Are graduate nurses adequately prepared for patient care? If you're like most respondents to a recent poll on our Web site, you don't think so. (The results appear on page 34.)
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Nurses entering the profession today are generally well versed in "book learning" but may lack real-world skills and instincts. Their colleagues who graduated years ago typically got more clinical exposure as students, some even working full-time nights in patient units. Today's eager grads and their seasoned colleagues must face the fact that adapting skills-lab techniques to complex clinical situations takes time and patience.
Researcher Patricia Benner's classic book From Novice to Expert details the five stages of developing an expert nurse.1 It's packed with true stories about memorable clinical situations in which nurses relied on their education and experience to make sound clinical decisions. The stories relate expert nurses taking in the big picture, trusting their gut when it told them a patient's status was deteriorating, and having the confidence to change course when care plans weren't working.
Critical thinking is an evolving process that isn't easily learned in the classroom-nurses perfect it through experience at the bedside. To start developing this level of expertise, new nurses need to work with good preceptors. And preceptors need help too.
A well-organized program can help both groups succeed. Getting preceptors and grads together as a group during orientation can break the ice and help them form realistic expectations before they start working together. They should take turns discussing their backgrounds, why they chose nursing, and what they expect to happen in the next few months.
Both preceptors and grads should be encouraged to talk openly and honestly about obstacles they might encounter and how they might deal with them. Preceptors, for example, could describe experiences with previous novices that could have worked better, and explain why. Grads should be able to describe their strengths, weaknesses, and fears without feeling threatened.
When preceptors and novices start working together, the preceptors need time to coach and evaluate their new colleagues. Patient care plus teaching takes longer than patient care alone, despite the helping hands. Preceptors deserve a lighter patient load until the new nurses gain experience and can shoulder more responsibility.
Learning is a lifelong endeavor. Nurses need at least a year to develop sound clinical knowledge and confidence, and preceptors need motivation and support to nurture these qualities in neophytes. When a seasoned nurse has the time and backing to make a new graduate's early nursing experiences positive, everyone wins-patients included-and the nursing profession can only grow stronger.
Cheryl L. Mee, RN, BC, CMSRN, MSN
1. Benner P. From Novice to Expert: Excellence and Power in Clinical Nursing Practice, commemorative edition. Upper Saddle River, N.J., Prentice Hall, Inc., 2001. [Context Link]