From enrolled nurse to registered nurse in the rural setting: the graduate nurse experience.

Introduction: This article reports on the findings of a study into enrolled nurse (EN) to registered nurse (RN) transition in South Australian rural settings. Rural RNs are required to be multi-skilled generalists capable of providing a wide range of nursing services to a diverse range of clients. This frequently occurs in situations without medical or specialist assistance. The objective of this study was to gain an understanding of the EN to RN transition process within this unique context.

Methods: A hermeneutic phenomenological approach guided the study because this employs the processes of description and interpretation to examine lived experiences. Following ethics approval, four rural hospitals were chosen as suitable sites for the study due to their combined proximity within a rural area. The administrators agreed to support the study and information sheets were distributed. The four participants, one from each hospital, self-selected and took part in an unstructured interview. All participants were ENs who had recently or were currently in the process of transition to RN. Data analysis used van Manen's holistic and selective approaches in conjunction with Hycner's more structured guidelines. Significant phrases or units of meaning were then identified and collated into relevant themes.

Results: Three main themes identified were: (1) great expectations--self-expectations; adjusting to the new role; other's expectations; (2) support: sink or swim--peer, managerial and medical staff support; (3) Jacks and Jills of all trades--coping with the scope; proficiency equals specialising; positives of rural transition. The study found that these new graduates had very high expectations of their performance and experienced difficulty in adjusting to their new role. This was far more likely when the new RN had previously worked at the venue as an EN. Other staff and administrators expected these new RNs to be experienced beyond the new graduate level resulting in poor skill match to workload allocation and lack of support.

Conclusions: The expectations placed on these new graduates by clinicians and managers far exceeded their level of expertise and resulted in them experiencing high anxiety levels. Ensuring this unique group of graduates are well supported throughout their transition phase is of utmost importance and this has implications for nurse managers, organisational administrators, nurse clinicians and future graduates. Rural ENs are increasingly undertaking nursing degrees and are urgently needed in rural settings. Accordingly it is in the best interests of managers and others to encourage and support them through an effective transition process.