Plan for the Successful Transition from RPN to RN
a) Introduction
The transition of nurses from a Registered Practicing Nurse (RPN) to a Registered Nurse (RN) is a process that faces numerous challenges (Duchscher, 2008). The successful transition of nurses from RPN to RN requires early preparation of the nurses the numerous concepts and responsibilities that they will face in the course of the transition. This paper is a plan that shows to achieve a successful transition from RPN to RN. The researcher relies on Duchscher’s (2008) model of transition shock to analyze the transition challenges that nurses face in practice while moving from RPN to RN.
There are four quadrants, according to Duchscher’s model, which causes the transition shock. They include relationships, knowledge, responsibilities, and roles (Duchscher, 2008). The factors mark the changes that occur during the transition, leading to the transition shock which nurses experience. The overarching concepts that the model highlights are also important. The concepts are loss, doubt, confusion, and disorientation (Duchscher, 2008). The overarching concepts are tied to the four quadrants as the body of this plan demonstrates.
The basis of this plan is Duchscher’s framework (model) is important for a successful transition of nurses from RPN to RN. The plan, therefore, uses the suggestions of Duchscher (2008), which the framework makes, to show how to achieve the successful transition from RPN to RN.
b) Literature Review
The existing literature on transition shock shows that nurses experience the shock in their initial stages of becoming registered nurses. According to Duchscher (2008), there is a change of the roles of a nurse when she moves from RPN to PN. Many things change in the environment of a nurse, and if the RN lacks early and adequate preparation, a lot of challenges await the nurse during the transition phase. The framework that Duchscher (2008) presents is very important in understanding the change factors that cause transition shock. The following is an analysis of Duchscher (2008) model of transition shock.
The Transition Shock according to Duchscher’s Framework
Duchscher’s framework of transition explains the causes of the transition shock using the four quadrants of relationships, knowledge, responsibilities, and roles. Each of the quadrants causes a transition shock. Duchscher ties the quadrant of relationships to loss; knowledge to doubt; responsibilities to confusion; and roles to disorientation (Duchscher, 2008). The factors cooperate in their interrelationships to causes a transition shock. A nurse requires an elaborate understanding of the implications of each quadrant and overarching concept, to experience a smooth transition from RPN to RN.
i. Relationships and loss
Duchscher’s framework shows that the transition from RPN to RN comes with new relationships. The model explains the relationships using the new requirements for registered nurses, which lack in the RPN environment. A registered nurse faces new leadership and collaboration tasks. The RN also has to relate with a new environment of a professional culture. The nurse has to relate the theoretical concepts of professionalism with the new environment where the nurse puts the theoretical concepts to practice. The RN also has to understand the intra-disciplinary and inter-disciplinary relationships, and inter-generational dynamics. Furthermore, the RN has to relate to an organizational structure, something which lacks in the RPN environment (Duchscher, 2008).
The relationships quadrant shows that there is a change in the way the RN relates to different factors in the work environment, something which compels the nurse to lose the old relationships and formulate new ones. The quadrant shows that the loss of relationships is what the RN experiences first during the transition, as loss is on the outermost part of the overarching concepts (Duchscher, 2008).
Zulkosky (2009) explains that RNs face challenges when entering the nursing profession, simply because they have to relate to a new environment that has new demands. The RN environment, according to Zulkosky (2009), is an environment that requires nurses to practice their theoretical concepts. They must also know how to solve the professional dilemmas, which compel them to choose between their personal preferences and the professional requirements. Zulkosky (2009) compares the transition from RPN to RN to the movement from one stage of life to another, and states that there are permanent changes of relationships, which the nurse must embrace. A registered nurse works in an environment that requires consultation from the peers before making major decisions, as some of the tasks may not give an opportunity for correction (Zulkosky, 2009).
ii. The Knowledge Quadrant
The registered nurse, at the transition stage, has a basic knowledge. The nurse must put the knowledge into practical situations (Schoesler and Waldo, 2006). Despite the requirement of putting knowledge into practice, which Schoesler and Waldo (2006) explain, Duchscher (2008) model shows that the second problem in the transition process is the doubt of knowledge. In the first 18 months of practice, according to Schoesler and Waldo (2006), the RN’s dilemma is to choose the most effective knowledge to apply to the practical work environment. The nurse has not yet mastered how to demonstrate the knowledge of the skills and tests, relational dynamics, and how to practice nursing as a profession.
Graduate nurses have to choose carefully from their theoretical knowledge in their first stages of practice as registered nurses (Dyess and Sherman, 2009). The authors explain that during the first stages of practice (transition stage), the RN requires close monitoring from the experienced peers. The RN can easily make mistakes, some that may be fatal (Dyess and Sherman, 2009).
iii. The Responsibilities Quadrant
New responsibilities emerge as the transition from RPN to RN occurs. During the first stages of the transition, the overarching concept of confusion is present in the new RNs, mainly because they take new responsibilities. Duchscher (2008) highlights some of the issues that create new responsibilities for the RN. The RN, for instance, has to craft a new socio-cultural assimilation. The RN must understand how to face the dilemma of handling patients from diverse socio-cultural backgrounds (Dyess and Sherman, 2009). In essence, the RN has the responsibility of serving patients from different cultural backgrounds. The knowledge of diverse cultures and their effect on the handling of patients is, therefore, important to the RN (Dyess and Sherman, 2009). Other new responsibilities that cause confusion to the RN during the transition stage include leadership and delegation, practicing theory, financial management, and balancing between home and work tasks, among others that Duchscher (2008) highlights.
