Leadership and management Report: Letter of Transmittal

Letter of Transmittal
The Director
Nursing Education Department
Ministry of Health
KAAH
Dear Ms Taibah
I hereby submit a report on nursing education of new graduate nurses in Saudi hospitals. The report extensively describes the problems associated with inadequate orientation for graduate nurses. It also makes several recommendations to the Nursing Education Department in KAAH
The report reviews the state of new graduate nurse retention and job satisfaction in Saudi Arabia’s health sector. It embarks on a comparative study of other countries using nursing academic journals and clearly establishes that graduate retention of new hires in the nursing sector is an area of major concern.
The report outlines different reasons that contribute to the high turnover of new graduate nurses. It makes recommendations that support the development of a longer orientation program for new nurses.
I acclaim this report to you and pray that the education department will accord high priority to its recommendations
Yours Sincerely
Emad
Management Issues in Nursing Education of New Graduate Nurses
Name
Course number
Instructor’s name
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Table of Contents
Executive summary .............................................................................................................iv
Introduction ..........................................................................................................................1
Background ...........................................................................................................................2
Literature Review .................................................................................................................4
Abating Work related Stressors....................................................................4
Mentorship ………………………………………………….....................5
Unrealistic expectations ..............................................................................6
Discussion .............................................................................................................................6
Recommendations ................................................................................................................8
Conclusion ...........................................................................................................................9
References ...............................................................................................................................10
Executive summary
Nursing education for new graduate nurses is very important in determining their retention and job satisfaction. Many new graduate nurses in Saudi Arabia undertake a three-month orientation program that is largely insufficient in developing their skills and competence in the profession. Many are frustrated by the high expectations to deliver holistic and evidence based care that only experienced nurses are able to provide. Additionally, many of the experienced nurses are reluctant to mentor the nurses as they are not obliged to do through any formal mentorship program. Many of them cite having little time and that the new nurses are too inexperienced. This leaves the new nurses at a loss on how to achieve competence in the profession and many leave employment owing to frustration and burnout.
This report proposes that the Nursing Education Department in KAAH establishes a policy to require every hospital in Saudi Arabia to have a one-year graduate development program. The program will designate nurse educators, address mentorship issues, address issues relating to coping with and abating work related stress. Nurse educators shall also partner with nursing schools to offer students a realistic view of the work related stressors. It also addresses detailed aspects such as providing opportunities for social interaction with experienced nurses for new nurses to develop connections necessary for informal mentorship. Nurse Managers are also required to provide supporting learning environments through fairness in rosters and having realistic expectations of the new nurses.
Introduction
Nursing management is pivotal in providing nursing education for graduate transitioning programmes. It addresses new graduate nurse job satisfaction and retention issues. New graduate nurse retention and job satisfaction is a major concern and nurse managers require implementing education orientation and professional development programs that encourage satisfaction which also translates to significant savings for the hospitals (Hillman & Foster, 2011).
Retention rates are lowest among new graduate nurses and the costs associated with high turnover have been estimated to vary from $ 8000 to $64000 for every nurse (Hillman & Foster, 2011). The high turnover is highly associated with dissatisfaction with the ineffective orientation processes which lack structure and clear focus (Takase, Nakayoshi, & Teraoka, 2012). New graduate nurses require supplementary proficiencies and knowledge in addition to the education that they obtain in nursing schools. This is necessary for the graduates to successfully transition to professional registered nurses roles (Hillman & Foster, 2011).
The first year of graduate nurses sets the course of their career and significantly affects their judgment of their profession in the long term. The first years provide them with insight because it is a learning period characterized with continuous education and mentorship to transition into professional competence. Learning takes the forms of orientation programs and preceptor relationships in the US. Research has shown that nurses that receive longer orientation which addresses their needs obtain higher job satisfaction than those receiving shorter orientation (Scott, Engelke, & Swanson, 2008).
