Becoming a Registered Nurse

Making the transition to practice

Jenny Temple

• Publisher: Learning Matters
• Year: 2012
• ISBN:
  9780857259325
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Final-year nursing students are often nervous about making the transition to being a registered nurse. This book helps students prepare for their first nursing role and uses ?real life? scenarios to consolidate their skills. It guides students through the final year with its increased demands, and assists them in meeting the NMC requirements for registration. It covers content commonly found on final year transition to practice modules including coping with stress; applying for jobs; what to expect from your first role; dealing with change; delegating and managing junior staff; handling risky situations; managing priorities and developing your career.

Chapter 1

Making the most of your final year as a student

NMC Standards for Pre-registration Nursing Education

This chapter will address the following competencies:

Domain 1: Professional values

1. All nurses must practise with confidence according to The code: Standards of conduct, performance and ethics for nurses and midwives (NMC 2008), and within other recognised ethical and legal frameworks. They must be able to recognise and address ethical challenges relating to people’s choices and decision-making about their care, and act within the law to help them and their families and carers find acceptable solutions.

Domain 2: Communication and interpersonal skills

1. All nurses must build partnerships and therapeutic relationships through safe, effective and non-discriminatory communication. They must take account of individual differences, capabilities and needs.

NMC Essential Skills Clusters

This chapter will address the following ESCs:

Cluster: Care, compassion and communication

5.	People can trust the newly registered graduate nurse to engage with them in a warm, sensitive and compassionate way.

By entry to register

10.	Has insight into own values and how these may impact on interactions with others.
12.	Recognises and acts autonomously to respond to emotional discomfort or distress in self and others.

Cluster: Organisational aspects of care

12.	People can trust the newly registered graduate nurse to respond to their feedback and a wide range of other sources to learn, develop and improve services.

By entry to register

8.	As an individual team member and team leader, actively seeks and learns from feedback to enhance care and own and others’ professional development.

Chapter aims

After reading this chapter, you will be able to:

• understand how best to deal with final-year pressures and anxieties;
• appreciate what will be different about your final-year practice learning experience;
• begin delegating to other staff;
• draw your experience, knowledge and skills together to meet the NMC requirements for entry on to the register;
• begin planning for your future.

Introduction

Your final year as a nursing student will feel different to previous years. You may have feelings of both nervousness about what will be expected of you this year, and some sadness, perhaps, that your final year is coming to an end. Many students report feeling under a lot of pressure in this final year, from passing assessments through to the increased autonomy and responsibility expected in their final practice learning experiences, which can include some delegating to other staff. There is no doubt that the final year can be tough. You will be expected to be operating at a higher level now, both in your academic work, where you will be expected to be thinking critically and learning independently, and in practice, where you will be expected to demonstrate the ability to be an independent practitioner, a team leader and an effective decision-maker under pressure. But this year is also exciting; now, finally, you can pull together all the knowledge and skills learnt throughout the rest of your course and see it all working in practice. It is natural to feel nervous, but acknowledging that everyone feels this way and learning to appreciate your own strengths and abilities, as well as areas for development, will enable you to succeed in this final year and enjoy it too.

This chapter will use an extended scenario to show what is expected of you in this final year and how to cope with the pressures and demands in order to succeed at it. It will look first at the pressures that you are likely to be feeling and how to cope with them. It will help you to identify your strengths and weaknesses, and consider how to develop your portfolio in your final year. It will explore your final placements or practice learning experiences, what is expected and how to make a success of them. It will also explore the step-up to delegating to other staff that will be part of your final placements. It will touch on planning for your future, which is an important part of your final year, and which will also be explored in more detail in Chapter 10.

Dealing with final-year pressure and anxieties

Scenario

You are a third-year student nurse who has already experienced a range of placements over the last two years, having commenced your nurse training straight after leaving school. In particular, you have spent time with the district nursing team and on two medical care areas, one of which was in a community hospital and the other the stroke unit of a busy district general hospital.

You have been told that your next placement will be in the intensive care unit (ICU) and the final one in a surgical ward. This has made you very anxious as you feel unprepared for either of these areas or for what might be expected of you, as you are in your third year. You have heard from colleagues that the ICU has very high standards of care and similar expectations of its students. You are sure that you will be the least competent student that they have ever had and will fail to cope with the pressures. In fact, despite a good range of marks for your academic work and passes in practice, you think you might as well leave now rather than waste everyone’s time.

Your flatmates try to reassure you but this doesn’t really help, although you agree not to resign straight away.

Activity 1.1 Decision-making

Faced with the situation in this scenario, what do you think you should do?

An outline answer is provided at the end of the chapter.

It is clear that you need to talk to someone about the situation and that your flatmates, although supportive, lack any real idea of what to do. Every university student has an allocated personal tutor and in nursing this is usually someone on the same part of the NMC register (NMC, 2008a). You may feel that this person will not understand the situation but your personal tutor will have considerable experience with student issues and will be able to discuss your options.

It is important that you start to consider tutors or senior clinical staff as colleagues who can assist you, perhaps as a sounding board for ideas, rather than simply as your assessors. In the world of work the function of clinical supervision (NHSME, 1993, in NMC, 2008a) can support staff to work through issues.

