The Transition From Student Nurse To Professional Nurse - Nursing Assignment Help

Assignment Task

Part 1
The transition from student nurse to professional nurse often presents new challenges and can be a daunting experience for a newly qualified professional (NQP). The lack of preparedness for this transition can be overwhelming for the NQP. The NQP requires a breadth and depth of qualities and competencies to effectively make the transition. Graduateness and resilience are some of the skills and qualities that will be discussed in the context of the NQP.
The NMC code (2018) states that graduates of nursing should to be competent  to practice autonomously, enabling professionalism. The acquisition of knowledge and skills or competencies are indicators of graduateness, knowing how to use their skills and be able to use their knowledge to practice independently (Ramsay and Monk 2017). 
Baldwin et al. (2014) assert that there are three major transferable graduate attributes essential for nursing graduates to function effectively and be professionally competent. These comprise (i) Knowledge –NQP must be able to apply theory to practice using clinical reasoning skill and critical thinking. (ii) Compassion - applying this knowledge in a manner that honours the patient and promotes their independence. (iii) Professional confidence - NQP must have the courage to apply evidence-base in their practice challenging current practice and to drive future change in healthcare.
A European observational study by Aiken et al. (2014) found that an increase of 10% in bachelor's degree nurses decreases the mortality of patients by 7%. This suggests that graduate nurses have the skills and qualities to improve the outcome for patients that non-graduate nurses do not have. A notable attribute for this finding is the ability of graduate nurses to apply their critical thinking skills in the nursing process. Similarly, Audet et al. (2018) concluded in their study that a higher proportion of graduate educated nurses in acute care hospitals lower mortality and failure to rescue . This was attributed to graduate nurses’ surveillance  skills in monitoring and detecting adverse effect. For example, in a mental health setting graduate nurses are better position to monitor the side effects of antipsychotic medication. Detecting neuroleptic malignant syndrome in patients and monitoring the vital signs knowing when to escalate to the medical team, which can be fatal in not detected on time.
Siviter (2014) asserts that nurses gather information through observation, practice, experience, learning and reflection as well as through research and evidence. Nurses must be aware of when to use this research, information and processes through critical thinking or clinical reasoning in the contextof the patient’s circumstances and situation. To illustrate during a discharge process in a mental health acute ward, the nurse must considerusing critical thinking to gather relevant information if the patient has a place to go to. This is crucial as the evidence suggest a comprehensive need assessment for adequate discharge planning to minimises relapse, prevent homelessness, suicide and provide continuity of care (Xiao et al. 2019). 
 Clinical decision making depends on critical thinking on the best available evidence for a better outcome for the patient.Roets et al. (2016) concluded in their study that graduate educated nurses were more involved in research and best practice guidelines in finding the best evidence for their patients. A graduate NQP is better positioned to apply critical thinking in making an evidence-based decision to practice confidently and autonomously.

