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Bridging the gap
Professional Practice Bridging the Gap “
DIDN’T FEEL PREPARED. I didn’t have I enough experience to work on the neurology
floor. It was overwhelming. The first month felt like baptism by fire.” This comment, made by a new graduate nurse (Pioneer Press, October 30, 2000), is not unique. Over the next several months, as students graduate and assume that first, most important, job, others will unfortunately have that same experience— and it does not have to be that way. The health care industry suffers from many gaps: (1) access to health care between those who need it and those who receive it; (2) sufficient staffing levels between the number of nurses needed and those available; (3) practice deficits between what is evidence based, and what professionals do; (4) different worldviews held by faculty and service leaders; (5) the gap between what students learn and what their first work experience is like. Each of these gaps challenges us. But that last gap is particularly nursing’s responsibility because (1) in the short term, inefficiency, turnover, and personal anguish occur; and (2) in the long term, nurses may leave the profession altogether. The Minnesota Colleagues in Caring Project recently held a conference addressing this topic, Bridging the Gap: Helping New Grads Become Successful Grads. Although we anticipated about 75 participants, more than 200 nurses came. The group was tremendously diverse with deans, faculty, administrators, staff nurses, staff development, and some new graduates themselves. Obviously the topic is important to many. The purpose of the day, as the first in a three-part series, was to bring together educators and service leaders for a Day of Dialogue to examine a shared problem—the dif-
JOANNE DISCH, PHD, RN, FAAN Director, Katharine J. Densford International Center for Nursing Leadership University of Minnesota School of Nursing, 308 Harvard St Minneapolis, MN 55455 Copyright © 2001 by W.B. Saunders Company 8755-7223/01/1704-0004$35.00/0 doi:10.1053/jpnu.2001.24859 156
ficulty new graduates experience transitioning from school to service settings—and what can be done about it. The emphasis of the day was on the shared nature of the problem. Reflecting on how education and service have historically approached this issue, the first sacred cow to be slain was the old implicit compact “handoff” model. That is, we must change the old model of educators bringing the student to graduation and their work being done, while staff development instructors and nurse managers pick up the new graduate in orientation and that is when their work begins. The goal for which we are all accountable is to assure new graduate success, and this is accomplished through educators and service leaders forming intentional partnerships to influence the educational and work settings. Other sacred cows soon fell too: ●
● ● ● ● ● ● ● ●
Critical care nursing is the most complex and challenging area of nursing, and should be the last clinical rotation. Graduates need 1 to 2 years of med/surg first. Graduates cannot work community/home care. Long-term care is a place for nurses who cannot get a job elsewhere. Preceptors should be the most knowledgeable and experienced nurses. The role of nursing is to meet all of the patient’s needs. The only goal is to provide quality care. Length of service has more power than quality of service. Improving quality in education or service delivery requires more resources.
What are the new assumptions? We do not know, but we agreed that we must create new assumptions, develop innovative new approaches—and do it together. Staff development educators and clinical staff responsible for preceptor programs must work with faculty who are teaching the seniors about nursing in today’s health care environment to jointly assure new graduate success. That is our second Day of Dialogue. We challenge you to begin your own.
Journal of Professional Nursing, Vol 17, No 4 (July–August), 2001: p 156
DIDN’T FEEL PREPARED. I didn’t have I enough experience to work on the neurology
floor. It was overwhelming. The first month felt like baptism by fire.” This comment, made by a new graduate nurse (Pioneer Press, October 30, 2000), is not unique. Over the next several months, as students graduate and assume that first, most important, job, others will unfortunately have that same experience— and it does not have to be that way. The health care industry suffers from many gaps: (1) access to health care between those who need it and those who receive it; (2) sufficient staffing levels between the number of nurses needed and those available; (3) practice deficits between what is evidence based, and what professionals do; (4) different worldviews held by faculty and service leaders; (5) the gap between what students learn and what their first work experience is like. Each of these gaps challenges us. But that last gap is particularly nursing’s responsibility because (1) in the short term, inefficiency, turnover, and personal anguish occur; and (2) in the long term, nurses may leave the profession altogether. The Minnesota Colleagues in Caring Project recently held a conference addressing this topic, Bridging the Gap: Helping New Grads Become Successful Grads. Although we anticipated about 75 participants, more than 200 nurses came. The group was tremendously diverse with deans, faculty, administrators, staff nurses, staff development, and some new graduates themselves. Obviously the topic is important to many. The purpose of the day, as the first in a three-part series, was to bring together educators and service leaders for a Day of Dialogue to examine a shared problem—the dif-
JOANNE DISCH, PHD, RN, FAAN Director, Katharine J. Densford International Center for Nursing Leadership University of Minnesota School of Nursing, 308 Harvard St Minneapolis, MN 55455 Copyright © 2001 by W.B. Saunders Company 8755-7223/01/1704-0004$35.00/0 doi:10.1053/jpnu.2001.24859 156
ficulty new graduates experience transitioning from school to service settings—and what can be done about it. The emphasis of the day was on the shared nature of the problem. Reflecting on how education and service have historically approached this issue, the first sacred cow to be slain was the old implicit compact “handoff” model. That is, we must change the old model of educators bringing the student to graduation and their work being done, while staff development instructors and nurse managers pick up the new graduate in orientation and that is when their work begins. The goal for which we are all accountable is to assure new graduate success, and this is accomplished through educators and service leaders forming intentional partnerships to influence the educational and work settings. Other sacred cows soon fell too: ●
● ● ● ● ● ● ● ●
Critical care nursing is the most complex and challenging area of nursing, and should be the last clinical rotation. Graduates need 1 to 2 years of med/surg first. Graduates cannot work community/home care. Long-term care is a place for nurses who cannot get a job elsewhere. Preceptors should be the most knowledgeable and experienced nurses. The role of nursing is to meet all of the patient’s needs. The only goal is to provide quality care. Length of service has more power than quality of service. Improving quality in education or service delivery requires more resources.
What are the new assumptions? We do not know, but we agreed that we must create new assumptions, develop innovative new approaches—and do it together. Staff development educators and clinical staff responsible for preceptor programs must work with faculty who are teaching the seniors about nursing in today’s health care environment to jointly assure new graduate success. That is our second Day of Dialogue. We challenge you to begin your own.
Journal of Professional Nursing, Vol 17, No 4 (July–August), 2001: p 156