Bill Whitehead 30 June 2019
I’ve been interested in supporting newly qualified nurses (NQNs) during their transition from student to staff nurse since I first qualified in 1990. It seemed obvious to me then that the provision of clinical educators in practice to support students should also be there to support NQNs. I had learned a lot during my traditional three year apprenticeship but I hadn’t realised the full range of skills needed in the specialist area of acute medicine that I landed in. These included an understanding of all the roles of the multi-disciplinary team, the treatment and care of patients with the specialist conditions on the ward and most importantly, an understanding of the social care required for the mainly elderly and often newly infirm patients on discharge. This took me a while to learn and there were times when I thought it was beyond. As a newly qualified former mature student, I knew that really what I needed was the time and support to learn. Consequently, I started looking into the theory and evidence around NQN transition nearly thirty years ago.
The transition from student to registered nurse has long been known to be a difficult time for NQNs joining the register. Marlene Kramer made this the subject of her PhD thesis in the 1960s and published her seminal book “Reality Shock: Why Nurses Leave Nursing” in the 1970s. The main finding of her research, over fifty years ago, was that NQNs were less likely to leave early in their career if they had a supportive programme linking their time as a student to registrant to support the transition. In the twenty-first century we have developed this supportive programme into preceptorship support programmes. These are usually run entirely by the employer of the NQN but as Kramer found in what she described as the “anticipatory socialisation programme” the support for transition works best if it starts during the pre-registration education programme. Where this can run seamlessly into local employers’ preceptorship programmes the transition shock for NQNs is understandably reduced to more manageable levels. There has been plenty of research in the intervening half a century since Kramer’s work and at least two systematic reviews of these research projects in the last few years to support the need for a period of good supported transition arrangements. The latest research includes Health Education England’s recent RePAIR project and the ongoing STAR project.
I’m the general secretary of the UK Clinical Nurse Educator Network (CNEnet). The network was set up to link up and share good practice between CNEs. I co-founded this organisation with Liz Allibone because we had both done this job and both, separately, completed research which indicated the need for it. One of the central roles of CNEs is supporting the transition of NQNs. We know this from our own experience and from a recent survey of members which indicated that over 90% had a role in supporting NQNs and believed that it encourages NQNs to join their organisation and to stay with them. Our research indicated that for best results an organisations preceptorship programme needs to provide three levels of support:
- A named more experienced registrant in their team as a preceptor
- A supportive team who recognise the need for NQNs to have time and support to learn the ropes
- An organisational level support programme ideally linked to local pre-registration programmes to provide a feeling of seamless supportive environment for the senior student transitioning into an NQN
This all needs dedicated staff to organise and sustain. Therefore, the clinical nurse educator is not an “expensive luxury”, as some employers have believed in the past, but a “practical necessity”. Without them, as Kramer proved fifty years ago, “nurses leave nursing” too early in their careers.
Could you add this to the bottom – For more information about the Clinical Nurse Educators Network see this link.