South Africa: How to Help New Nurses Bridge the Gap From Theory to Practice

In South Africa, newly qualified professional nurses often face great difficulties when entering clinical practice after completion of their studies. The transition from theory to practice can be daunting.

These challenges can be assigned to various factors, among others, being ill-prepared and having no guidance or support. For many, this role transition period can be traumatic and stressful due to insufficient clinical skills, a heavy workload, prioritisation of tasks, and decision-making.

Own experiences

My own experience as a nursing student, especially when I was placed in a theatre, was not pleasant. What stood out was how badly the theatre staff would treat nursing students. As a newly qualified nurse, my own transition experience was awful. It felt like I was in hell and I was constantly looking for other work.

After eight months, things improved as I gained experience. I realised that we need a culture change in theatre – behaviour needs to change and that behavioural change should start with me. That set me off on a journey to develop a preceptorship model for newly qualified professional nurses as part of my PhD in Nursing Science.

What we know

It is well-reported that in South Africa, and globally, health services are hamstrung by a shortage of nurses. Based on statistics from the South African Nursing Council (SANC) the total nursing workforce registered in the country by December last year was 276 415. There were 15 469 professional nurses in training at the time. This output of nurses who have completed the four-year degree has hovered around 3 500 every year since 2017, with last year’s output at 4 445 specialist nurses.

Amid an ageing nursing population and limited output of trained nurses that are not enough to wither the storm of nurse vacancies in the country, it becomes crucial to use who and what we have efficiently. It is of great importance to ensure that nurse graduates when they take up their roles in health facilities, are not only competent to do the work required of them but also confident. It is equally important to support rather than alienate them to the extent that they pursue other careers. We must keep and hang on to what we have.

But these nurses need support and guidance during their transition into their professional roles. Upon entry to professional practice, newly qualified nurses experience reality shocks, stress, fear, uncertainty, confusion about their role, lack of confidence and motivation, and feelings of being overwhelmed.

Preceptors, through preceptorship, are then ideal to support novice nurses and promote the transfer of learning.

It is of great importance to ensure that nurse graduates when they take up their roles in health facilities, are not only competent to do the work required of them but also confident.

What is meant by preceptorship?

Preceptorship is a period of support to newly qualified persons. This is a time when an experienced person guides and supports the newly qualified based on a predetermined programme or plan. The person facilitating and who provides this support and hands-on training is called a preceptor.

The preceptor and preceptee (the newly qualified nurse in this instance) will work together one-on-one, like a medical specialist who teaches surgical skills to a new medical officer. In nursing, the preceptor is a professional nurse with two or more years of experience within a specific unit and provides clinical teaching to newly qualified professional nurses. The most significant type of support provided is clinical support.

For this role, it is crucial that a preceptor must be good at teamwork, knowledgeable, and professional, and employ evidence-based practice and self-reflection.

The findings

Included as participants in my study were seven nursing managers, seven nursing preceptors, and eleven newly qualified professional nurses. Using semi-structured interviews, I investigated the transition experiences of newly qualified professional nurses with the aim of developing a preceptorship model. The purpose of the model is to, among others, reduce the transition challenges newly qualified professional nurses face, prevent newly qualified professional nurses from feeling as if they are being thrown into the deep end, reduce the reality shock experienced by the newly qualified professional nurses, and lessen the anxiety experienced by the newly qualified nurses.

The study participants described the newly qualified nurses’ transition to professional nursing as challenging. Newly qualified professional nurses described their experiences as that of feeling poorly prepared. “From the student to professional nurse, … you have a big job description and you have to take responsibility … , ja (yes) responsibility for everything. I think being a student, they don’t really prepare you for that,” said one participant about her transition experience.

Preceptors described the situation as akin to newly qualified nurses being thrown into the deep end. “They’ve never worked in the department before, so that nurse will not be practically prepared. Again, this largely depends on the previous placements. If they worked previously in that unit, you will be fine,” said one preceptor. Some of the operational managers described their experience as a reality shock. One operational manager experienced the readiness of newly qualified nurses for the professional role as: “Guidance in the way they need to be shown everything, they need to be taught everything as a professional nurse because the month before they started, they were still and the mentality is that I am still a student.”

So, developing this preceptorship model for newly qualified professional nurses, I believe, will contribute to the body of knowledge in nursing practice and nursing education. But, what does this model entail?

One operational manager experienced the readiness of newly qualified nurses for the professional role as: “Guidance in the way they need to be shown everything, they need to be taught everything as a professional nurse because the month before they started, they were still and the mentality is that I am still a student.”

How it works

Based on this preceptorship model, once a newly qualified professional nurse is assigned to a unit they will be enrolled in the preceptorship as soon as possible. The preceptorship will be based on the learning objectives identified for that specific unit. An initial baseline competency assessment is done to determine the newly qualified professional nurses’ competency and to prevent the repetition of things the preceptee already mastered. This will determine the context of the preceptorship programme and is done by the operational manager and preceptor.

Thereafter, the preceptor will facilitate the preceptorship and the operational manager will assist where needed. It is crucial to have the buy-in of the operational manager for a preceptorship’s success.

The preceptor will plan teaching and learning activities to develop the skills of the newly qualified professional nurse and address the set objectives. Usually, this is based on the problem areas within the unit. To address this, the newly qualified professional nurse will go through specifically designed learning experiences and activities. This process will include, among others, a learning outcome, teaching activity, and assessment of learning. After this process, the newly qualified professional nurses’ competency is then determined.

This model was evaluated by a panel consisting of one deputy manager nursing, one operational manager, six preceptors, and four newly qualified professional nurses. I wanted to establish if the concepts of this model were clearly defined, applicable, and simple and to rate the action points for operationalisation of the model. All these aspects were rated from very good to excellent. The deputy manager of nursing said, “A systematic approach to capacitate and develop newly qualified nurses has long been overdue. This model can only benefit all the parties involved and eventually enhance patient care.”

First of its kind

Despite the obvious benefits of such a model, I could not find a preceptorship model for newly qualified professional nurses in the country, therefore, this is the first of its kind for professional nurses in South Africa. This model is based on newly qualified nurses as adult learners. This model can be used in clinical settings during newly qualified nurses’ transition period and with any newly qualified person’s learning activity. This model may guide operational managers and preceptors in the effective preceptorship of newly qualified nurses and clarify their role within the preceptorship process. By applying this model, newly qualified nurses may experience a positive transition period, improving their clinical competence. Furthermore, this model provides information on the implementation and sustainability of a preceptorship programme.

There is a need for professional support and guidance of newly qualified professional nurses to help them prepare for their roles and enhance their clinical independence. The developed preceptorship model for the newly qualified professional nurses, I believe, will contribute to the transition of these cadres; ensuring that they receive clinical training from trained preceptors and support from nursing managers who collaborate to achieve an effective preceptorship. Thus, the results of this study can greatly benefit the body of knowledge of nursing education and the nursing profession.

*Hansen is a lecturer at the Western Cape College of Nursing, Boland/Overberg campus. He teaches Ethos and Professional Practice to undergraduate students, from the first – to fourth year.

This article is based on his presentation at the Rural Health Conference in September.