Monday 8 March 2021

Nursing Career, Nursing Responsibilities, Nursing Roles, Nursing Art

COVID-19 has forever changed the trajectory of nursing for experienced nurses but also for the next generation. Those in nursing school lost valuable clinical hours while those at the bedside will continue to suffer from the physical, emotional, and psychological effects of treating patients during the pandemic. During normal times, being a new to practice nurse is stressful and challenging but now, because of the ever-changing aspects of healthcare, it has increased a hundredfold.

Wolters Kluwer published a well-regarded study in 2020 that explored next-generation nurses, defined as nurses practicing less than 10 years. According to their study, these nurses are poised to influence the next two to three decades of healthcare. 

The study found six key characteristics of next-generation nurses, 

◉ Champions of consistency

◉ Proponents of value

◉ Care equalizers

◉ ‘Tuned in’ to the medication crisis

◉ Tech-savvy by nature

◉ Patient’s advocate

“COVID-19 has put a spotlight on the critical role nurses play in providing needed patient care. But it has also shown how much the healthcare system stands to lose if the current nursing shortage continues and clinical training doesn’t keep pace with nursing in today’s world,” said Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse of Health Learning, Research and Practice, Wolters Kluwer. “The survey findings are a wake-up call for hospitals and nurse leaders whose workforces are transforming rapidly, leaving knowledge and training gaps in their wake.”

1. Rushing New Nurses Through Hospital Orientation 

Based on the study, next-generation nurses expect and need the same orientation and education post-graduation as previous generations. Unfortunately, this is not happening. COVID has caused a massive shortage of nurses, especially critical care nurses, forcing hospitals to push new nurses through orientation quicker than in previous years. Generally, new to practice nurses receive three to four months of orientation for general medical surgical nursing. Critical care nurses would receive six to eight months in a progressive orientation. 

Hospital and unit orientation are considered essential for any new to practice nurse. Nurses coming right from school do not have the expected competencies to care for patients on their own, especially complex ones. Extensive orientations are needed to ensure these competencies. Even prior to the pandemic, hospitals would often find ways to decrease orientation as it costs a great deal of money and is not federally funded. Healthcare systems are essentially paying two nurses salaries to do the job of one nurse. Controversy regarding the length of orientation has long been debated by administration and clinical personnel. Costs spent on continual orientation of new clinical nursing staff were often lost to the development of patient care initiatives and improvements. 

As the pandemic lingered on, hospitals were forced to cut costs when possible. Lack of patients, cancellation of surgical procedures, and decrease in federal funding all forced hospitals to make decisions regarding extra spending. Nurse orientation was one of the programs that was cut in many healthcare systems across the country. That’s not to say that a new to practice nurse will not get an orientation - because legally they have to. But will it be enough? Will it prepare the nurse to do their job with confidence and the right abilities? 

2. Hospitals Expect Schools To Provide Orientation. They Can’t.

Hospitals are pushing for nursing programs to again assume the brunt of the bedside orientation. However, this is impossible. If a student is interested in becoming an oncology nurse - there is no clinical rotation during a traditional nursing program directly related to oncology. Can nursing programs teach students the basics to care for patients? Absolutely. And they should. Can they be taught the ins and outs of every disease process related to a specific patient population? Absolutely not. 

Prior to the 1960s and 1970s, nursing programs were often associate degree programs or hospital-based programs. Students would do clinical rotations at one hospital and most would take jobs in that same hospital upon graduation. Nursing programs were able to orient students to the units and the hospitals because everything was taught there. As nursing degrees moved to traditional four-year degrees at major universities, programs became affiliated with a variety of healthcare institutions.

3. The Pandemic Moved Clinicals Online

Another consideration regarding the importance of unit-based education is the current generation of new nurses and nursing students do not all have the same clinical experience. State boards of nursing are required to set forth a specific number of in-person clinical hours a student must have in order to graduate. Nursing programs are required to meet this minimum requirement in order to maintain accreditation and funding. As nursing clinicals were forced to go online at the start of the pandemic, every nursing school handled the clinical hours very differently. States gave leniency on the number of in-person required hours and the number of virtual hours allowed. Some programs purchased interactive virtual simulation while others had to resort to case studies and unfolding simulations via Zoom. This difference alone put many new to practice nurses at a very big disadvantage. 

4. New Nurses Must Advocate For Better Orientation

Because of the vast differences in the new to practice nurse’s experience, it's essential that nursing orientation continues, as it was pre-pandemic. Next-generation nurses should be their own best advocates regarding their orientation. It can be hard, especially as a new employee, but here are some tips that can help!

◉ Speak to your preceptor if you need more help with procedures, tasks, assessments

◉ Read through your hospital’s policies and procedures that are used on the unit

◉ Make friends with other orientees to help navigate the orientation process

◉ Purchase a study book directly related to the patients on your unit

◉ Speak to the unit nurse educator regarding your needs, expectations, and progress throughout clinical

◉ Don’t be afraid to ask for help!

◉ Take notes during the workday 

◉ Sit with your preceptor each week to talk about what is going well and what needs to change in order to succeed

◉ Take initiative and be an active part of the orientation process




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