Teaching while learning: A graduate nurse’s experience adapting to their new role in a specialised clinical area

Transitioning to practice can be complex for the new nurse (Missen et al., 2016). It can take graduate nurses time to become acclimatised to their new clinical role. It has been reported that many new nurses experience ‘transition shock’ when they first start working (Walker et al., 2017).

With this in mind, how do new nurses adapt to their clinical role when there is a high need for patient or family teaching? This adds another dimension and pressure to a nurse’s transition to practice, particularly if they have not covered the topic in their own university curriculum. Graduate nurses have reported that patient education can be a challenging part of their role (McKenna et al., 2018). Providing relevant, accurate information to support positive patient outcomes, especially to the vulnerable, can be a huge responsibility to carry for the new nurse. This scenario can set up to expose the new career nurse of feeling apprehensive and insecure in their role in front of the patient or family they are caring for.

This article describes the experiences of a new graduate nurse facing the teaching component of her role as a neonatal special care nurse, which requires skill, knowledge and insight to support the integration of parents to care for their newborn. Being a new learner in a specialised environment can be challenging to navigate. Teaching parentcraft skills as a new nurse when you have had limited prior exposure to caring for neonates can put you in a potential position of discrediting yourself in front of an already vulnerable and anxious family. A large part of the role is to instil confidence in parents by encouraging them to be involved in their baby’s care. Often parents will ask in passing “have you had children yourself?” Personally, I have prepared the cautious answer of “whilst I haven’t had children myself I have been taught to appropriately assess and read the cues of your baby.”

These feelings of uncertainty when teaching in a specialised area are not uncommon. When I discussed this topic with some other graduate nurses it became apparent to me that teaching parenting skills and involving parents in the care of their newborn, when you are still learning these skills yourself, can be stressful to manage. How to teach parents/patients is not commonly covered in the university nursing curriculum. In the neonatal area, the teaching focuses on informing parents on how to breastfeed, safely prepare formula, and to understand and support the developmental care of their baby. New nurses in this field are required to build on their own knowledge of these topics so they can then teach parents preparing for discharge. This means that new nurses are essentially teaching while learning. Research has suggested that there is a need to support nurses with less experience in providing patient teaching (Chidume and Pass-Ivy, 2020, McKenna et al., 2018). Not only are nurses required to understand the content well enough to teach, they are also required to be aware of different teaching methodologies so they understand how to teach and communicate in a way that is understood by the parent. Parent education is never just about ticking off a box on a discharge checklist. It requires consistent, constant messages being relayed from the time of admission. It considers appropriate language use, avoidance of jargon and the use of teaching aids such as diagrams, models or using demonstrations which can enhance the teaching and learning activity. Gaging the right moment to ensure that the parents are receptive to absorb the information is important. In addition to this, providing an environment that supports learning without distractions will ensure that parents have the best opportunity to learn.

So how do we teach our new nurses not only what to teach but how to teach?

From my limited experience, I believe it is important for educators and senior nurses to recognise that teaching patients in specialised areas may be challenging for new nurses. As such, it may be valuable to include parentcraft competencies and information on teaching methodologies during the orientation period. Educating graduate and even student nurses on suitable teaching methods that can accommodate the individual parent/patient’s health literacy level, language and cultural needs, may allow new nurses to feel more comfortable in their teaching. Some examples may include providing demonstrations, visual information sheets or information in multiple languages to guide the teaching. Understanding teaching methodologies could also encourage new nurses to identify what teaching styles aid their own personal learning and increase their understanding of how others learn.

Survival tips I have picked up for teaching while learning:

For graduate nurses working in specialised areas, it is important to show initiative by growing your own personal understanding of the topics you will be teaching patients. This includes being resourceful by locating evidence-based information, whether that is through hospital policies and guidelines, or by using patient information sheets which use easier to understand language. It is also important to evaluate how effective your teaching has been by asking the patient to demonstrate or explain what you have taught. Utilising the experts that you have around you and taking the time to listen in on conversations between more experienced health professionals and patients can help you learn the best ways to teach. Experienced health care staff have often mastered how to explain complex tasks in a way that is appropriate to the health literacy level of their patients. By taking the time to listen in on how others explain these concepts, you will be able to begin to understand what language and mannerisms enhance the successful dissemination of information. Recognise what you know and what you are yet to learn, and ask for help. When it comes to patient education, you cannot guess the answers as this puts patients at risk and you could lose the credibility you have with them.

Teaching parenting skills while learning how to take on the role of a nurse in a specialised area has been a challenge for me at times. This pressure is not necessarily only experienced by graduate nurses, but any nurse entering a new specialised field. I believe new nurses and educators have a role to play in reducing the challenge of patient teaching. It is important for nurses to seek support in engaging in effective patient teaching and work on building their own knowledge base in the use of appropriate teaching methodologies. As part of this, it may be valuable for senior nurses and education staff in specialised areas to include resources during orientation for new nurses on how to identify the most appropriate teaching strategies for educating their patients (Richard et al., 2018). Starting this process at a university level may allow student nurses to build their knowledge of effective teaching methods prior to their transition to becoming a graduate nurse. Consideration of implementing these changes would assist new nurses to become more confident and effective when providing teaching, whilst they undergo their own learning experience.