Transitioning Into Practice

Abstract

The strategies identified can be used to develop a structured orientation that may ease the transition into the CNS role.

Clinical Nurse Specialist Transition to Practice

“…The project findings on CNS TTP were consistent with issues identified in previous research including lack of understanding and visibility of the CNS role 6,9 ; workload and overwhelming expectations 8 ; limited administrative support, shortage of resources, and lack of structured training 8,13,31,33 ; and need for a competency evaluation. 8,38 Strategies recommended in the project findings and previous literature included the critical role of a preceptor, mentors, and support CNSs 6,36,38 ; a standardized competency-based evaluation tool 7,8,33,36,38 ; the importance of developing relationships with key organization leaders 9,31,33 ; and a structured 1-year TTP program.…”

“…The project findings on CNS TTP were consistent with issues identified in previous research including lack of understanding and visibility of the CNS role 6,9 ; workload and overwhelming expectations 8 ; limited administrative support, shortage of resources, and lack of structured training 8,13,31,33 ; and need for a competency evaluation. 8,38 Strategies recommended in the project findings and previous literature included the critical role of a preceptor, mentors, and support CNSs 6,36,38 ; a standardized competency-based evaluation tool 7,8,33,36,38 ; the importance of developing relationships with key organization leaders 9,31,33 ; and a structured 1-year TTP program. 7,8,12,33 Findings unique to this project that have not been emphasized in previous literature included the variations when comparing entry-level CNSs', experienced CNSs', and DONs' (nursing administrators) perspectives on CNS TTP; emerging needs for competency development in prescriptive authority and financial analysis; and the critical need for CNSs to develop networking and interdisciplinary relationships across the entire system.…”

“…Transition challenges revealed by CNSs included lack of standardized training and competency validation, 39 and stress, fear, or "imposter phenomenon" related to meeting expectations. 6,9 The most common strategy identified was having a preceptor. 6,7,33,[36][37][38] Additional strategies included seeking mentors 6,8,9,36,38 ; seeking peer support 6,9,12,37 ; assessing and learning the organization structure 9,37 ; developing organization relationships by meeting with key leaders 9,33 ; implementing projects and seeking involvement on larger projects or committees 9,33 ; developing a standardized CNS competency evaluation tool 7,8,33,36,38 ; and developing a structured orientation, residency, or fellowship program.…”

“…6,9 The most common strategy identified was having a preceptor. 6,7,33,[36][37][38] Additional strategies included seeking mentors 6,8,9,36,38 ; seeking peer support 6,9,12,37 ; assessing and learning the organization structure 9,37 ; developing organization relationships by meeting with key leaders 9,33 ; implementing projects and seeking involvement on larger projects or committees 9,33 ; developing a standardized CNS competency evaluation tool 7,8,33,36,38 ; and developing a structured orientation, residency, or fellowship program. 7,8,12,33 For the 4 studies that implemented a TTP program, sample size varied from 2 to 8 CNSs; length of time varied from 2 months to 1 year; and outcomes included competency demonstration on evaluations, job satisfaction, and retention.…”

“…6,7 CNSs often face reality shock during TTP as they recognize immense practice responsibilities combined with a steep learning curve. 6,9,10 There is a gap between theory and clinical practice for new CNS hires during TTP. 10,11 Factors such as loss of a previous peer group, stress, job dissatisfaction, and loss of control lead to attrition.…”