Facing challenges and discovering opportunities

Professional Update

Have you ever commenced work in a new area of nursing practice, one where you have no previous experience? You may have felt nervous with a sense of trepidation, unsure, excited, and motivated all at the same time. If you have found yourself in such a situation, you are not alone.

Whether commencing work as a new graduate, embarking on a career change, or being deployed, for most people, the transition from one clinical area to another is a time of upheaval often impacting a person’s identity, role, relationships, and behaviours regardless of their previous experience. Factors influencing the transitioning of nurses between clinical areas include global nurse shortages, particularly in specialist areas,1 through to changing community needs, for example, the COVID-19 pandemic.

I have spoken with many nurses over the last two years who have experienced such transitions due to the COVID-19 pandemic. A maternal, child and family health nurse, Jenny was asked to work in a mass vaccination clinic. Scott began working in a community nursing position, only ever having worked on a ward. Chris returned to work in intensive care after 10 years working as a registered nurse (RN) in general practice, and Chitra joined the virtual COVID-19 care team who worked remotely using telehealth to assess and monitor people isolating at home.

What was common amongst this group, apart from being RNs, was their fear of the unknown and how best to prepare for and work in a new area of practice. Essentially this is about how we define and expand upon our scope, ensuring we have the education, the competence, and the authority to practice.

Scope of practice is defined in broad terms by the NMBA as

…that in which nurses are educated, competent to perform and permitted by law. The actual scope of practice is influenced by the context in which the nurse practices, the health needs of people, the level of competence and confidence of the nurse and the policy requirements of the service provider.2

Determining how to manage changes associated with a clinical move is vital for each nurse. As educated health practitioners, nurses aim to deliver safe, evidence-based care; the Decision-Making Framework (DMF)3 for nursing and midwifery is part of the regulatory framework and can assist nurses in doing that. It is designed to help nurses make decisions regarding their scope of practice, their delegation responsibilities and to reflect on current and changing needs of their practice.

Jenny, Scott, Chris and Chitra used the DMF to reflect on their scope of practice before and on commencing in their new area. They offered the following thoughts and suggestions for others experiencing transition.

Nurses have transferrable skills. Even when moving to another area, during pre-registration education and with prior experience as a nurse, you develop the skills and knowledge to reflect, think critically and make evidence-based clinical decisions. This is about the way we think, not what we think, and can be transferred to many contexts.

Critically reflect on what you know and what else you need to know to safely extend your scope of practice. Sure, there may be new skills you need to learn, but this can be interesting as well as challenging. Engaging in clinical supervision or mentorship can help you reflect and develop strategies to work through challenges as they arise.

Talk to your manager and colleagues to learn about the area of practice. Use the early period of your employment to discover as much as possible about the role and develop a plan for what else you need to learn and how to achieve that.

Speak with the nurse educator/s about learning opportunities that can help you expand your scope of practice. Don’t be afraid to say you are unsure or need further assistance; that is how nurses make sure their practice is safe.

Understand your rights and obligations, particularly if an employer expects you to work beyond your scope of practice. Nurses are protected under section 136 of the Health Practitioner Regulation National Law Act 2009 (the National Law), making it an offence to incite unprofessional conduct or professional misconduct.4

Reflecting critically on practice, identifying transferrable skills, understanding your scope of practice, and working with others to identify learning needs, can help you meet and address the challenges associated with a clinical move and at the same time, reveal exciting opportunities.

1 Kinghorn GR, Halcomb EJ, Froggatt T, Thomas SDM. Transitioning into New Clinical Areas of Practice: An Integrative Review of the Literature. Journal of Clinical Nursing 2017; 26, (23-24): 4223-33.
2 Nursing and Midwifery Board of Australia. Registration Standards [updated 7 February 2017; cited 6 March 2019]. Available from: https://www.nursingmidwiferyboard.gov.au/Registration-Standards.aspx.
3 Nursing and Midwifery Board of Australia. Decision-making framework for nursing and midwifery. Melbourne: NMBA; 2020.
4 Office of the Queensland Parliamentary Counsel. Health Practitioner Regulation Law Act 2009 (National Law) (as in force in each state and territory) 2009 [cited 2022]. Available from: https://www.legislation.qld.gov.au/view/pdf/inforce/current/act-2009-hprnlq.

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