Helping Students Identify a Healthy Transition-to-Practice Work Environment.

In light of the growing number of nurse residency programs (NRPs) in the United States and evidence underlying the importance of healthy work environments, faculty should understand the implications of preparing students for postgraduate employment. Today's nursing faculty may be unfamiliar with the latest body of evidence supporting a transition to practice program for students. Nurse educators have a responsibility to prepare students for lifelong learning and professional development. Students need assistance in understanding that the transition period they will experience from student to nurse is challenging. Faculty members can equip nursing students with various resources to manage this transition. The purpose of the article is to provide faculty members with strategies for leading effective conversations with students about transition-to-practice work environments.

Background

For the last 20 years, scholars and experts have recommended a formal transition-to-practice program, or nurse residency, to help bridge the academic practice gap.[1-3] Nurse residency programs have shown to decrease stress, increase confidence, and assist in the effective transition of newly licensed registered nurses (NLRNs).[3] The Institute of Medicine[1] further advocated for transition-to-practice support for NLRNs by recommending the accreditation of NRPs. Later in 2018, the American Academy of Nursing issued a policy statement that strongly recommended the implementation and accreditation of NRPs.[2]

Accreditation

Currently, there are 2 accreditors of NRPs in the United States, the Commission on Collegiate Nursing Education and American Nurses Credentialing Center (ANCC). The ANCC Practice Transition Accreditation Program (PTAP) conceptual model and domains were chosen to guide the development of this article as this framework has been adopted by more than 100 transition-to-practice programs in the United States and integrated as a source of evidence in the 2019 Magnet Recognition Program Manual (Figure). Benner's Novice to Expert Theory is the backbone of the conceptual model, which depicts 6 domains that help organizations create a robust, evidence-based transition-to-practice program.[4]

The Practice Transition Accreditation Program™ (PTAP™) Conceptual Model. Copyright American Nurses Credentialing Center, 2019. Reprinted by permission, 2019.

Identifying Transition-to-Practice Work Environments

With knowledge of the educational accreditation process, faculty members are equipped to help students understand the importance of a standardized program for their transition into nursing practice. Advisory meetings during a student's final year should include discussions about employment in the immediate future after graduation. Educators need to assist students in deciphering the differences between health care organizations and the varying levels of support they will receive during their initial transition into practice. In light of burgeoning support and evidence about transition-to-practice programs, faculty should recommend that students seek employment at health care organizations that have a NRP and, when possible, have established credibility through accreditation.

As faculty engage students in conversation about their transition, it is beneficial to have a basic understanding of the domains for NRP accreditation. The ANCC PTAP™ Conceptual Model[4] can serve as a guide for faculty to conceptualize NRPs while also providing guiding principles to lead students in identifying the best transition-to-practice work environment.

Domains of the PTAP Model

The first domain, Program Leadership, focuses on the support provided by the program's director, educators, managers, and preceptors. This domain ensures that the executive team and program leadership are committed to the program and engaging in continuous improvement. Organizational Enculturation is the process of nurse residents adapting to the culture, vision, and values of the organization while ensuring an appropriate orientation to the practice setting is provided. The Development and Design domain sets forth the design of the program, from program length, curriculum, and competency development.

Practice-Based Learning entails the learning that takes place in a practice setting under the guidance of preceptors and mentors. Through this domain, programs ensure they teach residents how to identify learning needs, how to manage the role transition and stress, time management, and communication, and provide peer support. Nursing Professional Development entails the opportunities in the organization to sustain their continuing competence, engagement, and achievement of career aspirations. Quality Outcomes are measures that demonstrate the program's effectiveness from financial return and the satisfaction of stakeholders to patient outcomes.

Potential Strategies for Guiding Students

Using the PTAP Conceptual Model domains, faculty can guide discussions and student reflections on identifying work environments ideal for transitioning to practice. Initial discussions about topics such as transition to practice, job searches, and employment opportunities are likely to take place in the final semester of a nursing program. Topics such as these fit naturally into the nursing curriculum during leadership and management courses, lessons on professional nursing concepts, or as a component of a senior capstone course.

A toolkit was developed by the authors to use when engaging students in employment conversations (Supplemental Digital Content 1, http://links.lww.com/NE/A692, toolkit for faculty use). An initial teaching strategy is to explore the importance of NRPs and how they contribute to providing a healthy work environment. Helping students learn about the transition period may empower them while searching for a job and into their new role.[5] The toolkit provides a potential article to start this process. A second opportunity exists for faculty to design an active learning moment or reflective opportunity for students to engage in dialogue about the PTAP domains. For example, within the Organizational Enculturation domain, the faculty member could ask students to consider what they are looking for in an organization. Although Magnet Recognition or Pathway to Excellence Designation in an urban, teaching hospital is ideal for some students, encouraging students to think about other needs related to personal and professional life is important. Obtaining work-life balance has the potential to increase job satisfaction and well-being.[6]

Next, the faculty member could consider providing time for students to self-assess their personal and professional values. Posing the question of whether an organization's vision and values are in alignment with a student's own values will help integrate the two and prepare the student for practice.[7] When reviewing the Nursing Professional Development domain, faculty are in a position to be at the forefront of developing a new nurse's view of lifelong learning and continuing competence. Faculty could share with students the opportunities afforded to them in their first roles when discussing this domain. As part of the ongoing reflection and active learning about work environments, faculty can bring to light the importance of accreditation in health care. This leads to a discussion about the accreditation of transition-to-practice programs. Websites to find the latest accredited residency programs can be found in the toolkit.

A final strategy outlined in the toolkit is to prepare students for the job interview. During the job interview, students can be encouraged to ask questions about the leadership of the program, design, and development and practice-based learning potential. In the toolkit, a table of questions is listed for faculty to provide for students. Faculty may also consider providing opportunities to students to interact and engage with NRP directors, recruiters, or managers through mixers or mock interviews or in collaboration with the campus career and student life centers.

Conclusion

Nurse residency programs will continue to grow and evolve as a significant body of evidence has demonstrated their effectiveness in easing a new nurse's transition to practice. Faculty have many opportunities to mentor and guide students as they seek out work environments that will best support the development of their professional nursing identity in practice. However, if uninformed about the state of the science of transition-to-practice programs for new graduate nurses, faculty may inadvertently provide students with outdated or biased information. Being prepared to lead job discussions and respond to student queries about the careful selection of a supportive work environment may significantly impact a student's successful transition to practice. The resources provided will help faculty design educational activities, engage in meaningful dialogue with students, and ultimately encourage reflection on the importance of developing a professional nursing identity through the transition to practice.