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Issues Faced by Nurses during the Transition from Enrolled Nurse to Registered Nurse.


The purpose of this particular critical review is to analyse the issues that concern the transition from that of an Enrolled Nurse to a Registered Nurse. Literature is plentiful on the theme of transitioning from a nursing student to the post of a Registered Nurse, however there is comparatively less literature written on the issues of an Enrolled Nurse as they transition to a Registered Nurse.

Four core themes that became evident from the literature were reality jolts, feeling unready, feeling the lack of support and the existence of phenomenal expectations from the profession. Reality jolting is spoken of in the light of the training – practice divide, whereas the theme of seeming unprepared resulted in issues pertaining to self-confidence and capability. Degrees of support are comparatively poor, particularly for fresh graduates with earlier Enrolled Nursing involvement in the transitional stage. Peer anticipations were supplementary pressures for fresh graduates with earlier Enrolled Nursing skill as a hypothesis exists that such people will be able to survive. (Center, 2012)

The inclusion of fresh Registered Nurses into the nursing workforce remains the topic of a great deal of research since the education of Registered Nurses turned into the field of universities. The universal scarcity of nurses is well known: research emphasising on the retention of fresh graduates is thus obviously necessary. (Sargen et al., 2011)

There is a scantiness of literature that discusses research that specifically deals with the issue of changeover from the role of an Enrolled Nurse to that of a Registered Nurse. While a number of authors have pointed out specific aspects of practice during the changeover from a nursing student to the role of a Registered Nurse, limited information is available on the practices of fresh graduates as Registered Nurses who had earlier undergone training as Enrolled Nurses. Such graduates pass through the transitional stage facing identical challenges and suffering from similar levels of anxiety as their counterparts who began university trainings without any earlier nursing work. Fresh graduates with earlier Enrolled Nursing experience are distinctive as such nurses re-enter the staff in their novel role with an anticipation that the change will not be challenging on the ground of their earlier knowledge with nursing training. To comprehend better the issues that new graduates with earlier Enrolled Nursing experience, a literature review was carried out to analyse the issues pertaining to the transitional phase.

Enrolled Nurses previously have an extent of socialisation pertaining to the work surroundings. They are accustomed to the administration of treatment, patient wellbeing, arranging care and interacting with work associates. Having said that, stressors that can affect both the units include the rapid rise of responsibility that clashes with comparatively complex decision-framing and increased answerability. (Cooper et al., 2010) Usually, it is acknowledged that the transitional time of nursing student to the role of Registered Nurse is full of challenges, worry and concern. The interim experience is usually complicated by expectations from self, peer and executive expectations pertaining to coping. These anticipations may even counter any supposed experience benefit that earlier trained Enrolled Nurses might have had. The transition timespan is as worrisome for earlier trained Enrolled Nurses as it might be for fresh graduate Registered Nurses with no earlier medical knowhow. A study of the experiences of earlier trained Enrolled Nurses is beneficial as it emphasises on issues related to nursing training and the retention of qualified nursing workforce. (Phillips et al., 2013)

Literature Review

The searches pertaining to this theme were carried out on CIAP, Googlescholar, ScienceDirect, and Wiley Online Library databases by making use of the search phrases of , and . The outcome of the search was a range of journal articles pertaining to this theme. Current literature indicates that the changeover from a nursing student to a Registered Nurse can be taxing. The restricted amount of literature pertaining to studying the issues of earlier trained Enrolled Nurses in their changing phase to Registered Nurse points out similar problems. (Hayes et al., 2012)

Reality Jolts and the Professional Disruption of Principles

A major part of the data identifies reality jolting as a major issue for fresh graduates. Universities are accused by participants in a certain study for not gearing up nurses for the truths of the hospital setting. A majority of the articles to be spoken about analyse the disappointment experienced by fresh graduates at the consciousness that they were not able to spend adequate time with patients and make use of the all-inclusive nursing standards inculcated in them at the time of university trainings. As university scholars, standards and ideals are gained and sustained. (Gambino, 2010) Having said that, a number of fresh graduates who had earlier trained as Enrolled Nurses and continued serving in the same ward, thought that their freshly gained knowledge and talents were not willingly accepted by earlier seniors or counterparts. A majority of participants in this analysis complained about the loss of their earlier, familiar job of an Enrolled Nurse. Explanations for this are anecdotally stated as the trauma of breaking free from old familiar methods and being a learner once again.

Feeling Unready

There exists a widely-accepted belief that education pertaining to practice does not actually give the graduate the needed skills for the job. These insufficiencies stem from the relative ways through which skills are acquired: under direct observation as a student in a monitored academic situation; and then usually with limited or no supervision as a Registered Nurse within an active, workplace environment. In the case when more high-ranking or practiced nurses criticise that fresh graduates are ineffectually ready for the facts of the ward, the new graduate nurse can do nothing but feel insufficient and discouraged, regardless of the legitimacy of the assertion. (Smedley and Morey, 2010)

Interestingly, it was implied that nursing students tend to be more ready than they believe they are for their imminent role of a Registered Nurse, and the belief that this apparent under-valuation of skills and information could obstruct their outcomes in their graduate standpoint. Thus then, cultivating and confidence-enhancing strategies need to be engaged by more high-ranking nursing staff to enable a slicker transitional voyage.

