required of the ‘generalist’ rural RN normally let me work in here, so why am I [here] role. A participant explained the situation. now?’… They would say ‘Oh you’ll be right we are just in the office… and you can ring us’. [The] expectation [is] that you will be capable in all areas in a country hospital. People seem to think you Goh and Watt stress the importance of nursing graduates know…something about everything, and you might receiving timely open communication and constructive know little bits and pieces [as a new RN] but feedback about their performance. These actions raise a you…don’t know exactly the correct thing to do, graduate’s confidence, enabling them to learn and settle into especially if you get sent to outpatients [accident and their new role . Unfortunately the participants in this study emergency] . Expectations are fairly high that you spoke of lack of constructive communication and feedback will be able to function in any situation and I don’t from senior nurses, doctors and ward managers. They think that’s actually possible when you’re a first year RN. believed this impacted negatively on their ability to acclimatise to their new role and, therefore, hindered their professional development. Other staff are likely to continue Novice RNs are usually fragile and, when placed in to see the new RN in their EN role and omit support for their situations that prevent them operating effectively, their development. As one participant said: confidence can be negatively influenced . This is compounded by the fact that rural RNs are expected to Being an EN my transition was that I was expected to function in multi-dimensional roles, providing nursing care know more than I did [as a new RN] and I was to a diverse range of clients with different health needs. One questioned when I did not know. participant explained: © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 5 One day you are in surgical the next day you could be never know what’s coming through the door but you out in casualty with somebody with chest pain, and learn heaps [in the country setting]. then you back on the ward and you are looking after a mental health patient…mastering this diversity as a So the graduates also saw the challenges of rural practice in new RN. a positive light. They believed the vast array of clinical experiences they were exposed to in the rural setting assisted Such diversity of practice meant participants did not receive their professional development, even though it may take time the repeated exposure to situations that would increase their to have repeated exposure to situations and feel fully skills, knowledge and confidence, a concept that is supported competent. They believed the key to positive professional by Hoffman and Elwin . Subsequently participants development rested in learning in circumstances that foster identified a delay in the ‘gelling’ of deeper understandings of job satisfaction and professional autonomy. Hegney et al. RN practice, less than expected levels of confidence in their confirm that many rural nurses enjoy the diversity, RN role, and later onset of professional autonomy. One challenges, and autonomy of their role. participant explained that the repeated exposure to new situations meant consistent uncertainty about how she would Implications for practice cope. The transition from one nursing role to another is fraught As a [previous] EN I think a certain level of care and with challenges and opportunities. Hermeneutic knowledge is expected at a higher level, that you phenomenology has been used to gain insight into this know what you’re doing so you don’t need quite as transition process and to propose change. The findings of much support. [But] ... you have never been exposed this study have implications for nurse educators, nurse to certain things; until you are you don’t know how managers, organizational administrators, policy-makers, you are going to function. nurse clinicians, and future graduates All participants expressed the desire to gain experience and Education: This study confirms the findings of research confidence in their RN role and be seen as ‘specialists’ with evidence that a general bachelor of nursing degree does not advanced nursing skills. They believed this was necessary to adequately prepare undergraduates making their RN cope with the vast range of circumstances that arise in the transition in the rural context to managing the diversity and rural health setting. However, they believed they could only challenges of rural practice. Even graduates with previous become specialists if they gained experience elsewhere, such EN training may not feel any better prepared for these 20 21 as the city, and completed specialised courses. The challenges . Francis et al. believed the level of expertise unpredictability of the rural health environment may make it required by the rural RN can take years to achieve. Therefore difficult for RNs to feel they have control and to see that there is a need for undergraduate educators and rural nurse they are specialists in their own right. They did, however, managers to collaborate on strategies that facilitate an recognise the knowledge growth gained from their rural improved undergraduate educational preparation for nursing experiences. graduates making their RN transition in the rural context. Nurse educators, nurse managers, and administrators need to It would be good to specialise and I would love to do recognize it is not merely the undergraduate preparation that some critical care stuff…but I wouldn’t want to stay in that environment forever…. But I’ve learnt heaps is an issue for a nursing graduate’s RN transition in the rural as a country nurse and love it… I would shrivel up… context. The provision of appropriate educational support as a city nurse. I like the trauma side of things, you © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 