New graduate registered nurses: Risk mitigation strategies to ensure safety and successful transition to practice

Abstract

The COVID‐19 pandemic has impacted traditional pathways for new graduate registered nurses (NGRN's) transition to practice. In response to stay at home emergency orders in 2020, NGRN's experienced changes in pre‐licensure curriculum, clinical practicums, NCLEX testing, and licensure, all which influence preparedness for professional practice. The adverse impact on education and clinical training extends to all nursing students who attended higher education institutions of learning during 2020 to present and is a significant consideration with new graduates over the long‐term, whom will be caring for patients in healthcare settings. Well before this pandemic, literature identified that NGRN's were predisposed to knowledge‐practice gaps and lacked situational awareness. Recent nursing research emerging from the pandemic reveals a potentiating negative impact of the abbreviated pre‐licensure experiences on patient safety in the clinical setting. In the current healthcare environment, it is preemptive for healthcare institutions and schools of nursing to work cohesively to ensure patient safety through an increased emphasis on evidence‐based approaches to reduce patient harm and mitigate harm when it does occur. Further, in response to the increased demand for nurses by healthcare organizations, considerations for safety, risk management, and ethical care must be considered during the transition to practice for NGRN's.

Nursing Skills Boot Camp

“…In 2016, the third leading cause of death in the US was preventable medical error. 7 Increasing patient complexity in combination with the loss of experienced nurses as a result of retirements has led to an experience-complexity gap in nursing that can lead to patient safety issues. 9 Errors made by NPRNs lead to an increased risk of harm to patients because these nurses haven't yet developed the knowledge base and critical thinking skills necessary for their new role.…”

“…9 Errors made by NPRNs lead to an increased risk of harm to patients because these nurses haven't yet developed the knowledge base and critical thinking skills necessary for their new role. 7,[10][11][12] NPRNs account for a disproportionate…”

“…6 The exodus has only spotlighted the need for innovative programs to prepare and retain NPRNs as they enter the workforce. 7,8 As a result of observation and feedback, hospital administration, unit leadership, clinical educators, clinical nurses, and NPRNs at a large, urban, academic medical center in New Jersey recognized that NPRNs struggle to succeed early in the transition-to-practice phase. These individuals determined that deficits in knowledge on how to perform basic nursing clinical skills, such as head to toe assessments, proper selection and use of oxygen modalities, insertion and care of nasogastric tubes, insertion of straight and indwelling urinary catheters, care of chest tubes, programming of feeding and I.V.…”

Describing Medication Administration and Alert Patterns Experienced by New Graduate Nurses During the First Year of Practice

“…13 These stressors are compounded today, as new graduate nurses transition to practice in a healthcare delivery system strained by the COVID-19 pandemic. 14 To better understand new graduate nursing workflow and documentation workload and to improve patient safety, it is important to understand patterns of medication administration and alert generation during BCMA. The primary objective of this study was to describe medication administration and alert patterns among a cohort of new graduate nurses over the first year of practice.…”

“…Heavy workloads and lack of competence in clinical and technical skills contribute to stress experienced by new graduate nurses 13 . These stressors are compounded today, as new graduate nurses transition to practice in a healthcare delivery system strained by the COVID-19 pandemic 14 …”