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Abstract

This paper discusses continuing lifelong learning as panacea for augmenting nurses’ depth of practice and medical knowledge following graduation and subsequent transition to the role of a registered nurse. The position of scholars on continuing lifelong learning is essential as many have pronounced themselves on rudimentary elements as well as strategies to actualize it. Key findings were made from extant literature: First, implementation of continuous lifelong learning can be conducted through structured transition from student nurse to professional status, induction and continuous professional development of new staff, sustaining interest in nursing through induction of staff and implementation of professional development programs. Secondly, lifelong learning is unwittingly propagated by enlightened patients and their relatives, a development that compels nurses to seek more knowledge. Actionable strategies for promotion of lifelong learning have also been discussed. These include early introduction of student nurses to clinical practice, development of pregraduation study programs for at least one year, and removal of barriers to lifelong learning. Such barriers typically manifest through restrictive workplace policies which discourage professional growth. Additionally, entrenchment of collaborative learning approaches and departure from destructive tendencies at work such as adversarial relations with supervisors, ineffectual management, and bulging workload are also discussed. In addition, it was observed that experienced RNs tend to have useful “tricks of the trade” and “little things that matter” for new RNs to be effective in their work. Further, the preceptorship program and SIMulated Professional Learning Environment (SIMPLE) program has been found effective in shepherd transition of newly qualified nurses in their work.

Keywords: lifelong learning, registered nurses (RNs), SIMulated Professional Learning Environment (SIMPLE) program

Continuing Lifelong Learning to Enhance the Individual Scope of Practice and Clinical Knowledge following the Transition to the Role of a Registered Nurse

Transition from medical school to practice is both challenging and exciting for neophytes. The most apparent cause of excitement could be the “personal novelty” of joining the field of practice. However, beyond the façade lie decades old challenges such as heavy workloads, irregular shift hours, long durations of work, physical and emotional exhaustion among others. According to Chang (2015), the challenges facing newly graduated RNs are underlined by a dichotomy between “bureaucratic” and “professional” tasks. The resultant “role conflict” has been identified as the primary cause of exit from service (Chang, 2015). Research findings consider lifelong learning as panacea for transitory impediments in nursing. Lifelong is thus intended to cure imbalances entrenched by incongruence of classroom predictability and indiscernible realities of medical practice (Chang, 2015). Many healthcare providers now perceive lifelong learning as the most effective way of helping new nurses with near seamless integration into the profession by mitigating the effects of knowledge gap. Continued learning is also intended to enhance expertise in the conduct of intricate procedures, proper handling of drugs, professional handling of patients, team work, discretion in decision making and accountability for actions taken or otherwise, coping with shift work, team work and handling expanded clinical roles.

Significance of Lifelong Learning

Implementation of lifelong learning for new RNs provides an effective means of guaranteeing health for future generations in terms of direct health benefits to patients and real professional growth for RNs. According to (EBSCO, 2017), nurses consist of about 70% of all health professionals. Consequently, as key staff in the provision of direct health care, it is necessary to introduce new nurses into a culture of continual lifelong learning to improve services to patients. In the United States, with 4.5 million health professionals, of which nurses constitute 3.1 million, it is estimated that acquired knowledge through continuing education can potentially save about 15 million lives if each RN committed to saving just 5 lives in their lifetime (EBSCO, 2017). Secondly, newly graduated RNs have been found to posses many superlatives which older nurses lack. For instance, new nurses are favorably predisposed to continual learning. New RNs also exhibit greater communication skills with patients, healthier psychosocial assessment capabilities, and superior sense of accountability towards their patients (Chang, 2016; EBSCO, 2017). Thirdly, newly inducted nurses, just as young employees, possess the greatest propensity to change jobs. As a result, lifelong learning, along with other organizational motivators, has been touted as an effective “lock in” strategy for retaining this generation of employees.

Discussion

Research findings by Chang (2015) consider structured transition as necessary for leveraging on strengths of neophytes by adequately preparing them for the challenges of nursing. Accordingly, Chang (2015) acknowledges the challenges of transition for student nurses as principal causes of occupational stress. As a consequence, role transition becomes “messy” as it limits the employee to two undesirable situations: role ambiguity and role overload. Role ambiguity is characterized by lack of clarity on and specificity of expected activities to be carried out by the employee. The apparent “fluidity” of roles may cause the newbie to handle tasks deemed too complex for their qualifications and experience, a situation referred to as role overload. Chang (2015) further posits that the new dynamic for the RN inevitably leads to job dissatisfaction, and possible turnover.

Available evidence shows a strong correlation between nurse retention and lifelong education programs. In South Africa, for instance, Makua Memme Girly, a registered nurse and author of the biennial journal, Transition from Student Nurse to professional nurse: Induction and Professional Development Support of Newly Qualified professional Nurses, decries mass exit of newly graduated nurses from service. While policy directives which require all fresh nursing graduates to render mandatory service in public facilities for at least one year as a prerequisite for registration did arrest nurse exits, Makua (2016) observes that the impact of such measures may not be clear in the long term. An actionable proposal should include concrete steps by way of lifelong learning to aid transition to professional nursing. Lifelong learning, implemented through induction in the first six months and professional development over the course of the nursing career should be perpetuated to encourage new nurses to stay on the job (Makua, 2016). Further, characteristic challenges of the first six months of nursing, such as during the first six months where they have to learn their roles, guidelines and regulations of practice

Research evidence also shows that lifelong learning is too crucial to the success of nursing that its success should not be pegged on human resource manuals and policy directives. According to Novak et al. (2014), longevity and retention strategies should include focused programs aimed at sustaining interest in nurses so as to propagate a culture of knowledge acquisition, retention, synthesis, and application. Further, it is recommended that lifelong learning should confer on its recipient the capacity to solve actual problems through investigation, appreciation of tangible and intangible resources available, and an unbiased evaluation of career objectives (Novak et al., 2014).