The health care environment is often rapidly growing, dynamic and pressurised due to heavy disease burden, high acuity of patients and technological advances in healthcare. Hence, nurses must be educated to solve complex problems and make sound clinical judgments that are informed by the best available evidence. While part of the transition to NQP is concerned with the application of graduate skills, NQPs must also be resilient to thrive in this transition.
The NMC survey (NMC 2019) indicatesthe reason for the high attrition in the nursing profession in 2019 was too much pressure leading to stressand poor mental health. This has a detrimental effect on patient satisfaction and quality of care provided. Therefore, developing resilience is paramount for NQPs in their professional role, especially during the transition from pre-registration to professional.
Notably, mental health nurses experience verbal and physical abuse, coercive practices such as physical restraint and seclusion as well aslistening to the patient accounts of trauma, whichcan be traumatic for nurses (Foster et al. 2019). Resilience is a 'process of positive adaptation to stress and adversity, involving dynamic interactions between personal and environmental factors and resources' (King & Rothstein cited in Foster et al. 2019, p.72). It is a process of learning and reflectingon the challenges and making sense of the situation by putting things in perspective. It is the individual thinking style that determines their level of resilience, having resources to draw on in stressful situations (Ashton &Ripma 2017).To illustrate NQP may experience the suicide of a patient with whom the NQP may have develop a rapport. This may be challenging and traumatic for the NQP, but resilience will make the NQP to bounce back and continue the professional role of caring.
However, Traynor (2018) suggested critical resilience for nurses using their critical thinking ability as graduate nursesto question why things are the way they are anddoing this canleads to compassion. He argued that resilience is not just about positively adapting to challenges but about collective activism in challenging the dysfunctional system that causes these challenges on the organisational level. To illustrate, the United Kingdom government cut to the NHS budget even during a global pandemic, and the freezing on nurses’ pay rise put the workforce in destress and yet nurses are in the frontline providing quality care while some nurses may be going through emotional dissonance. Also, this was evident in the independent inquiry into Mental Health Services in Tayside where management resulted in rationing and increasing waiting times, putting pressure on staff and diminishing their Morales (Strang, 2020).
Resilience on individual and group level can be improved by developing emotional intelligence –‘the ability to identify, assess, manage and control self and reactions to others'(Karimi et al. cited in Barratt 2018, p.5). An example in a mental health setting would be when the NQP will have to break bad news to patients and their family. The NQP will have to control his/her emotion and be professional such as telling a family of the death of their love ones. It is not professional for NPQ to well up tears with the family of the deceased patient. 
Also, practising self-compassion –improving self-awareness and kindness to others can foster resilience. There are three components to self-compassion: mindfulness, self-kindness and common humanity (Barratt 2018). Using solution focused learning NQPs should consider if there is opportunity to reduce draining activities and focus more on nurturing activities as negative self-views affect one’s mental health(Jenkins & Carole 2018). Hope is the most significant contributor to developing resilience for NQPs and re-connecting to people with whom one has a close relationship and maintaining work-life balance (Hart 2014).
Part 2 : Reflection

I was in a forensic mental health setting on placement as one of the requirements for the mental health nursing program. It was a medium secure unit. I was involved as part of a team of nurses caring for a patient diagnosed with bipolar disorder. This patient had several admissions; every time he was discharged into the community, he would re-offend, and he will be readmitted into the forensic unit. 
 It became apparent that he was becoming increasingly unwell as he was not accepting his medication and showing signs of mania.He had not been sleeping well, elated and talkative. This became a concern for the ward staff as he often gets into arguments with other patients in the unit. A multidisciplinary team meeting was held where it was decided that a management plan need to be put in place for the patient.
The management plan was to seclude this patient from the rest of the patients for enhanced observations. During the period of his seclusion every time his medication was to be administered, the rapid response team and other staff memberswere called to help in restraining the patient if he refuses to accept his medication.This was a distressing period for staff and other patients as it limits therapeutic engagement with other patients. The forensic setting was traumatic for me knowing the index offences of the patients and listening to their stories of trauma. Besides, seeing the challenge staff must put up with in restraining the patient made me bring this matter up with my mentor.   
The nurses drew the two medications (haloperidol and Lorazepam) into two different syringes. I noted that the two medications look the same as they were both a clear liquid. Thinking critically, I asked the question 'what if the patient decided to have haloperidol instead of Lorazepam, how would the nurse differentiate between the two medication’. Then, the nurses replied,‘she has been doing it like this for a long time with no error’. I had to be assertive in seeking to understand how the two syringes could be differentiated for a person-centred administration of the intramuscular injection. In the end, the nurse agreed with the  and put a label on the syringes. Lee et al. (2018) argue that patients should be involved in their treatmentbringing their knowledge and concerns in their care. Medication safety intervention is improved when the patientunderstands what the medication regime entails. 
At the point of administering the injection, the patient was offered to choose one from the three medications as this was the management plan agreed for the patient. The patient chose his mood stabilizer tablet instead. As I reflected on this practice, I understood the importance to be resilient in challenging bad practice using critical thinking skills even with your superior which can minimize the likelihood of medication error. The issue was raised at handover with the charge nurse and it was agreed that going forward, medications must be labeled on the syringes.
 The placement was challenging for me knowing the index offences of the patients and the  need to be caring and compassionate in the face of these challenges was discussed with my mentor. My mentor suggested I practice self-care looking after myself because the forensic setting could be challenging and traumatic if one is not resilient.

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