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Journal of Nursing

What Can We Do to Promote Professional Socialization in Nursing?

Author 1: Nancy Bellucci, PhD, MSN, RN, CNOR Author 2: Shakeeka Misher, DNP, RN, RNC-MNN, NE-BC [email protected]


Abstract

Transitioning to a new work setting is challenging for many nurses, regardless of the time spent in practice. Promoting professional socialization, through mentoring and precepting, helps to facilitate a smooth transition. Effective mentoring, using role-play, reflective exercises, and debriefing, provides the transitioning nurse the opportunity to self-actualize his or her potential in the new work environment. The use of Benner's Novice to Expert Theory and Duchscher's Stages of Transition Theory as a basis for mentorship enhances safety and quality in the provision of care.

Introduction to Professional Socialization

Professional socialization is a process that entails many stages of development for the nursing student. Professional socialization is defined as the knowledge and skill that characteristics of a profession (Becker-Hentz, 2005). Becker-Hentz (2005) indicated that Florence Nightingale's process for training included professional socialization and emphasized character development as a primary determinant of the successful transition from student to professional nurse. Professional socialization should occur on all levels of learning in nursing. This article will provide guidance that could be useful in enhancing nursing mentees or newly onboarded nurse's professional socialization to a new clinical environment or role as a nurse in practice.

Facilitating the Transition

Mentors facilitate the nurse's transition from novice to expert through preceptorships, on-the-job training, and through formal roles as educator, mentor, or preceptors. Etheridge (2007) indicated that the goal or aim of nursing education is to provide guidance and to prepare the student nurse to make clinical judgments, promote patient safety, communicate effectively across disciplines, and to promote a successful transition from a novice nurse to an expert nurse. One of the ways that the nursing educator, mentor, or preceptor can facilitate the development of the student is by building self-confidence through one-to-one conferences and debriefing sessions. Further, the educator, mentor, or preceptor can encourage self-evaluation using an evaluation tool or encourage the student to reflect on a clinical day through journaling. The mentees can then review the self-evaluation with the educator, mentor, or preceptor and discuss the perceived strengths and weaknesses noted in the evaluation.

Idczak (2007) identified that reflection and journaling are activities that aid in student nurse transitioning. Reflection via journalizing provides the student with a method to self-evaluate. Likewise, the activity of journaling serves to enable the student to understand the thought processes experienced as a result of the experiences encountered (Idczak, 2007). Further, journaling is a free-form, personal activity that will encourage the student to expand on issues experienced as he or she transitions (Idczak, 2007). Reflecting on previous writings will enable the student to embrace personal growth as a professional nurse.

Using Benner's Stages Duchscher's Theory as a Guide

The integration of Benner's Stages From Novice to Expert and Duchscher's Stages of Transition Theory in a mentoring plan is helpful as a guide when assisting nursing mentees in professional socialization. Murray, Sundin, and Cope (2019) identified that the use of Benner's Stages in assisting new nurses in transitioning to practice enhances safety and quality in the provision of care, creates a realistic expectation for competence and skill acquisition, and improves retention. The levels of proficiency in Benner's (1982) stages are novice, advanced beginner, competent, proficient, and expert. Since novice nurses and nursing mentees will be in the clinical areas during each of these stages, the nurse educator, mentor, or preceptor must begin confidence building, self-esteem building, self-analysis skills, and communication skills from the beginning. Consistent with Benner, Duchscher's stages serve to describe the process of transition, such as doing, being, and knowing (Murray et al., 2019). Applying Benner's stages and Duchscher's Theory collectively, the nurse educator, mentor, or preceptor must realize that the novice and the advanced beginner may only have the ability to absorb or mentally adjust to new situations and experiences to a minimal degree (Benner, 1982). To facilitate the needs of mentees, Benner (1982) suggested that the educator, mentor, or preceptor devise guidelines that recognize readiness to learn, clinical competency, and aspect recognition or previous experience.

Integrating Professional Socialization in Education to Promote Clinical Growth

For the purpose of this article, we will discuss the application of professional socialization in two clinical areas, the perioperative and maternity settings. These two settings were chosen due to the requisite situational isolation that comes from these healthcare units, which require restrictive access. In the perioperative setting, specifically the operating room area, restrictions are placed on who can enter the area and are labeled unrestricted, semi-restricted, and restricted. In the labor and delivery unit, or maternity ward, which also would have the same levels of restricted access. Restricted access lends itself to a sense of isolation from the rest of the healthcare organization. We will discuss this a bit further.

