Engagement in Professional Nursing

Table of Contents

Organizational structure and culture.




Health Informatics.




Transition to practice.



Reference list

Organizational Structure and Culture


During my clinical placement, I had encountered a specific placement in my allocated hospital. I encountered a patient who was younger than most of the patients that I had dealt with earlier. The patient was 3 months old and came to the clinic with his father regarding psychotherapy for cystic fibrosis. I was instructed to perform a subjective assessment of the patient, Though the setting of this encounter was varied from the set up with which I was habituated. this patient was also different as it became clear gradually that his father was not able to speak or understand English and therefore caused a safety concern, as I had could not explain any procedure to his father as the patient was an infant. In normal situations with young patients, because of the age and presence of a guardian, it would be normal to direct the questions towards the patient’s parents. I would then physically examine the patient. However, in this case, it was hard to ask any questions to either the patient or the parent and instead most of the information regarding physiotherapeutic interventions and patient heath that was needed was gained by examining the patient. This was a safety issue as the parent was not comfortable with me handling the infant and looked above to my mentor for guidance and reassurance. However, my mentor guided us and we were able to get out of the problematic area. We were able to speak up about the issue and we were taught to ask questions to the patient party with a slow and loud voice. This helped the father’s understanding to a great extent. When examining the patient we made sure that we looked at the patient’s father every time while speaking and explain the procedures that we were about to do.


Developing a culture that empowers staffs to speak up when there is a concern about the health safety of patient care is economically and ethically responsible tasks. Presence of safety programs and speak up lessons in the organization makes sure that the frontline workers are provided with a chance to voice their concerns and make care safer (Law & Chan, 2015). The top priority of organizations is to provide safe and effective care. Organizational culture symbolizes shared ways of feeling, thinking, and acting in healthcare organizations.

The “Melbourne Health’s Safety Culture Program” is a part of initiatives that are undertaken for transforming the culture of the organization. the program makes sure that Melbourne health becomes the best place for working and the best place for getting treated and cared for. The safety culture program works towards developing a culture where nurses and workers are allowed to speak up for safety. A culture of feedback is created where staffs are allowed to speak up and raise concerns regarding patient safety and also conduct challenging conversations (thermh.org.au, 2020).


Safety culture is an organizational culture that has elevated importance in safety attitudes, values and beliefs. These are shared by most of the people in an organization. A positive safety culture can lead to better workplace safety and health and improved organizational performance. Teamwork skills and effective communication is important in improving patient safety. Graduate nurses are well-positioned to understand any early signs of safety concerns in care and rise those to the attention of the organization. Speaking up is raising concerns by health care providers for helping and improving patient safety and quality of care after becoming aware of the deficient actions of any person in a health care team (Nacioglu, 2016). These actions can comprise of mistakes of poor clinical judgments, rule-breaking, not following standard protocols, withholding patient information and so on. Safety concerns are more likely to take place in operating rooms, ICUs, emergency services. A graduate nurse has the first opportunity to view the procedures that are being done to a patient and therefore it is vital that a nurse speaks up and reports any concerns for the benefit of patient safety. Speaking up can also promote a safety culture in the health care organization as it can prevent any unsafe event that can cause harm to a patient (Kaziunas et al. 2015).

Health Informatics


During my clinical practice, I have observed the use of electronic medical records by my mentor. These are used to have an electronic record of patient information starting from treatments, medical dosage, health data, tests results and many more. It also reduces the time to scroll through papers and find the sheet of a patient. My mentor used it to find out the current health status of the patient and the dosage that was prescribed by the doctor. Though my mentor used it all the times I had used it once when I was in the rounds and had to update the patient information after her BP fluctuated and dosage was given to her.


Health informatics system provides tools and health information that is patient-centred and is integrated according to individual requirements in the clinical information systems. Health IT tailors health information and delivers targeted care and have an impact on fostering patient care management and monitoring. During my clinical placement, I have seen barriers in the effective use of these information systems (Levett-Jones, Reid-Searl, & Bourgeois, 2018). The Health IT that was used in the hospital was EMR, however, there were a limited number of EMRs and was not allocated to each doctor. Therefore these had multiple applications. Many users needed access to EMR at the same time to update patient information or to check the current status and test results. There was a requirement of more number of EMRs to increase the efficiency of doctors; more than one user had to use a single EMR that increased the chances of losing information or even forgetting to update information. An EMR was once present in the ICU with a doctor to update the tests that were required immediately, this created difficulty for another doctor who had to check the last BP and medicines that were given to the patient (Browne, Fetherston, & Medigovich, 2015). The use of multiple applications also required several sign-ins and a need to streamline the log-in verification. As one device was used by more than one doctor, there was an issue of inconsistent timestamps as the time was not in sync with other monitors.

