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'Newly qualified nurses must be supported so we don’t lose them'

  • 11 Comments

Newly qualified nurses face many challenges - being in charge of the care needs of patients who are seriously ill, having to delegate and often taking higher than expected levels of responsibility at short notice due to staff shortages.

This is nothing new, of course. I qualified as a registered general nurse after completing “apprenticeship-style” training where we spent most of our time in practice. Students made up the majority of the workforce in NHS hospitals. Routinely, wards were managed by a single staff nurse with only students for support.

My first job after qualifying was on the ward where I’d done my final student placement. Was it then a seamless transition from apprentice to RGN? Unfortunately, it wasn’t. Like so many nurses before and since, I found the role very different from that of a student. Yes, I could do the tasks associated with looking after a ward full of patients, but nothing can prepare you for the reality of that accountability.

In 2013, this is at least as big an issue for the newly qualified as it was in the 1980s - but the life of the new RN has undoubtedly become more complicated in the intervening years.

Some of us survive this period of uncertainty to have careers as nurses and others don’t. Left to sink or swim, too many newly qualified nurses simply give up the profession in the early months because of this “reality shock”. However, it doesn’t have to be like this. A large body of evidence shows that, given support for a few months after qualification, most of those newly qualified nurses become valuable, experienced RNs. That is why it is vital that employers follow the advice of the Nursing and Midwifery Council and the Department of Health to provide a period of preceptorship after qualifying. We simply cannot afford to lose these new members of our profession.

We know from our extensive recent systematic review that any form of support is better than nothing (Whitehead et al, 2013). Nevertheless, once employers have a system of support in place they should work to improve it. To do this, a culture of support is needed everywhere that newly qualified nurses are deployed.

According to our recent preceptorship research, this appears to work best in organisations that take a three-level approach: they deliver a preceptorship programme for all newly qualified nurses and meet regularly for peer support; they encourage local teams to look out for newly qualified nurses and be aware of their needs; and newly qualifieds have a personal preceptor. The preceptors are essential elements of this and require specific preparation, ongoing support and recognition of their role by their employers.

These systems of support should be the norm, not the exception. If we want to prepare a high-quality, caring workforce, we need to start by caring for the members of our profession at the start of their careers.

Bill Whitehead is assistant subject head of nursing, University of Derby

  • 11 Comments

Readers' comments (11)

  • bill whitehead

    The argument put forward in this article is supported by our collaborative research with Chesterfield Royal Hospital (CRH). The early findings of this have been disseminated widely at international, regional and local level. The final report of this case study research is almost ready. This was done with the purpose of improving an embedded preceptorship support programme at CRH. Nevertheless, early dissemination indicates that it will be of interest to others.

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  • Pirate and Parrot

    We do now live in a permanently-connected age.

    I think all newly-qualified clinicians, and probably all clinicians who are effectively temporarily taking on a more demanding role, would be helped if they could sometimes just have a 'quick word/chat' with a more experienced colleague: this ought to be easily possible by mobile phone these days, when not possible any other way. A bit of 'at-the-time-reassurance' would probably remove a lot of this stress.

    Parrot

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  • Pirate and Parrot | 19-Oct-2013 2:19 pm

    why do you need a mobile phone. can't they talk to their colleagues face to face?

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  • michael stone

    Bill started his piece by mentioning situations when newly qualifed staff might be out of their 'comfort zones' because of staff shortages - obviously face-to-face is best if someone appropriately qualified can be spoken to quickly face-to-face. I'm guessing that Parrot meant it should now always be possible to very quickly 'have a word with a more experienced person' even if that (and the arrangements for it to be possible) involved a phone call.

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  • Julie Bernstein

    Even though accelerated pay progression for newly qualified health professionals has gone from Agenda for Change, it states in the FAQs that preceptorship is still in place. I don't think preceptorship by mobile phone is acceptable. I would expect monthly clinical and/or managerial supervision at the very least and preferably the chance to meet with other preceptees to work through competencies, such as described in the College of Occupational Therapists' guidelines and in the preceptorship policy of many NHS Trusts. It was definitely worth flagging this up again Bill, and that last sentence is an important message for all employers about all their employees, not just the new ones.

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  • I graduated last year as an RMN and have worked in two different trusts. Both times I did not receive preceptorship - the first trust didn't offer it as I had applied to work somewhere else soon afterwards (I was there for 6 months though) the second trust I'm with at the moment haven't been able to do their usual preceptorship training because they haven't got enough preceptees.

    I found my time at university very stressful and had to take time off on several occasions. I'm not very confident in myself even though I know I have the ability and skills. It should be mandatory to offer some form of formal and informal support to newly qualified nurses. There is no point in training us for 3+ years only to then set us free into the wild and expect us all to be able to keep our heads above the sand.

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  • Anonymous | 22-Oct-2013 0:23 am

    hopefully once you have found your feet it will show you how things should and should not be done so you can offer your support to students and new graduates and maybe it will even encourage you to train and qualify as a preceptor. Sadly one often has to learn the hard way in life but it should also provide us with some valuable experience although many seem to forget the lessons they have learned.

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  • Bill and I worked as colleagues many years ago and we developed a preperation programme for preceptors way before any of the standards etc came out as even then we both recognised how important the quality of the experience for both parties should be.
    One of the main features was the use of action learning for the preceptors.
    Whilst it is sad that some 10 years later we are still having this debate I totally support Bill's work and hope that one day all newly qualified nurses in the NHS will have access to the support they need and ongoing support will exisit for all nurses and healthcare workers.

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  • My experience of preceptorship as a newly qualified 4 years ago was pretty much non existent, though this was down to short staffing and rather than lack of will. In a specialist environment I was very keen to work in, but had not done as a student, I was completely out of my depth with virtually no support. In the 8 months I stuck it out I lost half a stone in weight through stress. On breaking down at the end of a horrific shift I was told 'well, no one died did they?' I left shortly after and on the following ward, being fully staffed, and with a different attitude to newly qualifieds, I was able to progress in both skills and confidence. I nearly left the profession because of my first experience, I'm glad I didn't and can offer my support to the 'newbies' of the future.

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  • Bill and I worked as colleagues many years ago and we developed a preperation programme for preceptors way before any of the standards etc came out as even then we both recognised how important the quality of the experience for both parties should be.
    One of the main features was the use of action learning for the preceptors.
    Whilst it is sad that some 10 years later we are still having this debate I totally support Bill's work and hope that one day all newly qualified nurses in the NHS will have access to the support they need and ongoing support will exisit for all nurses and healthcare workers.

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