6 must continue throughout a graduate nurse’s transitional support and nurturing requiring the combined efforts of journey from novice to competent nurse, then proficient administrators, clinicians, and educators. nurse and finally expert nurse. Such support needs to be readily available within a work place which also identifies Organisational administrators: Health administrators are the need for appropriately educated mentors. These mentors increasingly aware of the difficulties and problems caused need both clinical experience and the ability to identify the by the current reluctance of RNs to practice in the rural support needs of individual graduates, to foster learning and setting. Presently there is a greater proportion of ENs than 2-4 increased autonomy. RNs practising in the rural context . These ENs seeking RN qualifications are a new and willing workforce. Therefore it Nurse managers: Nurse managers need an awareness of the is advantageous for health administrators and policy process individuals undergo when making role transition developers to encourage and support the EN to RN transition within the workplace. This is essential because the way new in order to increase the number of practising RNs. This RNs manage the variances of the healthcare environment is transition needs to occur under circumstances that foster job instrumental in influencing their decisions to stay in satisfaction and so is likely to positively impact on staff 18,20 nursing . Nurse managers must acknowledge that morale, retention and recruitment, and on patient care. although a graduate’s previous EN education and experience Ultimately this means that health budget planning and may assist with practical nursing work, the new RN role implementation must support appropriate staffing levels in requires a different level of critical thinking and practical order to foster educational support, job satisfaction, and application. Subsequently RN graduates with EN training professional autonomy of the rural RN. require a similar degree of guidance, support, and understanding to that provided for other nursing graduates Nurse clinicians: Nurse clinicians must remember that role entering the healthcare sector . transition creates ambiguity and conflict, and that it has the potential to generate feelings of insecurity and unfamiliarity It is in nursing managers’ interests to understand how the for individuals undergoing this process. The expectation that anomalies of a rural practice impact on a graduate nurse’s graduates with previous EN training require less support transition, and to ensure that the appropriate infrastructure is than other graduates is best addressed through appropriate available to support nursing graduates cope with the staff development. Work colleagues must align their challenges. Managers also have a responsibility to ensure expectations with individual graduate’s abilities and ensure mentors have the skills, knowledge and time to do their job consistent mentoring . Recognition that this role is new to of supporting new graduates . The response, ‘You’ll be these graduates, and that the resulting unfamiliarity can right just ring if you need anything’ is not what nursing impact on professional development and practice, should be graduates need when faced with the prospect of a patient considered by those working with the transition RN . The with chest pain coming through the accident and emergency learning of another role within the same work context can be door, nor is it legally acceptable. The provision of unnerving, requiring added understanding and support. appropriate orientation and suitably educated mentors who Graduates need to be able to freely communicate concerns are regularly rostered with graduates (especially during the and feel they will be responded to appropriately. They need initial months of a graduate nurse’s transition) is important. to be given time to develop their clinical practice and to Shift rostering must consider appropriate skill mix and increase in confidence and autonomy at their individual workload allocation to ensure continued job satisfaction and pace. The provision of positive constructive feedback is also retention and to foster increased professional autonomy. important to successful professional development. Job Jones and Cheek point out that practice development is a satisfaction will occur in a work environment that provides concern for all, and that it is a complex system of learning encouragement - not humiliation. © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 7 Future graduates: While the findings of this study cannot encouraged and supported the EN to RN transition in this be applied to all nursing graduates, these participants’ unique setting. experiences are none-the-less important, for they can assist future graduates and those responsible for their transition to This study has achieved its objective through the recognise that the RN role is not a mere extension of an EN identification and discussion of three essential themes which qualification. The education and experience of the EN will were identified from the participants’ descriptions of assist a new RN with general nursing duties involving transitioning from EN to RN in a rural setting. While the clinical dexterity and work place familiarity; EN to RN experiences of these participants cannot be applied to all transitions can also create challenges concerning role rural RN graduates with previous EN status, one cannot ambiguity, self-expectation, and others’ expectations. A new dispute its strengths in drawing attention to the needs of such graduate RN’s previous EN status is likely to lead to new graduates. Appropriate actions taken by nurse workplace assumptions of better coping and the need for less administrators, managers and educators who oversee practice support. Therefore, these new RNs need to develop the and staff