Learning new skills and interacting with physicians are stressful experiences for new graduate nurses.7 A study by Casey and colleagues suggests that new graduate nurses feel inadequate and lack self-confidence.8 VALOR participants share these concerns. The initial journal entries revealed fears of making a mistake, harming patients, fitting in to the work culture, working with doctors, feeling anxious about patient interactions, and performing clinical skills competently.
Initially, students focused on needing extensive practice with nursing skills as evidenced by one student’s comments, “I’m honestly concerned about some of the procedures; I’ve only put in 3 IVs during nursing school, I am not confident walking in to a room and performing a procedure on my own. I would be overwhelmed.” When considering RN-to-MD communication, one student commented, “I’m nervous, doctors can be very hard on new nurses, I’ve witnessed this over and over.”
During the first weeks, the participants discussed the fear of being “on their own” without the benefit of their instructor once they graduate. One person noted this feeling as “The seed of fear grows as graduation approaches.” This lack of self-confidence and feeling scared is a consistent issue with all the VALOR students the first day of the program.
During the program, VALOR students developed nursing skills and became certified in advanced cardiac life support (ACLS). One student suggested that the ACLS class was a great team builder and instilled confidence among the VALOR participants. Another student shared, “We all agreed that attaining this certification was a culmination of our overall VA experience.” A student who was working in an acute care area applied the newly learned ACLS skills the following week when a patient coded. The student’s journal reflected how preparation makes a difference and described his experience and knowing how to react as “powerful.”
The Reality of Nursing
The VALOR program helps connect the academic environment with the realities of the workplace. Wilson found bridging the theory-practice gap between school and workplace improves learning opportunities for students.9 Wilson also suggests that having peers to identify with helps to bridge the theory-practice gap.9 Journal entries reflected “the perfect hospital” of textbooks was different from working every day and “almost being a nurse.” During the VALOR program, students immerse themselves in the realistic nursing environment of staff shortages, equipment unavailability, disgruntled patients, and peer-to-peer communication that is not always civil. The 40-hour workweek provides a realistic hands-on view of nursing and introduces students to socializing as a nurse and the nursing work culture.
After the 2013 summer portion of the program, students were able to differentiate between the realities of the world of health care and the academic view of the health care environment. As students progressed over the summer, a noticeable transformation took place. The student who wrote about needing more skills practice on day 1 found that she was comfortable with injections, hanging IVs, and providing patient care at the end of week 3. Students grew more comfortable collaborating with doctors and other interdisciplinary professionals. They also became competent with basic nursing skills and had a realistic view of the nursing world.
In addition, students became aware of the emotional aspects of nursing. One student discussed making a difference in a veteran’s life after participating in a substance abuse group. “While I was on my way home I started thinking about those vets and their stories, and I started getting emotional. I just felt bad that after doing the great deed of fighting for our country that they became victims of substance abuse,” the student explained. “That afternoon, as I departed the vets, I left hopeful and realized I could make a difference in the life of a veteran.” Another student perceived that doctors were discussing a veteran’s terminal lung cancer “nonchalantly” and reflected, “though I do recognize that a certain degree of disconnection must take place, a certain measure of empathy must remain at all times to effect positive outcomes in the patient’s health.”
VALOR students noted that the program gave them exposure to different areas of nursing. This experience assisted them in deciding on an area of nursing interest. One student who always wanted to be an emergency department nurse found that after that rotation, she was not “cut out to be an emergency department nurse.” Some students came into the program thinking they knew precisely what they wanted to do following graduation, but found a new interest.
Daily Debriefings
Through daily debriefing discussions, students learn about best practices, patient advocacy, nursing leadership, and communication skills. Some have said that it has helped them “get through the day” knowing they had an outlet to review their experiences with VALOR peers. Discussions focus on both the positive and negative aspects of their day.