The transition from student to staff nurse has always been stressful, and has been exacerbated in recent years by the national shortage of nurses, increased patient demands, the change in training to Project 2000 and the increased complexity of the nursing role. This has affected recruitment and retention.
Research has shown that the first six months after registration are particularly stressful for newly qualified staff nurses.1 This is due to work overload, lack of practical skills, the gap between educational priorities and the reality of clinical practice, along with a lack of qualified support in the clinical area.
The recent national nursing recruitment campaign and pay review emphasised the seriousness of the problem.
In March 1998, Birmingham Heartlands and Solihull trust introduced a development programme for newly qualified staff to address these issues. It has been a success, with 85 newly qualified staff nurses recruited to it.
What makes transition to staff nurse difficult?
The trust had held regular open days, advertised, and introduced streamlined recruitment procedures and return-to-nursing courses to combat recruitment problems.
But before March 1998, interest among newly qualified nurses was low. So the professional development link nurse and the nurse adviser for specialist medicine were charged with the task of investigating the needs of newly qualified nurses.
The starting point was holding interviews with third-year student nurses at the local university to identify key themes. Three factors emerged:
the need for comprehensive support systems;
the need for structured development opportunities;
the opportunity to rotate around a variety of clinical areas.
Project 2000, which began in the UK in September 1989, involved a radical reorganisation of nurse education. This has been seen as contributing to the widening gap between theory and practice and to the potential for registered nurses who are 'not fit for purpose'.2
Nurses themselves identify shortfalls in their practical training and express considerable fear about the transition from student to staff nurse.
Our 18-month development programme evolved from the three key themes emphasised by students. It includes support throughout application and interview, a comprehensive induction, clinical supervision, preceptorship and an open-door policy, with support given as and when required.
How the development programme works
The professional development link nurse, supported by the professional development support nurse, makes contact with all local students during their final 10 months of training. They then remain in touch with the students, including those who respond to national adverts for the programme. Interviews are conducted and there are open days and informal visits. Students are given support with problems that they may be encountering. Following interview, briefing meetings are held to ensure that all queries are addressed, and that the components of the induction programme are explained before employment with the trust begins.
Induction and support
Throughout the induction both the link nurse and the support nurse provide support on a group and one-to-one basis. At this point the new staff nurses are extremely vulnerable and often need help with personal as well as professional issues.
The nurses attend clinical supervision on a monthly basis, in peer groups facilitated by the support nurse. This helps allay fears and reduces the feeling of isolation and incompetence that is often experienced. All newly qualified nurses are assigned a preceptor in their clinical area who fulfils the role identified by the UK Central Council for Nursing, Midwifery and Health Visiting.
The support nurse visits the nurses in their clinical areas and gives advice and assistance with professional, personal and clinical issues. Often the nurses want support with their first experiences of drug administration or with developing general nursing skills. This helps to reduce the gap between theory and practice.
On average, each nurse sees the support nurse twice a month, once during clinical supervision and once in their clinical area. The open-door policy means staff can also drop in to see either the link nurse or support nurse, for example, after a particularly bad shift. This support is available throughout the 18-month programme.
Development opportunities for the programme are structured in six-month schedules. In the first six months, nurses are offered clinical supervision and training - including cardiopulmonary resuscitation, manual handling and fire procedures. It also covers professional practice and accountability, delegation and conflict management. Staff also complete the trust's intravenous drug administration course.
Each nurse has a development folder, containing learning contracts and basic clinical objectives. This forms the foundation of their professional portfolio.
In the second six months, study days are offered, on male catheterisation, advanced life support, tissue viability, and venepuncture and cannulation, along with portfolio development and assertiveness.
The practice and professional development team has designed a first-line management course with six core modules, which staff nurses attend in the final six months of the programme. This provides the nurses with insight into their role as managers and assists in the development of skills they will require for progression to a more senior post.
Experience of different clinical areas
Project 2000 reduced the time students spent in the field. This has resulted in newly qualified nurses being uncertain about which clinical area they wish to practice in. So during the 18 months of the development programme nurses rotate through medical, surgical and specialty areas. Each time they change areas, a period of induction and preceptorship is provided.
The development programme began in March 1998 with 18 newly qualified nurses, all in rotation posts. By September the credibility of the programme had grown and a further 36 nurses joined, in both rotation and static posts. During March 1999 a further 31 joined, bringing the total to 85. Evaluation questionnaires show high levels of satisfaction.
Retention of the staff on the programme has been a success. Only six of the 85 on the programme have left the trust. A full evaluation of the programme is being undertaken. But it can already be seen that recruitment rates have significantly increased, and clinical managers comment on how quickly nurses on the programme settle to their first posts.
It is essential that organisations realise the importance of nurturing and supporting newly qualified nurses. This enables them to develop into competent practitioners who not only deliver high-quality patient care, but also want to stay in the nursing profession.
Andrea Field is professional development link nurse, Birmingham Heartlands Hospital.
1 Charnley E. Occupational stress in the newly qualified staff nurse. Nursing Standard 1999; 13(29): 33-37.
2 Whittle T, Whittle C. Get in the right lane. Nursing Standard 1997; 12(8): 24-26.
An 18-month support programme for newly qualified nurses at one trust has improved recruitment and retention.
The programme includes training in clinical activities as well as ongoing supervision and support and a management course.
Of 85 nurses who completed the programme only six have left the trust.