Every spring I see my neighbors plant their amazing vegetable garden and always have high hopes of doing the same. One year I even went to the extent of having my husband till up a portion of the yard to garden far more than I needed, which I filled with seeds and small plants. I was so excited to begin reaping the reward of fresh vegetables! I threw on fertilizer a couple times early on and tried to keep up on the weeds, but really who has time for that?! I was lucky to get it watered regularly. Usually, that got done after I went out to check on things and saw the leaves beginning to droop. My high hopes soon diminished, as it began to resemble something out of a horror movie and less of a masterpiece like my neighbor had. The plants didn't produce near the volume of vegetables as my neighbor’s, and the quality of the crop was pretty pathetic. As a self-proclaimed “Martha Stewart wannabe”, I spent some time reflecting on what went so wrong.
I used fertilizer (once or twice), I weeded it (a little), and I watered it (when the leaves started to wilt). I knew all that support was necessary to garden, but I was doing it all wrong. As a busy mom, volunteer, and professional nurse, I found it very difficult to make the time (notice I didn't say take the time - I likely had the time, but chose to use it differently) to nurture my garden with fluffy stuff like weeding, fertilizing, pruning, and watering in the way needed to have my plants flourish and produce delicious vegetables. I planted the seeds, went through the motions, and expected vegetables to be produced. I knew how important each of those things were, yet I wasn't necessarily putting in the time, continued support, and attention needed to keep it going.
As I type this I can't help but see how the same holds true for how we 'grow' our nurses. We know what they need, we may have programs in place, but we struggle to give the programs the time and attention they need to thrive. I recently listened to a webinar through the Association of Nursing Professional Development in which Louise Jakubik, PhD, RN-BC, CSP described the career continuum of a new nurse and described the purpose and timing of each phase.
In an era of busy and overworked nurse leaders, you are likely being pressured to get new nurses with the program quicker and cut down on the 'fluffy' stuff just as I did with my garden. You may find yourself 'planting the seeds', but not getting the outcomes you are after. Sure you have an orientation program in place, but is it evidence-based and up-to-date? You may have a nurse residency program, but does it last an entire twelve months and include all the comprehensive components needed? Once nurses are through orientation and residency, do you continue to provide mentoring for these employees? Hopefully yes, but if you are like many of us you are tempted to wipe your hands clean and move on to the next thing on your very full plate. Not because you don't care, but because you are a busy person being pulled in a million different directions and getting pressure from the higher-ups to get through things quicker. You are just trying to do the best you can with what you have time for, but because of this, in the end, the product might not be what you hoped.
It is important to clearly understand the purpose and timing of each phase of support and education needed for the new nurse as they develop and become competent in the profession. Then you can clearly communicate the necessity of each to those distinct phases to those at the decision-making table. While I am very familiar with each of the phases as I am sure you are, it is always important to revisit the timing and purpose of each and ensure you are staying true to each step along the way. As much as we want to get new nurses from 0 to 60 in the click of a mouse, that just isn't the reality. Dr. Jakubik described four distinct phases of a nurse’s career continuum as stated below.
Phase 1 – Onboarding
Onboarding occurs in the initial weeks of a new hire’s career at a specific organization. It includes things like learning about their employment benefits, how to use the time clock, dress code, and other necessary information needed to begin to familiarize the new hire to the organization. Some of this will continue on into the next phases, but the bulk of this happens in those very early weeks.
Phase 2 – Orientation
Orientation is a very distinct phase of the new nurse’s career where they are tasked with learning the skills and knowledge necessary to function in their role. For a new graduate nurse working at the bedside, this would include learning the day-to-day routines, policies regarding skills such as medication administration, and other patient care skills needed at the bedside. Typically, during this phase, the employee works one-on-one with a preceptor who is responsible for teaching the functions necessary for the role of the nurse.
Phase 3 – Nurse Residency
Nurse residency, on the other hand, takes over where orientation leaves off, focusing on professional skills of the nurse and providing support as the new graduate nurse transitions from a novice or advanced beginner to a competent professional. Socialization to the profession of nursing continues as the new nurse learns the norms, attitudes, skills, and knowledge necessary to function in their professional role. Providing a network of support from a group of peers and coaches/mentors allows the new nurse to know they are not alone in their experiences, decreasing the likelihood of turnover while they continue to develop.
Phase 4 – Ongoing Mentoring
Once completing the transition to a competent professional, the professional nurse will require ongoing mentoring throughout their career that encourages lifelong learning, encouragement and assistance with professional advancement, and eventually succession planning.
Each phase is of equal importance and very different in what it does for the nurse. I encourage nurse leaders, educators, and nursing professional development staff to take a look at the education and support provided to nursing staff as they advance through their career. Do you have support in place at all stages of their career? Is the support/education provided based on the best available evidence? Are you introducing each phase at the correct time in their career continuum? And do you strive to provide each phase with the time, attention, and continued support to keep the programs thriving?
Nicole Weathers
Program Manager, IONRP
nicole-weathers@uiowa.edu