In perioperative education, professional socialization is an integral component of the education plan. In this setting, the nursing student (a.k.a., perioperative bridge nurse) is placed in the clinical situation on a daily basis and must be able to function within the social construct of the environment. Thus, the integration of methods to enhance professional socialization is used to promote effective communication and promote the mentees’' self-confidence. The methods used to enhance professional socialization for the perioperative bridge nurse are role-playing scenarios, weekly self-evaluations, weekly peer preceptor evaluations, and weekly feedback sessions from the educator, mentor, or preceptor and clinical manager.

In the labor and delivery environment, professional socialization is the nucleus of clinical growth. Professional socialization is essential in all stages of Benner's, from novice to expert. Irrespective of years of experience in nursing, the stages of Benner are fluid and dependent upon the task at hand, environment, and collaboration with others. The vital component of clinical growth occurs at varying degrees and levels across one's professional career. Professional socialization allows for networking, collaboration, and mutual support for healthcare providers. The connection established with patients, fellow peers, leadership, and providers propels one's ability to be an integral part of the patient and their support system's birthing journey.

Creating A Bridge not a Barrier

The relationship between the mentee and mentor should be one that finds its foundation in open communication and mutual respect. The mentor and the manager are required to facilitate a learning environment that promotes a just culture, is conducive to learning, and aids newly hired nurses to achieve desired clinical outcomes (National League for Nursing (NLN), 2005).

Likewise, the nursing profession is required to abide by professional standards and a code of ethics. These standards and codes of ethics serve as a guiding force throughout the nursing career, and in all of the interactions, nurses have while caring for patients and representing an institution. The NLN (2007) created an excellence model to identify eight core elements necessary to attain and maintain excellence in the nursing profession. Additionally, the NLN (2007) stressed that the nurses need to understand the principles that are fundamental to their profession, be able to use technology to manage and find information, and be leaders and agents for change.

Likewise, nursing mentees and mentees require strong mentoring to understand his or her potential role as a nurse. Further, staff preceptors and mentors need mentoring to be effective leaders in the clinical areas. Culleiton and Shellenbarger (2007) identified that providing active mentorship during the transitioning phase is a helpful strategy that is useful for the enhancement of the mentee. Therefore, effective mentoring programs provide a strategy for improving retention in nursing (Culleiton & Shellenbarger, 2007). Further, equal importance is placed upon the facilitation of positive mentee-mentor relationships during the transition period.

The American Association for the Colleges of Nursing (2014) indicated that the United States is facing a major nursing shortage and an increase in workforce opportunities in the next eight years. The Institute of Medicine (IOM) (2011) recommended that all nurses have a Bachelor's of Science in Nursing (BSN) by the year 2020. The IOM's recommendations create an emergent need to increase the nursing faculty workforce. Nursing is one of the many vocations in which a growing demand for improvement of workforce retention exists.

In the wake of a nursing faculty shortage, there is a need to retain and recruit new nurses into many aspects of the nursing profession. Academic institutions and health care facilities are responsible for the retention of the nursing workforce. An important component of maintaining work environments conducive to retention of the nursing faculty workforce is associated with the provision of adequate mentorship. Health Resources and Services Administration (HRSA) (2010) indicated that the primary problems facing healthcare are: 1) financial constraints; 2) healthcare workforce shortages; 3) the changing needs of an aging population which have prompted a national dialogue on the need for new healthcare models to meet the healthcare demands of the 21st century; and, 4) facilitation of working nurses' abilities to participate in continuing education programs and increasing healthcare information technology demands. Medical schools, institutions, practitioners, and mentees will be required to create strategies for coping with the increase in the volume of new information and changing patient demographics (HRSA, 2010).

Effective mentoring improves the confidence of a mentor and leads to success as a teacher in practice. Two methods that are effective in building rapport between the mentee and mentor are role-playing and debriefing through post-conferencing. The post-conferencing and the role-playing activities help the mentee to identify barriers in communication and ways in which barriers could be reduced. The mentees can use this newly gained information when each returned to the clinical area in a solo capacity. The mentees could be asked to reflect on personal experiences and the benefits of using effective communication.
In the perioperative setting, the perioperative bridge nursing mentee would engage in role-playing scenarios devised by the educator, mentor, or preceptor. In each of the scenarios, the mentee would assume the individual roles found in the perioperative setting, which are the surgeon, the anesthesia personnel, the scrub nurse, and the circulating nurse. The educator, mentor, or preceptor would serve as an observer or the surgeon depending upon the type of scenario and the topic of focus. For example, the educator, mentor, or preceptor could manipulate the scenarios, and the mentees could provide reactions based upon what each was taught in the didactic sessions. The mentees would base their responses upon their observations in the operating room setting. The educator, mentor, or preceptor would then explain some of the reactions and observed behaviors, which would provoke the mentees to reevaluate their initial opinions of the situations. At the end of the role-playing activities, a post-conference would be conducted.

