This section will continue to discuss the #1 Patient Safety Concern from ECRI 2024 – Clinician’s Transition to Practice. Last time I discussed what was happening to people in training during COVID. Individuals were impacted by COVID in that they were shunted away from bedside training opportunities. Training programs certainly tried to respond in a manner that kept trainees safe, while still trying to maximize training opportunities. Students are paying for their education and must be kept safe undue risks. Even those who are further along in their training such as residents, are earning far less that those that have completed training and should receive some protections from situations in which we know there are unusual risk (such as a pandemic). It’s not that physicians don’t face the risks from contagious diseases when we care for patients, we do. Yet I believe that those who are still in training should receive protections from severe risk when possible. Even so, there were residents who did get sick during Covid and a few didn’t survive it. The end result of this time is that these people who are now entering into their early career as young physicians, have had a different experience which will impact them. As noted by ECRI….”without sufficient preparation, support, and training as they transition into practice, clinicians can experience loss of confidence, burnout, and reduced mindfulness around culture of safety.”
Based on these changes in the training experience ECRI has the following concerns about new practitioners (from the ECRI blog):
- Newer clinicians lack confidence. Among nurses with less than two years’ experience, 30% reported that they do not feel well prepared to practice on their own.
- Newer clinicians are working in understaffed environments. Twenty-eight percent of the time a patient enters an acute care setting, they are likely entering a unit nurses believe is lacking the appropriate staff to provide quality care.
- Newer clinicians speak up less often. Only 33% of clinicians who had worked less than one year in their work setting had voluntarily reported one or more safety events. By contrast, 50% of those with 6 to 10 years of experience had made such reports.
These concerns from ECRI are interesting in that I have not seen evidence that understaffed environments have a correlation to speaking up. Further, the concerns related to confidence and speaking up, seem like things that could be true of any new clinicians, not just those who have been through the time period of Covid. I would be most concerned that those who were trained during Covid, simply had less time to train at the bedside with the presence of their teachers. Lack of confidence is appropriate to this setting, and in fact, we want people who may be aware of their limitations. These people can ask for help and look to those with more experience. But for those who are current in practice, we need to be more aware that some of our newer colleagues may need additional support in their new roles.
It will be easier for new trainees to ask for help if those currently in practice are open and interested in mentoring and supporting those who are new to practice. For medical students, who have transitioned into residency, residency programs need to be prepared to support residents who may not have had the normal medical student experience. Many of these new residents can go on to perform very well as long as it is recognized that their experiences as students were different. The same is true for new physicians who have emerged from the residency programs of Covid.
Let these people know that we recognize that their experiences were different, but there is every reason to expect that they will do just fine as they transition into their new roles. Make certain they are given the grace to speak up about the things they see as well as when they feel uncertain. Track staffing as possible to be certain new people have adequate support as they start their roles.
With support in transition to new roles, people are able to overcome some deficits that may have occurred in training.