From student to staff nurse: advice for a smooth transition
How to make the most of preceptorship, plus practical tips from educators and new registrants
How to make the most of preceptorship, plus practical tips from experts and new registrants
Making the transition from being a nursing student to a fully fledged professional can be tough.
‘Some adjust to it more quickly than others,’ says Jan Draper, professor of nursing at the Open University. ‘There is definitely a phase where people feel they’re in limbo. Then it settles, they get through to the other side and feel comfortable in their new skin.’
Anticipate how you’ll feel
Being held responsible and accountable is among the key challenges. ‘As a student, you have the protection of your mentor,’ says Professor Draper. ‘Some of the phrases I hear people using include “the buck stops here now”. That shift in perspective is part of what creates the anxiety.’
Anticipating that you may have an anxious time for a few months can help you to feel more prepared. ‘Thinking about what it might feel like and talking about different experiences may help,’ says Professor Draper. ‘Then it doesn’t feel so surprising.’
‘Be kind to yourself and don’t think you must be the expert – you’re only just starting out’
Jan Draper, professor of nursing at the Open University
Gaining support from your peers is crucial. ‘Sharing makes you feel you’re not the odd one out,’ she says.
It’s also important to take responsibility for what you don’t know and ask questions. ‘One day you’re a student and the next you’re a qualified nurse, but that doesn’t mean you know everything – you’re only one day beyond where you were before,’ says Professor Draper. ‘Be kind to yourself and don’t think that you must be the expert – you’re only just starting out. Don’t feel under pressure to do things that you don’t feel competent doing.’
Top tips for a smooth transition
- When you are applying for jobs, check what preceptorship is offered. ‘Some organisations are more structured, while others are lighter-touch,’ says Ruth Sivanesan, preceptorship lead at Guy's and St Thomas' NHS Foundation Trust in London
- Ask for help if you need it. ‘People don’t want anyone to think they are struggling and don’t know what they are doing, so they shy away from asking. But that’s what preceptorship is for,’ says Emma Skinner, preceptorship programme lead at North Middlesex University Hospital NHS Trust
- Expect the unexpected, says Idiatu Arewa, a newly qualified nurse at North Middlesex. ‘Every day on the ward is different and you have to have a mindset that there is no standard day. You need to be adaptable and, above all, enjoy what you do’
- Ask as many questions as you like, says Reece Doonan, an adult nurse since 2017. ‘Be a sponge and just absorb all that knowledge’
- If there are aspects of practice you feel anxious about, face your demons head on, advises Open University professor of nursing Jan Draper. ‘Make sure you gain exposure to them, so you can handle them if they happen’
- If you are experiencing difficulties, be vocal. ‘We assume everyone knows how we feel, but when people are busy it can be hard for them to see it,’ says Lucy Gillespie, practice development lead at Nottingham University Hospitals.
- Make sure you have lots of support around you. ‘Whether that’s formal support in the workplace or family and friends outside who understand when you’ve had a difficult day,’ says Professor Draper
- Be open and honest if you’ve made a mistake, and don’t feel you’ll be blamed. ‘There are lots of ways we can help, including learning from it as an organisation,’ says Ms Gillespie
- Don’t forget why you came into nursing, advises Professor Draper. ‘There will be things during your working day that will challenge you. Hold on to what motivated you’
- And be proud of your profession, adds Ms Gillespie. ‘Don’t just think of all the things you didn’t do on a shift – think of what you achieved. It reinstates that pride in nursing’
The value of preceptorship
While preceptorship remains patchy across organisations, Professor Draper says good programmes can make a difference. ‘How we support and nurture newly qualified nurses has a knock-on effect downstream, minimising the amount of attrition we get,’ she says.
At Nottingham University Hospitals NHS Trust, preceptorship lasts anything from four months to two years, depending on the individual. Their programme includes an induction day, resilience-based clinical supervision, and a seven-day acute care skills foundation programme, which began around five years ago.
‘They work through the physicality of looking after patients who are acutely unwell,’ says the trust’s practice development lead for recruitment and retention, Lucy Gillespie. ‘They’ll have covered this in their training, but when it comes to coordinating it in practice, we recognise they need some extra investment.’
Common worries for newcomers include losing their registration because they do something wrong, being overwhelmed by tasks, making drug errors, and prioritising. ‘There can also be fears around being accepted,’ says Ms Gillespie.