Preceding studies have also shown that new graduate nurses require between two and three years orientation before becoming fully competent. Competence affords them confidence and is an important contributor to job satisfaction. Additionally, placing new graduate nurses in understaffed units increases their stress levels and turnover. New graduates obtain the most gain from orientation in units with adequate staffing with expert nurses to mentor them (Scott, Engelke, & Swanson, 2008).
The three-month orientation program for graduate nurses in Saudi Arabia is largely insufficient in equipping nurses with the necessary skills required to remain committed to the nursing profession and to obtain job satisfaction. The Saudi healthcare management body that manages nursing education in KAAH requires laying down policies that require hospitals to develop a one-year career development program for proper orientation of new graduate nurses deployed in various hospitals in the country.
Background
It was reported that the nursing workforce in Saudi Arabia’s health care system comprised of 29.1 per cent and 4.1 per cent of Saudi nurses in the public and private sectors respectively. This statistic indicates that the workforce largely comprised of expatriate nurses (Almalki, FitzGerald, & Clark, 2011). In addition to the low numbers of Saudi nurses, the health sector currently experiences high turnover of new graduate nurses. The Ministry of Health in Saudi Arabia initiated Saudization which is a process to increase the number Saudi nationals in the nursing workforce and decrease the number of expatriate workers. Even with Saudization, a more prominent problem of high turnover among the new graduate nurses in their first year prevails.
The healthcare system in Saudi is similar to others in the world which include short orientation, buddying or a after which new graduate nurses are expected to work efficiently (Fielden, 2012). They receive general orientation and competency based check off (CBCs) and frequently lack extra support. They also participate in elective reflective discussions where expert nurses deliver presentations with information on certain aspects of care (Fielden, 2012).
The experienced expert staff show reluctance to mentor the new graduate nurses in Saudi citing factors such as time constraints owing to busy schedules and that the graduates are extremely inexperienced. The new graduate nurses in Saudi lack adequate support and the problem is exacerbated by the fact that many of the expatriate staff that previously designated to be involved in managing their transition have left the country. The orientation program has since been left to the senior nursing staff who lack adequate capacity to address the graduate’s professional development needs (Fielden, 2012).
New graduate nurses in Saudi consistently experience frustration when they are unable to meet the high expectations in offering holistic and contextualized care in conformity with technical rationality approach. This approach requires proficiency in skills that are primarily obtained as a result of experience and insight in customizing care to specific patient’s situation rather than relying on technical knowledge and policy procedures. Novice nurses rely on the inflexible approaches which make limited contribution to efficiency, safety and positive health outcomes (Walker, Yong, Pang, Fullarton, Costa, & Dunning, 2013). It is required that new graduate nurses receive comprehensive education to attain competence and expertise to adequately meet the required expectations (Contemporary Issues, 2012).
Hospitals in Saudi Arabia acquire licensing and accreditation from various bodies such as the Saudi Commission for Health Specialties, the Joint Commission International and the American Nurses credentialing Centre. These bodies require hospitals’ compliance with the requirements that provide efficient education to assist graduates in their transition during their first year of practice. The current program is short and unstructured and it does not address the needs of Saudi’s new graduate nurses (Cubit & Ryan, 2011). There is need to invent a longer structured development program for the graduates to address the problem of job satisfaction and retention. Such programs must also include aspects that build the role of nurses as teachers and also covers their professional development (Fielden, 2012).
Literature Review
Theorists indicate that new graduate nurses go through three distinct stages before achieving competence in their work. The first stage involves seeking prescriptive information on how to undertake different clinical procedures and is termed as the being stage. They then transition into the doing stage where they constantly seek clarification on the accuracy of how they undertake procedures. They seek guidance on various tasks to confirm and validate their views and opinions in undertaking clinical tasks. The last stage is the knowing stage where they are actively involved in addressing others questions competently as well as supporting their colleagues (Parker, Giles, Lantry, & McMillan, 2012). Nurse education programmes must also take into consideration that mentorship is a critical aspect of learning. They should also recognize that new nurses require learning strategies of copin...