Causes of stress for the fresh graduate involve having to deal with the obstacles that their novel role offers, being unsure of what is anticipated from them, a scarcity of assurance in their skill to carry out safe nursing care, a deficiency of provision from the workplace and from the higher level nursing staff, the trouble adjusting to working in shifts and the spurt in the increase of accountability and liability. A fresh graduate RN, who had earlier been an EN might have the upper hand as they are expected to be acquainted with the strains of shift jobs; despite the fact that the other factors might affect all fresh graduates alike. (Phillips et al., 2013)

Research concluded that the analysed participants were generally unready for the disjointed socialisation procedures, with the frequent ward cycles involved in novel graduate courses offering fuel for additional turmoil as fresh graduates constantly seemed to face the experience of the first day of work once again. Such findings point out that the stress that is experienced as new tasks are tried might also be credited to the emotions felt by fresh graduates earlier trained as ENs in their search to acquaint themselves with a completely different role. (Parker et al., 2011)

Feeling Left Out

Horizontal forcefulness, interpersonal clashes and the like are general themes that come up from the researched literature. Researchers, in a survey concerning new graduates established that fresh graduates are repeatedly experiencing pessimism from nurses who have comparatively more experience concerning their tertiary training. Fresh graduates professed that their greater experienced co-workers were showing negative approaches concerning the fresh graduates’ stage of knowledge, while fresh graduates were more anxious about their degrees of capability and skill. A Canadian research concerning the transitional level of fresh graduates highlights the pressure put on fresh graduates concerning the need for further modifications to nursing training and workplace backing. (Hegney et al., 2010)

This discovery parallels Australian investigation, as the same anticipation is pointed out as placing a heightened pressure on fresh graduates as compared to those earlier trained as Enrolled Nurses. In a path-breaking analysis concerning transitional situations in rural situations for fresh graduates earlier trained as ENs, it was found participants indicate that they were inefficiently boosted in their new task as RNs. Those involved in the research reportedly gained extremely restricted educational advantages such as guidance or positive feedback.

Boundless Expectations

Particular literature pertaining to Registered Nurses who might have earlier been Enrolled Nurses indicates that these fresh graduates with earlier Enrolled Nursing knowledge have impractical expectations concerning themselves. Apart from this, a considerable extrinsic basis of stress for this unit is the peer and supervisory expectation that the change of the fresh graduate with EN skills will not be challenging. This anticipation is rather likely to cause a lack of backing, causing increased stress and reduced confidence in the fresh graduate. Research endorses the claim that enough support is necessary for every nursing graduate working through a transition if such nursing graduates are retained in the workforce. The restricted literature accessible indicates that the backing that nursing graduates with earlier Enrolled Nursing skills is gaining is insufficient. (Joyce and Piterman, 2011)

Fresh graduates with earlier Enrolled Nursing expertise had acquired knowledge and experience all through their university preparation and were supposing to be capable of putting these into use in their postgraduate service. Nevertheless, it was discovered that previous work associates were not voluntarily accepting of these recently acquired benefits. Thus, an issue developing from the collected works is divided on the notions of more practiced nurses that fresh graduates are lacking in the needed knowledge for the trade, and the pessimism from trained nurses focussed towards fresh graduates who are interested to use recently acquired understanding and skills. 

Inferences for Practice

A study done a decade ago revealed that reality jolts are a significant issue for fresh graduates. The deductions concurred several other studies. Having said that, they also analyse the cognitive discord experienced by fresh graduates as they take on their novel roles. The reality of being answerable for scientific decision-making is a tedious clash for fresh graduates, inclusive of those with earlier training as an EN. University trainers need to lay emphasis on the strategies dealing with this contradiction between the contented, harmless educational establishment and the authenticity of the workstation if the exceedingly confronting matter of reality jolts is to be dealt with. (Eley et al., 2010)

Research pointing out differences in self-analysis implies that fresh graduates have scarce confidence, undoubtedly backed by negative workforce attitudes. Despite the figurative theme of nursing staff ‘eating their young’ being extensively recognised, it appears that as a specialised organisation, nursing has been unable to deal with the issue for fresh nurses. This is lethal for employment retaining rates as fresh graduates might potentially re-assess their career decision. It is an untested theory that the origin of the issue lies in the previous generation of skilled nurses and there exists scope at this point for additional research for the testing of such a theory. (Duffield et al., 2011)


It is broadly acknowledged that the changeover from being a nursing student to taking on the role of a Registered Nurse is filled with many hurdles. The research considered here suggest that usually the hurdles of transition are present for fresh graduate Registered Nurses who had earlier undergone a training as an Enrolled Nurse. Reality jolts are a unique segment of the transition, also for the graduates who have earlier training to be Enrolled Nurses, as hopes are crushed, values defied and selfperceptions interrogated. Fresh graduates with earlier Enrolled Nursing work-experience have a distinctive peer and self-imposed pressure of the anticipation of ‘being capable of coping’. (Cant and Cooper, 2010)

This essay has demonstrated likeness in difficulties faced by fresh graduates during their transitional stage, and needs to draw attention to the requirements of fresh graduates with earlier Enrolled Nursing teaching. Pedagogical training, focussed on nursing students, fresh graduates and the nursing workforce, must keep in mind increased backing for all fresh graduates, inclusive of those who have earlier Enrolled Nursing experience. (Hutchinson et al., 2011)

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