‘Nursing is such an integral part of people’s care and we want the patient to feel we’ve done the best we can,’ she adds. ‘That puts a huge amount of pressure on someone who is newly qualified, who is trying to fit into a team. We shape our programme to support them.’
Preceptorship – a case study
North Middlesex University Hospital NHS Trust’s preceptorship programme, which began last November, brings together all newly qualified healthcare professionals at the trust – including nurses and midwives, physio and occupational therapists, and pharmacists.
‘We felt people could learn a lot from each other,’ explains practice educator and programme lead Emma Skinner. ‘The different professions have a lot in common in terms of support needs.’
Before their arrival, each new staff member is allocated a preceptor in their clinical area. The cohort, which is more than 100-strong, is split into five groups.
Each person attends four protected study days through the programme’s 12-month duration. Themes include professionalism – which covers accountability, delegation, time management, communication and team-working – and a mental health awareness day.
A third day looks at patient experience, including risk, quality improvement and raising concerns, and the final day focuses on professional and career development, looking at leadership, building resilience and becoming more assertive.
Every session includes time for reflective learning in small groups. ‘We ask them to bring an issue they’ve come across in their practice,’ says Ms Skinner. ‘Being multiprofessional is especially useful here, as practitioners often come at something from a very different angle, asking questions you may have never considered.’
For staff, this new approach has helped raise awareness of what each profession does and their specific challenges. ‘They get a lot out of it informally too, building relationships,’ says Ms Skinner. ‘It breaks down the professional silos because they’re in a room together and they talk.’
The shock of the new
Newly-qualified staff nurse Idiatu Arewa had been a healthcare support worker at the trust, where she also did most of her final-year placements, but she still found the transition a shock. ‘There’s a huge difference,’ she says. ‘No matter how many people tell you how different it will be, you can’t really anticipate it until you experience it for yourself.’
After completing her studies at Middlesex University, Ms Arewa took up a post on a surgical assessment unit last October. ‘You think there will be a transitional period, but it’s not like that,’ she says.
‘You’re a student one day and the next you’re a staff nurse with responsibilities, accountable for all the decisions you make. It’s quite scary.’
Ms Arewa has found the trust’s preceptorship programme invaluable. ‘It gives you help and guidance,’ she says. Initially she was sceptical about the session on development at such an early stage in her career, but soon changed her mind.
‘It gets you thinking about your next steps from the get-go,’ she says. ‘You can plan your goals and decide what kind of nurse you want to be.’
‘You don’t have to deal with things alone’
In London, all trusts have signed up to the Capital Nurse preceptorship framework. The six to 12-month programme includes a trained and allocated preceptor, alongside study days.
‘Having this framework has allowed us to say that, as a trust, preceptorship is really important, formalising the support we offer,’ says Ruth Sivanesan, preceptorship lead at Guy's and St Thomas' NHS Foundation Trust. ‘We know it helps new staff work better, have more confidence and feel happier in their jobs.’
‘I put a lot of pressure on myself to know more than I knew. I could have gained more experience and knowledge if I’d just asked’
Reece Doonan, a nurse since 2017
With hindsight, adult nurse Reece Doonan wishes he’d asked more questions when he took up his first post in major trauma and orthopaedics at St George’s Hospital in London in 2017. ‘I put a lot of pressure on myself to know more than I knew,’ he recalls. ‘It was a hindrance to me in the first few months. I could have gained more experience and knowledge if I’d just asked.’
Mr Doonan now works at Salford Royal NHS Foundation Trust’s emergency department, and the realisation that his mentor was no longer there to help was a pivotal moment. ‘You’re almost questioning your own ability and asking how you got here,’ says Mr Doonan. ‘It was both terrifying and rewarding.’
Chloe Taylor graduated from the University of Essex in October 2018, and now works in the emergency department at Southend University Hospital. ‘I struggled with delegating,’ she says. ‘I realised I couldn’t do everything and needed help. But it was hard to ask, as I felt I was hiving off my jobs.’
Support from her team has helped. ‘You realise you don’t have to deal with things alone,’ says Ms Taylor. ‘I love going to work and I couldn’t think of doing anything else now.’
Lynne Pearce is a health journalist