I also saw that the users had troubles in using the EMR as the doctors were not habituated to use touch screens to update patient information or to find this. This was a new update in the hospital that resulted in the barrier of poor usability. Doctors took much time to find information, to log in and update information. This delayed the entire process and the purpose of the EMRs which were to increase the speed of updating. The lack of ability to customize the EMRs according to the individual needs created a barrier in the effective use of the health information system (Sigalit, Sivia, & Michal, 2017).


The “code of ethics and standards” suggests that the ethical obligations of health informatics consist of securing the privacy of health information, disclosure of health information, use and maintaining of health informatics system, and making sure of the integrity and accessibility of health information. As a graduate nurse, the roles that I have in maintaining ethics in the health information system are, promoting high standards of health information systems, recognizing the main values of the HI system, understanding the broad ethical principles which reflect the core values, establishing ethical principles and framework for resolving conflicts and uncertainties and also understanding ethics education (Douglas, Windsor, & Lewis, 2015). As a graduate nurse, it is my responsibility to make sure that the patient information is kept confidential and is only released to others if permitted by law. It is my role to make sure that extra security steps such as strong security policies and privacy policies are maintained for securing the patient information. I also have the role to make sure that the principles of fidelity, autonomy, beneficence and justice are maintained in-patient care while using health informatics (Miah, Gammack, & Hasan, 2017). As a nurse, I have the role to provide ethical guidance to the patients and abide by the rules provided by the professionals. I also must follow the principles that are adhered to the conduct of professionals.

Transition to Practice


Nursing graduates often feel stressed out in the initial ward experience as a staff nurse especially in the first month. This is due to the change in work environments and a new work role. The stress when they were students rose from clinical placements, insufficient study time and academic assignments. The stress as qualified nurses rises from too much workload in the ward. They also face challenges in prioritizing and organizing heavy workloads and daily works during the first months (Hofler & Thomas, 2016). The nurses working in surgical or general wards develop high-stress levels because of heavy workloads. A stressful work environment accompanied by less support from human resources and staffs leads them to resign. 

Fresh graduates also face problems in creating relationships with colleagues that makes them alone and separated from the team. They have a belief that supportive colleagues can help them in adapting to their new role. They have an expectation to adjust and learn new roles quickly and develop a feeling of frustration when they cannot match up to their expectations (Ankers et al. 2018). They also waver to speak up when there is a requirement to talk to with senior nurses, physicians, patients and their family members. They also feel discouraged when there is a difference in theory and real practise that leads them to lose their confidence and results in poor clinical performance. Insufficient knowledge of clinical practice, the gap in working skills and hesitation to speak up adds to the challenges and leads them to work poorly.


The positive workplace behaviours that I can implement to maintain my health and well being as a new registered nurse are:

  • A positive approach to work- having a positive approach in every situation can improve my well being and also my work performance. I need to create a positive work environment so that I can accomplish my work in meaningful ways and successfully achieve my work goals. As a newly registered nurse, I am prone to burnouts due to workloads and new environment. Therefore keeping a positive approach and understanding the work methods minutely can help me to keep my well being at work (Adriaenssens, Hamelink, & Van Bogaert, 2017). A positive work environment can help me in fostering my wellbeing and my health.
  • Improving psychological capacities- to keep my well being and maintain my health I need to improve my psychological capacities. I can improve my confidence level by understanding the concept of self-efficacy. I need to have a high goal setting, be self-motivated and be open to accepting new challenges. I also need to keep my hopes high and be self-motivated to reach my goals. I need to have an optimistic approach so that I can elevate my self-esteem and distance myself from negative situations (Adriaenssens, Hamelink, & Van Bogaert, 2017). This can help me to protect myself from depression and thereby maintain my well being. I also need to be resilient and have the flexibility to arise from any setbacks and act at high levels by positively responding to challenges. As I am a newly registered nurse, it is expected that I will have an immense workload and will be stressed, therefore I need to follow these to keep my well being.

The self-care strategies are:

  • Staying hydrated- this is often a challenge for new nurses. For preventing dehydration, I need to take small sips of water throughout the day. I need to have an insulated tumbler to keep my beverages at the correct temperature (Ankers, Barton, & Parry, 2018).
  • Planning healthy meals- as I have a new role I can easily burn out my calories. I need to refresh my energy frequently by having healthy meals that are readily available. I should not take goods that have too much sugar or caffeine.

