Although leaders in academia and practice share the goal of ensuring new nurses are prepared to meet the demands of the constantly evolving healthcare landscape, transitioning new graduate nurses (NGNs) from school to the clinical environment has been a longstanding challenge. As the nurse's role transforms from an occupation to a profession, the depth and breadth of what nurses are expected to know and do has grown exponentially. It is not possible for NGNs to enter practice being 100% competent in all areas of nursing. While this shift in thinking has been difficult for practice leaders to overcome, the implementation of nurse residency programs like the Iowa Online Nurse Residency Program and other efforts around the transition to practice experience have helped bridge the academic practice gap and support the ongoing skill development of NGNs.
In recent years, we have seen a growth in the number of healthcare organizations making nurse residency programs a standard part of their professional development offerings. However, a new gap continues to strain this transition period. Workforce shortages are leaving healthcare organizations short-staffed, pushing healthcare organizations to speed up the orientation and training needed for new graduate nurses. At the same time, patient care continues to become more complex thanks to complicated technology integration and patients being sicker than ever before.2 Not only are we seeing fewer nurses working in the clinical setting taking care of sicker patients, but the experience of those working clinically has also decreased. The National Nursing Workforce Survey conducted by the National Council State Boards of Nursing in partnership with the National Forum of State Nursing Workforce Centers reported a decrease from an average of 20 years of experience in the 2020 survey to 15 years of experience in 2022. 37.9% of the workforce sample have only been licensed for ten years or less, this being the highest since 2015. An additional 24.6% were licensed between 11 and 20 years, resulting in more than 62% of RNs reporting fewer than 20 years of experience. 37.6% of RNs reported being licensed for more than 20 years, nearly 10% points lower than in 2015 (47%).1 What experts have termed the experience-complexity gap is making the transition from academic to practice more difficult than ever before.2
Given the current healthcare landscape in which we don't just have a workforce shortage but an experience shortage, nurses must have the ability to not only carry out the hundreds of clinical competencies required to provide nursing care they must be able to assess situations, make sense of the information collected, decide on the best course of action, take action, and evaluate the outcomes of those actions independently. Whether you call it critical thinking, clinical reasoning, clinical decision-making, problem-solving, or clinical judgment, this competency is the most vital for nursing professionals today. While there are hundreds of other competencies nurse professionals need, this one demands nurse leaders' and nurse educators' attention, and thankfully, that is exactly what is happening.
Recently, I joined a group of academic and practice leaders strategically addressing the academic practice gap. The International Consortium for Outcomes of Nursing Education (ICONEd), led by Mary Ann Jesse, Ph.D., RN, Associate Professor, and Assistant Dean for Academics at Vanderbilt University School of Nursing, is actively looking at what competencies practice partners across the continuum expect NGNs to have upon entry to practice and how they are measured. More specifically, they are exploring how clinical judgment is assessed at the end of formal academic preparation and upon entry to practice by practice partners.
This group has been working quickly and making significant progress in conducting literature reviews and gathering important information from transition to practice program leadership and their accrediting bodies across the US and Canada. You can learn more about this group and the work being conducted on the website. While we wait for more to come, I encourage you to do an assessment at your own healthcare organization. What competencies do you expect your new graduate nurses to have upon entry into practice? How are they being assessed? Are your preceptors skilled in the expected assessment process? How are you assessing clinical judgment/critical thinking in your new graduate nurses? In addition, I encourage you to reach out to academic partners in your local area and start a discussion if you haven't already. Continuing to bridge the gap, supporting nurses during their transition into practice will take academic and practice partners working together.
Nicole Weathers, MSN, RN, NPD-BC
Iowa Online Nurse Residency Program Manager
Want to learn more? Schedule a call today!
References
Smiley, R. A., Allgeyer, R. L., Shobo, Y., Lyons, K. C., Letourneau, R., Zhong, E., Kaminski-Ozturk, N., & Alexander, M. (2023). The 2022 National Nursing Workforce Survey. Journal of Nursing Regulation, 14(1), S1-S90. https://doi.org/10.1016/S2155-8256(23)00047-9
Virkstis, K. (2023, March 20). America can’t hire enough nurses. But that’s not the only problem. Advisory Board. https://www.advisory.com/daily-briefing/2021/09/22/nursing-skills-gap