Graduate Nurses in the Emergency Department

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Dear Editor:

I read with much interest the article in the October 2008 issue, “Transitioning from Novice to Competent: What Can We Learn from the Literature about Graduate Nurses in the Emergency Setting.”¹

I am a little over a semester away from completing my bachelor’s degree in nursing, and because of prior EMS experience, I have the desire to work in a local emergency department. However, time and time again, I hear novice nurses comment that you must have experience to work as an emergency nurse, which is very frustrating and has made me reconsider working in what could be such a rewarding and fulfilling position. However, one day, while working in my local emergency department as a secretary, I picked up a copy of the Journal of Emergency Nursing and found the article that has renewed my interest and desire to become an emergency nurse as soon I pass my State boards.

A study conducted by Lofmark, Smide, and Wikblad² found that the competence of final-year nursing students was higher than that of nurses. This study found that the planning and prioritizing of work and interventions, along with teaching of co-workers, were a sample of the areas that both graduate and experienced nurses identified as areas of lower competency. Many explanations can be considered for this finding, including the lack of opportunity to practice and the philosophy that nursing educators stress learning how to learn.

The article discussed selective negative themes that new graduate nurses experience, including work environment, stress/frustration, and inadequate preparation for entry into practice.¹ Employees at many organizations are experiencing frustration with increased patient loads, more job duties, and unclear job expectations, which then leads to dissatisfaction within the work environment. I believe if you were to ask any nurse, from novice to experienced, most would say there is one particular area they either currently feel unprepared for or felt unprepared for upon completion of their nursing education. I think the reason nurses feel unprepared is that not everyone has the same clinical experience or provides care for the same type of patients. On the other hand, mentoring, social support, and an orientation process were positively identified as facilitators of transition to competent clinical practice.² I have had the opportunity to work with a mentor/preceptor in my current part-time job, which has afforded me an opportunity to practice my skills while gaining the trust of an experienced nurse.

The orientation process for new graduate nurses is ever evolving. Many hospitals are developing nurse internships or residency programs to assist with the transition from being a novice to a competent nurse. Recently, I searched many hospital Web sites and found more information on these types of programs. I find these programs encouraging, because they will help graduate nurses feel more comfortable in their new role and new responsibilities, and for some, with a new employer.

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References 

1. Valdez AM. Transitioning from novice to competent: what can we learn from the literature about graduate nurses in the emergency setting. J Emerg Nurs. 2008;5:435–440
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2. Lofmark A, Smide B, Wikblad K. Competence of newly-graduated nurses—a comparison of the perceptions of qualified nurses and students. J Adv Nurs. 2006;53:721–728
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