Supporting New Nurses’ Growth

Keith Carlson, BSN, RN, NC-BC

Keith Carlson, BSN, RN, NC-BC

Supporting New Nurses’ Growth
Keith Carlson, RN, BSN, NC-BC

April 2, 2020


When a new nurse graduates and enters the workforce as a novice, they need mentoring, precepting, and a kind guiding hand to launch them on the right path. 

A graduate nurse doesn’t evolve from novice to expert on their own; it takes a great deal of experience to mold that individual into the professional they can eventually become. In this regard, are new nurses at this time in history truly receiving the support they need and deserve to succeed? 

A Launchpad and Some Rocket Fuel

A rocket (new nurse) can’t simply lift off from the factory that manufactured it (nursing school). If that rocket it doesn’t have a launchpad (first professional position) and the right fuel (precepting, mentoring, and expert guidance), it will never leave the ground. 

If we don’t expect a rocket to launch itself without any support once it’s been built, why would we expect a new nurse to succeed without the right ingredients? Even so, we often throw new nurses into the fire and wait to see if they burn. Does this really benefit anyone? 

Perpetuating a Negative Culture

New nurses are often subject to bullying, harassment, teasing, and all manner of disruptive behaviors, including direct sabotage of patient care as a form of intimidation. 

more seasoned nurses may say something like, “Well, I was treated like dirt when I was a new nurse and I toughed it out and made it, so now it’s my turn to make this new nurse pay.”

According to The Joint Commission, “over half of healthcare workers reported exposure to one of six specified disruptive behaviors, ranging from hanging up the phone before a conversation was over to physical aggression towards others. These behaviors were reported by staff in 98% of clinical and non-clinical work settings.” 

What’s wrong with this picture? 

Just because the nursing profession and the healthcare ecosystem are rife with bullying and disruptive behavior, this doesn’t make it right. If that calloused nurse mentioned above had a school-aged child who was being bullied, would that nurse think, “Well, I was bullied in 2nd grade, so my son should be able to take it like a man”? If she had a good heart and a head on her shoulders, she would likely know that bullying is never acceptable under any circumstances and would go to the school and convince the leadership to take action against bullying and suspend any child who continued to engage in such behavior. 

According to Dr. Renee Thompson of The Health Workforce Institute, research reveals that

71% of physicians and nurses have linked incivility to medical error; 27% of them said it led to a patient’s death, and 81% of nurses who leave an organization cite peer and nurse manager relations as a cause for leaving.”

New nurses don’t deserve to be subject to a negative workplace culture steeped in what we call “horizontal violence” or “lateral violence”, which is aberrant behavior between colleagues of equal stature or authority. Meanwhile, a doctor bullying an RN would instead be engaging in “vertical violence” since they hold a position of more authority within the organizational hierarchy.  

Negative workplace cultures do nothing for teamwork, cohesion, or collaboration, and new nurses can suffer the most when they enter a culture that feeds them to the wolves and enjoys watching them fail. 

A New Paradigm for New Nurses

In a more perfect world (that is, by the way, entirely within our grasp), newly graduated nurses would never be thrown to the lions or directly into the fire.

Rather, any new nurse entering a clinical setting of any kind would be assigned a fully trained preceptor who would skillfully guide that new nurse in moving from novice skill levels to competency over a fairly significant period of time.

In this more perfect world, instead of only the lucky few landing positions in new graduate residencies, it would be mandated that every novice nurse receive robust, skillful preceptorship authorized and overseen by a high-level certifying body like The Joint Commission (TJC). In fact, this would be seen as so crucial to quality of care and the training of high-quality nurse clinicians that any organization failing an inspection of their new nurse onboarding and preceptorship program would lose its Joint Commission accreditation. 

Additionally, once a new nurse would finish this accredited process, they would then move into an equally high-quality accredited mentorship program that would take up where the preceptorship left off to grow them from competent towards expert. Such mentoring would entail not just discussions of clinical skills, but also career-building, personal and professional growth, and the grooming of appropriate candidates for entering the nursing and healthcare leadership pipeline. In this way, the next generation of leaders would be groomed to take on emerging challenges as the older generation evolved towards retirement. Patients, facilities, and the entire nursing and healthcare industries would see massive long-term benefits of incalculable proportions. 

We Have to Start Somewhere

This description of a perfect world for new nurses may seem like a pipe dream, yet we must start somewhere. If we begin with kindness, compassionate guidance, and the acknowledgment that novice nurses are the future of our healthcare system writ large, we have already come a long way. And if we embrace the concept of zero tolerance for negative workplace cultures and disruptive behaviors, that would take us even further along this righteous path. 

Those calloused nurses who tease, bully, and intimidate new nurses are actually teasing, bullying, and intimidating the very nurses who may eventually be caring for those same nurse bullies, or perhaps their loved ones.

Every patient deserves a nurse, and every nurse deserves to be treated by his or her colleagues with kindness, compassion, and respect. The panacea described above may appear impossible to achieve, yet if a critical mass of nurses and nurse leaders embraced such a paradigm, there is no telling what we could eventually achieve, both individually and collectively. 

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