Dr Bill Whitehead, Deputy Dean of the College of Health and Social Care at the University of Derby, discusses the importance of the transition period for student nurses to registered nurses in order to retain vital nursing staff.
There is a well-known global shortage of registered nurses and the most important stage in ensuring the retention of the new nurses we are educating as the transition from student to registered nurse (RN) is difficult. Consequently, employers supporting newly qualified nurses (NQNs) during their transition from student to staff nurse is vital to ensuring the retention of nurses and building the nursing workforce to provide the quality care that is needed for our ageing population.
Clinical nurse educators
Our research, completed as part of my PhD research with clinical educators, looked at how effective they were in practice and indicated that the deployment of clinical nurse educators (CNE) in practice settings is important for learners in those areas. Therefore, it seems clear that the provision of clinical educators in practice to support students should also be there to support NQNs. Our nursing students learn a lot during their pre-registration degree but, they cannot learn the full range of skills needed in the specialist area they will work in for their first post as an RN. This takes a while to learn and what is needed is the time and support to learn.
Transition from student to registered nurse
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 packages. 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. This means it can run seamlessly into local employers’ preceptorship programmes so 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.
Clinical Nurse Educator Network
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 CNEnet national chair, Liz Allibone, Head of Clinical Education and Training at the Royal Brompton and Harefield NHS Foundation Trust, 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.
How to provide the best support for NQNs
Our research indicated that for best results, an organisation’s 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 a 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.