Karimi and Yazdi (2014) consider mentorship for young nurses as an environmental element of learning and an indispensable enabler of clinical excellence. Whereas career growth and personal advancement play a crucial role in lifelong learning, Karimi and Yazdi (2014) further consider on job mentorship and career modeling as the pillars of an enduring lifelong learning process.

Edelson (2015), while delving into the motivators of lifelong learning, identifies routine demands for answers from patients and relatives of patients as the key reason for the quest for knowledge and advancement. Additionally, Edelson (2015) posits that in the era of globalization, where patients can easily access information on their conditions, and the right drugs to take. Under the circumstances, patients expect their caregivers to be much more knowledgeable than they are. Edelson (2015) also identifies another driver for lifelong learning as policy frameworks by health institutions themselves. For instance, healthcare institutions in the United States are actively striving to have at least 80% of their nurses with a minimum qualification of a bachelor’s degree. Another study by Dr Lúanaigh Padraig of the department of department of health in Brisbane Australia opines that continuous lifelong learning can be obtained from respected RNs who have useful “tricks of the trade” and “little things that matter” to help train young nurses effectively (Lúanaigh, 2015). Further, a preceptorship approach, which has been successfully implemented in the United Kingdom, has shown strong correlation with positive performance outcomes for new RNs (Whitehead et al., 2016).

Evaluation

Since lifelong learning was identified as a vital retention tool for young nurses, several strategies have been generated from research findings. For instance, Tiwaken, Caranto and David (2015) propose early introduction of student nurses to clinical practice. Proponents of this approach postulate that early exposure to learning away from the safety and predictability of the faculty environment provides priceless opportunities for developing sense of accountability for others. Consequently, review of relevant curricula to infuse nursing practice in the initial stages of training is encouraged, as students will be better prepared to develop requisite interpersonal skills, and a bridging of skills gap with theoretical knowledge.

Secondly, in order to facilitate career growth of nurses to the professional level, it has been suggested that the major impediments to lifelong learning be removed. A toxic culture as evidenced by adversarial relations with supervisors, ineffectual management, and bulging workload have are the main identifiable reasons for denying young nurses study leave (Coventry, Maslin‐Prothero, & Smith, 2015). Removal of these barriers will potentially motivate the young nurses to grow in the profession, increase competency and confidence, and eradicate the desire to leave the profession. Management should consequently institute regulations which promote professional development such as provision of relief cover, implementation of paid leave, and promotion of a healthy working environment for professional advancement.

Third, innovative attempts should be made at deepening practical skills and clinical competence. This strategy can be actioned by developing pregraduation study program solely intended for inculcation of clinical skills. This stratagem, initially piloted on 198 students from Chang Gung University in Taiwan, showed the relationship between clinical proficiency, emotional stress, and predisposition to exit in within the first 12 months of service (Cheng, Tsai, Chang, & Liou, 2014). The potency of the strategy was supported by research data which shows positive correlation between clinical expertise and employee retention. Incidentally, students who did not take part in the program showed markedly higher stress levels, and an elevated chance of quitting employment in the first 12 months. A follow-up on participants and non-participants on the program showed that the program increased the scope of clinical knowledge of participants and reduced their chances service (Cheng et al., 2014). On the flip side, the students who were excluded from the program exhibited lower clinical expertise, showed comparatively higher stress levels, and much higher proclivity to exit the nursing profession. The study also found that new graduate nurses had a tendency to quit between the sixth and twelfth months.

Finally, implementation of lifelong collaborative programs learning into nursing has been proposed. According to Whitehead et al. (2016), implementers of collaborative learning recognize nursing as a highly personal and interactive endeavor. Since the proposed approach entails communal learning, practical exposure to learning imperatives, communication with group members in an empathetic, informal setting, it fits in the basic purview of nursing. (Whitehead et al., 2016; Liaw et al., 2014; Walston & Khaliq, 2014) extol this approach for instilling in learners a sense of self-worth and security, and credits it with contributing to some 37% of self-directed learning. It is recommended that such learning be conducted in small groups so as to crystallize benefits of group learning into a more wholesome learning experience Whitehead et al., 2016). New RNs should be encouraged to sharpen their investigative skills so as to enhance innovation and knowledge sharing.

Conclusion and Recommendations

Continuous lifelong learning is currently considered one of the most necessary programs for safeguarding the future of nursing. From the preceding discussion, its significance to nursing mainly revolves around addressing mass exit of new nurses from the profession and building clinical competence and professional experience. Proposed strategies by various professionals have also been considered as part of reviewed literature. These approaches include execution of continuous lifelong learning through structured transition so as to prevent possible “culture shock” for new RNs, inclusive induction seminars intended to encourage transition into real actual practice, and continuous professional development to guarantee continuous professional development. Other strategies discussed include implementation of professional development programs through the preceptor program, repeal of policy guidelines and policies which impede lifelong learning and inculcation of collaborative learning approaches. Finally, a departure from destructive tendencies at work has been proposed as a means of perpetuating a culture of excellence and meritocracy.

In order to realize intended benefits of continuous lifelong learning, the following measures have to be added to the existing strategies: Principally, lifelong learning should be regarded as an integral part of nursing practice. Similarly, elimination of barriers to full access to lifelong learning programs should be prioritized and completed. Correspondingly, healthcare providers and stakeholders should be encouraged to support lifelong learning programs through planned investments and robust evaluation systems.