The ultimate goal of all pre-licensure nursing programs is to focus on preparing individual nurses for entry into point-of-care positions in a variety of settings from acute care, long-term care, primary care, and more. Regardless of the success of quality nursing education programs in preparing students for practice, these entry level graduates benefit from programs that ease the transition into their selected practice environment. Post-licensure residency programs augment nursing education and prepare the new graduate for successful integration within their specialization and work environment.

This transition into practice issue is not new. In 1974, Marlene Kramer wrote, Reality Shock: Why Nurses Leave Nursing, describing issues linked to professional socialization, the psychological and social difficulties, and stressful role conflicts that were experienced from the school to employment transition. Later, Lave and Wenger (1991) ambitiously described how cognitive preparation was insufficient for an introduction into the social aspects of practice.

Lave and Wenger’s (1991) research documents how individuals new to a profession (newcomers) begin on the periphery prior to their eventual acceptance as “legitimate” in the world of experienced practitioners (old-timers). As healthcare organizations have increased their span of focus and levels of complexity, the problem of transitioning to practice has not dissipated. Rather, the need to support new nurses in role transition is even greater, so much that it took on new importance after becoming a recommendation in the Institute of Medicine’s (IOM) (2010) Future of Nursing: Leading Change, Advancing Health report.

The Organization of Associate Degree Nursing (OADN) acknowledges that there are multiple terms or descriptors used to define transition to practice programs. Most common is the term “residency.” Another term is “apprenticeship.” Yet another is “extended-onboarding.” Each term has proponents and distractors. OADN takes no position on the terminology used.

Rather, we support the threads that link these terms together:

1. Orientation (sometimes called on-boarding) is not considered a transition to practice program (Spector, 2009). Orientation is time-limited and covers essential components of an organization’s human resource and clinical practices, including competency expectations and validation, and introduces nurses to organizational practices. Orientation is often a regulatory requirement and is considered a minimum requirement for employment.
2. Transition into practice programs (Spector, 2009), by any name, are designed for post- orientation support and development of new nurses. The essence of these programs intentionally aids nurses with professional socialization into practice; provides guidance on how to navigate within the organization by understanding roles, power, influences and resource availability and management; and offers opportunities for debriefing and reflection related to being a nurse within the organization rather than a sole focus on skill development or technology usage. The outcome of such programs leads to enhanced identity within the discipline, growing confidence in a field of specialization, an ability to navigate through conflict among various stakeholders, and generating deeper insights into care management and its challenges and opportunities in complex cases.
3. Specialty orientation/courses that lead to specialization in areas such as critical care, perioperative nursing, oncology, and beyond do more to prepare nurses for complex care management, advanced assessment, high-stakes interventions, and rapid-response evaluations rather than necessarily aiding with transition to practice.
4. Orientation, transition into practice, and specialty orientation are all suitable investments for organizations to support.

These statements are intended for point-of-care nurses and exclude the professional discussions regarding APRN post-graduation transitions. OADN appreciates those facilities who develop and implement transition to practice programs for entry level graduate nurses and supports the transition to practice initiatives.

 

References

Institute of Medicine. (2010). Future of nursing: Leading change, advancing health. Retrieved from https://www.nap.edu/read/12956/chapter/1

Kramer, M (1974). Reality shock: Why nurses leave nursing. St. Louis: C.V. Mosby

Lave, J & Wenger, E (1991). Situated learning: Legitimate peripheral participation. New York: Cambridge University Press

Spector, N. (2009). Transition to practice regulatory model: Changing the nursing paradigm. Retrieved from https://www.ajj.com/sites/default/files/services/publishing/deansnotes/nov09.pdf

 

Approved by the OADN Board of Directors: April 2, 2019

 

Download a PDF of this position statement.