Reference List for Transition of New Graduate Nurses to The Workforce

Adriaenssens, J., Hamelink, A., & Van Bogaert, P. (2017). Predictors of occupational stress and well-being in First-Line Nurse Managers: A cross-sectional survey study. International journal of nursing studies73, 85-92, retrieved from: http://www.academia.edu/download/53704608/definit_proof--1-s2.0-S0020748917301128-main.pdf

Ankers, M. D., Barton, C. A., & Parry, Y. K. (2018). A phenomenological exploration of graduate nurse transition to professional practice within a transition to practice program. Collegian25(3), 319-325, retrieved from: https://www.researchgate.net/profile/Yvonne_Parry2/publication/320094976_A_phenomenological_exploration_of_graduate_nurse_transition_to_professional_practice_within_a_transition_to_practice_program/links/59cdd77da6fdcce3b346434c/A-phenomenological-exploration-of-graduate-nurse-transition-to-professional-practice-within-a-transition-to-practice-program.pdf

Browne, C. A., Fetherston, C. M., & Medigovich, K. (2015). International clinical placements for Australian undergraduate nursing students: A systematic thematic synthesis of the literature. Nurse Education Today35(10), 1028-1036, retrieved from: https://researchrepository.murdoch.edu.au/id/eprint/27233/1/browne,_fetherston,_medigovich.pdf

Douglas, C., Windsor, C., & Lewis, P. (2015). Too much knowledge for a nurse? Use of physical assessment by final‐semester nursing students. Nursing & Health Sciences17(4), 492-499, retrieved from: https://eprints.qut.edu.au/84013/1/Accepted%20version.pdf

Hofler, L., & Thomas, K. (2016). Transition of new graduate nurses to the workforce: Challenges and solutions in the changing health care environment. North Carolina Medical Journal77(2), 133-136, retrieved from: https://www.ncmedicaljournal.com/content/ncm/77/2/133.full.pdf

Kaziunas, E., Buyuktur, A. G., Jones, J., Choi, S. W., Hanauer, D. A., & Ackerman, M. S. (2015, February). Transition and reflection in the use of health information: the case of pediatric bone marrow transplant caregivers. In Proceedings of the 18th ACM Conference on Computer Supported Cooperative Work & Social Computing (pp. 1763-1774), retrieved from: https://www.socialworldsresearch.org/sites/default/files/kaziunas_et_al_2015_transition_bmt_final.pdf

Law, B. Y. S., & Chan, E. A. (2015). The experience of learning to speak up: a narrative inquiry on newly graduated registered nurses. Journal of Clinical Nursing24(13-14), 1837-1848, retrieved from: http://www.academia.edu/download/45268488/2015The_experience_of_learning_to_speak_up-a_narrative_inquiry_on_newly_graduated_registered_nurse.pdf

Levett-Jones, T., Reid-Searl, K., & Bourgeois, S. (2018). The clinical placement: An essential guide for nursing students. Elsevier Health Sciences., retrieved from: http://www.academia.edu/download/39563890/The_Clinical_Placement._An_essential_gui20151030-5625-qrdffs.pdf

Miah, S. J., Gammack, J., & Hasan, N. (2017). Extending the framework for mobile health information systems Research: A content analysis. Information Systems69, 1-24, retrieved from: http://vuir.vu.edu.au/33723/3/1-s2.0-S0306437917301631-main.pdf

Nacioglu, A. (2016). As a critical behavior to improve quality and patient safety in health care: speaking up!. Safety in Health2(1), 10, retrieved from: https://link.springer.com/article/10.1186/s40886-016-0021-x

Sigalit, W., Sivia, B., & Michal, I. (2017). Factors associated with nursing students' resilience: Communication skills course, use of social media and satisfaction with clinical placement. Journal of Professional Nursing33(2), 153-161, retrieved from: https://www.researchgate.net/profile/Sigalit_Warshawski/publication/307874999_Factors_Associated_With_Nursing_Students%27_Resilience_Communication_Skills_Course_Use_of_Social_Media_and_Satisfaction_With_Clinical_Placement/links/59d7293da6fdcc52acace40f/Factors-Associated-With-Nursing-Students-Resilience-Communication-Skills-Course-Use-of-Social-Media-and-Satisfaction-With-Clinical-Placement.pdf

thermh.org.au, (2020), What is the Melbourne Health Safety Culture Program?, retrieved from: https://www.thermh.org.au/file/2996#:~:text=What%20is%20the%20Melbourne%20Health%20Safety%20Culture%20Program%3F,-The%20Melbourne%20Health&text=The%20Safety%20Culture%20Program%20is,safe%2C%20reliable%20and%20quality%20care.

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