Crossing the bridge

In the last few months in Scotland, (NQNs) newly qualified nurses joined the register and took up posts across health and social care. Although this year saw a further increase in applications to nursing programmes across the country, vacancies remain high and are increasing.

Making the transition from student nurse to registered nurse is something no nurse forgets; it is etched in their memory as one of the most terrifying and memorable times in their career. Imagine how it feels then to qualify in the ‘International Year of the Nurse’, in the middle of a global pandemic and no graduation ceremony.

The world was very different when I qualified. When all I thought about was how proud I felt to get my epilates and replace my 3 striped card nurse hat with the thick blue stripe that showed I was now a qualified nurse. I was also grateful when these were phased out soon after I qualified, as by the end of the shift most nurses looked like they had been dragged through a hedge backwards. Anyone out there who trained in the 80’s will echo this sentiment, I’m sure. This however meant I no longer could hide behind my student name badge with an expectation by patients, families and colleagues to be competent and confident to carry out this new role.

I felt that I had to know everything about everyone in an instant and I remember struggling to get my tongue around some of the conditions, terminology, and medications, feeling like I had to learn a new language, which I am glad to say I’m pretty fluent in now. Everyone else on the ward seemed so in control and confident with me the only NQN on that ward, which definitely added to the pressure. Back then I was confident that the staff had my back, we were a team and I was part of it. I had transformed into the nurse who held the keys on shift when my probation period was over.

My point in raising this is that everyone has been that nurse, although this time is exceptional for all staff, each nurse will understand your fears and it’s so important that you realise that being newly qualified doesn’t mean you will be left without support , and more importantly you can speak up. There really is no such thing as a stupid question when it comes to safeguarding patients and staff. Being assigned a mentor during this time to keep balance and perspective will allow you to grow and develop your skills alongside a preceptorship programme in place. Three or four years of study to get to this point, but no foresight could’ve prepared any nurse for what it would be like to be a NQN in 2020.

Unfortunately for our 2020 nurses who have just qualified, they are faced with a greater transition complicated by workforce issues, infection control and high-risk challenges at a time when even the most qualified of staff have real concerns and deficits. Working in an ever-changing landscape adds to the feelings of uncertainty. This is compounded by the potential for witnessing increased loss of life both for patients and for some, potentially colleagues too. Feelings of isolation and vulnerability although common are often overwhelming whilst ensuring adherence to the nursing codes, which highlight the pressures of accountability in clinical practice. The NMC describes Delegation and Accountability as “the principle that individuals and organisations are responsible for their actions, and may be required to explain them to others” (NMC, 2018b). There remains limited research in relation to transition but key areas are around the preparation for this change in identity, status and future career. Higher education institutions do and will continue to play a significant role by working with students to plan for a successful transition and develop strategies to better manage their work.

But this year we must recognise that there will without question be potential for work-related stressors. Complexities due to workplace changes will occur as a result of the pandemic and the physical exhaustion being felt by all staff are added to the requirement to keep working in the knowledge of this.

There are many interventions across the country being developed to ensure this transition results in improved staff retention and attainment of skilled practice. The STAR project funded by the Burdett Trust for nursing is an example of this. It is so important that all staff but especially NQNs at this time have a sounding board, a safe open culture and access to compassionate leadership to ensure the attrition rates improve, because we know this is significant within the first 3 years of post- registration. Professional socialisation is often stated as fundamental to limit staff stress, forming identity and understanding personal and professional beliefs and values that form a nurse identity. To ensure wellbeing and motivation at work, and to minimise workplace stress, recent research evidence by the Kings Fund (commissioned by RCNFoundation) suggests that people have three core needs:

• autonomy – the need to have control over their work lives, and to be able to act consistently with their values  
• belonging – the need to be connected to, cared for, and caring of others around them at work, and to feel valued, respected and supported 
• contribution– the need to experience effectiveness in what they do and deliver valued outcomes.

In recognition of the strain on nursing staff during this pandemic there will be without question the need for extra funding to support staff well-being and mental health if we are to achieve the 2030 vision for nursing, and we can’t have our students or NQNs the greatest victims of this.

So many of our student nurses are going above and beyond, being involved in so many additional support networks, debates, demonstrating strong leadership skills well in advance of registering.

The hope is that this resilience will continue and create a real determination for the recognition of the job they do and more importantly, what they could do in the future to ensure sustainability of the profession.

If you have a NQN – what are you doing to recognise their fears, their potential and ensure they feel part of the team? If you are a NQN – what do you feel you need to cope with this transition? It is important not to exploit newly qualified staff and although this is done often without intention, it is a real issue for some. I was saddened to hear through a friend that her daughter who had recently qualified as Mental Health Nurse was asked to stay on shift for an additional 2 hours on top off a 12hr shift because of staff shortages. This resulted in her missing her last train home, as she doesn’t drive. She had only started 15 days before in her new post and felt she could not say no. This is unacceptable on a number of levels and I do hope this is an exception.

We can’t extinguish the enthusiasm of our new staff; they have worked hard to get to where they are, and this is just the start. Remember not all staff have the confidence to challenge decisions or deal with conflict, it’s not easy for anyone to stand up for themselves when they feel vulnerable.

It is important to find your cheerleader, ensure you have a voice and start as you mean to go on,  as you have already shown by being a nurse in 2020 that you have what it takes and we can rely on you to achieve the 2030 vision.

Jacqui Neil

Transforming Workforce Lead

@TransformNurse