You might also think of talking to your parents or ‘significant others’ as they too may be able to empathise with you and suggest support mechanisms. Here again you are shifting your relationship with adults away from adult–child towards adult–adult, so that you ultimately make your own decisions; this is a concept taken from Berne’s (1964) ideas of transactional analysis.

Clearly, it will help to contact the placement and ask to talk about your concerns with a mentor (NMC, 2008a) or someone senior. It may be that your concerns are typical of students being placed on ICU, particularly late in their programme. You need to take control of your learning experiences and develop in a proactive way

Using others to help you address your anxieties

Scenario

You ring the ICU and ask to speak to one of the mentors and are given the dates and times of your shifts. Unfortunately, it was apparently very busy on the unit and the staff nurse couldn’t talk to you at length. Of course this has made you even more concerned and you are ‘forced’ to book an appointment with your personal tutor. You have never asked to meet your tutor before, and have previously always responded to his e-mail request for an appointment at the end of each placement. It is clear that this situation is different, as you are still considering resigning and think of yourself as a failure. Your tutor agrees to see you in a couple of days’ time.

Activity 1.2 Reflection

What are your own anxieties as you approach the end of your programme? Make a private list of the main things which concern you at this stage. Thinking about your own anxieties as you move towards the end of your pre-registration period will help you prepare for future situations, such as applying for a job.

As this is a personal reflection, no outline answer is supplied.

It is apparent that up to now you have not taken the lead in requesting help, but ownership of a problem and the ability to manage it are signs of maturity. You need to think through why you feel that resignation is your only option, particularly towards the end of your programme.

Once you qualify you will work with learners who themselves express concerns about continuing with a programme of learning. As a true mentor, helping individuals work through issues, such as their suitability for a programme, stress, anxiety or ill health can be a real asset to a student, even if only by referring them to specialist support. Your university or practice base will often have a list of helpful contacts.

Scenario

Your tutor, John, is very welcoming and instead of a designated half-hour tutorial, he offers you a cup of tea, as he’s just put the kettle on, and he says that he is free to talk for as long as it takes. He asks you to explain why you wanted to meet and how he can help, but firstly asks you to recap your placements to date and your academic achievements, as he doesn’t have your file. You tell him about your marks and your range of placements and then your fears for the final year’s placements. All of this comes out as a rushed jumble of words and you know that you haven’t made a good impression. You have probably only compounded your own worst fears! So John asks you to take a deep breath and start again, this time much slower and with more detail.

Activity 1.3 Communication

Why do you think John wants to know what has been happening to you on the programme to date? What is the purpose of this questioning within the role of tutor?

An outline answer is provided at the end of the chapter.

Getting to the root of a problem can be very difficult, particularly when individuals feel that they are alone and that no one else can have experienced the same concerns. By getting you to repeat, slowly, your concerns, John is asking you to take some control of the problem. He is not belittling your concerns but trying to get you to be in charge. John asks you to talk about issues that you have achieved already, thus providing you with some positive reinforcement. This is a way of starting the conversation in a structured way, and allows you to reflect on your experiences, in particular the successes.

Scenario

You start again, this time more calmly, and find yourself explaining all about how you have enjoyed the community placements with the opportunity to follow some patients’ care over several weeks. You are fearful that you will now not have the clinical skills necessary for ICU work or be able to cope with the speed of throughput on a busy surgical ward. You explain that, as you understand the need for this type of placement on the programme and you won’t be able to cope, you might as well resign now!

John then asks you about what you have enjoyed during the previous placements, and why. You start to talk about what it was like working on the stroke unit and why you found it so enjoyable; in brief, it was the continuity of care and the feeling that you were really making a difference to someone’s life. The tutor asks you again whether your mentor would think the care you gave was one of your strengths, and reluctantly you agree.

Then you start to describe how it wasn’t really your care that worked but the effective communication between the members of the multidisciplinary team and between the hospital and community staff. You don’t acknowledge your part in the effective communication until questioned by your tutor, who reminds you about a comment from your mentor on one of the practice summative assessment documents. At last you acknowledge that, yes, you have been complimented on your effective communication skills, both verbal and non-verbal.

Activity 1.4 Communication

Why do you think communication skills are so important and will be needed in the months leading to your registration?

An outline answer is provided at the end of the chapter.

Communication

You will need to demonstrate written communication through your portfolio and CV, which you will be expected to present to future employers in job applications. You may then have to build on these written skills in a verbal interview, which may build in further written, mathematical or psychometric tests. (There are more details on applying for other posts in Chapter 10.)

If you are particularly proud of something that has taken place during your programme, then you should bring this to the attention of future employers. For instance, you may have rece...

Table of contents

• Cover Page
• Title
• Copyright
• Contents
• About the author
• Foreword
• Acknowledgements
• Introduction
• 1 Making the most of your final year as a student
• 2 Becoming an independent practitioner
• 3 Dealing with change
• 4 Working with staff: your role as a leader
• 5 Taking on a mentorship role
• 6 Risks and decisions
• 7 Nursing the deteriorating patient
• 8 How to manage competing demands
• 9 What if someone wants to make a complaint?
• 10 Developing your career: is there a perfect route?
• References
• Index