In the labor and delivery setting, the development of clinical judgment occurs through residency programs, preceptors, mentors, and nurse educators. Nursing engagement occurs in the clinical environment, classroom setting, team meetings, and committees such as the mortality and morbidity committee. Orientation guidelines integrate individual and departmental competencies (Ahmed et al., 2019). Technology has allowed the labor and delivery department the ability of professional growth and development through local and centralized electronic fetal monitors that assist in the facilitation of nursing intervention, collaboration, and debriefing scenarios. These opportunities are utilized as a teaching moment, sharing pearls of wisdom, and collaborating to impact patient care. The use of nurse mentors facilitates employee engagement and professional development (Coughlin et al., 2017).

Forms of Evaluation

Evaluation of the process involving the mentee is vital. Additionally, the use of reflection as a tool for gaining insights on personal, professional growth increase self-awareness. In either the perioperative or the maternity setting, the educator, mentor, or preceptor, preceptor, or primary mentor could use methods such as weekly self-evaluations, weekly peer preceptor evaluations, and weekly feedback sessions from the educator, mentor or preceptor, and clinical manager to promote professional socialization. For example, the mentees would be expected to complete a self-evaluation every week, and the preceptors each worked with were expected to perform a peer evaluation. The evaluations could be reviewed by the educator, mentor, or preceptor. A one-to-one meeting would be scheduled with the student to review the progress. Additional meetings would occur with the clinical manager, if available, as a means for socializing the student with his or her future manager over a preset period of time.

An important aspect of the self-evaluation would be associated with the identification of the student's perception of personal performance and progress in skill and competency acquisition. Self-evaluation could be performed by engaging in one-to-one debriefing or journaling. The student would share this reflection with the educator, mentor, or preceptor during the weekly meeting. The one-to-one meeting serves as an opportune time for the educator, mentor, or preceptor to share what had been observed over the previous week. The objective of providing the feedback is to encourage the mentee's confidence and to promote continued learning.

Conclusion

Effective mentoring using active learning processes such as role-playing, coaching, journaling, and debriefing, will serve to improve the confidence of nurses as they transition in a new practice setting. Working to socialize the nurse to the professional work setting will promote an environment of collaboration and open communication. The enhancement of collaboration in the healthcare environment will contribute to improved patient outcomes, reduce medical errors, and improve the overall health of the working environment (TJC, 2009). Working together to build one another's skills and confidence in the delivery of care is one of the most important contributions we can make in sustaining the future of our nursing workforce.


References

Ahmed, S., Srivastava, S., Warren, N., Mayra, K., Misra, M., Mahapatra, T., & Rao, K. (2019). The impact of a nurse mentoring program on the quality of labour and delivery care at primary health care facilities in Bihar, India. British Medical Journal Global Health, 4, 1-11. doi: 10.1136/bmjgh-2019-001767
Becker-Hentz, P. (2005). Education and socialization to the professional nursing role. In K. Masters' Role Development in Professional Nursing Practice.
Benner, P. (1982). From novice to expert. The American Journal of Nursing, 82(3), pp. 402-407. doi: 10.2307/3462928
Coughlin, V., Skariah, M., Tavarez, V., Best, A., & Prendergast, E. (2017). Clinical coaching and transitioning into the professional role using nurse mentors. The Journal of Obstetric, Gynecologic, & Neonatal Nursing, 46(3), S32. doi: 10.1016/j.jogn.2017.04.062
Etheridge, S. A. (2007). Learning to think like a nurse: Stories from new nurse graduates. The Journal of Continuing Education in Nursing, 38(1), 24-30.
Idczak, S. (2007). I am a nurse: Nursing students learn the art and science of nursing. Nursing Education Perspectives, 28(2), 66-71.
Murray, M., Sundin, D., & Cope, V. (2019). Benner's model and Duchscher's theory: Providing the framework for understanding new graduate nurses' transition to practice. Nurse Education in Practice, 34, 199–203. doi: 10.1016/j.nepr.2018.12.003
The Joint Commission (TJC). (2009). Patient safety topics - Sentinel event #40: Behaviors that undermine a culture of safety. The Joint Commission.

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