development in rural venues will result in a better ability to clearly articulate concerns and needs to educators prepared and more stable workforce. Perhaps the most and workplace managers. In addition graduates will need to important change agents are the new RN graduates be proactive in regard to professional development needs themselves, who must voice their needs to their managers and developing support systems, which include work and educators, and participate in strategies and further mentors, colleagues, and friends that will assist and support research to ensure beneficial transition processes for future them throughout their RN transition. graduates. Further research will determine what is needed, what References resources are available and the ideal process for implementing or encouraging these changes. Clare and van 1. Bushy A. International perspectives on rural nursing: Australia, Loon recognise that the first 3 to 6 months of a new Canada, USA. Australian Journal of Rural Health 2002; 10: 104- graduate’s transition are the most crucial in terms of positive professional adjustment and nursing career commitment. Therefore positive interventions at this time are essential. 2. Baldock D. Profile of the registered and enrolled nurse workforce in South Australia 2002. Adelaide, SA: Department of Conclusion Human Services, 2002. Phenomenology seeks to discover what a phenomenon 3. Bradley C. Final Report: Research into Recruitment, Retention means and how it is experienced. The aim of this study was and Role of Rural Enrolled Nurses in South Australia. Adelaide< to explore the lived experiences of ENs making their RN SA: Centre for Research into Nursing and Healthcare University of transition within rural contexts. Currently there is a shortfall South Australia, 2000. of RNs prepared to practice in the rural setting. However, there is a higher proportion of ENs to RNs working in rural 4. Hegney D, McCarthy A, Rogers-Clark C, Corman D. Why health care, with many of these ENs undertaking nursing nurses are attracted to rural and remote practice. Australian Journal degrees. This identifies a nursing workforce prepared to of Rural Health 2002; 10: 178-186. practise in the rural context, and one possible means of addressing the RN shortage. For example, RN shortages could be reduced if healthcare units and policy-makers © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 8 5. Blue I, Fitzgerald M. Interpersonal relations: case studies of 14. van Manen M. Researching lived experience. Human science working relationships between Registered Nurses and general for an action sensitive pedagogy. London, ON: State University of practitioners in rural Australia. Journal of Clinical Nursing 2002; New York Press, 1990. 11: 314-321. 15. Streubert Speziale H, Rinaldi Carpenter D. Qualitative 6. Hegney D, McCarthy A. Job satisfaction and nurses in rural Research in Nursing Advancing the Humanistic Imperative, 3rd Australia. Journal of Nursing Administration 2000; 30(7/8): 347- edn. Philadelphia, PA: Lippincott, 2003. 16. Cohen M, Kahn DRS. Hermeneutic phenomenological research 7. Johnson D, Preston B. An overview of issues in nursing a practical guide for nurse researchers. London: Sage Publications education. National Review of Nursing Education 2002, The 2000. Nursing Workforce. Canberra, ACT: Commonwealth of Australia 2002, 125-173. 17. Hycner R. Some guidelines for the phenomenological analysis of interpretive data. Human Studies 1985; 8: 279-303. 8. Clare J, White J, Edwards H, van Loon A. Curriculum, clinical education, recruitment, transition and retention in nursing. 18. Cowin L, Jacobsson D. The nursing shortage: part way down Adelaide, SA: Flinders University, 2002. the slippery slope. Collegian 2003; 10(4): 25-30. 9. Goh K, Watt E. From ‘dependent on’ to depend on’ the 19. Nayda R. Registered nurses' communication about abused experience of transition from student to registered nurse in a private children: rules, responsibilities and resistance. Child Abuse Review graduate program. Australian Journal of Advanced Nursing 2003; 2004; 13: 188-199. 21(1): 14-20. 20. Johns C. Transition of the enrolled nurse to registered nurse in 10. Hoffman K, Elwin C. The relationship between critical thinking the rural setting. Honours thesis. University of South Australia, and confidence in decision-making. Australian Journal of 2005. Advanced Nursing 2004; 22(1): 8-12. 21. Francis K, Bowman S, Redgrave M. Knowledge and skills 11. Kilstoff K, Rochester S. Hitting the floor running: transitional required by rural nurses to meet the challenge of a changing work experiences of graduates previously trained as enrolled nurses. environment in the 21st century: a review of the literature. Wagga Australian Journal of Advanced Nursing 2004; 22(1): 13-17. Wagga: NSW: Charles Sturt University, 2000. 12. Gibson T, Heartfield M, Cheek J. Final Report to the Australian 22. Jones J, Cheek J. The scope of nursing in Australia: a snapshot Nursing Council Inc: an examination of the role and function of the of the challenges and skills needed. Journal of Nursing enrolled nurse and revision of competency standards. Adelaide, Management 2003; 11: 121-129. SA: Centre for Research in Nursing and Health Care University of South Australia, 2002. 23. Thompka L. Graduate nurses' experiences of interactions with professional nursing staff during transition to the professional role. 13. Paech S. Making the transition from enrolled to registered Journal of Continuing Education in Nursing 2001; 32(1): 15-19. nurse. Collegian 2002; 9(3): 35-40. 24. Clare J, van Loon A. Best practice principles for the transition from student to registered nurse. Collegian 2003; 10(4): 25-30. © R Nayda, J Cheri, 2008. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 9

Journal

Rural and Remote Health – Unpaywall

Published: Jun 13, 2008

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