iv. Roles Quadrant and disorientation of the RN
Finally, the RN has the task of assuming new roles during the transition. In most cases, the RN has numerous roles to play, a factor which causes stress (strain) according to Duchscher (2008). The roles of the RN may be different from the nurse’s expectations during the RPN phase. The nurse must, therefore, learn to adapt to new roles. The RN should also be flexible enough to play different roles. The RN, for instance, has the responsibility of being a leader, a colleague to other nurses (team-playing), a practitioner, and financial manager (Duchscher, 2008). The same RN still retains the family responsibilities. Skills of multi-tasking are necessary for the RN, during the transition. Sometimes, the RN who is under the stage can easily confuse the roles because they are numerous, yet the nurse is still an armature. Such a confusion of roles disorients the RN.
c) Synthesis of Transition Knowledge
The knowledge of the transition from RPN to RN has many implications for nurses, and it can help in achieving a successful transition between the two phases that a nurse undergoes. The first implication is that there is a need for nurses to prepare themselves, psychologically, for the new relationships, knowledge, responsibilities, and roles that they face during the transition (Duchscher, 2008). Psychological preparation entails the readiness of the nurses to face the numerous challenges in their new environment as RNs (Dyess and Sherman, 2009).
The literature on transition from RPN to RN shows that the work environment for nurses gives them many responsibilities. Many nurses face the emotional burden because the transition presents the intense and overwhelming period for the nurses. The emotions that nurses show during the transition, according to Duchscher (2008), originate from different sources. Graduate nurses have their own expectations about the work environment. Sometimes, the expectations contradict the reality that they discover in the field. Some nurses may imagine that they will work independently with their theoretical knowledge and the little practice at the RPN stage. However, when they enter the RN phase, they must accept to be nurtured by the experienced nurses, who know how to handle the pressure that the practice of nursing presents (Schoesler and Waldo, 2006).
Physically, nurses spend a lot of energy during the transition. They spend their energy concealing the feelings of the transitional shocks, responding to the changes in the transition process, and adapting to the new life that is full of responsibilities and roles (Duchscher, 2008). The nurses also face the dilemma of learning new cultures (Zulkosky, 2009), due to the diverse cultural background of the patients they handle.
Intellectually, there is a reality shock when the theoretical knowledge of the nurses contradicts the practical requirements (Duchscher, 2008). Some nurses feel that their trainers did not teach them the right skills, something which demoralizes them (Zulkosky, 2009). However, a nurse must understand the nature of the transition process, that such reality shocks are ordinary. Nurses should have the knowledge on the transition process, something which makes them understand what they should expect during the transition.
In addition, nurses should know that during the transition, they have little practice of nursing and little tacit (practical knowledge) about the profession (Duchscher, 2008). They should also understand that the practice may be unpredictable or inconsistent with their theoretical background knowledge (Duchscher, 2008). The practice environment during the transition may also lack adequate support in terms of consultation. Learning to be independent is, therefore, an important factor for a successful transition from RPN to RN.
Apart from knowing the dynamic nature of the workplace in terms of emotional, physical, and intellectual challenges, and being prepared for them, the nurse should also understand that the transition presents an opportunity and the challenge of new social development (Duchscher, 2008). The nurse must, consequently, learn to relate to new social and administrative structures. The nurse must also understand that she becomes socially independent, at the workplace, in the course of the transition. There may be little or no assistance during the transition (Duchscher, 2008). At the same time, the nurse loses the support that the training period and the RPN stage give. The RN also has little exposure to the role models or assistants, during the transition (Duchscher, 2008). The nurse should not collapse emotionally the transition stage does not give the support. Instead, the nurse should learn to solve the emerging challenges in an independent way, because this is what the work environment requires.
Conclusion
The transition from RPN to RN has several challenges for graduate nurses. The nurses enter a new phase of professional practice, which has little or minimum support. The nurse has numerous changes to adapt to, yet there are few role models that she knows during the transition.
Duchscher’s framework provides an important source of knowledge and solutions for nurses, during the transition period. The framework provides four quadrants that explain the challenges that the nurses face, namely the relationships, knowledge, responsibilities, and roles quadrants. The overarching concepts, which the framework ties to each of the quadrants, namely loss, doubt, confusion, and disorientation, explain the challenges that nurses face during the transition.
This paper has provided a plan for a successful transition from RPN to RN. The writer has analyzed the framework and reviewed literature on the transition, to explain the challenges that await the graduate nurse during the transition. Understanding the challenges is part of the psychological preparation for the transition process. The synthesis section has recommended the solutions that the graduate nurse can apply towards overcoming the challenges. Accepting the challenging nature of the transition process, the ability to work independently, adapting to the practical environment that contradicts the theoretical learning, and the ability to work under pressure (multi-tasking), are some of the solutions that the plan has proposed. The plan is, therefore, relevant and necessary to graduate nurses who are yet to undergo a transition, and those who are already on the transition.
The transition from RPN to RN is an important issue in the professional life of a nurse. Understanding the transition is important to the nurse, as it ensures a successful transition between the two phases. A graduate nurse who understands the transition learns to be independent, multitasks, and avoids emotional collapse during the transition stage. The nurse also adapts to the new social and administrative structures easily, and serves patients from diverse cultures easily.
References
Duchscher, J.E.B. (2009). Transition shock: the initial stage of role adaptation for newly
graduated Registered Nurses. Journal of Advanced Nursing, 65 (5): 1103-13.
Dyess, S.M., & Sherman, R.O. (2009). The first year of practice: new graduate nurses’ transition
and learning needs. Journal of Continuing Education in Nursing, 40 (9), 403-10
Schoessler, M., & Waldo, M. (2006). The first 18 months in practice: a developmental transition
model for the newly graduated nurse. Journal for Nurses in Staff Development, 22 (2), 47-54
Zulkosky, K. (2009). Self-efficacy: a concept analysis. Nursing Forum, 44 (2): 93-102.
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